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Cardiology: Horizon Scanning

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The following journal articles are available from the Library and Knowledge Service electronically or in print. Please follow links to access full text online, contact me to order copies, or call into Wilfred Stokes library, Stoke Mandeville Hospital.

A systematic review and meta-analysis of the effects of supervised exercise therapy on modifiable cardiovascular risk factors in intermittent claudication.
Jansen SCP. Journal of Vascular Surgery 2019;69(4):1293-1308 .
[This systematic review and meta-analysis shows favorable effects of SET on modifiable cardiovascular risk factors, specifically blood pressure and cholesterol levels. Despite the moderate quality, small trial sample sizes, and study heterogeneity, these findings support the prescription of SET programs not only to increase walking distances but also for risk factor modification.]
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A systematic review of patient‐reported outcomes associated with the use of direct‐acting oral anticoagulants.
Afzal SK. British Journal of Clinical Pharmacology 2019;
[Review of 21 studies reports patients appear to prefer treatment with DOACs vs warfarin, as shown by the higher quality of life, satisfaction and adherence described in the studies. However, heterogeneity in the analysed studies does not allow firm conclusions.]
Available with an NHS OpenAthens password for eligible users

Advanced airway management during adult cardiac arrest: A systematic review.
Granfeldt A. Resuscitation 2019;139:133-143 .
[We identified a large number of studies related to advanced airway management in adult cardiac arrest. Three recently published, large randomized trials in out-of-hospital cardiac arrest will help to inform future guidelines. Trials of advanced airway management during in-hospital cardiac arrest are lacking.]
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Analysis of How Emergency Physicians' Decisions to Hospitalize or Discharge Patients With Acute Heart Failure Match the Clinical Risk Categories of the MEESSI-AHF Scale.
Miró Ò. Annals of Emergency Medicine 2019 ;:10.1016/j.annemergmed.2019.03.010.
[The disposition decisions made in current clinical practice for ED acute heart failure patients calibrate with MEESSI-AHF risk categories, but nearly half of the patients currently discharged from the ED fall into increased-risk MEESSI-AHF categories]
Available with an NHS OpenAthens password

Antibacterial Envelope to Prevent Cardiac Implantable Device Infection.
Tarakji KG. New England Journal of Medicine 2019;:doi: 10.1056/NEJMoa1901111.
[Adjunctive use of an antibacterial envelope resulted in a significantly lower incidence of major CIED infections than standard-of-care infection-prevention strategies alone, without a higher incidence of complications. ]
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Anticoagulation therapy in heart failure and sinus rhythm: a systematic review and meta-analysis.
Beggs SAS. Heart 2019;:doi: 10.1136/heartjnl-2018-314381 .
[Our meta-analysis provides evidence to oppose the hypothesis that thrombosis or embolism plays an important role in the morbidity and mortality associated with HFrEF, with the exception of stroke-related morbidity.]
Available with an NHS OpenAthens password for eligible users

Antithrombotic dose: Some observations from published clinical trials.
Dimmitt SB. British Journal of Clinical Pharmacology 2019;
[The clinical doses of antithrombotics—antiplatelet and anticoagulant agents—need to balance efficacy and safety. It is not clear from the published literature how the doses currently used in clinical practice have been derived from preclinical and clinical data.]
Available with an NHS OpenAthens password for eligible users

Antithrombotic Therapy after Acute Coronary Syndrome or PCI in Atrial Fibrillation.
Lopes RD. New England Journal of Medicine 2019;:doi: 10.1056/NEJMoa1817083.
[In patients with atrial fibrillation and a recent acute coronary syndrome or PCI treated with a P2Y12 inhibitor, an antithrombotic regimen that included apixaban, without aspirin, resulted in less bleeding and fewer hospitalizations without significant differences in the incidence of ischemic events than regimens that included a vitamin K antagonist, aspirin, or both. ]
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Association Between Mean Arterial Pressure and Acute Kidney Injury and a Composite of Myocardial Injury and Mortality in Postoperative Critically Ill Patients: A Retrospective Cohort Analysis.
Khanna AK. Critical Care Medicine 2019;47(7):910-917.
[Hypotension thresholds that provoke renal injury, myocardial injury, and mortality in critical care patients remain unknown. We primarily sought to determine the relationship between hypotension and a composite of myocardial injury (troponin T ≥ 0.03 ng/mL without nonischemic cause) and death up to 7 postoperative days. Secondarily, we considered acute kidney injury (creatinine concentration ≥ 0.3 mg/dL or 1.5 times baseline).]

Association of habitual glucosamine use with risk of cardiovascular disease: prospective study in UK Biobank.
Ma H. BMJ 2019;365:l1628.
[To prospectively assess the association of habitual glucosamine use with risk of cardiovascular disease (CVD) events.]

