Atrial fibrillation as a risk factor for myocardial infarction

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We all know that ischaemic heart disease is a risk factor for AF, through multiple mechanisms, however how about AF as a risk factor for having an MI?

Turns out AF doubles your risk (1.7 after adjustment for major risk factors). This association was stronger in women, and not significant in the older age group.

It’s not just strokes – AF is becoming a serious public health issue, and one we don’t know enough about. Read more at JAMA Internal Medicine.

 

image | Wikimedia Commons

source | JAMA Internal Medicine

 

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Transcatheter aortic valve replacement

This one is more for the cardiologists among you, however it is a technique that is becoming increasingly common. Transcatheter aortic valve replacement or implantation is generally indicated for the treatment of severe symptomatic aortic stenosis in patients with inoperable or high risk but operable comorbidities. Here, the results from all US TAVR cases (almost eight thousand cases) are presented.

So, what do you need to know?

  • average age was 84
  • About half are women
  • the STS predicted mortality was 7% – actual in hospital mortality was 5.5%, and 7.6% at 30 days
  • 64% were done from the femoral approach
  • there was a 2% stroke rate
  • 1.9% required dialysis due to renal failure
  • 0.5% of patients required intervention

An interesting read regarding TAVR/TAVI in general, and useful to provide more information to patients. Check it out here.

 

source | Journal of the American Medical Association

image | Heart Hospital of Austin

Mechanical CPR

A few people have been waiting for these trial results for a while – a comparison between mechanical and manual CPR. A few of these devices have been around for a while, with different methods used in each. This article in JAMA covers the LINC trial, looking at 2589 patients with out of hospital cardiac arrests across 5 years.  Continue reading

Echocardiography for everyone

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Pre-test probability determines post-test probability. As such, no matter how good a test is, you can’t just apply it to everyone regardless of symptomatology and expect it to prevent illness. Then again, that is what we use good screening tests for, but usually still tailored to the right population. So, can you use echo as a screening test in the general population?

This study of nearly 7000 people in Norway (based on the Tromso Study), randomly allocated people to either echo or control. During 15 years of follow up, there was no significant difference when it came to death, risk of myocardial infarction or stroke. This fits with the guidelines. In the article , they found the prevalence of structural or valvular disease to be around 7.6%. Interestingly, in one subgroup there was a mortality benefit – those with a family history of cardiovascular disease – but post hoc subgroup analyses are always hard to hang your hat on.

It’s an interesting study, as echo is becoming increasingly popular and performed in situations where it isn’t always truly indicated. Some even say our stethoscopes will be replaced by portable ultrasound.

Check it out at JAMA Internal Medicine, here.

P.S. bonus points for picking the diagnosis in the image above.

Continue reading

Steroids in acute COPD exacerbations

COPD exacerbations are incredibly common, managed under respiratory and general medical units for the most part. The duration of higher dose steroids vary however – some give just a few days, others up to two weeks. The REDUCE trial from JAMA this month proves the optimal duration, comparing 5 with 14 days.

Essentially, just over 311 patients were looked at with both intention to treat and per protocol analysis. There wasn’t any difference etween time to re-exacerbation or mortality, meaning that you can get away with a shorter course of steroid. Presumably this would lead to less adverse reactions – this trial didn’t see any difference in hyperglycaemia or hypertension however.

So, five days seems like the way to go. Keep this in mind for next time – read the article here. And of course, don’t forget to re-iterate the importance of smoking cessation.

 

source | JAMA 

image | Pulmonary Pathology

Just liver disease or cirrhosis?

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If there’s one thing consultants always reminisce about, it’s the death of clinical medicine. Nowadays, it’s all about the bloods, the scans, and the invasive tests, when it actuality a learned hand can reveal a great deal. When you see your patient with liver disease however, we often think about the FibroScan, ultrasound or liver biopsy – but what can the examination reveal about cirrhosis? Continue reading