In the POAF group, oral anticoagulant (OAC) therapy was initiated in 175 patients (8.4 percent) within 30 days (83 percent received warfarin). Antiplatelet therapy was initiated within 30 days after discharge in 78.9 percent of patients receiving OAC and in 79.7 percent of patients not receiving OAC. In the NVAF group, OAC was initiated in 3,549 patients (42.9 percent) within 30 days (78 percent received warfarin).

The rate of thromboembolism in the POAF vs. NVAF groups was 18.3 vs. 29.7 events per 1,000 person-years. POAF was associated with a significantly lower risk of thromboembolism compared with NVAF (adjusted hazard ratio [HR], 0.67; pp<0 .001). OAC therapy was associated with a significantly lower risk of thromboembolic events in both groups compared with patients who had none.

The rate of all-cause mortality in the POAF vs. NVAF groups was 46.9 vs. 88.0 events per 1000 person-years. POAF was associated with a significantly lower risk of all-cause mortality compared with NVAF (adjusted HR, 0.55; pp< 0.001). OAC therapy during follow-up was associated with a significantly lower risk of all-cause mortality in patients with NVAF (adjusted HR, 0.51; p<0 .001) but not in patients with POAF (adjusted HR, 1.09; p=0.56) compared with patients who had no OAC therapy.

“Developing new-onset POAF after CABG surgery was associated with a lower long-term thromboembolic risk compared with NVAF,” the authors conclude. “Further, patients with POAF did not have significantly higher associated risk of thromboembolism compared with those who did not develop POAF after CABG surgery. These data do not support the notion that POAF should be regarded as equivalent to primary NVAF in terms of long-term thromboembolic risk.”

Butt JH, Xian Y, Peterson ED, et al. JAMA Cardiol 2018;Mar 28:[Epub ahead of print].

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Results showed that participation increased from 6.0 percent to 24.6 percent at the 12 facilities that implemented home-based cardiac rehab programs. And from 10.9 percent to 17.6 percent at the 23 facilities that offered referral to off-site cardiac rehab or VHA on-site cardiac rehab. There was no obvious change in cardiac rehab participation at the 52 facilities that offered referral to off-site cardiac rehab only (from 6.4 percent to 6.6 percent).

Furthermore, in a sensitivity analysis that required three or more cardiac rehab sessions, participation increased from 5.1 percent to 16.6 percent at facilities that offered home-based cardiac rehab; from 8.3 percent to 9.6 percent at facilities that offered off-site or VHA on-site cardiac rehab; and from 5.2 percent to 6.0 percent at facilities that offered off-site cardiac rehab only.

The authors also found that patients offered home-based cardiac rehab were less likely to drop out after the first session than those for whom home-based cardiac rehab was not available (16.8 percent vs. 20.2 percent).

“We recognize that results may be biased because facilities that developed home-based cardiac rehab programs were likely to be stronger proponents of cardiac rehab, and overall cardiac rehab participation remained low,” the authors concluded. “Nonetheless, these findings demonstrate that home-based cardiac rehab may be an effective tool for increasing cardiac rehab participation among patients who would otherwise decline to participate.”

Schopfer DW, Krishnamurthi N, Shen H, et al. JAMA Intern Med 2018. Jan 22:[Epub ahead of print].

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After six months, 64 percent of men in the intervention group had blood pressure in the normal range, compared with just 12 percent of the control group. In the intervention group, systolic blood pressure decreased from 153 mm Hg at baseline to 126 mm Hg, and diastolic blood pressure decreased by 18 mm Hg. In contrast, in the control group, systolic blood pressure decreased from 155 mm Hg to 145 mm Hg, and diastolic blood pressure dropped by 4 mm Hg.

At baseline, about one-half of participants in both groups were taking at least one blood pressure medication. After six months, 100 percent of those in the intervention group and 63 percent of those in the control group were taking blood pressure medications.

Researchers are now studying whether the effects are sustained for an additional six months. They hope to expand the program to other parts of the country. “By bringing state-of-the-art medicine directly to the people who need it on their home turf, in this case in a barbershop, and making it both convenient and rigorous, blood pressure can be controlled just as well in African-American men as in other groups,” Victor said. “If this model was scaled up and sustained, millions of lives could be saved, and many heart attacks and strokes could be prevented.”