Atrial fibrillation type and renal dysfunction as important predictors of left atrial thrombus.
Kapłon-Cieślicka A. Heart 2019;:doi: 10.1136/heartjnl-2018-314492.
[In real-world AF patients with majority on oral anticoagulation, LAA thrombus was found in approximately 6%. Two variables not included in the CHA2DS2-VASc score (AF type and renal dysfunction) proved strong, independent predictors of LAA thrombus and might improve thromboembolic risk stratification.]
Available with an NHS OpenAthens password for eligible users

Cardiac Arrest and Subsequent Hospitalization-Induced Posttraumatic Stress Is Associated With 1-Year Risk of Major Adverse Cardiovascular Events and All-Cause Mortality.
Agarwal S. Critical Care Medicine 2019;47(6):e502-e505.
[To compare 1-year all-cause mortality and major adverse cardiovascular events in cardiac arrest survivors with and without posttraumatic stress disorder symptomatology at hospital discharge.]

Cardiac Arrest Prior to Venoarterial Extracorporeal Membrane Oxygenation: Risk Factors for Mortality.
Fux T. Critical Care Medicine 2019;47(7):926-933.
[Mortality after cardiac arrest remains high despite initiation of venoarterial extracorporeal membrane oxygenation. We aimed to identify pre-venoarterial extracorporeal membrane oxygenation risk factors of 90-day mortality in patients with witnessed cardiac arrest and with greater than or equal to 1 minute of cardiopulmonary resuscitation before venoarterial extracorporeal membrane oxygenation. ]

Cardiovascular Events and Mortality in White Coat Hypertension: A Systematic Review and Meta-analysis.
Cohen JB. Annals of Internal Medicine 2019;:DOI: 10.7326/M19-0223.
[Conclusion: Untreated white coat hypertension, but not treated white coat effect, is associated with an increased risk for cardiovascular events and all-cause mortality. Out-of-office BP monitoring is critical in the diagnosis and management of hypertension.]
Available with an NHS OpenAthens password for eligible users

Caring for women with chronic hypertension.
Lovell H. British Journal of Midwifery 2019;27(6):343-351.
[The number of women entering pregnancy with chronic hypertension is increasing, predominantly because of rising rates of obesity and pregnancy at advanced maternal age. ‘Chronic hypertension’ is often used interchangeably with the term ‘pre-existing hypertension’, but it is important to remember that a significant proportion of women are newly diagnosed in pregnancy. Chronic hypertension significantly increases the risks in pregnancy for both the mother and the fetus.]
Available with an NHS OpenAthens password for eligible users

Clinical Guidelines Synopsis: 2018 American Heart Association/American College of Cardiology/Multisociety Guideline on the Management of Blood Cholesterol–Secondary Prevention.
Grundy SM. JAMA Cardiology 2019;4(6):589-591.
[This article reviews secondary prevention trials in patients with established ASCVD which demonstrate therapy with statins reduces recurrent cardiovascular events, as well as statin add-on drugs e.g. ezetimibe and proprotein convertase subtilisin/kexin type 9 inhibitors.]
Available with an NHS OpenAthens password for eligible users

Comparison of Dual Therapies for Lowering Blood Pressure in Black Africans.
Ojji DB. New England Journal of Medicine 2019;:doi: 10.1056/NEJMoa1901113.
[These findings suggest that in black patients in sub-Saharan Africa, amlodipine plus either hydrochlorothiazide or perindopril was more effective than perindopril plus hydrochlorothiazide at lowering blood pressure at 6 months.]
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Computed tomographic coronary angiography in risk stratification prior to non-cardiac surgery: a systematic review and meta-analysis.
Koshy AN. Heart 2019;:-.
[Severity and extent of CAD on CTA conferred incremental risk for perioperative MACE in patients undergoing non-cardiac surgery. The 'rule-out' capability of CTA is comparable to other non-invasive imaging modalities and offers a viable alternative for risk stratification of patients undergoing non-cardiac surgery.]

Contactless cardiac arrest detection using smart devices.
Chan J. npj Digital Medicine 2019;2:52.
[Rapid diagnosis and initiation of cardiopulmonary resuscitation (CPR) is the cornerstone of therapy for victims of cardiac arrest. An under-appreciated diagnostic element of cardiac arrest is the presence of agonal breathing, an audible biomarker and brainstem reflex that arises in the setting of severe hypoxia. Here, we demonstrate that a support vector machine (SVM) can classify agonal breathing instances in real-time within a bedroom environment.]
Freely available online

Coronary Angiography after Cardiac Arrest without ST-Segment Elevation.
Lemkes JS. New England Journal of Medicine 2019;:doi: 10.1056/NEJMoa1816897.
[Among patients who had been successfully resuscitated after out-of-hospital cardiac arrest and had no signs of STEMI, a strategy of immediate angiography was not found to be better than a strategy of delayed angiography with respect to overall survival at 90 days.]
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Cost-effectiveness of cardiac rehabilitation: a systematic review.
Shields GE. Heart 2018;104(17):1403-1410 .
[This systematic review of studies evaluates the cost-effectiveness of CR in the modern era, providing a fresh evidence base for policy-makers. Evidence suggests that CR is cost-effective, especially with exercise as a component. However, research is needed to determine the most cost-effective design of CR.]
Freely available online

Dapagliflozin and Cardiovascular Outcomes in Patients With Type 2 Diabetes Mellitus and Previous Myocardial Infarction.
Furtado RHM. Circulation 2019;139(22):2516-2527 .
[Patients with type 2 diabetes mellitus and previous MI are at high risk of MACE and cardiovascular death/hospitalization for heart failure. Dapagliflozin appears to robustly reduce the risk of both composite outcomes in these patients. Future studies should aim to confirm the large clinical benefits with sodium glucose transporter-2 inhibitors we observed in patients with previous MI.]

