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Not all strategies for the management of chronic heart failure have been shown to be equally effective in improving outcomes, and the ideal programme has yet to be defined. The WHICH? trial sheds some light on whether a clinical, in-hospital or a home-based strategy of care is superior and cost-effective.
In a large, new, observational study, β-blocker treatment did not improve clinical outcomes in patients with coronary artery disease (CAD), including those with previous myocardial infarction, and was associated with more events in individuals with risk factors only. The role of β-blockers for secondary prevention in these patients should be reconsidered.
Adding C-reactive protein (CRP) level to conventional cardiovascular risk models has been suggested to improve risk prediction for cardiovascular events. However, evaluation of the potential impact of CRP measurement in cardiovascular risk management will require studies designed to quantify the effect of additional CRP assessment on medical decision-making, patient outcomes, and cost-effectiveness.
In the diseased heart, cardiomyocytes undergo necrotic cell death. A healing response results in myofibroblast production of collagen and other matrix molecules, which initially serve to preserve the structural integrity of the myocardium. However, myofibroblast dispersion fails to occur in many cardiac diseases, and perpetual matrix formation leads to adverse remodelling of the heart. In this Review, Weber et al. discuss relevant mechanisms of cardiac fibrosis and consequent remodelling, and highlight potential strategies for cardioprotection.
The success of transcatheter therapeutics relies heavily on the choice of vascular access site and on adequate arteriotomy closure. In this article, Byrne and colleagues review the state-of-the-art and future developments in vascular closure devices. They also compare the safety and efficacy of radial artery and femoral artery access for diagnostic and interventional procedures.
Timeliness of reperfusion is paramount in the management of patients with ST segment elevation myocardial infarction. Both fibrinolysis and primary percutaneous coronary intervention are inherently associated with patient and health-care system delays. In this Review, Jens F. Lassen and colleagues describe the types of delay to reperfusion and their effects on outcome, and discuss strategies to optimize reperfusion therapy in these patients.
Rheumatic heart disease (RHD) is preventable, yet continues to be a leading cause of morbidity and mortality in children in developing countries. In this Review, Kathryn Roberts and colleagues examine whether RHD fulfils the 1994 Council of Europe criteria for a disease suitable for screening, assess cardiac auscultation and echocardiography as methods of screening for RHD, and discuss areas of controversy that require further research in order to make recommendations about screening for this disease.
