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<p>Pericardial complications are very common following cardiac surgery. It is estimated that up to 30–40% of patients may develop a postpericardiotomy syndrome (PPS) and >50–60% of patients show pericardial effusions after cardiac surgery.<cross-ref type="bib" refid="R1">1 2</cross-ref><cross-ref type="bib" refid="R2"></cross-ref> Pericardial complications may range from asymptomatic pericardial and/or pleural effusion to cardiac tamponade, and may include PPS, and postoperative atrial fibrillation (POAF), triggered by pericarditis in predisposed individuals.<cross-ref type="bib" refid="R3">3</cross-ref> All these complications may prolong the duration of hospitalisation, significantly increase management costs and may also severely impair patient quality of life, often delaying postoperative rehabilitation. On this basis, prevention of pericardial postoperative complications is of paramount importance in clinical practice.</p> <p>The aim of the present systematic review by Malektojari <I>et al</I> is to evaluate the efficacy and safety of proposed preventive strategies for the prevention of such complications with a main focus on PPS, pericardial effusion, pericarditis and POAF.<cross-ref type="bib"...
<p>Heart failure (HF) is one of the significant complications in patients with myocardial infarction (MI), leading to increased risk for cardiovascular morbidity and mortality.<cross-ref type="bib" refid="R1">1</cross-ref> Left ventricular ejection fraction (LVEF) is a crucial parameter in HF assessment and management, although the differences in mortality are little different between HF with LVEF≥50% or HF with preserved ejection fraction (HFpEF) in patients with post-MI compared with HF with LVEF≤40% or HF with reduced ejection fraction (HFrEF).<cross-ref type="bib" refid="R2">2</cross-ref> However, mortality rate is greater in HF cases developing >3 days following MI compared with less than or equal to 3 days after MI.<cross-ref type="bib" refid="R2">2</cross-ref> Therefore, early identification of HF in high-risk populations, particularly post-MI, is essential for improving outcomes.</p> <p>Risk factors for developing HF after MI vary and are influenced by whether the patient has HFrEF or HFpEF. Common predictors include older age, prior hypertension, diabetes and atrial fibrillation. HFrEF is more commonly...
<p>Heart failure (HF) is a complex syndrome which leads to significant morbidity and mortality, poor quality of life and extremely high costs to healthcare systems worldwide. Although progress in the management of HF in high-income countries is leading to an overall reduction in the incidence and mortality of HF, there is a starkly different scenario in low- and middle-income countries (LMICs). There is a substantial lack of data on HF in LMICs, as well as a scarcity of diagnostic tools, limited availability and affordability of healthcare and high burdens of cardiovascular risk factors and communicable diseases. Patients in this setting present with more advanced HF at much younger ages and are, more often, women. In this review, we aim to comprehensively describe the burden of HF from an LMIC perspective, based on the more recent available data. We summarise the major causes of HF that are endemic in these regions, including hypertension, cardiomyopathy, rheumatic heart disease, HIV-associated heart disease and endomyocardial fibrosis. Finally, we discuss the challenges faced by the least developed health systems and highlight interventions that may prove to be more efficient in changing the paradigm of HF of the more vulnerable populations.</p>
<sec><st>Background</st>
<p>Pericardial complications following cardiac surgery are common and debilitating, significantly impacting patients’ survival. We performed this network meta-analysis to identify the most effective and safest preventions and treatments for pericardial complications following cardiac surgery.</p>
</sec>
<sec><st>Methods</st>
<p>We systematically searched PubMed/MEDLINE, EMBASE and Cochrane CENTRAL from inception to 22 January 2024. Pairs of reviewers screened eligible studies. They included randomised controlled trials that enrolled adults undergoing major cardiac surgeries and reported postpericardiotomy syndrome, pericardial effusion and pericarditis as primary or secondary outcomes. We summarised the effects of interventions using relative risks and corresponding 95% CIs. We performed a frequentist random-effects network meta-analysis using the restricted maximum likelihood estimator.</p>
</sec>
<sec><st>Results</st>
<p>We included 39 trials that enrolled a total of 6419 participants. Our network meta-analysis demonstrates colchicine reduces the risk of postpericardiotomy syndrome (RR 0.53, 95% CI 0.38 to 0.73). Beta-blockers probably prevent atrial fibrillation with a large magnitude of effect (RR 0.4, 95% CI 0.20 to 0.81) and may prevent postoperative pericarditis (RR 0.66, 95% CI 0.45 to 0.97) compared with control. Fish oil (RR 0.28, 95% CI 0.09 to 0.90), non-steroidal anti-inflammatory drugs (RR 0.37, 95% CI 0.23 to 0.59) and colchicine (RR 0.37, 95% CI 0.23 to 0.59) may reduce the risk of postoperative atrial fibrillation. We found no evidence of a difference in the risk of pleural effusion, all-cause mortality, serious adverse events or postoperative ICU stay.</p>
</sec>
<sec><st>Conclusions</st>
<p>The results of our study highly recommend colchicine use to reduce the risk of the postpericardiotomy syndrome and beta-blocker use to reduce postoperative atrial fibrillation. Additionally, our study suggests that further research is needed to investigate other interventions and to evaluate newly proposed interventions in large, high-quality trials, as the current evidence for some interventions is relatively weak.</p>
</sec>
<sec><st>Background</st>