Victor RG, Lynch K, Li N, et al. N Engl J Med 2018;March 12:[Epub ahead of print].

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The median follow-up was 32 months (and as long as 6.5 years) in the 6,190 patients (84 percent men). The rate of the composite primary outcome (consisting of cardiovascular death, nonfatal myocardial infarction, nonfatal stroke or urgent revascularization due to angina) from the time from study drug randomization to first occurrence was similar in both treatment groups, meeting the study’s threshold for noninferiority of febuxostat to allopurinol.

However, there was a potential signal for increased mortality with febuxostat compared with allopurinol in the analysis of the individual endpoint components, with a 34 percent higher rate of death from cardiovascular causes and a 22 percent higher rate of death from any cause. Mortality rates with febuxostat and allopurinol were similar among the 50 percent of patients with a history of chronic kidney disease.

Approximately 45 percent of patients discontinued febuxostat before the study ended. Although the elevated risk of death was diminished in these patients, overall more patients died after stopping their assigned study drug than while taking it.

The increased risk of death was consistent across subgroups. Among patients receiving febuxostat, there was a higher risk of death in patients who did not regularly take aspirin and those who regularly took nonsteroidal anti-inflammatory drugs (NSAIDs), compared with those taking aspirin or not taking NSAIDs. Yet, researchers caution that CARES was not designed to assess potential medication interactions.

“It is important to be careful when interpreting these findings; it doesn’t necessarily indicate there’s an interaction between these drugs and febuxostat,” White said. “It might have been that these patients had more active gout with more flares, for example.”

The investigators were not able to determine the reason for the surprising results and plan to further examine the data for insights into the optimal treatment for gout in patients with both cardiovascular disease and kidney disease. Ongoing studies in Europe are evaluating the risks and benefits of febuxostat in patients who have cardiovascular risk factors without established cardiovascular disease.

White WB, Saag KG, Becker MA, et al. N Engl J Med 2018;March 12:[Epub ahead of print].

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The results suggest that the benefit for the primary outcome may be greater in patients with a history of heart failure at baseline, a group that experienced a 39 percent reduction compared with the 13 percent reduction in those without HF (p for interaction = 0.021). In the patients who had a history of HF and use of loop diuretic, there as a 46 percent reduction in the primary outcome.

Likewise, there was a 30 percent reduction in fatal or hospitalized HF and a 33 percent reduction in hospitalization for HF. A broad range of participant subgroups all benefited from an SGLT-2 inhibitor, including those using established treatments for the prevention of HF.

According to the researchers, the results provide evidence of the protective effect of canagliflozin in HF and suggest a role for SGLT-2 inhibitors in the prevention of HF for type 2 diabetes patients. Additional data from ongoing diabetes trials will further clarify this role.

Rådholm K, Figtree G, Perkovic V, et al. Circulation 2018:March 11:[Epub ahead of print].

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There were 994 in-hospital deaths (7.8 percent). In-hospital mortality was lower in patients with a contact-to-balloon time of ≤90 min vs. >90 min. One-fifth of patients with contact-to-balloon times ranging from 150 to 180 min died after PCI. Mortality was 42 percent among patients with CS vs. 2.7 percent of STEMI patients without clinical signs of hemodynamic instability. Resuscitated patients with OHCA had a mortality rate of 36 percent.

“By reducing the contact-to-balloon time to less than 90 min, one additional life could be saved out of five patients treated with CS,” the authors wrote. “However, this number needed to treat was much higher in stable patients (one life additionally saved out of 53 patients).” For contact-to-balloon times ranging from 60 to 180 min, there was a nearly linear relationship between treatment time and mortality. Every 10-min treatment delay resulted in 3.31 additional deaths in 100 PCI-treated CS patients without OHCA – significantly higher vs. the two OHCA groups (2.09) and without CS (1.34), and hemodynamically stable patients (0.34, p<0.0001).

“[O]ur data suggest that efforts to shorten the time to PCI therapy should be applied to all STEMI patients and that particularly patients with hemodynamic instability may benefit most from future improvements in STEMI treatment protocols,” the authors wrote.

Scholz KH, Maier SK, Maier LS, et al. Eur Heart J 2018;Feb 14:[Epub ahead of print].

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