Diagnosis of obstructive coronary artery disease using computed tomography angiography in patients with stable chest pain depending on clinical probability and in clinically important subgroups: meta-analysis of individual patient data.
Haase R. BMJ 2019;365:l1945.
[To determine whether coronary computed tomography angiography (CTA) should be performed in patients with any clinical probability of coronary artery disease (CAD), and whether the diagnostic performance differs between subgroups of patients.]

Did This Patient Have Cardiac Syncope?: The Rational Clinical Examination Systematic Review.
Albassam OT. JAMA 2019;321(24):2448-2457.
[The clinical examination, including the electrocardiogram as part of multivariable scores, can accurately identify patients with and without cardiac syncope.]
Available with an NHS OpenAthens password

Duration of dual antiplatelet therapy after percutaneous coronary intervention with drug-eluting stent: systematic review and network meta-analysis.
Yin SH. BMJ 2019;365:l2222.
[To evaluate the efficacy and safety of standard term (12 months) or long term (>12 months) dual antiplatelet therapy (DAPT) versus short term (
<6 months) DAPT after percutaneous coronary intervention (PCI) with drug-eluting stent (DES).]>
Early or Delayed Cardioversion in Recent-Onset Atrial Fibrillation.
Pluymaekers NAHA. New England Journal of Medicine 2019;:-.
[In patients presenting to the emergency department with recent-onset, symptomatic atrial fibrillation, a wait-and-see approach was noninferior to early cardioversion in achieving a return to sinus rhythm at 4 weeks. ]

Effect of P2Y12 Inhibitor Monotherapy vs Dual Antiplatelet Therapy on Cardiovascular Events in Patients Undergoing Percutaneous Coronary Intervention: The SMART-CHOICE Randomized Clinical Trial.
Hahn JY. JAMA 2019;321(24):2428-2437.
[Among patients undergoing percutaneous coronary intervention, P2Y12 inhibitor monotherapy after 3 months of DAPT compared with prolonged DAPT resulted in noninferior rates of major adverse cardiac and cerebrovascular events. Because of limitations in the study population and adherence, further research is needed in other populations.]
Available with an NHS OpenAthens password

Effect of Trans-Nasal Evaporative Intra-arrest Cooling on Functional Neurologic Outcome in Out-of-Hospital Cardiac Arrest: The PRINCESS Randomized Clinical Trial.
Nordberg P. JAMA 2019;321(17):1677-1685 .
[Among patients with out-of-hospital cardiac arrest, trans-nasal evaporative intra-arrest cooling compared with usual care did not result in a statistically significant improvement in survival with good neurologic outcome at 90 days.]

Effect of ultra-short-term treatment of patients with iron deficiency or anaemia undergoing cardiac surgery: a prospective randomised trial.
Spahn DR. The Lancet 2019;:doi: 10.1016/S0140-6736(18)32555-8.
[An ultra-short-term combination treatment with intravenous iron, subcutaneous erythropoietin alpha, vitamin B12, and oral folic acid reduced RBC and total allogeneic blood product transfusions in patients with preoperative anaemia or isolated iron deficiency undergoing elective cardiac surgery.]
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Effects of Nutritional Supplements and Dietary Interventions on Cardiovascular Outcomes: An Umbrella Review and Evidence Map.
Khan SU. Annals of Internal Medicine 2019;:DOI: 10.7326/M19-0341.
[Reduced salt intake, omega-3 LC-PUFA use, and folate supplementation could reduce risk for some cardiovascular outcomes in adults. Combined calcium plus vitamin D might increase risk for stroke.]
Available with an NHS OpenAthens password for eligible users

Effects of tolvaptan add-on therapy in patients with acute heart failure: meta-analysis on randomised controlled trials.
Ma G. BMJ Open 2019;9:e025537.
[The result suggests that comparing with the standard diuretic therapy, tolvaptan add-on therapy did not reduce the incidence of WRF and short-term mortality, however, it can decrease body weight and increase the sodium level in patients who are with ADHF. Further researches are still required for confirmation.]
Freely available online

