By Chris Cole
Pros & Cons With Perioperative Beta-Blockers
Previous research indicates that perioperative beta-blockade among patients undergoing noncardiac surgery who are at risk of a perioperative cardiovascular event reduces 30-day myocardial infarction rates but increases risk for mortality and stroke. To determine the long-term impact of beta-blockade, researchers reviewed 1-year data from this patient population, comparing those who received a beta-blocker or placebo starting 2 to 4 hours before surgery and for 30 days after. At 1-year follow-up, mortality rates were 9.8% for the beta-blocker group and 8.5% for the placebo group. Respective stroke rates were 2.0% and 1.4%. However, myocardial infarction rates were lower for the beta-blocker group than for the placebo group (5.0% vs 6.2%).
HF, Mortality & the Flu Vaccine
Small observational cohort studies have examined the effect of influenza vaccination on clinical outcomes in heart failure (HF) patients, but they have provided inconsistent results. A meta-analysis of five of these studies, including nearly 80,000 patients with HF, was conducted to better understand the effect. Among patients aged 64 to 75 on average and with a follow-up period of 1 to 4 years, influenza vaccination was found to reduce all-cause mortality risk by 48% during flu season and 21% during the rest of the year, when compared with no vaccination. Influenza vaccination was also associated with a 22% decreased risk of cardiovascular event-related hospitalization. The study investigators note that a large-scale randomized trial is needed to confirm these results.
Barbershop Intervention Reduces BP
Although African-American men have high rates of uncontrolled hypertension, they are underrepresented in pharmacist intervention trials in traditional healthcare settings. For a study, African-American male patrons with systolic blood pressure (BP) of 140 mm Hg or higher were enrolled in a study in which barbershops were randomly assigned to a pharmacist-led intervention (barbers encouraged meetings in barbershops with specialty-trained pharmacists who prescribed drug therapy under a collaborative practice agreement with the participants’ doctors) or an active control approach (barbers encouraged lifestyle modification and doctor appointments). At 6 months, mean systolic BP fell 27.0 mm HG in the intervention group, compared with 9.3 mm Hg in the control group. Among the intervention group, 63.6% achieved a BP lower than 130/80 mm Hg, compared with just 11.7% of the control group.
Music & Exercise Tolerance
While many individuals are motivated by music while exercising, few studies support the benefits of music on exercise tolerance. To compare the impact of music on exercise capacity during scheduled exercise stress tests, researchers randomized patients who were able to walk on a treadmill to headphones containing up-tempo music or no music. Groups had similar medical history, age, and gender distribution. When compared with the non-music group, patients in the music group had a significantly longer exercise time (505.8 vs 455.2) and a trend toward longer metabolic equivalent of task (9.45 vs 8.67).
Aspirin, Mortality, Type 2 Diabetes & HF
Data are lacking on the impact of aspirin for primary prevention in patients with type 2 diabetes and heart failure (HF). For a study, patients aged 55 and older with type 2 diabetes and no history of myocardial infarction (MI), stroke, peripheral artery disease, or atrial fibrillation were assigned to no aspirin or aspirin >75 mg. When compared with no-aspirin, aspirin was associated with a hazard ratio of 0.89 for a composite outcome of all-cause mortality and HF-related hospitalization during 5.2 years of follow-up. However, patients assigned to aspirin had higher rates of non-fatal MI and stroke.
Detecting AF With an ECG Patch
Appropriate therapy can greatly reduce atrial-fibrillation-associated morbidity, when AF is recognized early. Yet, guideline-recommended opportunistic screening rates remain suboptimal. While novel digital technologies may allow for pragmatic and scalable screening of AF, the feasibility and benefits of such technologies are not well known. Patients with a mean age of 73.7 and without a diagnosis of AF but who were thought to be at high risk of AF underwent active AF monitoring at home via a wearable ECG patch and were matched with two observational controls. Among more than 90% of participants who completed 1 year of follow-up, AF was newly diagnosed in 6.2% of ECG patch patients and 2.3% of controls. Active monitoring was associated with increased initiation of anticoagulant therapy (5.4% vs 3.4%). However, no differences were observed between the groups in stroke incidence (1.9% vs 2.1%).