Genetic beta-blockade
What are the implications of an exciting discovery of intrinsic genetic beta-blockade common to 40% of people of African ancestry?

Dr Eric Topol invites you to share your opinions.

Click here to view the video blog and join the discussion.

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On moving to industry: Interview with Dr Terry Ferguson
In conversation with heartwire news and features editor Larry Husten, Dr Terry Ferguson muses on changes to daily life, decision making processes, and patient care from a different perspective resulting from his new position in industry.
The Cardiology Show
Surrogate end points on trial: ENHANCE and other controversies
Part 2 is now live!
Nine of the world's top cardiologists gathered in Chicago to take on the issues raised by data released at the American College of Cardiology Scientific Sessions.

Dr Valentin Fuster moderates this frank and sometimes heated discussion on the results of ENHANCE, STRADIVARIUS, ONTARGET, and PERISCOPE, and the questions they raise about the responsibility of industry and the relevance of surrogate end points.
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Smoking ban?
Read about our forum moderator's heroic and sometimes comic efforts to get a smoking ban passed by her city council in tobacco country.
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Controversies: ENHANCE and ACCORD
Clinical trials are under attack and in the headlines. What is the proper role of the investigators? What are the responsibilities of industry? Join Drs Eric J Topol and Robert M Califf in a discussion of the many issues surrounding ENHANCE and ACCORD.
Question
Do you think the ACC and SCAI should continue to combine their annual meetings in future years?
(See:Arranged marriage: Funding and "cultural differences" may dictate whether SCAI-ACC/i2 stay hitched)
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HeartWire  >  Acute coronary syndromes
ACS patients in India: Younger, poorer, sicker, and dying
Apr 24, 2008 18:30 EDT / A new registry analysis of almost 21 000 STEMI and non-STEMI patients admitted to Indian hospitals suggests that the country, along with other developing nations, is in dire need of better emergency services, healthcare insurance, and public-education campaigns if any dint is to be made in the global CVD epidemic. (Xavier D et al. Lancet 2008; 371:1435-1442.)
No increased in-hospital mortality in AMI patients arriving during "off" hours
Apr 21, 2008 16:00 EDT / AMI patients arriving at US hospitals on weeknights, holidays, or weekends were more likely to receive fibrinolysis and less likely to undergo PCI, but they were no more likely to die in the hospital than patients coming in on weekdays. (Jneid H et al. Circulation; published online before print April 21, 2008.)
AHA promotes chest-compression-only bystander-initiated CPR
Mar 31, 2008 16:00 EDT / The public is now urged to start chest compressions on any adult who collapses suddenly; mouth-to-mouth ventilation is sanctioned only for rescuers with both the training and the confidence to do it right. (Sayre MR et al. Circulation; published online before print March 31, 2008.)
Progress in pre-PCI clopidogrel dosing: Increases can be based on platelet reactivity
Mar 29, 2008 19:30 EDT / A small randomized trial opens the door to the prospect of individualized pre-PCI clopidogrel dosage increases to overcome "resistance" to the antiplatelet drug; patients with the titrated dosage increases had fewer clinical events over 30 days. (American College of Cardiology 2008 Scientific Sessions.)
ACS patients do better in clinical-trial hospitals
Mar 26, 2008 14:15 EDT / Hospitals that participate in clinical trials appear to provide better care for ACS patients, a new study suggests. (Majumdar SR et al. Arch Intern Med 2008; 168:657-662.)
Secondary prevention: Benefits extend to elderly
Mar 25, 2008 16:15 EDT / A contemporary study following elderly MI patients has shown improvements in mortality over a decade, with around a 3% reduction in deaths per year. The results are probably due to increased use of cardiovascular medications and should encourage doctors to make sure they apply evidence-based interventions to all eligible patients, say the researchers. (Setoguchi S et al. J Am Coll Cardiol 2008; 51:1247-1254.)
New statement on cocaine-associated MI urges caution with beta blockers, emphasizes kicking the habit
Mar 17, 2008 16:00 EDT / The evaluation and management of patients who develop chest pain or MI after using cocaine should mirror that of patients who have not used cocaine, but with several important caveats. (McCord J et al. Circulation; published online before print March 17, 2008.)
