Qualitative evaluation to understand barriers and facilitators to prescribing angiotensin receptor-neprilysin inhibitors (ARNi) and sodium-glucose cotransporter inhibitors (SGLT2i) in patients with heart failure with reduced ejection fraction (HFrEF).

Background: Despite sodium-glucose cotransporter-2 inhibitors (SGLT2i) and angiotensin receptor/neprilysin inhibitors (ARNi) being cost-effective evidenced-based therapies for the management of Heart Failure with Reduced Ejection Fraction (HFrEF), research shows that less than 30% of patients with HFrEF are prescribed these agents.

Objective: This study aimed to understand clinician-perceived barriers and facilitators to prescribing ARNi and SGLT2i in patients with HFrEF.

Methods: We conducted virtual and in-person semi-structured interviews in a large integrated healthcare delivery system in the United States.

Evaluation of pharmacist-led transition of care program in patients with acute coronary syndrome.

Background: Guideline-directed medical therapies (GDMTs), initiated in-hospital and continued during the transition to outpatient care, are paramount to successful outcomes for patients with acute coronary syndrome (ACS). Incomplete discharge medication prescribing and delayed follow-up lead to worse cardiovascular outcomes.

Objectives: We investigated a system of care using inpatient and outpatient clinical pharmacists to close GDMT gaps, ensure seamless transition to outpatient care, improve patient education, and optimize therapies.

Intermediate and long-term residual cardiovascular risk in patients with established cardiovascular disease treated with statins.

Introduction: Statins remain the first-line treatment for secondary prevention of cardiovascular (CV) events, with lowering of low-density lipoprotein cholesterol (LDL-C) being their therapeutic target. Although LDL-C reduction significantly lowers CV risk, residual risk persists, even in patients with well-controlled LDL-C; thus, statin add-on agents that target pathways other than LDL-C, such as the omega-3 fatty acid eicosapentaenoic acid, may help to further reduce persistent CV risk in patients with established CV disease.

Methods: This narrative review examines the contemporary literature assessing intermediate- and long-term event rates in patients with established CV disease treated with statins.

Temporal trends in cardiovascular outcomes and costs among patients with type 2 diabetes.

Background: Type 2 diabetes (T2D) is a strong risk factor for cardiovascular (CV) disease. CV outcomes in T2D have generally been improving over time but recent data from the US suggest attenuation of trends in older adults with reversal of trends in younger adults. However, published data are only reported through 2015.

Association between the diagnostic classification of newly diagnosed coronary artery disease and future heart failure development.

Objective: The first clinical manifestation of coronary artery disease (CAD) varies widely from unheralded myocardial infarction (MI) to mild, incidentally detected disease. The primary objective of this study was to quantify the association between different initial CAD diagnostic classifications and future heart failure.

Methods: This retrospective study incorporated the electronic health record of a single integrated health care system.

Establishing a National Cardiovascular Disease Surveillance System in the United States Using Electronic Health Record Data: Key Strengths and Limitations.

Cardiovascular disease surveillance involves quantifying the evolving population-level burden of cardiovascular outcomes and risk factors as a data-driven initial step followed by the implementation of interventional strategies designed to alleviate this burden in the target population. Despite widespread acknowledgement of its potential value, a national surveillance system dedicated specifically to cardiovascular disease does not currently exist in the United States. Routinely collected health care data such as from electronic health records (EHRs) are a possible means of achieving national surveillance.

Changes over time in the cardiovascular risk profile of type 2 diabetes from 2007 to 2020: A community-based study.

Aims: To quantify changes over time in cardiovascular (CV) risk factor control and in the uptake of glucagon-like peptide-1 receptor agonists (GLP-1RAs) and sodium-glucose cotransporter-2 (SGLT2) inhibitors from 2007 to 2020 in a real-world community-based cohort of type 2 diabetes (T2D) patients.

Materials And Methods: This study identified 95 461 T2D patients, who were followed for an average of 6.4 years through a single healthcare organization's electronic health record.

Burden and Predictors of Chest Pain-Related Health-Care Utilization Following Percutaneous Coronary Intervention.

Chest pain (CP) has been reported in 20% to 40% of patients 1 year after percutaneous coronary intervention (PCI), though rates of post-PCI health-care utilization (HCU) for CP in nonclinical trial populations are unknown. Furthermore, the contribution of noncardiac factors - such as pulmonary, gastrointestinal, and psychological - to post-PCI CP HCU is unclear. Accordingly, the objectives of this study were to describe long-term trajectories and identify predictors of post-PCI CP-related HCU in real-world patients undergoing PCI for any indication.

Quantifying the Risk Continuum for Cardiovascular Death in Adults with Type 2 Diabetes.

Objectives: In type 2 diabetes (T2D), the most common causes of death are cardiovascular (CV) related, accounting for >50% of deaths in some reports. As novel diabetes therapies reduce CV death risk, identifying patients with T2D at highest CV death risk allows for cost-effective prioritization of these therapies. Accordingly, the primary goal of this study was to quantify the risk continuum for CV death in a real-world T2D population as a means to identify patients with the greatest expected benefit from cardioprotective antidiabetes therapies.

Trends in Atrial Fibrillation Incidence Rates Within an Integrated Health Care Delivery System, 2006 to 2018.

Importance: Atrial fibrillation (AF) is the most common cardiac arrhythmia, and multiple studies have reported increasing AF incidence rates over time, although the underlying explanations remain unclear.

Objectives: To estimate AF incidence rates from 2006 to 2018 in a community-based setting and to investigate possible explanations for increasing AF by evaluating the changing features of incident AF cases and the pool of patients at risk for AF over time.

