Health status is an important outcome in older patients undergoing transcatheter edge-to-edge mitral valve repair (TMVR) because of high surgical risk. Arnold and coauthors studied quality of life using the Kansas City Cardiomyopathy Questionnaire (KCCQ) in 7504 patients (median age, 81 years) undergoing TMVR from 2013 to 2017 at 240 sites in the national Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapy Registry. Health status was poor before TMVR, improved within 30 days (mean KCCQ score increased from 42 to 67 points), and remained stable through 1 year among surviving patients. However, high rates of missing health status data remain a concern for these registry-based studies.
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Previous studies have assessed the association of biomarkers with outcome after acute coronary syndromes (ACSs), but the association of multiple biomarkers with mortality is uncertain. Lindholm and coauthors evaluated 17 095 patients enrolled in the biomarker substudy of the Platelet Inhibition and Patient Outcomes trial in which 6 biomarkers reflecting different physiological processes were studied in relation to mortality. N-terminal pro-B-type natriuretic peptide and growth differentiation factor-15 were associated with all-cause mortality and sudden death, while N-terminal pro-B-type natriuretic peptide, C-reactive protein, growth differentiation factor-15, and cystatin C were associated with heart failure mortality. In an Editorial, Gaggin and Januzzi emphasize that continued analyses of patient heterogeneity in response to therapy is an important first step toward more personalized patient care using biomarkers.
Editorial
Racial/ethnic differences in the use of oral anticoagulants, particularly direct-acting oral anticoagulants (DOACs), in patients with atrial fibrillation (AF) are uncertain. Essien and coauthors assess anticoagulant use in patients with AF enrolled in the Outcomes Registry for Better Informed Treatment of Atrial Fibrillation II, including 11 100 white individuals, 646 black individuals, and 671 Hispanic individuals. Black individuals were less likely to receive any oral anticoagulant than white individuals and less likely to receive DOACs if anticoagulants were prescribed; after controlling for socioeconomic factors, use of DOACS remained significantly lower in black individuals. There was no difference in anticoagulant use between white and Hispanic individuals, but both black and Hispanic individuals treated with DOACS were less likely to receive appropriate dosing than white individuals.
Editor’s Note
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Guidelines recommend patient engagement in treatment decisions but do not describe how best to most effectively communicate atherosclerotic cardiovascular disease (ASCVD) risk. Navar and coauthors enlisted 2708 participants from the Patient and Provider Assessment of Lipid Management Registry. Participants were more likely to consider risk “high to very high” and were more willing to undergo treatment when shown lifetime ASCVD risk than when presented with either 10-year ASCVD risk or cardiovascular death risk. Participants shown a bar graph or no graphic had higher perceptions of disease severity and higher willingness to consider therapy than those shown risk information with a pictogram. These findings were robust across demographic and socioeconomic subgroups.