Gregory Y. H. Lip

Occupational radiation exposure in the electrophysiology laboratory with a focus on personnel with reproductive potential and during pregnancy: A European Heart Rhythm Association (EHRA) consensus document endorsed by the Heart Rhythm Society (HRS)

Occupational radiation exposure in the electrophysiology laboratory with a focus on personnel with reproductive potential and during pregnancy : A European Heart Rhythm Association (EHRA) consensus document endorsed by the Heart Rhythm Society (HRS).

Time trends in cardiovascular drug treatment and cardiovascular events in patients with acute heart failure

Background: Heart failure (HF) is associated with an increased risk of thrombotic events, which can be reduced by adequate drug treatment. We assessed the temporal relationship of the incidence of myocardial infarction (MI) and stroke, and the specific cardiovascular treatment that was given. Methods: Data were obtained from the PHARMO Record Linkage System, a population-based registry of pharmacy records linked with hospital discharge records in The Netherlands. Patients were selected based on a first hospital discharge diagnosis of documented HF. Two time intervals were compared: 1998-2002 and 2003-2007. We analyzed prescribed medication in the first 90 days after hospitalization, and the occurrence of MI and strokes in the first year after hospitalization. Logistic-regression analysis was performed to calculate odds ratios (OR) between the two periods. Results: We identified 6526 patients in 1998-2002 and 6369 patients from 2003-2007. During the first year after acute HF, the incidence of thrombotic events was 4.1% and 3.4% in the two periods, respectively. After adjustment for age and previous thrombotic events the incidence was 21% lower in 2003-2007 (Table). Prescription of ACE-inhibitors and beta-blockers has increased in the recent years, but were still prescribed to only 60% of HF patients (Table). Conclusion: The incidence of thrombotic events appears to have decreased in patients with acute HF, which may be due to better use of medication. However, many patients remain undertreated (Table persent).

Non-selective beta-blockers decrease thrombotic events in patients with heart failure

Background: Beta-blockers are often prescribed to patients with heart failure (HF) without distinctions between types of beta-blockers. The 2002 COMET study showed superiority of carvedilol (a non-selective beta-blocker) over metoprolol (selective beta-blocker) on mortality and cardiovascular events in patients with HF. However, this study was criticised for several reasons. Laboratory findings suggest a reduced prothrombotic response upon sympathetic activation by non-selective beta-blockers. We therefore hypothesised that non-selective beta-blockers reduce vascular events compared to selective beta-blockers in patients with HF. Methods: Data were obtained from the PHARMO Record Linkage System, a population-based registry of pharmacy records linked with hospital discharge records in The Netherlands. We identified a cohort of 20,870 patients with documented HF in the period 1998 to 2007, based on hospital discharge diagnosis. This method has been validated for selecting HF patients. We used Cox regression analysis, with time varying beta-blocker covariate to assess the difference in the incidence of thromboembolic events (acute coronary syndrome (ACS), stroke, or pulmonary embolism) between patients using selective and non-selective beta-blockers. Results: Median follow-up was 2.0 years (interquartile range (IQR): 0.7-4.1). Directly after discharge, 6,980 patients were prescribed a selective beta-blocker and 2,504 patients a non-selective beta-blocker. Total follow-up was 56,667 person-years, of which 18,245 person-years for selective beta-blockers and 6,455 for non-selective beta-blockers. The hazard ratio (HR) for any thrombotic event for non-selective beta-blockers compared to selective beta-blockers was 0.76 (95% confidence interval (CI): 0.64-0.89). After adjustment for potential confounders the difference remained significant (HR 0.84, 95%CI: 0.72-0.99). Conclusion: Non-selective beta-blockers are associated with a lower risk of thromboembolic events compared to selective beta-blockers in patients with HF. The hypothesis that non-selective beta-blockers reduce the prothrombotic state in these patients should be further explored.