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Outcomes of care for patients with ischemic heart disease (IHD) and heart failure (HF) may vary across VA medical centers (VAMCs). Groeneveld and coauthors studied 930 079 patients with IHD and 348 015 with HF among 138 VAMCs and their outpatient clinics between 2010 and 2014. Risk-standardized mortality rates varied from 5.5% to 9.4% for IHD and from 11.1% to 18.9% for HF and significantly exceeded the national means for IHD and HF in 29 and 35 VAMCs, respectively. In an Editorial, Heidenreich discusses the need to address quality measures known to improve mortality to identify interventions that will improve outcomes.
The potential association of the 2017 American College of Cardiology/American Heart Association hypertension (HT) guidelines with cardiovascular disease (CVD) events and mortality is uncertain. Using 2013-2016 National Health and Nutrition Examination Survey data, Bundy and coauthors estimated that 35.9% of US adults will be recommended for HT treatment according to the 2017 guidelines compared with 31.1% according to the 2014 guidelines. Assuming that US adults achieve recommended goals, this would result in a reduction of 610 000 CVD events and 334 000 total deaths. In an Editorial, Fine, Goff, and Mensah indicate that these data show the possible benefits of more effective HT treatment but also emphasize that lifestyle factors will reduce the number of individuals requiring treatment and the intensity of therapy when it is required.
Editorial Editor’s Note
Author Audio Interview
Most sudden and/or arrhythmic deaths (SADs) in patients with coronary heart disease occur in those without severe systolic dysfunction. Chatterjee and coauthors studied a cohort of 5761 patients with coronary heart disease among 135 North American sites who did not qualify for implantable cardioverter defibrillator therapy based on current ejection fraction (EF) thresholds. During a median of 3.9 years, SAD accounted for 114 of 202 cardiac deaths (56.4%). The lowest SAD rates were associated with a left ventricular EF of more than 60% (1.0%), and the highest SAD rates were associated with a left ventricular EF of 30% to 40% (4.9%) and class III/IV heart failure (5.1%). As only arrhythmic sudden cardiac deaths are rescued by ICDs, Tseng emphasizes in an Editorial that it is essential to distinguish arrhythmic from nonarrhythmic causes of sudden cardiac death.
Atrial fibrillation (AF) represents a potent stroke risk, but whether the burden of paroxysmal AF (PAF) influences risk is uncertain. In a retrospective cohort study, Go and coauthors identified 1965 patients with PAF on 14-day continuous ambulatory electrocardiographic monitoring from October 2011 to October 2016. After adjusting for either Anticoagulation and Risk Factors in Atrial Fibrillation or CHA2DS2-VASc stroke risk scores, the highest tertile of AF burden (≥11.4%) was associated with a more than 3-fold higher adjusted rate of thromboembolism while not taking anticoagulants compared with the combined lower 2 tertiles of AF burden. In an Editorial, Steinberg and Piccini conclude that a greater burden of AF is associated with a higher risk of ischemic stroke independent of known stroke risk factors in adults with PAF.
Highlights. JAMA Cardiol. 2018;3(7):549. doi:https://doi.org/10.1001/jamacardio.2017.3371
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