Tag Archives: new england journal of medicine

BLOCK HF: CRT Superior To Conventional Pacing In Heart Failure Patients With AV Block Reply

by • Heart Failure, Heart Rhythms • Tags: , , , , , ,

 

Patients with atrioventricular (AV) block generally receive right ventricular pacing; cardiac resynchronization therapy (CRT) has been restricted to patients with a low ejection fraction and a wide QRS duration. However, RV pacing may worsen LV dysfunction in AV block patients with low ejection fractions. Previous studies have raised the possibility that these patients may benefit from biventricular pacing with a CRT device.

Now, results from the Medtronic-sponsored BLOCK HF (Biventricular versus Right Ventricular Pacing in Heart Failure Patients with Atrioventricular Block) trial, published in the New England Journal of Medicine, lend more support for the expansion of CRT devices into this population. Anne Curtis and colleagues randomized 691 patients to standard RV pacing or  biventricular pacing. After 37 months of followup, a primary outcome event– death, urgent care visit for heart failure that required intravenous therapy, or a 15% or more increase in the LV end-systolic volume index– occurred in 55.6% of the RV pacing group versus 45.8% in the biventricular pacing group (HR 0.74, CI 0.60-0.90).

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Click here to read the full post on Forbes.

 

Anne Curtis

 

 

 

 

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FDA Officials Calm Concerns Over Excessive Bleeding With Dabigatran 1

by • Heart Rhythms, Policy & Ethics, Prevention, Epidemiology & Outcomes • Tags: , , , , , ,

Concerns over excessive bleeding complications with dabigatran (Pradaxa, Boehringer Ingelheim) as compared with warfarin are most likely due to the heightened sensitivity and vigilance that can accompany a new drug, according to FDA officials in a perspective published online in the New England Journal of Medicine.

“We believe that the large number of reported cases of bleeding associated with dabigatran provides a salient example of stimulated reporting,” write Mary Ross Southworth, Marsha Reichman, and Ellis Unger. “In this case, such reporting provided a distorted estimate of the comparative bleeding rates associated with dabigatran and warfarin in clinical practice.”

Click here to read the full story on Forbes.

 

Another Negative Trial With Darbepoetin Alfa 1

by • Heart Failure, Prevention, Epidemiology & Outcomes • Tags: , , ,

Once again a trial testing the erythropoiesis-stimulating agent darbepoetin alfa (Aranesp, Amgen) has produced a negative result. Results of the RED-HF (Reduction of Events by Darbepoetin Alfa in Heart Failure) trial were presented at the ACC in San Francisco and published simultaneously in the New England Journal of Medicine.

A total of 2278 patients with systolic heart failure and mild-to-moderate anemia were randomized to darbepoetin alfa (Aranesp, Amgen) or placebo. As expected, treatment with darbepoetin alfa significantly improved hemoglobin levels. However, no significant improvements in outcomes were associated with darbepoetin alfa.

Click here to read the full story on Forbes.

 

New Studies Examine Prolonged Anticoagulation For VTE Recurrence Reply

by • Prevention, Epidemiology & Outcomes • Tags: , , , , , , , ,

Three studies published in the New England Journal of Medicine provide important new information about the risks and benefits of extended prophylaxis using two of the new oral anticoagulants in patients who have had venous thromboembolism (VTE).

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In an accompanying editorial, Jean Connors writes that “deciding how to balance the risks and benefits of extended anticoagulation is difficult” in patients with unprovoked VTE, since the risk of recurrent VTE may reach 40% at 5 years. Patients at low-to-moderate risk of recurrence may benefit from aspirin, which “may be safer than the newer agents,” though “it appears to have less efficacy in reducing recurrent events.” For patients at higher risk, “the new targeted anticoagulants are attractive alternatives to warfarin. The finding that a low prophylactic dose of apixaban has the same efficacy as the full therapeutic dose, with no increased risk of major bleeding, may tip the risk-to-benefit ratio in favor of extended treatment for this patient population. The wide therapeutic window of this agent enables use of a lower dose that retains great efficacy with no or only a minimal increase in bleeding.”

Click here to read the entire post in Forbes.

The New England Journal of Medicine

 

 

 

‘Somebody has finally twigged that the heart and the lungs are joined up to each other and live in this space called the chest…’ 1

by • People, Places & Events, Policy & Ethics, Prevention, Epidemiology & Outcomes • Tags: , , ,

Here are a few gems from Richard Lehman’s weekly cardiovascular literature review. Read the whole thing on CardioExchange.

On a JAMA study showing that ramipril increases walking time in patients with intermittent claudication:

This is the kind of trial that makes nobody millions of dollars, but which we should all be doing in our fields of interest. It took just three interested hospitals in Southern Australia.

