June 2024 Dispatch for the CV Team

Every month, Section Editor L.A. McKeown curates a roundup of recent news tidbits from journals and medical meetings around the globe.

Patients with multivessel disease who decline CABG despite recommendations from a heart team but then undergo PCI have worse outcomes at 1 year compared with patients for whom PCI was the recommended management strategy, according to study of 3,687 consecutive patients. Writing in the Journal of the American Heart Association, the researchers say increased risks of death and stroke drove the differences.

In patients with high body mass index (BMI) and atrial fibrillation (AF), dual direct-current cardioversion (DCCV) results in greater cardioversion success compared with single DCCV. The dual procedure uses two sets of defibrillator pads to deliver simultaneous shocks, resulting in higher cumulative energy and current density to the heart muscle. Reporting the findings of the RCT in JAMA, the study authors say “no consensus exists regarding the optimal cardioversion strategy in patients with obesity, highlighting the importance of defining an alternative strategy that is effective and safe.”

Investigators in China have developed a prediction model that combines artificial intelligence (AI) and facial thermal imaging and may detect CAD better than traditional methods. When they tested the model in patients with suspected CAD, the thermal imaging plus AI model was 13% more accurate in diagnosing patients than risk factors and clinical signs and symptoms alone. While the approach will need to be tested in larger populations, the study published in BMJ Health & Care Informatics sheds new light on temperature differences of the jaw, eye, and temple and how they relate to the CV disease states.

The US Food and Drug Administration has approved the first generic drug versions of sacubitril/valsartan (Entresto; Novartis). The generics are expected to be available sometime in 2025 after the manufacturer’s patent for the drug expires and will come in doses of 24/26mg, 49/51 mg, and 97/103 mg.

Compared with anticoagulation alone, catheter-based therapy or systemic thrombolysis result in fewer adverse clinical outcomes and lower risk of death in patients who have evidence of clot-in-transit in the right heart on echocardiography. Rates of cardiac arrest and hemodynamic decompensation were 60% in those on anticoagulation alone versus 12% for catheter-based therapy or systemic thrombolysis (P = 0.005), according to data published in Circulation: Cardiovascular Interventions.

Nurse case management plus home BP telemonitoring is more effective than home telemonitoring alone in low-income Black and Hispanic stroke survivors with significant comorbidities and uncontrolled hypertension, according to a study published in JAMA. At 12 months, those with case management, which included clinic visits with nurse practitioners, community health worker home visits, and chronic disease self-management workshops, had systolic BP that was on average 8.1 mm Hg lower than those who did telemonitoring alone.

A new multispecialty document provides consensus recommendations for the management of diabetes, cardiorenal, and metabolic diseases (DCRM). Published in Metabolism, it reviews lifestyle therapy, patient education, medical therapy considerations, and comorbidity prevention and management to “bridge the gap between separate, individual specialties and make integrated recommendations that could be directly applied to complex individuals within primary care or specialty practice.”

In patients with AF, an organized care pathway that starts in the emergency department (ED) can improve early access to ablation as well as initiation of anticoagulants and antiarrhythmic drugs, the ER2EP study shows. Compared with usual care, patients enrolled in the pathway strategy also had fewer hospitalizations and ED visits for cardiac-related issues, investigators note in the paper published in JACC: Advances. 

An analysis of health behaviors and factors that make up the American Heart Association’s Life’s Essential 8 shows sex differences in some key CV health metrics. Writing in the American Journal of Preventive Cardiology, the authors found that compared with men, women had higher health factor scores driven primarily by higher BP score, but lower health behavior scores driven primarily by lower physical activity score. By race/ethnicity, Black females had the poorest CV health scores of all groups. “These findings are a call to action for future primary prevention strategies focused on addressing these factors, both health factors and health behaviors, to improve the health of women,” the authors write.

Perinatal depression may increase women’s risk of developing CVD decades after giving birth, according to a study published in the European Heart Journal. The Swedish analysis of nearly 600,000 women found a 36% increased long-term risk of CVD in those who had the condition compared with those who did not, which “may have strong clinical and public health relevance by suggesting the importance of factoring in perinatal depression for risk prediction or stratification of future CVD events among women.”

News Highlights From TCTMD:

Despite Gains, Black Americans Still Face Higher CV Mortality

Semaglutide Has Similar Benefits in Women and Men With HFpEF

Genetic Tests for Predicting Clopidogrel Response Gain Traction: AHA

Dramatic LDL Drops Seen in PAD Patients With Team-Based Care

Long-term Mortality After TAVI Lower With DOACs vs VKAs