Cryoballoon Vs Radiofrequency Ablation for AF
The Particulars: Evidence suggests that radiofrequency ablation is the most common form of catheter ablation for the treatment of drug-refractory paroxysmal atrial fibrillation (AF), followed by cryoballoon ablation as the second most common. Few studies have compared the efficacy and overall safety of these approaches in this patient population.
Data Breakdown: For a study, patients with drug-refractory paroxysmal AF were randomized to cryoballoon or radiofrequency ablation and followed for an average of 1.5 years. Approximately 35% of patients in both groups experienced recurrence of AF, had atrial flutter or atrial tachycardia, used antiarrhythmic drugs, or required repeat ablation. The composite endpoint of death, cerebrovascular events, or serious treatment-related adverse events occurred in about 10% of patients in the cryballoon group, compared with a rate of about 13% in the radiofrequency group.
Take Home Pearl: Cryballoon ablation does not appear to be inferior to radiofrequency ablation with regard to safety or efficacy for the treatment of drug-refractory paroxysmal AF.
Analyzing STEMI Risk Factors
The Particulars: Current data are lacking on the rates of heart disease risk factors among patients treated for STEMI.
Data Breakdown: Cleveland Clinic researchers analyzed data on nearly 4,000 patients treated for STEMI between 2005 and 2014. The average age of patients decreased from 64 to 60 during the study period. Results showed that:
- The prevalence of obesity increased from 31% to 40%.
- The proportion of patients with diabetes increased from 24% to 31%.
- The proportion with high blood pressure increased from 55% to 77%.
- Smoking rates increased from 28% to 46%.
- The proportion of patients with three or more major risk factors increased from 65% to 85%.
Take Home Pearl: In recent years, patients undergoing treatment for STEMI appear to have become younger, more obese, and more likely to have preventable risk factors.
Educating Women on Cardiovascular Risks
The Particulars: Data indicate that heart disease awareness among women has stalled in recent years despite decades of campaigns from various women’s heart health advocacy groups. Understanding the obstacles to awareness may improve recognition of cardiovascular risks among women in the future.
Data Breakdown: An internet-based survey was conducted in which investigators asked women in the United States about their health conditions and experiences interacting with healthcare providers. Among respondents, 74% had at least one heart disease risk factor. However, only 16% reported being informed by a physician that they have or are at risk for heart disease, and only 34% reported being advised to lose weight. Focusing directly or exclusively on weight loss appeared to be counterproductive to heart disease awareness efforts.
Take Home Pearls: Although many U.S. women appear to have one or more heart disease risk factors, few have been told by a physician that these factors put them at risk for developing cardiovascular disease. Efforts to increase awareness of these risks may benefit from countering stereotypes about body weight and heart disease with more evidence-based communication and preventive care.
Digital Tool Aids Weight Loss in Cardiac Rehab
The Particulars: Previous research indicates that adherence rates for cardiac rehabilitation are low. At the same time, use of mobile and digital technologies has been growing rapidly. Adding digital health tools to cardiac rehabilitation may help increase adherence rates and therefore improve cardiovascular outcomes.
Data Breakdown: For a study, Mayo Clinic researchers randomized patients who were eligible to take part in cardiac rehabilitation following an acute coronary syndrome to usual care or cardiac rehab coupled with a digital health intervention. The intervention included semi-weekly educational messages, videos and articles with accompanying quizzes about heart healthy lifestyles, tips, and platforms to track and log exercise and dietary habits. Patients in the intervention group lost four times as much weight as those in the usual care group.
Take Home Pearl: The addition of a digital health tool to traditional cardiac rehabilitation appears to help acute coronary syndrome patients lose significantly more weight than those receiving cardiac rehab alone.
CAD Plus Depression Ups Heart Attack & Mortality Risks
The Particulars: Prior studies have suggested that depression worsens patient outcomes following a heart attack or cardiac bypass surgery. However, little is known regarding whether a new diagnosis of depression affects outcomes in patients with coronary heart disease.
Data Breakdown: Canadian researchers analyzed data on nearly 23,000 patients diagnosed with stable coronary artery disease (CAD) following a coronary angiogram for chronic stable angina. During an average of 3 years follow-up, patients with CAD who were also diagnosed with depression had an 83% higher risk of all-cause mortality when compared with those without depression. Patients with depression were also 36% more likely to have a heart attack.
Take Home Pearls: Among patients with stable CAD, depression appears to significantly increase the risk of all-cause mortality and heart attack. Screening for mood disorders may be warranted in patients with CAD.
