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The last week of each month, our editorial team compiles a list of our most popular cardiology content from the past month for a month in review recap. The January 2023 cardiology month in review features a trio of articles related to management of atrial fibrillation, the FDA approval of Abbott’s Navitor system, and a study spotlighting the prevalence of mental health conditions among cardiologists.
The most common arrhythmia and among the most common forms of cardiovascular disease, atrial fibrillation represents one of the most underrecognized threats to public health in modern medicine. Linked to increase risk of stroke and mortality, the Centers for Disease Control and Prevention report atrial fibrillation was mentioned on more than 180,000 death certificates in 2019 and is projected to impact 12.1 million people in the US in 2030. As a result, atrial fibrillation is often at the forefront of discussion and research in cardiovascular medicine. January 2023 did not break this trend. Below, our editorial team highlights a trio of atrial fibrillation-related articles among the most popular cardiology content of the month.
Physical activity represents a cornerstone of cardiovascular risk reduction. Now, results of the ACTIVE-AF trial indicate increased levels of physical activity might reduce arrhythmia recurrence among patients with paroxysmal or persistent, symptomatic atrial fibrillation.
A trial assessing the effects of a 6-month supervised exercise and home-based physical activity intervention, results of the trial suggest freedom from arrhythmia was achieved by 40% in the exercise group and 20% in the control group (HR, 0.50; 95% CI, 0.33-0.78) at 1 year. Results also indicated randomization to the exercise intervention was associated with a lower mean symptom severity score at both 6 and 12 months.
On January 6, a systematic review and meta-analysis published in JAMA Network Open provided an overview of the differences in outcomes following mechanical thrombectomy between patients with and without atrial fibrillation. Led by a team of 3 from the Mayo Clinic in Rochester, MN, the study leveraged data from 10 studies with a total population of 6543 and concluded those with atrial fibrillation had significantly higher rates of mortality and significantly lower rates of functional independence after mechanical thrombectomy compared to those without atrial fibrillation, even with comparable, successful reperfusion outcomes.
A multicenter, randomized trial, the CAPLA study randomized 338 patients with persistent atrial fibrillation to compare the effects of pulmonary vein antral isolation (PVAI) against PVAI with posterior left atrial wall isolation (PWI) for achieving freedom from atrial arrhythmia of more than 30 seconds without the presence of antiarrhythmic medication at 12 months after a single ablation procedure. The trial also included 23 respecified secondary endpoints.
Results of the trial indicated freedom from recurrent atrial arrhythmia after 1 ablation procedure without the use of antiarrhythmic medication was present in 52.4% assigned to PVAI with PWI and 53.6% of those assigned to PVI alone (between-group difference, –1.2%; HR, 0.99 [95% CI, 0.73 - 1.36]; P=.98). Findings of note from analysis of secondary endpoints indicated the mean procedural times (142 vs 121 minutes; mean difference, 21 minutes; P <.001) and radiofrequency abolition times (34 vs. 28 minutes; mean difference, 6 minutes; P <.001) were significantly shorter for PVI alone compared to PVAI with PWI.
On January 17, Abbott announced the US Food and Drug Administration had granted approval to the Navitor system for treatment of treat people with severe aortic stenosis who are at high or extreme risk for open-heart surgery. Billed as the latest addition to the company’s transcatheter structural heart portfolio, the transcatheter aortic valve implementation system features a unique fabric cuff to reduce or eliminate paravalvular leak. In their release, Abbott noted the Navitor system is implanted using Abbott's FlexNav delivery system, which is designed to accommodate different patient anatomies and small vessels for stable and accurate valve delivery and placement.
A pair of articles tackling different studies published in journals affiliated with the American College of Cardiology painting grim pictures for the field of cardiology round out our most popular content for January 2023. The first, details the prevalence of mental health conditions among cardiologists across the globe. The second, calls attention to a lack of uptake of guideline-directed medical therapy in heart failure.
A study published in JACC confirms what so many in cardiology already recognize as a reality: a considerable amount of the field is dealing with mental health struggles. An analysis of data from a 2019 survey conducted by the American College of Cardiology, results indicate 28% of the more than 5800 respondents reported some form of mental health condition, with more than 40% of cardiologists reporting a mental health condition also reporting being dissatisfied with 1 or more career-related metrics.
Check out the clip below from an interview with Andrew Sauer, MD, who authored an editorial comment that accompanied the study in JACC, on the subject of mental health in cardiology.
With STRONG-HF outlining the benefit of in-hospital initiation and rapid uptitration of guideline-directed medical therapy in patients with heart failure, the community was compelled to adopt this strategy, which is what many in the community have been preaching for years. Less than 3 months after STRONG-HF stole the spotlight at AHA 2022, an analysis of the CAN-HF registry is shedding light on the proportion of patients hospitalized with acute heart failure considered eligible for each pillar of guideline-directed medical therapy.
Results of the study, which included data from 943 patients hospitalized at 7 medical centers in Canada from January 2017-April 2020, suggest 74% to 95% of the study cohort admitted with AHF were eligible for 1 of 4 foundational therapies and nearly three-quarters of patients were eligible for combined quadruple therapy.