Efficacy of primary treatment with immunoglobulin plus ciclosporin for prevention of coronary artery abnormalities in patients with Kawasaki disease predicted to be at increased risk of non-response to intravenous immunoglobulin (KAICA): a randomised controlled, open-label, blinded-endpoints, phase 3 trial.
Hamada H. The Lancet 2019;393(10176):1128-1137.
[Combined primary therapy with IVIG and ciclosporin was safe and effective for favourable coronary artery outcomes in Kawasaki disease patients who were predicted to be unresponsive to IVIG. ]
Available with an NHS OpenAthens password for eligible users

Epidural analgesia for adults undergoing cardiac surgery with or without cardiopulmonary bypass.
Guay J. Cochrane Database of Systematic Reviews 2019;3:CD006715.
[General anaesthesia combined with epidural analgesia may have a beneficial effect on clinical outcomes. However, use of epidural analgesia for cardiac surgery is controversial due to a theoretical increased risk of epidural haematoma associated with systemic heparinization. This review was published in 2013, and it was updated in 2019.]

Exercise-based cardiac rehabilitation for chronic heart failure: the EXTRAMATCH II individual participant data meta-analysis.
Taylor RS. Health Technology Assessment 2019;23(25):
[Exercise-based cardiac rehabilitation improved exercise capacity and health-related quality of life in people with heart failure regardless of severity, age and gender, but had no effect on mortality or hospitalisation.]

Exercise-based cardiac rehabilitation for patients following open surgical aortic valve replacement and transcatheter aortic valve implant: a systematic review and meta-analysis.
Anayo L. Open Heart 2019;6(1):e000922.
[Exercise-based CR probably improves exercise capacity of post-TAVI and post-SAVR patients in the short term. Well conducted multicentre fully powered RCTs of ≥12 months follow-up are needed to fully assess the clinical and cost-effectiveness of exercise-based CR in this patient population.]
Freely available online

Heart failure: support at the end of life.
Mendes A. British Journal of Nursing 2019;28(10):653.
[The author begins a series on cardiology with a look at attitudes to and guidelines on providing end-of-life care for people with heart failure. End-of-life care has been historically associated with cancer. However, there are many chronic conditions that require the appropriate provision of supportive and palliative care, and the specialised training, multidisciplinary collaboration and sensitive communication skills that come with this.]
Available with an NHS OpenAthens password for eligible users

Higher rates of depression among women living with Coronary Heart Disease are associated with poorer treatment outcomes and prognosis.
McGuigan K. Evidence-Based Nursing 2019;22(2):47.
[The 20 studies reviewed showed a higher prevalence of depression among women after the initial cardiac event. Although symptoms of depression in women fell over the following 6 months; when compared with men the levels of depression among women remained higher up to 2 years after the initial event. ]
Available with an NHS OpenAthens password

Hypothermia outcome prediction after extracorporeal life support for hypothermic cardiac arrest patients: An external validation of the HOPE score.
Pasquier M. Resuscitation 2019;:-.
[This study provides the first external validation of the HOPE score reaching good calibration and excellent discrimination. Clinically, the prediction of the HOPE score remains accurate in the validation sample. The HOPE score may replace serum potassium in the future as the triage tool when considering ECLS rewarming of a hypothermic cardiac arrest victim]

Immunotherapy for cardiovascular disease.
Lutgens E. European Heart Journal 2019;:ehz283.
[This review discusses the potential of novel immunotherapeutic targets that are currently considered to become a future treatment for cardiovascular disease.]
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Impact of Exercise Rehabilitation on Exercise Capacity and Quality-of-Life in Heart Failure: Individual Participant Meta-Analysis.
Taylor RS. Journal of the American College of Cardiology 2019;73(12):1430-1443 .
[These results, based on an IPD meta-analysis of randomized trials, confirm the benefit of ExCR on HRQoL and exercise capacity and support the Class I recommendation of current international clinical guidelines that ExCR should be offered to all HF patients.]
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Intensive care use and mortality among patients with ST elevation myocardial infarction: retrospective cohort study.
Valley TS. BMJ 2019;365:l1927.
[To evaluate the effect of intensive care unit (ICU) admission on mortality among patients with ST elevation myocardial infarction (STEMI).]

Interventions to support return to work for people with coronary heart disease.
Hegewald J. Cochrane Database of Systematic Reviews 2019;3:CD010748.
[People with coronary heart disease (CHD) often require prolonged absences from work to convalesce after acute disease events like myocardial infarctions (MI) or revascularisation procedures such as coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI). Reduced functional capacity and anxiety due to CHD may further delay or prevent return to work.]

Iron Supplementation Improves Cardiovascular Outcomes in Patients with Heart Failure.
Zhou X. The American Journal of Medicine 2019;:doi: 10.1016/j.amjmed.2019.02.018.
[Our meta-analysis suggests that iron therapy can reduce heart failure hospitalization, increase cardiac function, improve quality of life, and decrease serum levels of NT-proBNP and CRP in patients with heart failure.]
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Mediterranean-style diet for the primary and secondary prevention of cardiovascular disease.
Rees K. Cochrane Database of Systematic Reviews 2019;3:CD009825.
[The Seven Countries study in the 1960s showed that populations in the Mediterranean region experienced lower coronary heart disease (CHD) mortality probably as a result of different dietary patterns. Later observational studies have confirmed the benefits of adherence to a Mediterranean dietary pattern on cardiovascular disease (CVD) risk factors but clinical trial evidence is more limited.]

