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Updated Guidelines for NSTE-ACS

Updated Guidelines for NSTE-ACS

Recently, the American College of Cardiology and American Heart Association (ACC/AHA) updated their guideline on the management of patients with non-ST-elevation acute coronary syndrome (NSTE-ACS). “This guideline is the first full revision of previous recommendations since 2007,” says Ezra A. Amsterdam, MD, FACC, who co-chaired the ACC/AHA writing committee. The other co-chair was Nanette Wenger, MD, of Emory University, and the writing group included 18 clinicians from multiple specialties involved in the care of patients with NSTE-ACS. “The ACC/AHA update offers a new name and terminology that reflects current ways of thinking about the condition,” says Dr. Amsterdam. “The terminology now emphasizes the pathophysiologic continuum of unstable angina and NSTEMI and their frequently indistinguishable clinical presentations.” The update incorporates both established and new evidence from published clinical trials and information from basic science and comprehensive review articles. Dr. Amsterdam notes that there have been major advances since 2007 with regard to enhancing the care of these patients. Although still extensive and comprehensive, the document is now more direct and succinct. Important Changes “A significant change in the guideline was to replace the term ‘initial conservative management’ with ‘ischemia-guided strategy,’” says Dr. Amsterdam. “This was done to more clearly convey the physiologic rationale of this approach.” When treating NSTE-ACS, the guideline notes that an early invasive strategy for those with high-risk coronary artery disease has been successful. However, low-risk patients can benefit substantially from guideline-directed medical therapy (GDMT), an approach that has not always been optimally used. Advances in cardiac troponin testing should help clinicians detect patients with NSTE-ACS, according to Dr. Amsterdam. “Advances in non-invasive assessment of prognostic risk...
Heart Rhythm 2015

Heart Rhythm 2015

New research was presented at Heart Rhythm 2015, the Heart Rhythm Society’s annual scientific sessions, from May 13 to 16 in Boston. The features below highlight some of the studies that emerged from the conference. Physical Activity, AF, & Gender The Particulars: Results of previous studies on the impact of physical activity on the risk of atrial fibrillation (AF) have been inconclusive in many investigations. Few analyses have assessed the effect of intensity of physical activity on AF, particularly with regard to gender. Data Breakdown: Researchers performed a systematic review of 14 studies involving nearly 400,000 patients that reported on the relationship between physical activity and AF incidence. Among men, vigorous exercise increased the risk of AF, whereas moderate exercise lowered AF incidence. For women, moderate and high intensity physical activity both reduced subsequent risks of AF. Take Home Pearls: Moderate exercise appears to reduce the risk of AF in men and women. However, vigorous exercise appears to reduce the risk of AF in women but increase this risk in men. Measuring Activity in Patients With ICDs The Particulars: Implantable cardioverter defibrillators (ICDs) automatically collect physical activity data in order to provide quantifiable and easily accessible measures of functional status. However, few studies have assessed the relationship of these measures with survival in this patient population. Data Breakdown: More than 98,000 patients with ICDs were followed in a study to examine the association between survival and increments of 30 minutes of physical activity per day. After 4 years, the survival rate was about 90% among the most active patients when assessed at baseline, compared with a rate of 50%...

Can Patients Chew Gum Immediately Before Surgery?

A study presented at the American Society of Anesthesiologists (ASA) meeting in October of last year found that patients who chew gum in the immediate preoperative period may safely undergo surgery. The authors, based at the University of Pennsylvania, found that gum chewing increases saliva production and the volume of fluid in the stomach, but stomach acidity was equivalent to that of non-gum chewers. An article about the study said The mean gastric volume, or total amount of liquid in the stomach, was statistically higher in patients who chewed gum before their procedure (13ml) versus those who did not (6ml). A 7 mL difference might be statistically significant, but surely is not clinically important. The research differed from previous studies because it involved patients who underwent upper gastrointestinal endoscopy, which enabled the investigators to recover all of the fluid in the stomach for testing. Prior studies had been done using nasogastric tubes, and it was impossible to determine whether all gastric fluid was recovered when the tubes were suctioned. The study involved 34 gum chewers who were allowed to chew any type or any amount of gum, compared to 33 patients who did not chew gum. Another article quoted its lead author. “We found that although chewing gum before surgery increases the production of saliva and therefore the volume of stomach liquids, it does not affect the level of stomach acidity in a way that would elevate complication risks,” explains Dr. Goudra. He says patients shouldn’t be encouraged to chew gum before procedures involving anesthesia, but the habit shouldn’t necessitate the cancellation or delay of scheduled cases if other aspiration...
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