Health care articles within Nature Reviews Cardiology

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  • Review Article |

    Although currently available anticoagulants, such as warfarin, can prevent stroke in patients with atrial fibrillation, the drug-related bleeding risk remains unacceptably high, and therapy could be contraindicated if the risk exceeds that for stroke. In this Review, Freek Verheugt assesses the performance of new anticoagulants that directly inhibit different stages of the coagulation cascade.

    • Freek W. A. Verheugt

  • Review Article |

    Atrial fibrillation (AF) has multifactorial intracardiac and extracardiac causes. Current development of anti-AF agents is focused on modulation of ion channel activity as well as on upstream therapies that reduce structural substrates. In this Review, Burashnikov and Antzelevitch examine new and emerging pharmacological approaches to rhythm control in patients with AF and summarize the available data on these drugs.

    • Alexander Burashnikov
    •  & Charles Antzelevitch

  • Review Article |

    As part of our focus issue on atrial fibrillation, Dewire and Calkins review current strategies and emerging technologies for catheter ablation of patients with this arrhythmia. The authors also discuss the current clinical role of AF ablation in various high-risk groups of patients, such as the elderly and those with concomitant heart failure.

    • Jane Dewire
    •  & Hugh Calkins

  • Review Article |

    Sudden cardiac arrest causes more than 60% of all deaths from cardiovascular disease. In this Review, Adabag and colleagues discuss trends in the incidence of sudden cardiac death (SCD), and the risk factors and triggers of this devastating event. The authors also highlight the lack of a concise definition for SCD and suggest that prospective community surveillance programs, using multiple sources to identify cases, would enable more accurate determination of SCD burden. They also review the growing evidence for the role of public-access defibrillators in improving survival after sudden cardiac arrest.

    • A. Selcuk Adabag
    • , Russell V. Luepker
    •  & Bernard J. Gersh

  • News & Views |

    Defibrillators, with or without cardiac resynchronization therapy, can reduce the rate of sudden death. However, shocks are unpleasant, often unnecessary, and can damage myocardium or defibrillator leads, thereby increasing morbidity and mortality and detracting from the benefits of this therapy. Conservative programming of devices may reduce such risks.

    • John G. F. Cleland
    •  & Laszlo Buga

  • News & Views |

    Despite angiographically successful primary percutaneous coronary intervention (PCI) in patients with ST-segment elevation myocardial infarction, microcirculatory failure is common and leads to an increased risk of morbidity and mortality. The administration of intracoronary streptokinase immediately after PCI may improve outcomes and provides a promising potential therapy for the future.

    • Paul W. Armstrong

  • News & Views |

    Tibaldi et al. have addressed the feasibility of 'hospital-at-home' care as an alternative to hospitalization for elderly patients with chronic heart failure. Although this study addresses an important subject, and the results are intriguing, extrapolation to other settings may not be easy. The study should, therefore, be regarded as hypothesis-generating rather than definitive.

    • Karen J. Hogg
    •  & John J. V. McMurray

  • News & Views |

    Two large trials were conducted to evaluate the effects of an angiotensin-converting-enzyme inhibitor, an angiotensin-receptor blocker or a combination of both in high cardiovascular risk patients. A decrease in the prevalence of left ventricular hypertrophy (LVH) was reported, but this did not translate into a prognostic benefit. New-onset LVH was associated with an increase in cardiovascular events.

    • Alberto Zanchetti

  • News & Views |

    The ROOBY investigators found off-pump CABG surgery to be significantly inferior to on-pump surgery with regard to 1 year mortality, revascularization, or new myocardial infarction. This unexpected finding could be related to the fact that most of the participating surgeons were experienced in on-pump CABG surgery, but relatively inexperienced in the off-pump procedure.

    • Robert A. Guyton

  • Review Article |

    In this Review, the authors discuss the utilization of multiple, high spatial resolution contrast weightings for thein vivoassessment of carotid atherosclerotic disease. Although 'carotid MRI' is presently an established imaging tool dedicated to research, the burgeoning data from prospective studies has placed it at the precipice of translation to clinical practice.

    • Hunter R. Underhill
    • , Thomas S. Hatsukami
    •  & Chun Yuan

  • Review Article |

    The incidence of prehypertension and hypertension among children and adolescents is rising as a result of the epidemic of youth overweight and obesity. Brian McCrindle addresses this important public health problem by reviewing the evaluation and management aspects of this condition that are specific to infants, children, and adolescents.

    • Brian W. McCrindle

  • Review Article |

    In this Review, the authors discuss innovations in ventricular assist devices technology as an alternative therapeutic option for patients with advanced heart failure. In particular, they focus on the newer, third-generation VADs that are currently being developed for mechanical cardiac support.

    • Rajan Krishnamani
    • , David DeNofrio
    •  & Marvin A. Konstam

  • News & Views |

    The Carillon system is a percutaneously delivered, coronary-sinus-based mitral annuloplasty device. A safety and feasibility trial now demonstrates low rates of major adverse events, with improvements in quality of life. Though promising, this report raises important questions related to relative efficacy and durability compared with other relevant therapies, and related to current clinical indications.

    • Jason H. Rogers
    •  & Steven F. Bolling

  • News & Views |

    Amiodarone effectively maintains sinus rhythm in patients with atrial fibrillation, and although dronedarone is less effective it has a better safety profile. The choice of antiarrhythmic drug (or nonpharmacological strategy) depends on the ultimate goal of therapy, which should be considered in the context of the patient's clinical presentation and the treatment tailored to the individual.

    • Eric N. Prystowsky

  • News & Views |

    Stroke is the leading cause of morbidity and mortality in patients with atrial fibrillation. Whereas warfarin reduces the risk of stroke, its interactions with other drugs and food, individual differences in its efficacy and the need for frequent monitoring make its use inconvenient. Dabigatran etexilate might represent a step forward in the care of patients with atrial fibrillation.

    • Sarah A. Spinler

  • News & Views |

    Clinical trial data, including those from MADIT-CRT, support the use of cardiac resynchronization therapy in patients with asymptomatic and mildly symptomatic heart failure and ventricular dyssynchrony. However, important questions remain about which of these patients benefit most from this therapy.

    • Johannes Holzmeister
    •  & William T. Abraham

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