Meta-analysis of clinical trials examining the benefit of structured home exercise in patients with peripheral artery disease.
Golledge J. British Journal of Surgery 2019;106(4):319-331 .
[This meta-analysis suggests that structured home exercise programmes are effective at improving walking performance and physical activity in the short term for patients with PAD.]
Available with an NHS OpenAthens password for eligible users

Meta-Analysis of Direct-Acting Oral Anticoagulants Compared With Warfarin in Patients >75 Years of Age.
Malik AH. American Journal of Cardiology 2019;:10.1016/j.amjcard.2019.02.060.
[DOACs were found to be safer and more effective than warfarin for the treatment of nonvalvular AF in older patients. Apixaban appears to provide the best combination of efficacy and safety in this population.]
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Morphological and topographical appearance of microaneurysms on optical coherence tomography angiography.
Schreur V. British Journal of Ophthalmology 2019;103(5):630-635.
[To investigate retinal microaneurysms in patients with diabetic macular oedema (DME) by optical coherence tomography angiography (OCTA) according to their location and morphology in relationship to their clinical properties, leakage on fundus fluorescein angiography (FFA) and retinal thickening on structural OCT.]
Available with an NHS OpenAthens password for eligible users

Multicenter Implementation of a Novel Management Protocol Increases the Outpatient Treatment of Pulmonary Embolism and Deep Vein Thrombosis.
Kabrhel C. Academic Emergency Medicine 2019;26(6):657-669.
[Conclusions: A treatment protocol combining risk‐stratification, rivaroxaban treatment and defined follow‐up is associated with an increase in pulmonary embolism [PE] and deep vein thrombosis [DVT] patients treated as outpatients, with no increase in adverse outcomes.

Myocardial injury after non-cardiac surgery: diagnosis and management.
Devereaux PJ. European Heart Journal 2019;:ehz301.
[This articles reviews the definition, diagnostic criteria, pathophysiology, prognosis, characteristics, and pharmacological and surgical management of myocardial injury after non-cardiac surgery.]
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Near-infrared spectroscopy monitoring during out-of-hospital cardiac arrest: can the initial cerebral tissue oxygenation index predict ROSC?
Tsukuda J. Emergency Medicine Journal 2019;36(1):33-38.
[Near-infrared spectroscopy is a modality that can monitor tissue oxygenation index (TOI) and has potential to evaluate return of spontaneous circulation (ROSC) during cardiopulmonary resuscitation (CPR). This study's objectives were to evaluate whether TOI could be associated with ROSC and used to help guide the decision to either terminate CPR or proceed to extracorporeal CPR (ECPR).]

Optimal Timing of P2Y12 Inhibitor Loading in Patients Undergoing PCI: A Meta-Analysis.
Komosa A. Thrombosis and Haemostasis 2019;:doi: 10.1055/s-0039-1683421.
[The timing of P2Y12 inhibitor loading in patients undergoing percutaneous coronary intervention (PCI) is a matter of debate. The aim of our study was to compare the efficacy and safety of oral P2Y12 inhibitors: clopidogrel, ticagrelor and prasugrel administered at two different time points in relation to PCI: early (> 2 hours pre-PCI) versus late (< 2 hours pre-PCI or post-PCI).]
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Oral anticoagulants in atrial fibrillation with valvular heart disease and bioprosthetic heart valves.
Malik AH. Heart 2019;:doi: 10.1136/heartjnl-2019-314767.
[NOACs performed better than warfarin for a reduction in SSE, MI and ICH in patients with VHD. Individually NOACs performed similarly to each other except for an increased risk of ICH and major bleeding with rivaroxaban and a reduced risk of major bleeding with edoxaban 30 mg. In patients with a BPHV, results with NOACs seem similar to those with warfarin and this needs to be further explored in larger studies.]
Available with an NHS OpenAthens password for eligible users

Pharmacotherapy for hypertension in adults 60 years or older.
Musini VM. Cochrane Database of Systematic Reviews 2019;6:CD000028.
[Elevated blood pressure (known as 'hypertension') increases with age - most rapidly over age 60. Systolic hypertension is more strongly associated with cardiovascular disease than is diastolic hypertension, and it occurs more commonly in older people. It is important to know the benefits and harms of antihypertensive treatment for hypertension in this age group, as well as separately for people 60 to 79 years old and people 80 years or older.]

Prehospital determinants of successful resuscitation after traumatic and non-traumatic out-of-hospital cardiac arrest.
Barnard EBG. Emergency Medicine Journal 2019;36(6):333-339.
[Out-of-hospital cardiac arrest (OHCA) is prevalent in the UK. Reported survival is lower than in countries with comparable healthcare systems; a better understanding of outcome determinants may identify areas for improvement.]