On a NEJM study studying rivaroxaban in acutely ill medical patients:

Rule One for selling reprints is that you make the conclusion of the Abstract as favourable as possible, because this is all that most clinicians read…

On a Lancet study showing a close association between pneumonia and cardiovascular disease:

Golly, somebody has finally twigged that the heart and the lungs are joined up to each other and live in this space called the chest, or thorax. This could have major implications. We could start thinking of providing services for elderly breathless patients rather than making them wander from chest physicians to cardiologists and back again: we could tackle the problem of the post-hospital syndrome by attending to the cardiovascular risks of chest infections and the right ventricular contribution to heart failure; we could even ask patients what their main problems are and whether they are sufficiently addressed to make them feel safe at home. But all this requires a level of genius far beyond the reach of any known health service.

 

 

YouTube, NEJM, Whitney Houston, and Alpha Male Monkeys 3

by • People, Places & Events, Policy & Ethics • Tags: , ,

Take a close look at this screenshot from YouTube (click to expand):

  • Jim Ware, the legendary New England Journal of Medicine biostatistician: 8 views.
  • Jerome Kassirer, Marcia Angell, and Arnold Relman, former NEJM editors: 36, 28, and 257 views.
  • Whitney Elizabeth Houston Funeral Service: 994,920 views. (And how many more Whitney Houston videos do you think are out there?)
  • Alpha Male Monkey attacks man: 2,135,280 views.

Draw your own conclusions. Here’s just one from me: we need to figure out how we can use social media better than we do now.

Guest Post: More Lessons From the Riata ICD Lead Recall 7

by • Heart Rhythms, Policy & Ethics • Tags: , , , , , , ,

Editor’s Note: The following guest post is published with the permission of its author,  Edward J. Schloss, MD, (Twitter ID @EJSMD) the medical director of cardiac electrophysiology at Christ Hospital in Cincinnati, OH. This post is longer and far more technical than most of the content published on CardioBrief. Due to the extraordinary nature of the material, however, I believe this post will likely be of considerable interest to many cardiovascular healthcare professionals.

More Lessons From the Riata ICD Lead Recall

by Edward J. Schloss, MD

In an earlier guest post (What are the Lessons of the Riata ICD Lead Recall?) I summarized points from Robert Hauser’s  important perspective in the New England Journal of Medicine regarding the St. Jude Riata ICD lead recall. In this followup, I’d like to discuss St. Jude’s responses to this piece and place the arguments into a broader context.

Last week Mark Carlson MD, Chief Medical Officer of St. Jude Medical, posted a response to Hauser’s perspective, and he made similar points in a letter subsequently published in NEJM. In the original response, Carlson writes “we believe that there were inaccuracies and omissions in the editorial that are important to recognize in order to more fully understand this issue.”

Major points of disagreement in the two pieces include:

  1. Timing of the initiation of a prospective trial looking at Riata externalizations and failures.
  2. Similarities and differences between the currently marketed Durata lead and it’s recalled predecessor Riata ST.
  3. Robustness of the existing St. Jude lead surveillance systems.

Having looked at this issue in some depth, I feel it would be reasonable for me to weigh in on these matters.

Regarding the timing of the recent trial, Dr. Carlson writes:
Click to continue reading…

ASSERT Sheds Light on the Role of Subclinical AF in Stroke Reply

by • Uncategorized • Tags:

A new study published in the New England Journal of Medicine sheds some much-needed light on the precise role of subclinical atrial fibrillation (AF) in the prognosis and development of ischemic stroke. ASSERT (Asymptomatic Atrial Fibrillation and Stroke Evaluation in Pacemaker Patients and the Atrial Fibrillation Reduction Atrial Pacing Trial) followed 2580 patients with a newly implanted pacemaker or ICD and with no previous diagnosis of AF.

At 3 months, subclinical AF lasting longer than 6 minutes had been detected in 10.1% (261) of the subjects. During 2.5 years of follow-up, 51 patients in the study had an ischemic stroke or systemic embolism. Of these, 11 were in the group with subclinical AF by 3 months. Patients with subclinical AF had more than double the risk for stroke or systemic embolism:
Click to continue reading…

No Mortality Benefit Found For Low-Molecular-Weight Heparin in Acutely Ill Patients Reply

by • Uncategorized • Tags: , ,

Although venous thromboembolism (VTE) is a serious problem for acutely ill patients in the hospital, a new study published in the New England Journal of Medicine failed to find any improvement in mortality associated with thromboprophylaxis.

Ajay Kakkar and the LIFENOX investigators randomized 8307 acutely ill patients to enoxaparin or placebo for 10 days. All patients wore elastic stockings with graduated compression.

There was no difference in 30 day mortality or major bleeding between the groups:
Click to continue reading…