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Clinical guidelines advocate oral anticoagulation (OAC) for stroke prevention in patients with atrial fibrillation and ≥1 risk factors for stroke, but 40% of eligible patients receive aspirin, and those at greatest risk are least likely to be prescribed OAC. Why is there a discrepancy between guidelines and clinical practice?

The success of transcatheter aortic valve implantation (TAVI) is centred around the collaboration between cardiac surgeons and interventional cardiologists. A report from the German Quality Assurance Registry on TAVI now suggests that clinical outcomes in hospitals without cardiac surgery departments are similar to those in centres with onsite cardiac surgery support.

After some alarming results of intensified glucose control in patients with type 2 diabetes mellitus, and noninferiority (without superiority) of alogliptin, saxagliptin, sitagliptin, and lixisenatide treatment compared with placebo, the positive results in survival and cardiovascular and renal outcomes with empagliflozin and liraglutide have been acknowledged with enthusiasm by diabetologists and should deeply interest cardiologists.

Takotsubo syndrome is often thought to be the result of catecholamine-mediated myocardial stunning triggered by emotional or physiological stress. In this Perspectives article, Kastaun and colleagues discuss the latest studies evaluating the psychoneuroendocrinological and psychosocial mechanisms underlying the pathophysiology of Takotsubo syndrome.

In this Perspectives article, Ormerod et al. propose that dynamic left ventricular systolic dysfunction provoked by obstruction in hypertrophic cardiomyopathy is a manifestation of inefficient cardiac energy utilization. This mid-systolic drop in left ventricular Doppler ejection velocities has been termed the 'lobster claw abnormality'. Energy insufficiency is also present in nonobstructive hypertrophic cardiomyopathy, and this paradigm might suggest novel therapies.

Patients with acute coronary syndromes have an increased risk of stent thrombosis. A considerable proportion of these patients are also at increased risk of bleeding, representing a challenge to optimal selection of stent type and duration of dual antiplatelet therapy. Recent evidence supports polymer-free drug-eluting stents as a safe and effective option for this challenging subset of patients.

A recent pooled analysis of data from four studies found no increased risk of cardiovascular events and death with increased sodium intake in patients without hypertension. However, the study estimated sodium intake using only overnight urine collections rather than 24-h samples, and sodium excretion was not constantly monitored.

The mechanisms of thromboembolism in patients with atrial fibrillation are complex and not well understood, and existing stroke risk scores are limited in their predictive capacity. In this Review, Calenda et al. discuss stroke risk assessment in atrial fibrillation and explain how the atrial myopathy concept might help to refine stroke risk prediction.

Nutraceuticals are natural compounds that are beneficial for the prevention or treatment of disease. In their Review, Moss and Ramji summarize the preclinical and clinical studies to evaluate the efficacy of various nutraceuticals, such as polyunsaturated fatty acids, flavanols, and vitamins C and E, for the prevention of atherosclerosis.

Diagnosis and treatment in patients with an aborted cardiac arrest (ACA) pose a challenge for cardiologists, because the underlying causes of ACA and the appropriate therapies are varied. In this Perspectives article, Schwartz and Dagradi offer their view on how genetics is shaping the management of survivors of ACA, and discuss the importance of genetic testing for the protection of these patients and their families.

Both the cardiovascular research and clinical communities are ideally positioned to develop and implement precision medicine to achieve more effective prevention and treatment. This Review highlights the advances in modern biomedicine that make possible the precision medicine era, provides current examples of the use of this approach in the cardiovascular field, and defines the goals and barriers to implementation of a precision medicine system.

Refractory cardiogenic shock carries a poor prognosis, with an inhospital mortality of ∼50%. In this Review, Reyentovich and colleagues discuss the current therapeutic and management options available for patients with refractory cardiogenic shock.