Streamlined "CPR" by EMS can improve survival in out-of-hospital cardiac arrest
Mar 12, 2008 18:00 EDT / The technique emphasizes chest compressions and early IV epinephrine while reducing the role of assisted ventilation. (Bobrow BJ et al. JAMA 2008; 299:1158-1165.)
Stay in touch: Postdischarge contact with MI patients boosts adherence to meds
Mar 11, 2008 17:00 EDT / Especially beta blockers, two separate studies suggest. (Daugherty SL et al. Smith DH et al. Arch Intern Med 2008; 168:485-491, 477-483.)
No easy way to predict which ACS patients will require CABG
Mar 6, 2008 12:00 EST / The biggest determinants of CABG appear to be racial and regional factors, so that decisions about upstream antithrombotic use are best made locally, a new study concludes. (Chew DP et al. Am Heart J; published online before print February 21, 2008.)
Marijuana use associated with increased risk of mortality among acute MI patients
Mar 3, 2008 17:15 EST / Marijuana use by acute MI survivors is associated with a threefold higher risk of mortality after infarction, and a nearly fourfold increase in death from noncardiovascular causes. (Mukamal KJ et al. Am Heart J 2008; 155:465-470.)
Stem-cell therapy in CV disease: Review finds "modest benefit with little toxicity"
Feb 28, 2008 10:45 EST / LV functional gains are limited but enough to make a clinical difference, the author says. (Burt RK et al. JAMA 2008; 299:925-936.)
Disparities in awareness of MI symptoms
Feb 22, 2008 16:15 EST / A survey in 14 US states has found that less than a third of adults are aware of all five warning signs and symptoms of MI and would call 911 as their first response. There were variations in awareness between races and between the sexes and also by geographic region and education. (Fang J et al. MMWR Morb Mortal Wkly Rep; published online February 22, 2008.)
Baxter heparin now officially in short supply
Feb 21, 2008 12:30 EST / The product has now been added to the FDA's list of drug shortages, while investigations into the adverse reactions have revealed that one Chinese supplier was not inspected by the FDA because of a name mix-up.
Higher blood transfusion rates for ACS patients in the US, but no reductions in death/MI
Jan 8, 2008 15:15 EST / Mounting concern that blood transfusions may do more harm than good is particularly germane in the US, where, according to a new analysis, patients with ACS may be significantly more likely to undergo blood transfusions than non-US patients yet see no corresponding benefits in terms of reduced death or MI. (Rao S et al. Am J Cardiol 2008; 101:25-29.)
Better exercise counseling needed for CHD patients
Jan 8, 2008 10:15 EST / Patients with heart disease are less likely to comply with physical-activity recommendations than subjects without heart disease, a new study shows. (Zhao G et al. Am J Cardiol; published online before print December 21, 2007.)
What initial dose of aspirin is right for STEMI patients?
Dec 20, 2007 12:15 EST / An initial dose of 162-mg aspirin may be as effective as and perhaps safer than 325 mg for the acute treatment of ST-elevation MI, a new study suggests. (Berger JS et al. Circulation; published online before print December 17, 2007.)
New data look promising for rivaroxaban
Dec 12, 2007 15:30 EST / Two phase 3 trials with the new oral anticoagulant rivaroxaban suggest it is more effective than enoxaparin in preventing venous thromboembolism in patients undergoing major orthopedic surgery. (American Society of Hematology 2007 Annual Meeting.)
AHA, ACC update management guidelines for ST-elevation MI
Dec 12, 2007 10:15 EST / The new and modified treatment recommendations account for, among other things, recent revelations about COX-2 inhibitor safety and the new abundance of antithrombin agents. (Antman EM et al. Circulation; J Am Coll Cardiol; published online before print December 11, 2007.)
Mortality after bleeding in MI patients lower in real world than in clinical trials?
Nov 28, 2007 16:30 EST / Although bleeding may be causally related to adverse outcomes in some patients in the real-world setting, it is often merely a marker for patients at higher risk for adverse outcomes, the GRACE investigators suggest. (Spencer FA et al. Circulation; published online before print November 19, 2007.)
GIK therapy no benefit in STEMI, possible harm
Nov 27, 2007 16:00 EST / The latest in a long line of trials to show no benefit of high-dose glucose-insulin-potassium infusion as an adjunctive treatment in patients with STEMI has been published. Combining the new data with an older trial, the researchers also found a suggestion of possible early harm with GIK. (Diaz R et al. JAMA 2007; 298:2399-2405.)