Preoperative Exercise Rehabilitation in Cardiac and Vascular Interventions.
Drudi LM. Journal of Surgical Research 2019;237:3-11 .
[Our qualitative findings suggest that prehabilitation may improve clinical outcomes, physical performance, and health-related quality-of-life measures in patients undergoing cardiac and vascular surgery procedures.]
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Primary care management of chest pain after coronary artery bypass surgery.
Gimpel D. BMJ 2019;365:l1303.

Resistance training as a treatment for older persons with peripheral artery disease: a systematic review and meta-analysis.
Parmenter BJ. British Journal of Sports Medicine 2019;:
[RT clinically improved treadmill and flat ground walking ability in persons with peripheral artery disease. Higher intensity training was associated with better outcomes. Our study makes a case for clinicians to include high-intensity lower body RT in the treatment of peripheral artery disease.]
Available with an NHS OpenAthens password for eligible users

Stroke in Patients With Peripheral Artery Disease.
Kolls BJ. Stroke 2019;: doi: 10.1161/STROKEAHA.118.023534.
[In patients with symptomatic PAD, ischemic stroke and TIA occur frequently. Comorbidities such as age, prior stroke, prior atrial fibrillation/flutter, diabetes mellitus, higher blood pressure, prior amputation, lower ankle-brachial index, and geographic region were each independently associated with occurrence of all-cause stroke. Use of ticagrelor, as compared with clopidogrel, was associated with a lower adjusted rate of ischemic and all-cause stroke. ]
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Tai Chi: a promising adjunct nursing intervention to reduce risks of cardiovascular disease and improve psychosocial well-being in adults with hypertension.
Smith G D. Evidence-Based Nursing 2019;22(2):45.
[Tai Chi was shown to significantly lower blood pressure and to improve psychosocial well-being compared with brisk walking. These findings suggest that Tai Chi may provide a non-pharmacological treatment option to reduce the risk of CVD in adults with established hypertension. ]
Available with an NHS OpenAthens password

The Effect of Cardiac Rehabilitation on Health-Related Quality of Life in Patients With Coronary Artery Disease: A Meta-analysis.
Francis T. Canadian Journal of Cardiology 2019;35(3):352-364 .
[Receiving CR was shown to improve HRQOL, with exercise-, nonexercise-, and psychological-based interventions playing a vital role. Although these improvements in HRQOL were modest they still reflect an incremental benefit compared with receiving usual care.]
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The effects of adrenaline in out of hospital cardiac arrest with shockable and non-shockable rhythms: Findings from the PACA and PARAMEDIC-2 randomised controlled trials.
Perkins GD. Resuscitation 2019;140:55-63 .
[Relative to placebo, the effects of adrenaline ROSC are greater for patients with an initially non-shockable rhythm than those with a shockable rhythms. Similar patterns are observed for longer term survival outcomes and favourable neurological outcomes, although the differences in effects are less pronounced. ]

The Impact of Supervised Exercise Training on Traditional Cardiovascular Risk Factors in Patients With Intermittent Claudication: A Systematic Review and Meta-Analysis.
Cornelis N. European Journal of Vascular and Endovascular Surgery 2019;:doi: 10.1016/j.ejvs.2018.12.014.
[This meta-analysis supports the beneficial effects of SET on walking capacity. Little evidence for an improvement of the CV risk profile was found following exercise in patients with IC. However, given the scarcity of data, high quality RCTs that include an assessment of CV risk factors are urgently required to determine the effect of exercise therapy in the secondary prevention of CV disease of IC patients.]
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The rise and fall of aspirin in the primary prevention of cardiovascular disease.
Raber I. The Lancet 2019;
[This narrative review discusses the role of aspirin in primary prevention of cardiovascular disease, contextualising data from historical and contemporary trials.]
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There may be a role for addition of rivaroxaban to aspirin in patients with stable coronary artery disease.
Banerjee A. Evidence-Based Medicine 2019;24(2):78-79.
[There appears to be a role for addition of rivaroxaban to aspirin in patients with stable CAD, and the fact that the benefit was consistent whether myocardial infarction was recent or many years previously suggests that rivaroxaban may be useful over long periods of treatment. Rivaroxaban does not have a role as an alternative to aspirin in this context. However the absolute risk reduction was small therefore efforts may be better focused on improving adherence to existing evidence-based drugs.]
Available with an NHS OpenAthens password

Thyroid and Cardiovascular Disease: Research Agenda for Enhancing Knowledge, Prevention, and Treatment.
Cappola AR. Circulation 2019;135(25):2892–2909.
[This report describes the current state of the field, outlines barriers and challenges to progress, and proposes research opportunities to advance the field.]
Freely available online

Understanding the consequences of education inequality on cardiovascular disease: mendelian randomisation study
BMJ 2019;365:l1855 .
[BMI, systolic blood pressure, and smoking behaviour mediate a substantial proportion of the protective effect of education on the risk of cardiovascular outcomes and intervening on these would lead to reductions in cases of cardiovascular disease attributable to lower levels of education. However, more than half of the protective effect of education remains unexplained and requires further investigation.]
Freely available online