Comparing Approaches to Postoperative AF
The Particulars: Data are unclear on the optimal treatment of cardiac surgery patients with postoperative atrial fibrillation (AF) who are in stable condition. Comparing heart-rate control and rhythm control may help determine the best initial treatment for this patient group.
Data Breakdown: For a study, patients with new-onset postoperative AF were randomly assigned to undergo either rate control or rhythm control. Length of hospital stay was about 5 days for both groups, and no significant differences were observed between groups with regard to rates of mortality or overall serious adverse events. A stable heart rhythm without AF for the previous 30 days was recorded in 93.8% of patients in the rate-control group and 97.9% of individuals in the rhythm control group at 60 days. Most patients in both groups had been free from AF from discharge to 60 days.
Take Home Pearls: Rate control and rhythm control appear to be equally beneficial in the treatment of postoperative AF. These strategies appear to be associated with similar lengths of hospital stay as well as rates of complications and persistent AF.
TAVR Vs SAVR in Intermediate-Risk Patients
The Particulars: Previous research has indicated that survival rates are similar following transcatheter aortic valve replacement (TAVR) and surgical aortic valve replacement (SAVR) in high-risk patients with aortic stenosis. However, little is known about survival rates following these approaches among intermediate-risk patients.
Data Breakdown: More than 2,000 intermediate-risk patients with severe aortic stenosis were randomized to undergo either TAVR or SAVR for a study. Transfemoral access was used in about 75% of cases, and transthoracic access was used in about 25% of cases. Rates of all-cause mortality, postoperative events, and disabling stroke were similar following TAVR or SAVR. When transfemoral access was used, TAVR resulted in lower rates of mortality and disabling stroke than SAVR, whereas these rates were similar when transthoracic access was used. Aortic valve areas were larger and rates of acute kidney injury, severe bleeding, and new-onset atrial fibrillation were lower following TAVR. Rates of major vascular complications and paravalvular aortic regurgitation were lower following SAVR.
Take Home Pearl: Among intermediate-risk patients with severe aortic stenosis, TAVR and SAVR appear to result in similar rates of mortality and disabling stroke.
Survival After Ischemic Cardiomyopathy Treatment
The Particulars: Few studies have compared survival rates among patients receiving CABG plus guideline-directed medical therapy with those of individuals receiving medical therapy alone in patients with coronary artery disease (CAD), heart failure, and severe left ventricular systolic dysfunction.
Data Breakdown: Patients with an ejection fraction of 35% or less and CAD who were deemed amenable to CABG were randomized to CABG plus medical therapy (CABG group) or medical therapy alone (medical therapy group) for a study. Participants were followed for an average of 9.8 years in the analysis. All-cause mortality rates were 58.9% for the CABG group and 66.1% for the medical therapy group. Cardiovascular-related mortality rates were 40.5% for the CABG group and 49.3% for the medical therapy group. Death from any cause or hospitalization for cardiovascular causes occurred in 76.6% of patients in the CABG group and 87.0% of those in the medical therapy group.
Take Home Pearl: When compared with medical therapy alone, CABG plus medical therapy appears to have a significantly greater survival benefit among patients with ischemic cardiomyopathy.
CABG With or Without Mitral Valve Repair
The Particulars: In a previous study, researchers found no significant difference at 1 year in left ventricular end-systolic volume index (LVESVI) or survival when comparing CABG alone with CABG plus mitral valve repair in patients with moderate ischemic mitral regurgitation. Longer-term data are lacking in this patient population.
Data Breakdown: Researchers followed patients with moderate ischemic mitral regurgitation for 2 years after they underwent CABG or CABG plus mitral valve repair. They found average LVESVI levels of of 41.2±20.0 ml/m2 of body-surface area in the CABG-alone group and 43.2±20.6 ml/m2 in the combined-procedure group. Mortality rates were about 10% for both groups. Overall rates of hospital readmission and serious adverse events were also similar in both groups. However, rates of moderate or severe residual mitral regurgitation were higher for those receiving CABG alone. On the other hand, rates of neurologic events and supraventricular arrhythmias were higher for the group receiving CABG plus mitral valve repair.
Take Home Pearl: In patients with moderate ischemic mitral regurgitation, CABG and CABG plus mitral valve repair appear to have similar effects on left ventricular reverse remodeling and similar rates of mortality, hospital readmission, and serious adverse events.