Cardiology最新文献

Background: Cardiovascular disease is the leading cause of morbidity and mortality in the elderly population. Coronary artery disease, heart failure, and peripheral artery disease constitute the prevailing conditions. Cardiac rehabilitation (CR) represents a cornerstone in the secondary prevention of cardiovascular disease, since it has been associated with significant cardiovascular benefits in the above-mentioned conditions, by significantly reducing cardiovascular outcomes and improving functional independence and quality of life. Besides, CR offers the background for optimizing the control of cardiovascular risk factors and implementing physical exercise, also providing psychological and social support.

Summary: The prevalence of cardiovascular disease increases with age, associating high morbidity and mortality. In addition, comorbidities, frailty, and other geriatric conditions, entities that also entail poor prognosis, are often present in elderly patients. Indeed, frailty is recommended to be systematically addressed in elderly patients with cardiovascular disease, and there is growing evidence regarding the benefits of CR programs in this setting, also associated with lower adverse events during follow-up. However, elderly patients are less often referred to CR after a cardiovascular event when compared to their younger counterparts. In this review, we summarized the benefits of CR programs in the elderly population with established cardiovascular disease, proposing a comprehensive framework that integrates personalized care strategies.

Key messages: Cardiovascular disease is the leading cause of morbimortality, especially in the elderly. The management of cardiovascular disease in elderly patients poses unique challenges, since they represent a heterogeneous group and evidence is low. CR can provide significant benefits in older patients, encompassing physical training and specific management of geriatric syndromes.

Introduction: The swift uptake of new medications into clinical practice has many benefits; however, slow uptake has been seen previously with other guideline-directed medical therapies (GDMT) in heart failure (HF). Sodium glucose co-transporter 2 inhibitors are a novel therapy in HF proven to be efficacious and will have beneficial clinical outcomes if prescribed. Understanding physician perspectives on prescribing GDMT in HF can help target strategies to bridge the gap between guidelines and practice.

Methods: The study followed the PRISMA guide for scoping reviews. A search was conducted using EMBASE, Medline, and PubMed databases in April 2024. Studies included were those using qualitative methods to assess physician perspectives towards prescribing any HF medication. Common themes were identified through thematic synthesis following the methods from Cochrane Training and using software MAXQDA Analysis Pro.

Results: 708 studies were found in the search, with 23 full studies included. The most pertinent barriers identified were concern for medication adverse effects, unclear role responsibilities between physicians of different specialities, patient co-morbidities, and unwillingness to alter therapies of stable patients. The most identified enablers included awareness of efficacy, influence from colleagues, and the use of multi-media approaches for information dissemination. Perceptions were also found to change over time and vary among prescriber groups.

Conclusions: Physicians perceive common barriers and enablers of prescribing GDMT in HF, despite differences in prescriber groups and time periods. The identified barriers and enablers may be targeted to improve implementation of GDMT into clinical practice.

Introduction: This pooled analysis was conducted to assess the clinical safety and performance of the Supra family (Sahajanand Medical Technologies Ltd., Surat, India) of sirolimus-eluting stents (SES) in patients with acute coronary syndromes (ACSs) including ST-segment elevation myocardial infarction (STEMI) from two real-world all-comers Indian registries at 1 year.

Methods: We evaluated 1,824 patients with ACS who underwent percutaneous coronary intervention with the Supra family of SES from two real-world Indian registries (891 patients from T-Flex registry and 933 patients from Tetriflex real-world registry). The primary endpoint was the incidence of target lesion failure (TLF) defined as a composite of cardiac death, target-vessel myocardial infarction (TV-MI), and target lesion revascularization (TLR) at 1-year follow-up. The safety endpoint was stent thrombosis at 1-year follow-up.

Results: Among a total of 1,824 patients with ACS, 689 (37.8%) patients presented with STEMI. In ACS and STEMI groups, 47.6% and 41.8% patients had multivessel disease, respectively. Of 2,128 lesions in ACS group, 76.7% lesions were type B2/C and 16.2% lesions were totally occluded. In the STEMI group, out of 784 treated lesions, 76.7% were type B2/C lesions and 21.9% were totally occluded. At 1-year follow-up, incidence of TLF was 5.3% (cardiac death: 0.9%, TV-MI: 2.5%, TLR: 1.9%) in patients with ACS and 6.2% (cardiac death: 1.4%, TV-MI: 2.1%, TLR: 2.7%) in patients with STEMI. The 1-year rate of definite/probable stent thrombosis was 0.3% and 0.7% in patients with ACS and STEMI, respectively.

Conclusion: This patient-level pooled analysis provides evidence for the safe and effective use of the Supra family of SES in complex patient populations such as ACS and even in STEMI with favorable rates of TLF and stent thrombosis at 1-year follow-up.

Introduction: Coronary microvascular dysfunction (CMD) is common in patients with and without obstructive epicardial coronary artery disease (CAD). Risk factors for the development of CMD have not been fully elucidated, and data regarding sex-associated differences in traditional cardiovascular risk factors for obstructive CAD in patients with CMD are lacking.

Methods: In this single-center, prospective registry, we enrolled patients with nonobstructive CAD undergoing clinically indicated invasive assessment of coronary microvascular function between November 2019 and March 2023. Associations between coronary microvascular dysfunction, traditional cardiovascular risk factors, and sex were assessed using univariate and multivariate regression models.

Results: Overall, 245 patients with nonobstructive CAD were included in the analysis (62.9% female; median age 68 (interquartile range: 59, 75). Microvascular dysfunction was diagnosed in 141 patients (57.5%). The prevalence of microvascular dysfunction was similar in women and men (59.0% vs. 57.0%; p = 0.77). No association was found between traditional risk factors for coronary atherosclerosis and CMD regardless of whether CMD was structural or functional. In women, but not in men, older age and the presence of previous ischemic heart disease were associated with lower coronary flow reserve (β = -0.29; p < 0.01 and β = -0.15; p = 0.05, respectively) and lower resistive reserve ratio (β = -0.28; p < 0.01 and β = -0.17; p = 0.04, respectively).

Conclusion: For the entire population, no association was found between coronary microvascular dysfunction and traditional risk factors for coronary atherosclerosis. In women only, older age and previous ischemic heart disease were associated with coronary microvascular dysfunction. Larger studies are needed to elucidate risk factors for CMD.