Tag Archives: acute coronary syndrome

The National Institute for Health and Care Excellence (NICE) has said that thousands of people with atrial fibrillation (AF) could be prevented from having strokes, disability or death if its new guidance is followed. It says many patients with AF are not being appropriately anticoagulated and highlights how there has not been widespread uptake of novel oral anticoagulant drugs (NOACs) which were approved by NICE in 2012. Clinical guideline 180 published in June 2014 updates and replaces the 2006 NICE clinical guideline 36. The full guidance can be found at http://www.nice.org.uk/guidance/CG180 NICE Chair, Professor David Haslam writes on the

Introduction Following observations that smokers experience decreased mortality following acute myocardial infarction (acute MI [AMI]) in comparison with non-smokers,1 the term ‘smoker’s paradox’ was introduced into scientific discourse more than 25 years ago.2 The ‘smoker’s paradox’ following various reperfusion strategies, however, is argued not to be due to any benefit from smoking itself but simply due to smokers being likely to undergo such procedures at a much younger age, and, hence, having, on average, lower comorbidity. In a recent systematic review (with a search by September 2010)2 of 17 studies presenting adjusted tota

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That CMR is the gold standard for heart size and function, and for congenital and inherited heart disease is little disputed. The additional benefit of CMR for tissue characterisation has gained widespread acceptance, particularly now with convincing prognostic data across a wide variety of disorders,1 and the large EuroCMR registry (27,000 patients, 15 countries),2 showing that CMR entirely changed diagnosis in nearly 10% of subjects. CMR adoption as a ‘workhorse’ for ischaemia and viability testing has, however, been slower, with continued calls for cost-effectiveness and head-to-head comparison data with other modalities. These data ar

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Introduction Cardiovascular disease (CVD) is the leading cause of death in England and Wales (124,000 deaths in 2005) and for every fatality, there are at least two people who have a major non-fatal CVD event.1 Myocardial infarction (MI) is associated with substantial morbidity and mortality. There is a high risk of recurrence after the initial event. Recommendations on the secondary prevention of cardiovascular disease for patients in primary and secondary care have been published in guidelines from the National Institute for Health and Clinical Excellence (NICE) in England.1,2 In the May 2008 CG67 guideline, high-intensity dosage of statin

PARTNER: transcatheter valves just as good as surgery for high risk aortic stenosis Transcatheter aortic valve implantation (TAVI) is just as effective at reducing mortality as surgery for severe aortic stenosis in elderly patients whose age and overall health posed high risks for conventional surgery, according to the results of the PARTNER (Placement of AoRTic TraNscathetER Valve trial). However, stroke rates were higher in the trancatheter group. The transcatheter approach involves delivering a bioprosthetic valve to its target location with a catheter using either transfemoral access or trans-apical access (through the ribs) if peripheral

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Introduction The low molecular weight heparin (LMWH) enoxaparin is recommended by the European Society of Cardiology as an antithrombotic agent for the treatment of acute coronary syndromes (ACS) (class I level A indication in the treatment of acute ST-elevation myocardial infarction [MI] along with thrombolytic therapy and class IIa level B recommendation in the treatment of ACS without ST elevation).1,2 A dosing strategy of 1 mg/kg twice daily is recommended as higher doses have been shown to result in increased bleeding without further clinical benefit.3 Weight-adjusted dose reduction is advised in patients >75 years and in those with