Cardiology

Anticoagulation: Extended treatment for venous thromboembolism

Indefinite anticoagulation with direct oral anticoagulants (DOACs) is increasingly being recommended after symptomatic venous thromboembolism (VTE) in many clinical scenarios. This is because of the ease of use and lower bleeding risk of DOACs compared with warfarin and cumulative evidence of recurrence risk if anticoagulants are stopped, particularly after unprovoked VTE. The decision for extended use should be tailored to each patient, based on the risk of recurrence and bleeding, and patient preference.

Modern Medicine – Issue 2 2023

Heart Failure: A Growing Problem in Younger Patients

Heart failure (HF) is a major public health challenge, accounting for significant morbidity and premature mortality globally, including in sub-Saharan Africa (SSA). In contrast to Western countries, where HF is considered a disease of older persons, in SSA it affects younger individuals. Acute decompensated HF is the most common primary diagnosis for patients admitted to hospital with heart disease in SSA.

Modern Medicine – Issue 2 2023

Atrial Fibrillation: Management of older patients

GPs are central to the long-term primary care management of patients with atrial fibrillation (AF), noting that the target population of older people is both expanding and further rapidly ageing, rendering decision-making even more complex. A patient-centred treatment plan should focus on three key goals: detecting AF to enable early treatment initiation, managing the dysrhythmia to optimise cardiac function and prevent symptoms, and preventing thromboembolism to reduce stroke risk. An individualised, evidence-based approach to AF management requires comprehensive assessment of age-related factors to identify treatment goals, the riskbenefit profile of available treatments, and any medication management issues, with documentation of decision-making and regular reassessment to identify any changes. An integrated care approach can help GPs optimise AF management in older people, drawing on the collective expertise and support of the wider healthcare team, particularly as both risk assessments and treatment goals change with increasing age.

Modern Medicine – Issue 1 2023

Triglycerides – a Strong Predictor of CV Events

The increasing prevalence of obesity is directly associated with the increase in type 2 diabetes (T2D) and metabolic syndrome (MS), which, in turn, are associated with lipoprotein abnormalities described as atherogenic dyslipidaemia (AD). AD is causally linked to the development and progression of atherosclerotic CV disease (ASCVD).

Modern Medicine – Issue 6 2022

ADA Guidelines on Lipid Management in Those with Diabetes

Atherosclerotic cardiovascular disease (ASCVD)–defined as coronary heart disease (CHD), cerebrovascular disease, or peripheral arterial disease presumed to be of atherosclerotic origin – is the leading cause of morbidity and mortality for individuals with diabetes and results in an estimated $37.3 billion in cardiovascular-related spending per year associated with diabetes. Common conditions coexisting with type 2 diabetes (eg, hypertension and dyslipidaemia) are clear risk factors for ASCVD, and diabetes itself confers independent risk. This is a shortened version of the American Diabetes Association (ADA)’s article on cardiovascular risk management in Standards of Medical Care in Diabetes–2022

Modern Medicine – Issue 6 2022

Evaluating Basic Two-dimensional Echocardiography for Screening in Coronary Artery Disease

Background
Basic two-dimensional echocardiography (2D-echocardiography)screens for suspected coronary artery disease (CAD) by detecting impaired left ventricular function (LVF) which declines as atherosclerosis worsens.
Aim
To evaluate basic 2D-echocardiography for CAD screening.
Methods
CAD screening was performed with 2D-echocardiography. For global screening, left ventricular ejection fraction percentage (LVEF%) was determined and categorised into global systolic LVF. For regional screening, global average echocardiography score (GAES) was quantified, then categorised into functional impairment. After screening, high-risk patients
underwent diagnostic coronary angiography. Abnormal angiography had50% luminal stenosis. Angiography was also quantified with Coronary Intervention with Taxus and Cardiac Surgery (SYNTAX) score, then categorised. Statistical Package for Social Science 25.0 analysed data.
Results
There were 471 patients screened for CAD; 154/471 (33%) underwent angiography. For angiography selection amongst 471 screened patients, GAES was higher (p< 0.001) and positively correlated (Pearson’s coefficient 0.296); LVEF% was lower (p = 0.002) and negatively correlated (Pearson’s coefficient -0.187). Amongst 154 patients, SYNTAX score correlated negatively with LVEF% (Pearson’s coefficient -0.276) and positively with GAES (Pearson’s co-efficient 0.180). For categories, angiography had 66/154 (42.9%) normal and 88/154 (57.1%) abnormal results. SYNTAX score had 134/154 (87.0%) low-risk and 20/154 (13.0%) medium-high-risk categories. GAES correlated positively with angiogram results (Spearman’s coefficient 0.298) and SYNTAX categories (Spearman’s coefficient 0.110). LVEF% correlated negatively with angiogram results (Spearman’s coefficient -0.307) and SYNTAX categories (Spearman’s coefficient -0.254).

Conclusions

The distribution of underlying atherosclerotic vessels resulted in regional wall abnormalities being more significant than global function on 2D-echocardiography. We conclude that basic 2D-echocardiography remains useful in CAD screening.

Modern Medicine – Issue 6 2022

β-blockers: A Long-standing Cornerstone of HFrEF Therapy

β-adrenergic blockade has been a mainstay of therapy in chronic heart failure with reduced ejection fraction (HFrEF) for more than two decades. β-blocker therapy is strongly supported across major consensus recommendation statements in patients with reduced EF and has consistently been shown to reduce mortality and HF-related hospitalisations in those who do not have contraindications.

Modern Medicine – Issue 5 2022

European Guidelines on Lipid Modification for Cardiovascular Modification

The emergence of a substantial body of evidence over the last few years has required new, up-to-date European Society of Cardiology and European Atherosclerosis Society ( E S C – E A S ) guidelines . Fenofibrate, a peroxisome proliferatoractivated receptor-α agonist, has been suggested as an important treatment opt ion in the management of dyslipidaemia owing to its effects on hypertriglyceridaemia and low high-density lipoproteincholesterol ( H D L – C ) concentrations.

Modern Medicine – Issue 3 2022

High Heart Rate can Herald Cardiovascular Trouble

Large epidemiological studies have demonstrated that elevated heart rate is an independent risk factor for mortality and morbidity in healthy individuals with and without hypertension and in patients with coronary artery disease (CAD), myocardial infarction, and congestive heart failure.

Modern Medicine – Issue 3 2022

Neuro-modulation: A New Approach to HF

Heart failure (HF) is a complex clinical syndrome characterised by abnormalities in cardiac structure and function, dynamic remodelling, and perturbations of the neurohormonal axis. recently, the concept of neuro-modulation, rather than neuro-inhibition, has been successfully tested with the angiotensin receptor neprilysin inhibitor (arni) class representing a potential shift in the treatment of HF from partial neurohormonal system inhibition to an integrated composite neurohormonal system modulation.

Modern Medicine – Issue 6 2021