Vasopressors during adult cardiac arrest: A systematic review and meta-analysis.
Holmberg MJ. Resuscitation 2019;139:106-121 .
[Controlled trial data suggest that epinephrine improves ROSC, survival to hospital discharge, and 3-month survival in out-of-hospital cardiac arrest. The improvement in short-term outcomes appeared more pronounced for non-shockable rhythms. Differences in long-term neurological outcome did not reach statistical significance, although there was a signal toward improved outcomes. Controlled trial data indicated no benefit from vasopressin with or without epinephrine compared to epinephrine only]
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Venous Thromboembolism After Shoulder Arthoplasty and Arthroscopy.
Rapp CM. Journal of the American Academy of Orthopaedic Surgeons 2019;27(8):265–274.
[VTE after shoulder surgery has been a topic of increasing interest over the past decade, and the purpose of this review is to examine the recent literature on pathophysiology, risk factors, incidence, diagnosis, sequelae, prevention, treatment, and current recommendations regarding VTE after shoulder surgery.]
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Vitamin D Supplementation and Cardiovascular Disease Risks in More Than 83 000 Individuals in 21 Randomized Clinical Trials: A Meta-analysis.
Barbarawi M. JAMA Cardiology 2019;:doi:10.1001/jamacardio.2019.1870.
[Updated meta-analysis of 21 RCTs (n=83,291) found that vitamin D supplementation was not associated with reduced major adverse CV events, individual CVD end points (MI, stroke, CVD mortality), or all-cause mortality, and thus does not support supplementation for CV protection.]
Available with an NHS OpenAthens password for eligible users

Weight change and the risk of incident atrial fibrillation: a systematic review and meta-analysis.
Jones NR. Heart 2019;:doi: 10.1136/heartjnl-2019-314931.
[Weight gain may increase the risk of AF, but there was no clear evidence that non-surgical weight loss altered AF incidence. Strategies to prevent weight gain in the population may reduce the global burden of AF. Given the lack of studies and methodological limitations, further research is needed.]
Freely available online


The following new guidance has recently been published:

Cardiac contractility modulation device implantation for heart failure.
National Institute for Health and Care Excellence (NICE);2019.
[1 Recommendations 1.1 The evidence on cardiac contractility modulation device implantation for heart failure raises no major safety concerns. However, the evidence on efficacy is inadequate in quantity and quality. Therefore, this procedure should only be used in the context of research...]
Freely available online

Direct-acting oral anticoagulants (DOACs): increased risk of recurrent thrombotic events in patients with antiphospholipid syndrome.
Medicines and Healthcare Products Regulatory Agency (MHRA);2019.
[Drug Safety Update. A clinical trial has shown an increased risk of recurrent thrombotic events associated with rivaroxaban compared with warfarin, in patients with antiphospholipid syndrome and a history of thrombosis. Other direct-acting oral anticoagulants (DOACs) may be associated with a similarly increased risk.]
Freely available online

Guidelines for Perioperative Care in Cardiac Surgery: Enhanced Recovery After Surgery Society Recommendations.
JAMA Surgery;2019.
[Enhanced Recovery After Surgery (ERAS) evidence-based protocols for perioperative care can lead to improvements in clinical outcomes and cost savings. This article aims to present consensus recommendations for the optimal perioperative management of patients undergoing cardiac surgery.]
Freely available online

Lead-I ECG devices for detecting symptomatic atrial fibrillation using single time point testing in primary care.
National Institute for Health and Care Excellence (NICE);2019.
[1 Recommendations. 1.1 There is not enough evidence to recommend the routine adoption of lead-I electrocardiogram (ECG) devices (imPulse, Kardia Mobile, MyDiagnostick and Zenicor-ECG) to detect atrial fibrillation when used for single time point testing in primary care for people with signs or symptoms of the condition and an irregular pulse. Further research is recommended...]

Percutaneous insertion of a cerebral protection device to prevent cerebral embolism during TAVI.
National Institute for Health and Care Excellence (NICE);2019.
[1 Recommendations 1.1 The evidence on percutaneous insertion of a cerebral protection device to prevent cerebral embolism during TAVI raises no major safety concerns other than those associated with the TAVI procedure. However, the evidence on efficacy for preventing TAVI-related stroke is inconclusive. Therefore, this procedure should only be used with special arrangements for clinical governance, consent, and audit or research...]
Freely available online

Percutaneous mechanical thrombectomy for acute deep vein thrombosis of the leg.
National Institute for Health and Care Excellence (NICE);2019.
[Evidence-based recommendations on percutaneous mechanical thrombectomy for acute deep vein thrombosis of the leg in adults. This involves removing the clot through a catheter inserted into the vein.]
Freely available online

Perioperative cardiovascular risk in patients with obstructive sleep apnea.
[Several small prospective studies in patients with obstructive sleep apnea (OSA) have demonstrated increased cardiovascular (CV) risk perioperatively. Now in the largest prospective study to date, the increased CV risk was confirmed in 1200 patients undergoing major noncardiac surgery.]