<p>Atrial fibrillation (AF) is a major and increasing burden on health services. This study aimed to evaluate the cost-effectiveness of digoxin versus beta-blockers for heart rate control in patients with permanent AF and symptoms of heart failure.</p>
</sec>
<sec><st>Methods</st>
<p>RAte control Therapy Evaluation in permanent Atrial Fibrillation (RATE-AF) was a randomised, open-label, blinded, endpoint trial embedded in the UK National Health Service (NHS) to directly compare low-dose digoxin with beta-blockers (ClinicalTrials.gov: NCT02391337). A trial-based cost-utility analysis was performed from a healthcare perspective over 12 months. Resource use in primary and secondary healthcare services, medications and patient-reported quality of life were prospectively collected to estimate differences in costs and quality-adjusted life years (QALYs).</p>
</sec>
<sec><st>Results</st>
<p>RATE-AF randomised 160 patients with mean age of 76 (SD 8) years and 46% women, of which 149 patients (n=73 digoxin, n=76 beta blockers) had complete data and survived to 12-month follow-up. Treatment with digoxin was significantly less costly, with a mean saving of £530.41 per patient per year (95% CI –£848.06 to –£249.38, p=0.001). This was principally due to substantially lower rates of adverse events, with less primary and secondary healthcare utilisation compared with beta-blocker therapy. There was no significant difference in QALYs (0.013; 95% CI –0.033 to 0.052, p=0.56). At the £20 000 per-QALY willingness to pay threshold, the probability of digoxin being cost-effective compared with beta-blockers was 94%, with potential annual savings to the NHS of £102 million/year (95% CI £48 million to £164 million saving, p=0.001).</p>
</sec>
<sec><st>Conclusions</st>
<p>Digoxin is a less costly option when compared with beta-blockers for control of heart rate in suitable patients with permanent AF, with larger cost-effectiveness studies warranted to advise on national and global policy-making.</p>
</sec>
<sec><st>Trial registration number</st>
<p> <A HREF="NCT02391337">NCT02391337</A>, EudraCT 2015-005043-13.</p>
</sec>
<sec><st>Background</st>
<p>Heart failure with preserved ejection fraction is a recognised outcome in patients with myocardial infarction, although heart failure with reduced ejection fraction is more common. Identifying early indicators specific to heart failure with preserved ejection fraction in patients with myocardial infarction could support targeted preventive strategies. This study aimed to determine if pulse pressure and aortic valve peak velocity could serve as early predictors of heart failure with preserved ejection fraction in patients with myocardial infarction.</p>
</sec>
<sec><st>Methods</st>
<p>We retrospectively analysed data from 5188 participants in the Atherosclerosis Risk in Communities Study who were free from heart failure at baseline, including 802 individuals with a history of myocardial infarction. Heart failure events were classified as either heart failure with preserved ejection fraction (left ventricular ejection fraction ≥50%) or heart failure with mildly reduced or reduced ejection fraction (left ventricular ejection fraction <50%). Competing risk regression models were used to examine associations of baseline pulse pressure and aortic valve peak velocity with heart failure subtypes.</p>
</sec>
<sec><st>Results</st>
<p>Over 6 years of follow-up, 217 cases of heart failure with preserved ejection fraction (including 50 in patients with myocardial infarction) and 127 cases of heart failure with mildly reduced or reduced ejection fraction (33 in patients with myocardial infarction) were identified. Among patients with myocardial infarction, a 1-SD increase in pulse pressure was associated with a 1.60-fold higher risk of heart failure with preserved ejection fraction (95% CI 1.30 to 1.97), and a similar association was observed for aortic valve peak velocity (HR: 1.37, 95% CI 1.19 to 1.58). Patients with pulse pressure ≥68 mm Hg had a 3.83-fold higher risk of heart failure with preserved ejection fraction compared with those with lower pulse pressure, and those with aortic valve peak velocity ≥1.4 m/s had a 2.10-fold higher risk compared with those with lower values. Patients with myocardial infarction with two or more risk factors among elevated pulse pressure, aortic valve peak velocity, diabetes and atrial fibrillation had over 16 times the risk of developing heart failure with preserved ejection fraction compared with those without these risk factors (p<0.001).</p>
</sec>
<sec><st>Conclusions</st>
<p>Pulse pressure and aortic valve peak velocity are significant predictors of heart failure with preserved ejection fraction in patients with myocardial infarction, suggesting their potential value in early risk stratification. These findings support the use of these markers to guide timely interventions aimed at preventing the progression to heart failure with preserved ejection fraction.</p>
</sec>
<p>Advances in molecular genetics during the past decades led to seminal discoveries in the genetic basis of cardiovascular diseases, resulting in a new understanding of their pathogenesis, determinants of natural history and more recently paved the way for innovative therapies. A significant gap, however, exists between the rapidly increasing knowledge, especially of cardiovascular Mendelian disorders, and the medical applications in daily practice. This paper will focus on the practical issues the cardiologist may be faced with when suspecting a Mendelian disorder. The objective is to review the general issues related to genetic counselling and genetic testing, and to provide key messages for their integration into the medical management of the patients and relatives, according to a precision medicine approach.</p>
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