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$$ Vs Mortality in MI; Lowest TAVR Pacing Rate Yet; Lethal ESRD/LVAD Combo

$$ Vs Mortality in MI; Lowest TAVR Pacing Rate Yet; Lethal ESRD/LVAD Combo

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Editor’s Note: Cardiovascular Daily emails will be back in your inbox Jan. 2 after closure for the holidays, but keep clicking through to our homepage at for fresh cardiology news and features through the week.

As the U.S. Preventive Services Task Force announced this week that it’s still not ready to back routine electrocardiography screening of atrial fibrillation or cardiovascular disease risk, the issue of wearables that can do such screening out of the office was left as uncertain.

One cardiologist told about a “super healthy” patient in whom the Ziopatch turned up a few runs of potential atrial fibrillation. Second and third options on how to treat ensued. Now with the Apple Watch having an FDA-cleared ECG band likely to be used by mainly younger, healthy people, “I think we are going to be seeing a lot of this,” said Ethan Weiss, MD, of the University of California San Francisco. Read his op-ed piece on MedPage Today here.

Medicare Spending in MI

The more Medicare spent on care for acute myocardial infarction hospitalization, the better the survival rates only when it comes to percutaneous coronary intervention (PCI), a study reported online in JAMA Cardiology.

Early PCI was associated with lower mortality at 180 days as well as $700 less in skilled nursing facility costs and $298 less in home health agency, hospice, and durable medical equipment bills.

“These results are intriguing because they raise the possibility that an expensive procedure, at least when used appropriately, can save later downstream costs in addition to reducing mortality,” suggested an accompanying editorial.

Growth in other components of spending were not tied to improved survival. Non-percutaneous cardiac procedures were actually associated with higher odds of 180-day mortality, although likely a marker of factors like severity.

See full MedPage Today coverage here.

Novel TAVR Valve

The novel Centera transcatheter aortic valve — a low-profile nitinol valve delivered by a motorized delivery system that allows it to be repositioned — had “excellent” hemodynamic results in a study reported in the Journal of the American College of Cardiology.

But it was most notable for the 0.6% rate of moderate-or-worse paravalvular aortic regurgitation and 4.5% rate of new permanent pacemakers (5.3% of those without prior pacemakers in the as-treated population).

While the researchers cautioned there were small numbers and operators opted not to implant pacemaker at their discretion in patients with transient conduction abnormalities, those pacemaker rates were “the lowest compared with any other transcatheter heart valve” and “at least similar to the permanent pacemaker implantation rates of previous surgical series,” an accompanying editorial noted.

MedPage Today has the rest of the story.

Renal Disease and LVAD

The combination of end-stage renal disease (ESRD) and advanced heart failure necessitating a left ventricular assist device (LVAD) is an especially lethal scenario, according to a small Medicare study in JAMA Internal Medicine showing that 81.9% of such patients had died by a little over 2 years of follow-up compared with 36.4% of LVAD recipients without ESRD.

The hazard ratio with ESRD among LVAD recipients remained 36-fold even after accounting for factors like demographics and comorbidity, with the survival gap widest between groups in the first 60 days.

“Patients with ESRD at the time of LVAD placement had an extremely poor prognosis, with most surviving for less than 3 weeks,” the researchers concluded. “The median survival of 16 days after LVAD placement and high in-hospital mortality for patients with ESRD in this study suggests that these procedures are either being offered at a time when patients are actively dying or that they actually precipitate this process.”

MedPage Today has more here.

In Other News

Women’s hearts may be more affected by constriction of peripheral vessels during mental stress than are men’s, according to a prospective cohort study in Arteriosclerosis, Thrombosis, and Vascular Biology.

Was the ORBITA trial actually underpowered? Saurabh Jha, MD, says no but raises a deeper statistical analysis question about the seminal stable angina treatment trial.


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