Risk prediction for sudden cardiac death in arrhythmogenic right ventricular cardiomyopathy.
[Sustained ventricular arrhythmias (VAs) and/or sudden cardiac death (SCD) are common in patients with arrhythmogenic right ventricular cardiomyopathy (ARVC), sometimes occurring as the initial manifestation of disease.]

Tofacitinib (Xeljanz▼): restriction of 10 mg twice-daily dose in patients at high risk of pulmonary embolism while safety review is ongoing.
Medicines and Healthcare Products Regulatory Agency (MHRA);2019.
[Drug Safety Update. Following observation in a clinical study of an increased risk of pulmonary embolism and overall mortality with tofacitinib 10 mg twice-daily in rheumatoid arthritis, a safety review has started and new contraindications introduced. The 10 mg twice-daily dose of tofacitinib (authorised for ulcerative colitis) must not be used in patients at high risk of pulmonary embolism.]
Freely available online

UpToDate Practice Changing UpDate :Optimal antithrombotic therapy in patients with AF who undergo PCI or who sustain an ACS
[For most patients with atrial fibrillation who require an oral anticoagulant and who undergo percutaneous coronary intervention (PCI), we suggest antithrombotic therapy during the first 6 to 12 months after PCI with NOAC plus clopidogrel rather than with three antithrombotic drugs (Grade 2B).]
Available with appropriate registration or membership


The following report(s) may be of interest:

Can erection problem medicines help reverse heart failure?
NHS Behind the Headlines; 2019.
[Researchers investigated the effect of the medicine tadalafil, brand name Cialis, on sheep hearts. The sheep developed a condition similar to heart failure in humans after being implanted with a pacemaker that made their heart beat artificially fast. Researchers said the hearts of sheep treated with Cialis retained the ability to contract and push blood around the body, as well as the ability to respond to an adrenaline-like medicine.]
Freely available online

Claims that tomato juice is good for the heart not backed by evidence.
NHS Behind the Headlines; 2019.
[Japanese researchers offered people free tomato juice for a year, to see if it made a difference to their blood pressure or cholesterol levels. While it made no difference to the 481 people in the study overall, the researchers found that people with raised blood pressure (94 people) or LDL ("bad") cholesterol (125 people) did have a small drop in their levels. Whether this change had any clinical significance is unclear. There was also no comparison group.]
Freely available online

Does more leg fat protect women against heart attack and stroke?
NHS Behind the Headlines; 2019.
[Researchers looked at the body composition of 2,683 women in the US who were a healthy weight and had been through the menopause. They found women who had a higher percentage of fat around their trunk were more likely to have a heart attack or stroke than women who had more fat on their legs, but less around their upper body. Because of the nature of the study, we cannot be sure that body fat distribution directly caused the differences in risk of having a heart attack and stroke.]
Freely available online

Heart scan may detect young people at risk of sudden cardiac death.
NHS Behind the Headlines; 2019.
[A very small number of people with hypertrophic cardiomyopathy (HCM), estimated to be around 1 in 100, are at risk of sudden cardiac arrest. A new study aimed to see if a special type of cardiac MRI could detect abnormalities of the heart muscle fibres in HCM that are thought to be linked to the high-risk category. It compared the scans of 50 people with HCM and 30 healthy controls and found that they could detect various differences between them.]
Freely available online

Providing pressurised air through a mask may improve outcomes for people with deteriorating heart failure.
NIHR Dissemination Centre; 2019.
[NIHR Signal. This review evaluated 24 trials of 2,664 adults comparing a group who received air under pressure through a mask, to a group receiving standard medical care. These types of masks are not routinely used for all people with deteriorating heart failure currently. However, this review found that they may be beneficial earlier in the progression of the condition, and this can avoid escalation of care to more invasive ventilation.]
Freely available online

Supplement used for joint pain may reduce risk of heart disease.
NHS Behind the Headlines; 2019.
[Researchers analysed the diet and lifestyle of almost half a million adults aged 40 to 69 in the UK, and followed them up for an average of 7 years. They found people who regularly took glucosamine, a food supplement taken to reduce symptoms of joint pain and stiffness, were about 15% less likely to develop heart disease or have a stroke. This was an observational study, which means we do not know for sure that glucosamine was the reason why fewer people taking it had heart disease or stroke.]
Freely available online


The following website(s) may be of interest:

CredibleMeds QTDrugs Lists update.
[Lofexidine (a drug for treatment of opiate withdrawal) was added to the Possible Risk of TdP list because we have found evidence of QT prolongation.
Hydroquinidine (an antiarrhythmic drug) has been added to the Known Risk of TdP list because we have found evidence of TdP cases reported with its use.
Xylometazoline (a decongestant nasal spray) has been added to the list of drugs that patients with congenital long QT syndrome should avoid if possible. ]
Available with free registration

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