Design, Setting, And Participants: This cohort study included 500 684 patients who received primary care and other health care services for more than 2 years through a single integrated health care delivery network in Pennsylvania.

Primary percutaneous coronary intervention for ST-segment-elevation myocardial infarction in a patient taking dabigatran for chronic anticoagulation.

Interventional cardiologists have few data on which to base clinical decisions regarding optimal care for ST-segment-elevation myocardial infarction patients who are taking therapeutic chronic oral anticoagulation. We present what we believe to be the first reported case of emergency coronary angiography and primary percutaneous coronary intervention in an ST-segment-elevation myocardial infarction patient who was on a dabigatran regimen for atrial fibrillation. The patient tolerated the procedures well and had no observable bleeding sequelae.

Four-year trends of inappropriate proton pump inhibitor use after hospital discharge.

Background: Several hospital-based studies have determined that physicians often inappropriately prescribe acid-suppressive medications for stress ulcer prevention in hospitalized patients and continue these drugs after discharge. We sought to determine the frequency of inappropriate proton pump inhibitor (PPI) use continued at discharge within our geographic region.

Methods: We undertook a retrospective review of the medical records and pharmacy prescription database of a large regional insurance carrier from January 2005 through December 2008 (total hospital admissions 96,669).

Spontaneous coronary artery dissection: case report and review of literature.

Spontaneous coronary artery dissection (SCAD) is an unusual cause of acute coronary syndrome or sudden cardiac death. SCAD has most frequently been described as presenting as an acute coronary syndrome in females during the peripartum period. It may also be associated with autoimmune and collagen vascular diseases, Marfan's syndrome, chest trauma, and intense physical exercise.

An unusual cause of right ventricular myocardial infarction.

A unique case of right ventricular myocardial infarction complicating an acute inferior-posterior myocardial infarction in a patient with a single left coronary artery is described. The clinical, electrocardiographic, and hemodynamic features of right ventricular myocardial infarction and the angiographic patterns of anomalous single coronary arteries are reviewed.

Enoxaparin dosing in the elderly using adjusted body weight.

We prospectively compared anti-Xa activity in 61 elderly (>65 years) subjects receiving enoxaparin according to standard or adjusted body weight (ABW) dosing. In the ABW dosing group, mean patient age was 76 years, mean weight 80 kg, mean serum creatinine 1.0 mg/dl, and mean CrCl 48 ml/min.

A randomized, multicenter trial of weight-adjusted intravenous heparin dose titration and point-of-care coagulation monitoring in hospitalized patients with active thromboembolic disease. Antithrombotic Therapy Consortium Investigators.

Background: Therapy with intravenous unfractionated heparin improves clinical outcome in patients with active thromboembolic disease, but achieving and maintaining a therapeutic level of anticoagulation remains a major challenge for clinicians.

Methods: A total of 113 patients requiring heparin for at least 48 hours were randomly assigned at 7 medical centers to either weight-adjusted or non-weight-adjusted dose titration. They were separately assigned to either laboratory-based or point-of-care (bedside) coagulation monitoring.

Clinical Experience with Routine Activated Coagulation Time Monitoring During Elective PTCA.

Background: Intracoronary thrombosis is an important factor in the pathogenesis of acute complications during percutaneous coronary interventions. The activated coagulation time (ACT) is a simple, reproducible bedside test that has become standard as the means of monitoring the anticoagulant effect of heparin during these procedures. To determine if ACT-adjusted heparin dosing reduces the procedure-related complications of elective PTCA, 1200 patients who underwent nomemergent percutancous transluminal coronary angioplasty (PTCA) between January 1, 1988 and February 26, 1992 were studied.

A comparison of two-dimensional echocardiography vs carotid duplex scanning in older patients with cerebral ischemia.

Background: To determine the relative value of two-dimensional (2D) echocardiography vs carotid duplex scanning and to devise an optimal, cost-effective diagnostic approach for older patients with cerebral ischemia, 68 consecutive patients in sinus rhythm who suffered focal cerebral ischemia were studied. All patients underwent 2D echocardiography and carotid duplex scanning in addition to routine clinical evaluation.

Methods: Twenty-five of 68 patients had Q-wave myocardial infarction by electrocardiography; nine (36%) of these 25 had left ventricular mural thrombi demonstrated by 2D echocardiography.

Accelerated coronary artery stenosis at a site proximal to coronary angioplasty.

Rapid progression of coronary stenosis has been described in patients undergoing percutaneous transluminal coronary angioplasty (PTCA), typically resulting in symptomatic angina 3 to 30 months postprocedure. We report a case of accelerated coronary stenosis in the instrumented vessel resulting in angina 3 days post-PTCA.

Angiographically documented thrombotic coronary artery occlusion secondary to mild nonpenetrating thoracic trauma.

A 22-yr-old man was found to have a subtotally occluding thrombus in the proximal left anterior descending (LAD) coronary artery shortly after suffering mild blunt chest trauma. After 6 days of anticoagulant therapy, the LAD appeared angiographically normal.

Severe metabolic and respiratory alkalosis associated with the treatment of congestive heart failure.

A high blood pH level is usually associated with an extremely poor prognosis. We present a case of significantly elevated arterial blood pH (pH, 7.81) that was associated with the aggressive treatment of congestive heart failure.

Accurate patient diagnosis of acute porcine valve failure.

Spontaneous porcine bioprosthetic valve failure is usually of gradual onset. We report a case of acute porcine mitral valve rupture resulting in rapid hemodynamic decompensation. The patient perceived the moment of valvular failure as the abrupt onset of a vibrating sensation in his chest.