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Surgical Management of Infective Endocarditis

SOURCES: Chu VH, et al. Association between surgical indications, operative risk, and clinical outcome in infective endocarditis: A prospective study from the international collaboration on endocarditis. Circulation 2015;131:131-140; Erbel R. The new strategy in infective endocarditis: Early surgery based on early diagnosis: Are we too late when early surgery is best? Circulation 2015;131:121-123.

A New Oral Treatment for Hyperkalemia: Patiromer

Patiromer (PAT) is an oral non-absorbable polymer that works by binding potassium (K+) in exchange for calcium in the distal colon. Currently available oral treatments for hyperkalemia are burdened by GI adverse effects as well as limited efficacy. Hyperkalemia is particularly problematic in chronic kidney disease (CKD), which may be compounded by the need to administer ACE inhibitors or angiotensin II receptor blockers (ARB).

Ambulatory BP Monitoring

The benefits of hypertension treatment (HTN), often cited as a 25% reduction in myocardial infarction, 40% reduction in stroke, and 50% reduction in heart failure, have generally been demonstrated in clinical trials based on an office blood pressure measurement. Since a substantial minority of patients enrolled in HTN trials — approximately one-third according to numerous estimates — ultimately turn out to have white coat HTN (wc-HTN), we may be underestimating the actual benefits of HTN treatment. Patients with wc-HTN do not suffer the same increased risk of cardiovascular events as HTN patients; hence, their inclusion in HTN trials “dilutes” treatment effects.

Bridging During Anticoagulation Interruptions Is Associated with Worse Outcomes

Despite the routine nature of discontinuing atrial fibrillation (AF) patients’ long-term oral anticoagulation (OAC) for procedures and “bridging” them with another agent, there is remarkably little data on the safety and benefit of this practice. Guidelines detailing when and how to initiate bridging therapy have been published, but data supporting why we should bridge at all are limited.¹ To help fill this void, Steinberg and colleagues used a national, community-based registry of outpatients with AF (ORBIT-AF) to examine current practices around periprocedural OAC management and associated outcomes. Outcomes evaluated included rates of major bleeding, as well as myocardial infarction, stroke or systemic embolism, cause-specific hospitalization, and death within 30 days.

Intravenous Fluids in Patients With Acute Heart Failure

MONOGRAPH: Volume overload is a hallmark of acute heart failure. In hospitalized patients, intravenous loop diuretics are the most common treatment for decongestion.

Drug Interactions and the Medical Home

MONOGRAPH: Drug-to-drug interactions are a concern of increasing significance at all levels of health care.

Medicaid is making an impressive impact

The year 2015 is shaping up to be another big one for the joint federal-state Medicaid program. It is the second year of the Affordable Care Act’s (ACA’s) broad expansion of Medicaid to individuals below 138% of the federal poverty level. Medicaid enrollment surged in 2014, which helped to drive down uninsurance nationwide. By October 2014, 68.5 million individuals were enrolled in Medicaid, an increase of 9.7 million, or 17%, from the average monthly enrollment in July to that of September 2013.¹That enrollment is in addition to the 950,000-person increase in enrollment among six states and the District of Columbia that had chosen to expand Medicaid prior to 2014.

Research eyes noninvasive test for endometriosis

Endometriosis is a common health problem for women. An estimated 11% of U.S. women have the gynecologic disorder, which happens when the lining of the uterus grows outside of the uterus.¹ In women with endometriosis, when the endometrial tissue enters the abdominal cavity, it attaches to organs in the abdominal and pelvic cavities, such as the ovaries, the intestines, or other organs or tissues. This tissue continues to follow the monthly menstrual cycle, and the resulting bleeding can cause inflammation, scarring, and pain. It is prevalent in 38% of infertile women and in 71-87% of women with chronic pelvic pain.²

Boost HPV vaccine uptake in university settings

While public health officials advocate for vaccination against human papillomavirus (HPV) in girls and boys ages 11-12, they also call for vaccination of young women ages 13-26 and males ages 13-21 who have not been previously vaccinated or did not complete the three-dose series.

It’s time for a tiered approach to counseling on emergency contraception

A recently published commentary calls for changes in patient counseling for emergency contraception (EC).¹ Why? Typical counseling does not take into account the relative effectiveness of available methods or patient characteristics, it asserts.