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August 10, 2019
News From Medscape
The following recommended articles on Medscape.com are freely available through the partnership between ABC and Medscape, no registration or login required.
Dedicated Cardiac Arrest Rapid Response Teams Get Best Results
Rapid response teams (RRTs) in top-performing hospitals for survival after cardiac arrest show distinct differences in structure and function from those at non-top-performing hospitals, a large qualitative study suggests.
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Stroke Prevention Best Path to Dementia Reduction, Experts Say
A global group of neurology experts has issued a call to action for a coordinated effort to reduce the incidence of dementia via stroke prevention. Worldwide, neurologic disorders account for the largest number of disease-adjusted life years (DALYs). More than half of DALYs from neurologic disorders result from stroke and dementia.
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Commentary: In Defense of Digoxin — No, It's Not a Killer Drug
Medical topics worthy of writing about transcend the details of the drug or device and implicate a broader lesson. The medical establishment's turn against digoxin perfectly illustrates this duality.
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Screen for Five Markers to Ward Off Heart Disease, Diabetes
By screening for five simple markers — waist size, blood pressure, HDL cholesterol, triglycerides, and glucose/HbA1C — during office visits, clinicians could identify high-risk adults who need to improve their lifestyle to prevent cardiovascular disease or type 2 diabetes. This is the main message from a new clinical practice guideline — "Primary Prevention of ASCVD and T2DM in Patients at Metabolic Risk" — issued by the Endocrine Society and published online July 31 in the Journal of Clinical Endocrinology and Metabolism.
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Items of Interest
ATTR Cardiomyopathy: 'Red Flags' for Screening
Certain "red flags" should prompt screening for transthyretin amyloid cardiomyopathy (ATTR-CM), according to consensus recommendations. Increased wall thickness with either heart failure or "red flag" signs and symptoms in men over age 65 years and women over 70 warrant screening, as indicated in the study in JACC: Heart Failure.
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Take Diabetes to Heart: New Subspecialty of Cardiometabolic Medicine?
The epidemic of obesity, cardiovascular disease, and type 2 diabetes has prompted a call for a new internal medicine subspecialty: cardiometabolic medicine. As proposed, the field would include elements of endocrinology, cardiology, and primary care and would address the needs of a large patient population that is now being seen by multiple specialists.
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Varied Bedtimes Tied to Obesity, Diabetes, High Blood Pressure
People who don’t consistently get the same amount of sleep or go to bed at the same time each night may be more likely to develop health problems like obesity, high blood pressure, high cholesterol and diabetes, a recent study in Diabetes Care suggests.
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A Nap a Day Keeps High Blood Pressure at Bay
It seems that napping may do more than just reboot our energy level and improve our mood. According to new research, people who took advantage of a midday snooze were more likely to have a noticeable drop in blood pressure compared with those who didn't nap.
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Study: Medicaid Expansion Improves Health Care Access
Expansion of Louisiana’s Medicaid system that took effect in July 2016 has improved access to health care, according to a Tulane University study. The study showed that the number of Medicaid enrollees who didn’t take medication as prescribed dropped by two thirds, and the number of people unable to receive care dropped by more than half. The study also found a decline in the number of people who couldn’t see a doctor due to cost and the number of their emergency room visits.
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Advanced Practitioners, NPs, PAs Supplement Patient Care Access
A new report suggests that Advanced practitioners (APs), such as NPs or PAs, have been effective for helping healthcare organizations maintain adequate patient care access and appointment availability, even following the Affordable Care Act (ACA), according to a recent study published in the Annals of Family Medicine.
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Featured Articles by Members
ABC Members: We welcome your published research submissions and articles for inclusion in future issues of Clinical Updates and Insights. Email Rachel Williams at rwilliams@abcardio.org and please attach file or include links to the original published work and/or abstract.
Income Inequality and Hypertension Control
Co-authored by lead author D. Edmund Anstey (with Jessica Christian and Daichi Shimbo)
An editorial analysis of the “Disparities in Socioeconomic Context and Association With Blood Pressure Control and Cardiovascular Outcomes in ALLHAT” by Andi Shahu et al. that reveals how socioeconomic context matters, even in a high-quality randomized trial (RCT) like ALLHAT, "where all participants had access to free medication, access to a doctor and were treated for their blood pressure under a standardized protocol."
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Small Cell Lung Cancer Invading the Left Atrium With Subsequent Malignant Embolic Stroke: A Case Report and Review of Literature
Co-authored by Ashraf Abugroun (with Raghav Chandra, Alan Goldberg, Elizabeth Cooney, Swati Mehrotra and Annabelle Volgman)
Cardiac tumors are uncommon, and the vast majority of them are metastases from extracardiac sources. Metastatic spread to the heart causes symptoms by mechanical obstruction of circulation, direct myocardial invasion, or distal embolization. We herein report a case of a 58-year-old male who presented to the hospital with multilobar intracranial embolic infarcts who was found to have small cell lung cancer (SCLC) with invasion of the left atrium and pulmonary artery resulting in malignant embolic stroke. Cerebral tumor thromboembolism from SCLC is extremely rare. This case demonstrates the thromboembolic risk associated with metastatic endoluminal cardiac tumors.
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A Case of Acute Heart Failure due to Immune Checkpoint Blocker Nivolumab
Co-authored by Giselle A. Suero-Abreu (with Munish Sharma and Bernard Kim)
Immune checkpoint inhibitors can be potentially cardiotoxic. Cardiomyopathy with these agents can have early onset and may start with non-specific symptoms like fatigue, weakness before presenting with obvious features of acute heart failure. Rapid progression and fulminant course of this disease necessitate high index of clinical suspicion and early diagnosis. Cardiotoxicity associated with immune checkpoint inhibitors when used alone or in combination is rare and has been reported only in a few case reports and case series studies. We present a case of acute heart failure in a 76-year-old female patient started on nivolumab for treatment of angioimmunoblastic T-cell lymphoma (AITL).
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Effect of Previous Exposure to Malaria on Blood Pressure in Kilifi, Kenya: A Mendelian Randomization Study
Co-authored by Marwah Abdalla (with Anthony O. Etyang, Sailoki Kapesa, Emily Odipo, Evasius Bauni, Catherine Kyobutungi, Paul Muntner, Solomon K. Musani, et al.)
We tested the hypothesis that Malaria exposure in childhood may contribute to high blood pressure (BP) in adults. We compared BP in individuals with and without sickle cell trait (SCT) and α+thalassemia, genetic variants conferring partial protection against malaria, at three sites, one where there is ongoing malaria transmission, in Kilifi, Kenya, and two, where there is no malaria transmission - in Nairobi, Kenya, and Jackson, Mississippi. We found that individuals with sickle cell trait had lower BP than those without sickle cell trait, but this was only in the area with malaria transmission, indicating that malaria is associated with high BP. Confirmation of the existence of a link between previous exposure to malaria and high BP at other sites and elucidation of the mechanisms involved may help in finding new ways to prevent and treat high BP.
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We LOVE to LEARN how our ABC Members are making a difference! Please Share. Giving a keynote speech? Presenting at a Grand Round? Receiving an Award? Interviewed by the Press? Published in a journal? Presenter or Panelist at a Conference? Graduating? Email Rachel Williams at rwilliams@abcardio.org or please tag or DM us on Facebook, Twitter or Instagram with links/details, so we can spotlight your excellence in our newsletter!

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