This week, Richard looks at endocarditis and ICDs, more stent wars, stroke prevention in A-Fib, and more.

When taking care of older patients, we often have an intuitive sense of which ones will do well after an intervention and which ones won’t. This has been termed the “foot of the bed” test, or alternately something which separates a “young 80-year old” from an “old 80-year old.”  Frailty is a syndrome defined as an increased physiologic vulnerability to stressors, and through its quantification we can help to standardize this clinical intuition. However, the routine measurement of frailty has largely remained outside both clinical trials and patient care. A… Continue Reading

This week, Richard discusses JAMA’s coverage of patient-centered care and all things CABG in NEJM.

This week’s topics include an “awful question” about statin therapy, coronary computed tomographic angiography in the ED, vorapraxar for secondary prevention, and stent wars.

A recent report published in the Archives of Internal Medicine highlights some “low-hanging fruit” for anyone trying to deliver more cost-effective healthcare. The authors (I am the first author and Harlan Krumholz, CardioExchange editor-in-chief, is the senior author) describe how branded formulations of fenofibrate — marketed by Abbott as Tricor and Trilipix — account for the vast majority of fenofibrate prescriptions, even though generic fenofibrate has been available for almost a decade. Abbott was able to stay one step ahead of the generic competition by repeatedly changing the dose of its branded formulations:… Continue Reading

Every electrophysiologist knows there are a million things that can be done for patients with atrial fibrillation. But sometimes not doing an invasive procedure is the best choice.

(Reprinted with permission from NOW@NEJM, a blog for physicians about the New England Journal of Medicine) Chest pain is the second most common reason for Emergency Room visits in this country, and although only 10-15% of patients admitted with chest pain are ultimately diagnosed with an acute coronary syndrome, the majority of patients get admitted. So common, in fact, is this admission diagnosis, that during cardiology rounds the other week, when I asked a resident how the patient was doing, she responded, “Oh fine, we’re just rome-eee-ing him,” (a new… Continue Reading

In the ASCERT observational study, stable patients (age 65 or older) with double- or triple-vessel CAD, but not left-main disease, were found to have better long-term survival after CABG than after PCI. ASCERT was a laudable achievement in terms of its scope and the level of collaboration it represents. The ASCERT investigators used inverse probability weighting (propensity scores) in an attempt to mitigate the impact of selection bias. However, this technique depends on measured variables. Experts are currently debating whether the registries analyzed in ASCERT — the STS Adult Cardiac Surgery… Continue Reading

This week’s topics include the EINSTEIN-PE trial of rivaroxaban, the risk for suicide or cardiovascular death after cancer diagnosis, and a comparison of computer reminders vs. pharmacist outreach about medication dangers.

CardioExchange welcomes this guest post 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. St. Jude Medical, a widely-used manufacturer of implantable cardiac devices, finds they have a bit of a problem with a form of insulation that surrounds wires contained in several lines of their pacing and defibrillator leads. They decide to pull these products from the market after substantial evidence that their leads’ reliability… Continue Reading