November 2021 News Roundup
This month features pharmacoequity, epicardial fat and arrythmias, paradigm shift in endocarditis treatment, and more.
Every month, Section Editor L.A. McKeown curates a roundup of recent news tidbits from journals and medical meetings around the globe.
Healthcare leaders, physicians, and diversity, equity, and inclusion (DEI) committees have a responsibility to advocate for wage equity for essential healthcare workers “whose courage during the pandemic has gone largely unnoticed,” according to an editorial in the New England Journal of Medicine. The authors contend that “no DEI agenda is complete without a systematic evaluation of whether our lowest-paid employees, a group that is disproportionately made up of Black and Brown workers, are appropriately compensated for their essential contributions to patient care and to the overall success of our institutions.”
Addressing the rising cost of prescription drugs and prioritizing pharmacoequity as a key metric of quality are crucial elements of a “policy prescription for reducing health disparities,” that was published as a viewpoint article in JAMA. The authors say achieving pharmacoequity is “critical to the health of the nation,” although it will not lead to equity without addressing “structures and policies that have left marginalized populations without sufficient resources to lead healthy lives.”
A state-of-the-art review in the Journal of the American College of Cardiology explains what is known about the influence of epicardial fatty tissue accumulation on the risk of atrial and ventricular arrhythmias. According to the researchers, the tissue can create “an anatomical obstacle to cardiac excitation that delays conduction.”
JACC: Case Reports features an unusual case of a previously unknown congenital heart defect in an elderly patient who presented with acute anterior STEMI and underwent PCI. When the patient died 17 days later an autopsy revealed strangulation of the apical heart through a congenital pericardial defect due to partial absence of the pericardium.
A comparison of characteristics and outcomes of structural heart disease patients treated before and during a regional peak of the COVID-19 pandemic shows that practice changes focused on minimizing complications, preventing virus transmission, and reducing in-hospital time had a lasting impact. The paper, in Structural Heart, describes the practice changes, many of which continued after elective procedures resumed.
Among patients with acute MI, about one in eight have a ‘Do Not Resuscitate’ (DNR) order, according to an analysis of more than 2.5 million US patients. Those with versus without a DNR were more likely to be older, White, female, and multimorbid. They also were less likely to undergo invasive management, researchers report in the American Journal of Cardiology. TCTMD’s Yael L. Maxwell has the story.
Infective endocarditis that cannot be adequately treated with antibiotics often requires surgery, but investigators writing in Catheterization and Cardiovascular Interventions describe how they used a mechanical thrombectomy device to remove a large tricuspid vegetation in a young intravenous drug abuser. A multicenter registry to further evaluate this technique for endocarditis is underway, and the researchers say it could represent a paradigm shift in treatment, particularly for poor surgical candidates.
According to a subanalysis of the FIGARO-DKD study, the selective, nonsteroidal mineralocorticoid receptor antagonist finerenone (Kerendia, Bayer Healthcare), reduces the incidence of new-onset heart failure (HF) and improves other HF outcomes in patients with chronic kidney disease and type 2 diabetes, regardless of their HF history. The results were presented at the recent virtual American Heart Association 2021 Scientific Sessions and simultaneously published in Circulation.
A moderated case session at TCT 2021 introduced an operator-developed technique for crossing wire-impenetrable proximal caps during chronic total occlusion (CTO) procedures. In a simultaneous publication in JACC: Cardiovascular Interventions, the researchers say their technique, known as the “Power Carlino,” may be useful in situations where even stiff guidewires fail to get the job done.