A few days ago, the distinguished healthcare writer Shannon Brownlee wrote a provocative blog post  about the overuse of stents. A key piece of evidence that she used was a paper co-authored by Grace Lin and Rita Redberg, in which focus groups of cardiologists cheerfully admitted that they would give stents to hypothetical patients who were, according to the current guidelines, not eligible for stents. Here’s a paragraph from her post: The really unsettling part of Lin and Redberg’s paper? The conversation they quote among the cardiologists from one of the focus groups that suggests that once… Continue Reading

Guest blogger John Mandrola shares a clinical anecdote that gets to the heart of the matter on this delicate issue.

Three experts discuss whether — and with which patients — they will use ticagrelor in clinical practice.

In 2006, the Occluded Artery Trial (OAT) showed no benefit of routine PCI in patients with persistently occluded infarct-related arteries that were identified at least one day after an MI. According to a recent study, led by Judith Hochman, OAT has had minimal impact on clinical practice. We asked Hochman and two other experts why OAT has not affected practice. Here are their answers: Judith S. Hochman (study author, NYU): OAT did not affect practice for various reasons. First, many physicians and patients don’t want to let go of the intuitive… Continue Reading

An electrophysiologist and blogger places the recent approval of rivaroxaban in the context of the seismic changes that have taken place and that are still expected in the anticoagulant marketplace.

Our panel responds to the what the cessation of the PALLAS trial means for dronedarone. Will you still use this drug?

The CardioExchange editors have asked a panel of experts to weigh in on a new study published in JAMA. It showed that nearly all the acute percutaneous coronary interventions (PCIs) in the National Cardiovascular Data Registry from June 2009 through September 2010 were warranted, according to “appropriate use criteria” for coronary revascularization. However, the study also revealed that 12% of the nonacute PCIs were inappropriate. We put these questions to the panel: Does the study’s major finding support the status quo, or do you see opportunities for improvement? What specifically… Continue Reading

CardioExchange welcomes this guest post, reprinted with permission, from Dr. Westby Fisher, an electrophysiologist practicing at NorthShore University HealthSystem in Evanston, Illinois, and a Clinical Associate Professor of Medicine at University of Chicago’s Pritzker School of Medicine. This piece originally appeared on his blog, Dr. Wes. Today was another tough day for Sanofi’s dronedarone antiarrhythmic medication (marketed as Multaq®) after the prospective randomized PALLAS Trial was stopped early. The PALLAS Trial was a trial that studied the safety and efficacy of patients with chronic atrial fibrillation (as opposed to the already-approved patient population with… Continue Reading

John Mandrola is a cardiac electrophysiologist and blogger on matters medical and general. Here is a recent post from his blog, Dr John M. I have said that the best tool for treating atrial fibrillation (AF) is education. I still strongly believe that, perhaps more than ever. AF presents itself to people in so many different ways – from no symptoms to incapacitation. Likewise, the treatments for AF range from simple reassurance and lifestyle changes, to taking a medicine, and on to having [a] complex ablation[s]. Because knowledge is so important to… Continue Reading