Volume 11 Issue 12, December 2014

In the EORP-AF Pilot registry on the prognosis and treatment of patients with atrial fibrillation (AF), 1-year mortality is high. Symptoms are still common in patients with AF, and hospital readmissions are mainly owing to AF and heart failure. Oral anticoagulation use has increased, but a rhythm-control strategy is uncommon.

A new meta-analysis challenges the notion that β-blockers improve survival in patients with heart failure (HF) and concomintant atrial fibrillation (AF). These results should be interpreted with caution. Although the mortality reduction conferred by β-blockers was likely overestimated in the past, benefits should be expected in a sizeable proportion of patients with HF and AF.

Novel oral anticoagulants (direct thrombin or factor Xa inhibitors) have become alternative options to vitamin K antagonists owing to their predictable and safe pharmacological profiles. In this Review, Baber and colleagues discuss the overall clinical effect of these drugs, which is a balance between ischaemic benefit and bleeding risk, in patients with atrial fibrillation, venous thromboembolism, or acute coronary syndrome.

Risk models to predict outcomes in cardiac surgery are increasingly being used to identify patients who might be better treated using percutaneous techniques than by surgical intervention. In this Review, Thalji and colleagues critically evaluate how the databases from which these models are derived might influence risk prediction in clinical practice, particularly for selecting patients to undergo transcatheter aortic valve implantation.

In conditions of prolonged stress valvular cells can contribute to valve disease progression. In this Review, Wang and colleagues describe how the biophysical and biochemical properties of the extracellular matrix can regulate valve cell function in the context of calcific valvular diseases. The authors also describe how new cell culture approaches can be employed to better understand the pathophysiology of valve diseases.

Combination antiretroviral therapy (cART) has substantially prolonged the lives of patients with HIV infection, but these individuals have an increased risk of coronary heart disease and myocardial infarction compared with uninfected individuals. In this Review, Reiss and colleagues discuss the control of both traditional and immune risk factors, and the appropriate selection of cART regimens, to reduce the risk of cardiovascular complications in patients with HIV.

Cardiovascular and renal disease often have similar origins and shared risk factors. With the progression of chronic kidney disease, additional risk factors develop, contributing to the evolution of both diseases. In this Perspectives article, Ruiz-Hurtado and Ruilope postulate that that simultaneous protection for both cardiovascular and renal disease can be achieved with the same therapy. They review the evidence from clinical trials supporting this theory, and discuss strategies to prevent both cardiovascular and chronic kidney disease.