June 2023 News Roundup
This month: early hysterectomy ups stroke risk, shopping carts for AF screening, trainees on the structural heart team, and more.
Every month, Section Editor L.A. McKeown curates a roundup of recent news tidbits from journals and medical meetings around the globe.
One in every 20 patients with a cardiovascular implantable electronic device (CIED) will develop a lead-related venous obstruction (LRVO) within 5 years, according to a Medicare analysis published in the Journal of the American College of Cardiology. While the majority of patients with obstruction were treated conservatively, those who underwent extraction of the device had a 40% reduction in LRVO-related healthcare utilization.
Since the expiration of the COVID-19 public health emergency last month, an estimated 1.5 million Medicaid patients in the United States have lost their health coverage, according to the Associated Press.
In other Medicaid news, a review published in Circulation: Cardiovascular Quality and Outcomes suggests that expansion of Medicaid under the Affordable Care Act of 2010 was associated with increased insurance coverage of cardiac treatments, improved cardiac morbidity/mortality outside of acute care settings, and some increase in screening for and treatment of cardiac comorbidities.
Women who undergo surgical hysterectomy in their 40s may be at increased risk of stroke, according to a large Korean analysis published in JAMA Network Open. “Further studies are needed to clarify the association between hysterectomy and hematocrit, iron, and ferritin levels and its possible effect on cardiovascular outcomes. Furthermore, it is difficult to explain why the risk of stroke appears to be significantly increased, while the risk of coronary artery disease and MI are not significantly different,” the study authors write.
Prior research has shown that elevating carbon dioxide levels for 24 hours in patients who are comatose after out-of-hospital cardiac arrest—to achieve mild hypercapnia with a target partial pressure of arterial carbon dioxide (PaCO2) of 50 to 55 mm Hg—can improve neurological outcomes. Still, the TAME trial’s 6-month results were negative, and writing in the New England Journal of Medicine, investigators say their findings suggest that there’s much left to learn.
British investigators have come up with a unique way of testing individuals for atrial fibrillation (AF)—as they shop for groceries. In the SHOPS-AF study, which took place at four supermarkets over a 2-month period, modified shopping-cart handles embedded with electrocardiogram (ECG) sensors were able to detect AF in 39 people who had no idea they had a heart rhythm disorder. Researchers reported the results at the Association of Cardiovascular Nursing & Allied Professions 2023.
In patients with both heart failure (HF) and chronic kidney disease, the likelihood of receiving quadruple therapy with an ACE inhibitor/ARB, an angiotensin receptor-neprilysin inhibitor (ARNI), an SGLT2 inhibitor, or a mineralocorticoid receptor antagonist (MRA) decreases along with declining eGFR levels, according to data from the CARDIOREN registry. Writing in Revista Española de Cardiología, the study authors say structured and specialized follow-up within HF clinics is needed to ensure that patients are receiving all recommended therapies.
Using the Framingham CV algorithm, women have lower overall scores than men, but a real-world analysis suggests that the score misses important sex-based differences. In the study, published in the Journal of Vascular Nursing, women had a higher number of risk factors, including diabetes, hyperlipidemia, obesity, and abdominal obesity, despite the lower overall scores.
Patients with cardiogenic shock who survive the first 30 days after TAVI have similar mortality rates as patients without shock, according to data from the Society of Thoracic Surgeons/American College of Cardiology TVT Registry. “TAVR should be considered as a definitive treatment in most patients in cardiogenic shock if they are anatomically suitable candidates and do not have prohibitive comorbidities that would curtail long-term survival,” the investigators report in the European Heart Journal.
A review article in Structural Heart outlines the importance of integrating trainees into the heart team as it continues to evolve and encompass more interdisciplinary collaboration. The authors argue that trainees should serve as “gatekeepers” for the structural heart team, holding responsibility for team meetings and being given protected time for research and publication.