REC: CardioClinics最新文献

Cardiovascular diseases are the leading cause of death in developed countries and account for more than a third of their healthcare costs. Acute coronary syndrome (ACS) is frequently one of the first manifestations of cardiovascular disease. There are important differences in post-ACS clinical management between centres and autonomous communities in Spain, as well as the clinical criteria used for applying the continuation of dual antiplatelet treatment (DAPT). Although there is an elevated number of potential candidates for prolonging DAPT beyond 1 year, recent data suggest that it is only applied in around one third of patients. Therefore, homogenizing treatment and follow-up criteria could contribute to reducing hospital stay and in-hospital mortality associated with ACS. To help this purpose, we propose a protocol of patient care management with practical applicability in our centres. This document also has the objective of synthesizing the recommendations of the clinical practice guidelines on post-ACS risk stratification and optimization of DAPT, proposing an algorithm to guide decision making. In line with the latest European clinical practice guidelines on ACS, we advise considering DAPT prolongation in patients who tolerated the treatment during the first year and have a significant residual thrombotic risk (moderate or high) without high bleeding risk. To assess bleeding risk, we recommend using the ARC-HBR scale, while the PRECISE-DAPT and DAPT scales can be used to integrate ischemic and haemorrhagic risk at discharge and 1 year after ACS, respectively.

Introduction and objectives

Same-day discharge (SDD) can be considered for patients who traditionally required overnight stay (ONS) after percutaneous coronary intervention (PCI). The authors aimed to evaluate viability of SDD-PCI.

Methods

Retrospective single-center observational study of patients who underwent elective PCI. SDD patients were selected based on clinical, angiographic, and sociodemographic characteristics. Patient and procedure characteristics were collected from local databases, and SDD-PCI adverse events (all-cause mortality, acute coronary syndrome, stent thrombosis, reintervention, major bleeding, stroke, contrast-induced renal failure, vascular access complications) at 30-days were analyzed.

Results

This study included 147 patients, 76% males with a mean age of 66 ± 10, that underwent elective PCI during the first year after implementation of SDD protocol. Most patients undergoing elective PCI were discharged the same day (n = 94, 64%). ONS group, when compared to SDD, had higher rates of acute coronary syndrome (38% vs 19%, P = .01) and left ventricular dysfunction (17% vs 6%, P = .04), higher Syntax I score (10 points [6–16] vs 8 points [5–12]; P = .01), more cases of multivessel PCI (24% vs 6%, P < .01) and a surrogate for longer procedures – fluoroscopy time (11 min [7–15] vs 8 min [5–13]; P = .02). There were no adverse events during the 30-day follow-up period of the patients treated in ambulatory regimen.

Conclusions

SDD-PCI is a safe procedure. Protocol implementation is key to guide interventional cardiologists in low-risk patient selection. The potential role in decreasing bed-shortage, hospital overcrowding, and healthcare costs is pivotal.

Obesity is a major public health concern due to its rising incidence and its association with numerous chronic diseases, such as heart failure, vascular disease, atrial fibrillation, and chronic kidney disease. Treating obesity has been shown to improve the prognosis of these diseases. The purpose of this position statement by the Association of Preventive Cardiology, the Clinical Cardiology Association, and the Heart Failure Association of the Spanish Society of Cardiology (SEC) is to provide guidance for preventing and treating cardiac, vascular, and renal complications related to obesity. The preparation of this work involved a multidisciplinary group of experts in endocrinology, nutrition, nephrology, internal medicine, family medicine, physical exercise, psychology, nursing, and cardiology. Patient experience was also considered.

Introduction and objectives

Sacubitril/valsartan (SV) is recommended in patients with heart failure, especially in reduced ejection fraction. So far, the safety of its use in perioperative cardiac surgery is uncertain but given its mechanism of action and possible blood pressure lowering effect, some guidelines recommend discontinuation, without clear evidence. This systematic review aims to assess clinical outcomes of use SV in the perioperative period compared with never having used it or its withdrawal.

Methods

Systematic literature review in MedLine, Cochrane, EMBASE and LILACs of studies published in English and Spanish. We included randomized clinical trials and non-randomized studies evaluating adult patients undergoing cardiac surgery that compared the use of SV up to the day of surgery versus stopping or not starting it prior to the procedure. In-hospital and 30-day mortality, length of stay in general ward and intensive care unit stay, orotracheal intubation, postoperative vasoplegia and need for renal replacement therapy were assessed. Quality was assessed using the ROBINS tool.

Results

Three non-randomized studies were included, one single-arm. There were fewer cases of in-hospital and 30-day mortality in the group in which SV was not discontinued, with no statistically significant difference. There was no difference in length of hospital or intensive care unit stay, orotracheal intubation, need for renal replacement therapy, or frequency of postoperative vasoplegia (OR, 0.77; 95%CI, 0.23–2.98).

Conclusions

The current evidence is scarce and of low quality so a recommendation regarding the use of SV prior to cardiac surgery cannot be generated, further studies are required.

Regular physical activity has been associated with a significant reduction in the risk of cardiovascular disease and an improvement in the quality of life. However, vigorous physical exercise might be a trigger of sudden cardiac death in individuals with an underlying cardiovascular disease. Preparticipation screening is aimed to early detect cardiovascular disorders potentially related to sudden cardiac death in athletes. The focus of the present review is to describe the main components of preparticipation cardiovascular screening according to age, type of sport and competitive level. In addition, the relevance of implementing an emergency action plan to deal with adverse cardiovascular events is highlighted.