Cardiovascular Disease

Apr 022012
 

This post was featured on KevinMD.com; an excerpt follows. “Full code” is the universal default status for patients who haven’t chosen otherwise. Yet I suspect most physicians believe this policy is wrong. We feel in our hearts we’re doing harm when we perform CPR on poor souls whose bodies are trying to naturally end their [… read more]

Feb 222012
 
Restrictive blood transfusion was fine for high-CV-risk patients after hip fracture repair (RCT, NEJM)

There’s not much data to guide the transfusion of red blood cells. In 1999, there was the beautifully executed and practice-changing Transfusion Requirements in Critical Care (TRICC) trial, which showed that a restrictive transfusion strategy (hemoglobin trigger of 7 g/dL) in ICU patients resulted in a non-stat.significantly lower mortality (19% vs. 23%) compared to a [… read more]

Feb 142012
 

Chronic obstructive pulmonary disease (COPD) and congestive heart failure (CHF) are common and together contribute enormously to the global burden of chronic disease. Although surely these conditions overlap and interact, surprisingly little study has been given to their interrelationship. Macchia et al prospectively evaluated and followed two cohorts of patients aged > 59, recruited from [… read more]

Jan 072012
 
Sleepy cops abound; you won't like them when they're angry (JAMA, NYT)

Did you ever wonder what that police officer is really doing while you wait forever in your car for him to write you your ticket? According to new research, it’s possible he’s taking a quick nap. And you’d best save your snarky comment when he brings you the citation: sleepy cops, it turns out, tend to be [… read more]

Jan 072012
 

One thing I thought I knew was that overweight and obesity cause coronary artery disease and make it worse. People with CAD who are obese should lose weight … right? Recent research shows it’s not that simple (although the answer is still “yes, probably”). Did you know about the “obesity paradox?” Or the “lean paradox,” [… read more]

Jan 012012
 
ACP advises against universal DVT/PE prophylaxis! "Quality" quagmire thickens (Guideline/Review, Ann Intern Med)

Daunted by the seeming impossibility of measuring and comparing hospitals on real outcomes (given our primitive state of data collection and heterogeneity in patient populations, among many other challenges), well-meaning bureaucrats and non-profiteering safety advocates like the Institute for Healthcare Improvement have created directives based on surrogate measures in an attempt to standardize and improve [… read more]

Jan 012012
 

This nice (and brief) review article on interpreting elevated troponin levels can be summed up by its quote from cardiologist Robert Jesse: “When troponin was a lousy assay it was a great test, but now that it’s becoming a great assay, it’s getting to be a lousy test.” Troponin abnormality is set at the 99th [… read more]

Jan 012012
 

The smoking cessation drug varenicline (Chantix) got a black-box warning in 2009 after the FDA received >500 reports of suicidal thoughts and behaviors, and 32 completed suicides in the U.S. (This was out of several million prescriptions filled, though.) After that postmarketing surprise, the FDA sponsored 2 observational studies in Chantix users: one at the [… read more]

Jan 012012
 

Severe sepsis makes the heart irritable, probably due to all the evil humors and increased cardiac demand. Between 6-20% of patients with severe sepsis develop atrial fibrillation for the first time; that’s old news. What’s been unclear is what new-onset atrial fibrillation in severe sepsis means: is it an expected, yeah-so-what marker of critical illness, [… read more]

Dec 262011
 

See Update Below: the larger RELAX trial (enrolling patients with less severe pulmonary hypertension) did not show a benefit of sildenafil. Guazzi et al randomized 44 people with heart failure with preserved ejection fraction and associated pulmonary hypertension (confirmed by right heart catheterization) to receive the phosphodiesterase-5 inhibitor sildenafil or placebo for one year, along with [… read more]

Dec 182011
 

Dumas et al prospectively observed 1145 consecutive victims of out-of-hospital cardiac arrest who survived to admission in France between 2000 and 2009. Among VT/VF patients, 65% got therapeutic hypothermia, while 60% of PEA/asystole patients did, with higher proportions receiving hypothermia later in the study period (86 and 73% respectively) . Most people in the PEA/asystole [… read more]

Dec 082011
 

A handful of people with pulmonary embolism have absolute contraindications to anticoagulation. Authors here describe these as: Any prior intracranial hemorrhage, known structural intracranial cerebrovascular disease (eg, arteriovenous malformation), known malignant intracranial neoplasm, ischemic stroke within 3 months, suspected aortic dissection, active bleeding or bleeding diathesis, recent surgery encroaching on the spinal canal or brain, [… read more]

Dec 072011
 
Trouble sleeping? Don't read this, it'll only make it worse

If you spend your nights lying awake worrying about having a heart attack, you’re entirely justified. But you’re probably just making it more likely. Lars Laugsand et al followed 52,610 Norwegian people for 11 years after the subjects completed an initial survey (investigators can do this in Norway, since they’ve got everyone’s health records in [… read more]

Dec 022011
 

Faced with steadily rising costs of medical care insurance, more and more U.S. employers are insisting that smokers pay a higher share of the premiums of their employer-sponsored insurance, according to a Towers Watson survey of 248 businesses.  19% of companies with >1,000 employees have increased smokers’ share of medical care insurance premiums, double the rate from [… read more]

Nov 252011
 

According to compelling new data, you can win the genetic lottery and live healthy all your life, and you’ll still be more likely to die from your first heart attack than the diabetic guy in the next bed who keeps going outside to smoke to relieve his chest pain. But you’ll at least have had more time [… read more]