Cardiology

Working too much is bad for your heart

In this large prospective cohort of British civil servants, researchers compared the risk of new coronary heart disease (CHD) in those working 7-8 hours a day, versus those working 3-4 extra hours a day. Those working extra had a 60% higher risk of incident coronary heart disease (MI, angina, or fatal CHD), even after adjusting for 21 cardiac risk factors and sociodemographic factors. Working too much can be bad for your heart (abstract)

Early CHF follow up associated with fewer readmissions

In this large database analysis of over 30,000 elderly CHF patients from over 200 hospitals, researchers analyzed the association of early follow-up after discharge (within 7 days) and all-cause readmission rates. Patients discharged from hospitals in the 3 highest median quartiles of early follow-up had significantly lower 30-day readmission rates compared to the lowest median quartile hospitals. Hospitals with more early follow-up may reflect better "systems" for a number of reasons (more PCP availability, better discharge planning, etc), but regardless, those able to facilitate early follow-up were more likely to keep their CHF patients at home within the 30 days after discharge (abstract)

Non-invasive ventilation beneficial in acute cardiogenic pulmonary edema

In this meta-analysis of patients with acute cardiogenic pulmonary edema, researchers found that CPAP reduced mortality and need for intubation, and bi-level ventilation reduced the need for intubation (but not mortality). Either modality of non-invasive ventilation appears to benefit patients with acute cardiogenic pulmonary edema (abstract)

30 day outcomes of elective cardioversion

In this retrospective analysis of 400 patients with new onset Afib who underwent cardioversion, it was successful in restoring sinus rhythm in 96% of patients (within 3 attempts). No patients experienced stroke, thromboembolic event, or died within 30 days. Almost all the patients had a CHADS2 score of 1 and were generally healthy. In this subgroup of healthy patients with low CHADS2 score, elective cardioversion is safe and effective in restoring sinus rhythm (abstract).

PPI-clopidogrel saga continues

In this retrospective analysis of a large database, researchers found that patients recently discharged after an MI or stent on PPI-clopidogrel had a 93% higher risk of re-hospitalization for MI (and 64% higher risk for re-hospitalization for MI or stent) than patients on clopidogrel without a PPI. This association was found despite type of PPI (omeprazole or pantoprazole). The current warning on PPI labeling, to avoid concomitant use with clopidogreal when able, is probably warranted, until the controversy can be resolved (abstract)
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