Incremental Impact of HTN Drugs; Outsourcing PCI in VA System; COPD Inhaler Heart Risks | IUK Med Online
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Incremental Impact of HTN Drugs; Outsourcing PCI in VA System; COPD Inhaler Heart Risks

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Incremental Impact of HTN Drugs; Outsourcing PCI in VA System; COPD Inhaler Heart Risks

Cardiovascular Daily wraps up the top cardiology news of the week

MedpageToday

  • by Senior Associate Editor, MedPage Today
  • This article is a collaboration between MedPage Today® and:

    Medpage Today

An analysis of the SPRINT trial showed that adding an antihypertensive in a class patients weren’t already on had substantial incremental benefit.

After adjustment for confounding by indication, adding a new class cut systolic pressure by a “clinically important” 14.4 mm Hg on average and major cardiovascular events by an absolute 6.2% among non-diabetic patients at high risk for cardiovascular events.

The incremental effect was on par whether patients were already on one, two, or three or more classes at baseline and across all subgroups of patients, researchers reported in BMJ.

“Our results challenge the view that adding antihypertensive drugs will result in progressively diminishing effects on blood pressure and cardiovascular events,” they concluded. “Our findings provide patients and clinicians with more rigorous nuanced insight into optimal management of hypertension.”

PCI for Veterans

Military veterans treated outside the VA medical system have worse outcomes and higher costs for elective percutaneous coronary intervention (PCI), researchers reported in JAMA Cardiology.

PCI procedures done through the VA Community Care program — which started to increase accessibility to medical care for veterans after a wait-time scandal in 2014 — had an adjusted 1.54% rate of 3o-day mortality compared with 0.65% at VA hospitals (P<0.001) and a significantly higher cost.

Non-VA and VA centers performed similarly for coronary artery bypass grafting (CABG) in terms of mortality and for 30-day readmissions after both PCI and CABG.

“The higher mortality of community care provided PCIs was not necessarily due to lower quality of care at community care hospitals. Other possible factors include delay in making care arrangements, incomplete coordination of care between VA and community care hospitals, or failure to refill medications prescribed by community care clinicians,” the authors wrote. “These are obvious areas for future research and quality improvement efforts.”

MedPage Today has the rest of the story here.

COPD Drug Risks

The cardiovascular risk from inhaled long-acting bronchodilators for chronic obstructive pulmonary disease (COPD) appeared temporary in a randomized study reported in JAMA Internal Medicine.

At 30 days, the adjusted risk of hospital admission for coronary heart disease, cardiac arrhythmia, heart failure, ischemic stroke at 30 days after starting on a long-acting β2-agonist (LABA) or long-acting antimuscarinic antagonist (LAMA) was about 50% elevated.

The risk peaked at around the 30th day after new initiation, then waned from 31 to 60 days, and dropped below baseline from 71 to 240 days.

“Given that cardiovascular disease is highly prevalent among patients with COPD, clinicians should also pay attention to the management of cardiovascular disease risk factors throughout the duration of LABA or LAMA therapy,” the researchers wrote. “We also suggest that physicians assess patients’ cardiovascular risk before initiation of LABAs or LAMAs, and, if needed, a preventive therapy for cardiovascular disease should be considered during the initial treatment of inhaled long-acting bronchodilators.”

See the full story on MedPage Today here.

TAVR and Gender

Newer transcatheter aortic valve replacement devices and techniques might even out outcomes between the genders, according to studies in JACC: Cardiovascular Interventions.

A large meta-analysis showed similar 30-day all-cause and cardiovascular mortality between men and women but a lower risk for women for all-cause mortality at 1 year (RR 0.85, 95% CI 0.79-0.91) and over more than 3 years’ follow-up (RR 0.86, 95% CI 0.81-0.92).

Analysis of the PARTNER II S3 trial study looking only at the newer-generation balloon-expandable Sapien 3 valve showed similar mortality between women and men both at 30 days (2.0% versus 1.2%, P=0.20) and at 1 year (9.3% versus 10.2%, P=0.59).

Separate analysis of a registry of intermediate-to-high risk women getting TAVR (42% with newer devices) concluded that sex-specific factors didn’t account for their TAVR outcomes.

That shift compared with earlier studies showing worse outcomes for men could be “perhaps due to improvements in valve sizing, availability of larger valves, and less paravalvular leak in males using modern deployment techniques and enhanced valve design,” an accompanying editorial suggested. See the full story here at MedPage Today.

In Other News

MedPage Today‘s Nicole Lou reports slow growth in centers adopting a TAVR embolic protection device after it got the FDA greenlight earlier this year.

Few commercial stem cell clinic providers offering treatment for heart failure are cardiologists and some aren’t even licensed physicians, according to a cardiologist who wrote a warning op-ed in STAT after surveying the field.

2018-01-05T12:00:00-0500
Comments

Accessibility Statement

At MedPage Today, we are committed to ensuring that individuals with disabilities can access all of the content offered by MedPage Today through our website and other properties. If you are having trouble accessing www.medpagetoday.com, MedPageToday's mobile apps, please email legal@ziffdavis.com for assistance. Please put "ADA Inquiry" in the subject line of your email.

