Clinical Cardiology Alert – December 1, 2023
December 1, 2023
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Five-Year TAVR vs. SAVR Data Show Encouraging Results, but Do Not Move the Needle for Clinical Decision-Making
The PARTNER 3 trial randomized low-risk patients to transcatheter aortic valve replacement vs. surgical aortic valve replacement. Five-year data show no significant differences in the composite endpoint of death, stroke, or rehospitalization.
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The Natural History of Aortic Stenosis Revisited
A large multi-institution observational study of patients referred for Doppler echocardiography to assess for aortic stenosis has shown that discrepant measurements are not uncommon. When four-year all-cause untreated mortality is considered, the intermediate grades of aortic stenosis behave like the next highest level stenosis, which suggests that we should consider intervening earlier in moderate to severe stenosis.
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Apixaban Dose in Atrial Fibrillation Patients with Chronic Kidney Disease
A large nationwide health systems database study comparing 5 mg apixaban vs. 2.5 mg twice daily in patients with stage 4/5 chronic kidney disease not on dialysis shows that the 5 mg dose increases the risk of bleeding compared to 2.5 mg without any improvement in the risk of stroke, systemic emboli, or death.
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Upgrading Prior Right Ventricular Pacing in Heart Failure
A randomized, controlled, open-label study of upgrading patients with right ventricular pacemaker-induced left ventricular dysfunction and heart failure to cardiac resynchronization pacing plus an implantable cardioverter defibrillator (ICD) has shown reduced heart failure hospitalization and improvements in left ventricular function compared to ICD placement alone.
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Subcutaneous Furosemide Infusion Device
A small patient-applied infuser pump for a pH neutral formulation of furosemide has been developed. A comparison of an intravenous (IV) bolus of furosemide to a five-hour infusion with the pump has been completed and shows that the device is well tolerated and provides similar bioavailability as IV furosemide.