October 2022 News Roundup

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

A meta-analysis of PCI outcomes in more than 2 million adults aged 80 years or older finds that while all-cause death rates are high at 1- and 3-year follow-up regardless of indication for the procedure, the major contributors to mortality are noncardiac. “Overall, clinicians need to appreciate the high cumulative incidence of various clinical outcomes in senior patients who have undergone PCI, taking into consideration the patient’s quality of life and goals of care, and individualize the treatment regime where appropriate,” the researchers write in Asia Intervention.

At high doses, tricyclic antidepressants may lead to chronotropic incompetence—the inability to increase heart rate to match cardiac output while exercising. In JACC: Case Reports, investigators describe finding a direct connection between a decrease in exercise tolerance and initiation of a high-dose tricyclic antidepressant in a 46-year-old male competitive road cyclist with a history of depression. The patient was ultimately switched to a different antidepressant that controlled his depressive symptoms but did not interfere with his exercise regimen. 

Over the last 15 years, hospitals in England and Wales have seen an increase in left main STEMI PCI procedures at hospitals without on-site surgical backup, yet no associated rise in death, in-hospital MACCE, or emergency CABG. Writing in Circulation: Cardiovascular Interventions, the researchers say the study of 40,744 patients supports the safety and feasibility of performing these more complex interventions when no surgical cover is available.

Simulated sports games, like those played on the popular Nintendo Wii game platform, may offer a low-impact way for patients with left ventricular assist devices (LVADs) to get needed daily exercise. In a small study, LVAD patients increased their 6-minute walk test scores after just 4 weeks of playing simulated games like bowling and golf for 30 minutes a day, 5 days a week, according to a study in ESC Heart Failure.

Out now in the American Journal of Cardiology, the largest international study of women across all internal medicine specialties shows that cardiology and interventional cardiology have the lowest rates of female representation at practicing specialist and trainee levels. 

Over the last three decades, out-of-hospital cardiac arrest (OHCA) survival increased 2.2-fold, with the greatest improvements in men and younger patients, according to a Swedish study published in the European Heart Journal. There also was a 4.8-fold increase in bystander CPR use, with good neurological function seen in up to 90% of patients discharged alive. However, the study also suggests a plateau in recent years in OHCA survival, whereas improvements in in-hospital cardiac arrest survival seem to be continuing on an upward trend.

The body mass index (BMI) that an individual has in adolescence may give a preview of their risk of developing atrial fibrillation (AF) as they age, a paper in the Journal of the American Heart Association suggests. The implication of the 32-year study of Swedish men is that a BMI of greater than 30 in youth may play a causal role in pathophysiological processes leading to AF and may lead to poorer outcomes, including higher all‐cause mortality, incident heart failure, and ischemic stroke.

Although most predictors of 30-day survival after STEMI are unmodifiable, an analysis of the France Percutaneous Coronary Intervention Registry, which includes every patient in the country undergoing coronary angiography, suggests that ischemic time and premedication are two areas that should be targets for improvement. One patient in five did not receive anticoagulants, aspirin, or other appropriate prehospital medication, according to the paper published in Medicine.

Racial and ethnic minority patients have less comprehensive family-history information in their electronic health records (EHRs) than white patients, a study of two large healthcare systems in Utah and New York finds. Writing in JAMA Network Open, the researchers say efforts are particularly needed to improve availability and comprehensiveness of family health information for Black, Hispanic or Latino, Spanish-speaking, and male patients to mitigate risk of health inequalities driven by inaccurate or incomplete EHRs.