Medpage Today

Incremental Impact of HTN Drugs; Outsourcing PCI in VA System; COPD Inhaler Heart Risks

Cardiovascular Daily wraps up the top cardiology news of the week

MedpageToday

  • by Senior Associate Editor, MedPage Today
  • This article is a collaboration between MedPage Today® and:

    Medpage Today

An analysis of the SPRINT trial showed that adding an antihypertensive in a class patients weren't already on had substantial incremental benefit.

After adjustment for confounding by indication, adding a new class cut systolic pressure by a "clinically important" 14.4 mm Hg on average and major cardiovascular events by an absolute 6.2% among non-diabetic patients at high risk for cardiovascular events.

The incremental effect was on par whether patients were already on one, two, or three or more classes at baseline and across all subgroups of patients, researchers reported in BMJ.

"Our results challenge the view that adding antihypertensive drugs will result in progressively diminishing effects on blood pressure and cardiovascular events," they concluded. "Our findings provide patients and clinicians with more rigorous nuanced insight into optimal management of hypertension."

PCI for Veterans

Military veterans treated outside the VA medical system have worse outcomes and higher costs for elective percutaneous coronary intervention (PCI), researchers reported in JAMA Cardiology.

PCI procedures done through the VA Community Care program -- which started to increase accessibility to medical care for veterans after a wait-time scandal in 2014 -- had an adjusted 1.54% rate of 3o-day mortality compared with 0.65% at VA hospitals (P<0.001) and a significantly higher cost.

Non-VA and VA centers performed similarly for coronary artery bypass grafting (CABG) in terms of mortality and for 30-day readmissions after both PCI and CABG.

"The higher mortality of community care provided PCIs was not necessarily due to lower quality of care at community care hospitals. Other possible factors include delay in making care arrangements, incomplete coordination of care between VA and community care hospitals, or failure to refill medications prescribed by community care clinicians," the authors wrote. "These are obvious areas for future research and quality improvement efforts."

MedPage Today has the rest of the story here.

COPD Drug Risks

The cardiovascular risk from inhaled long-acting bronchodilators for chronic obstructive pulmonary disease (COPD) appeared temporary in a randomized study reported in JAMA Internal Medicine.

At 30 days, the adjusted risk of hospital admission for coronary heart disease, cardiac arrhythmia, heart failure, ischemic stroke at 30 days after starting on a long-acting β2-agonist (LABA) or long-acting antimuscarinic antagonist (LAMA) was about 50% elevated.

The risk peaked at around the 30th day after new initiation, then waned from 31 to 60 days, and dropped below baseline from 71 to 240 days.

"Given that cardiovascular disease is highly prevalent among patients with COPD, clinicians should also pay attention to the management of cardiovascular disease risk factors throughout the duration of LABA or LAMA therapy," the researchers wrote. "We also suggest that physicians assess patients' cardiovascular risk before initiation of LABAs or LAMAs, and, if needed, a preventive therapy for cardiovascular disease should be considered during the initial treatment of inhaled long-acting bronchodilators."

See the full story on MedPage Today here.

TAVR and Gender

Newer transcatheter aortic valve replacement devices and techniques might even out outcomes between the genders, according to studies in JACC: Cardiovascular Interventions.

A large meta-analysis showed similar 30-day all-cause and cardiovascular mortality between men and women but a lower risk for women for all-cause mortality at 1 year (RR 0.85, 95% CI 0.79-0.91) and over more than 3 years' follow-up (RR 0.86, 95% CI 0.81-0.92).

Analysis of the PARTNER II S3 trial study looking only at the newer-generation balloon-expandable Sapien 3 valve showed similar mortality between women and men both at 30 days (2.0% versus 1.2%, P=0.20) and at 1 year (9.3% versus 10.2%, P=0.59).

Separate analysis of a registry of intermediate-to-high risk women getting TAVR (42% with newer devices) concluded that sex-specific factors didn't account for their TAVR outcomes.

That shift compared with earlier studies showing worse outcomes for men could be "perhaps due to improvements in valve sizing, availability of larger valves, and less paravalvular leak in males using modern deployment techniques and enhanced valve design," an accompanying editorial suggested. See the full story here at MedPage Today.

In Other News

MedPage Today's Nicole Lou reports slow growth in centers adopting a TAVR embolic protection device after it got the FDA greenlight earlier this year.

Few commercial stem cell clinic providers offering treatment for heart failure are cardiologists and some aren't even licensed physicians, according to a cardiologist who wrote a warning op-ed in STAT after surveying the field.

2018-01-05T12:00:00-0500
Comments

Accessibility Statement

At MedPage Today, we are committed to ensuring that individuals with disabilities can access all of the content offered by MedPage Today through our website and other properties. If you are having trouble accessing www.medpagetoday.com, MedPageToday's mobile apps, please email legal@ziffdavis.com for assistance. Please put "ADA Inquiry" in the subject line of your email.



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Dr Irfanullah Khan Born: 15th July,1994 in Khagram,Dir Upper KPK Pakistan. Others names:Doctor Irfo,Peshoo Education:Pharm-D Scholar Graduated from Abasyn University Peshawar. Occupation:Clinical Pharmacist,Doctor,Entrepreneur. Home Town:Dir Upper Height: 6 feet. Website:Iukmedonline.com

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