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Update from the AHA 2010

Update from the AHA 2010. Jonathan Silberberg February 2011. Part 1. Trials. Rocket-AF Closure I Emphasis-HF SMART Fish oil and AF Symplicity -HTN 2. Rocket-AF. Trial of rivaroxiban in AF oral Factor Xa inhibitor Half life 5-12 hours, given once daily

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Update from the AHA 2010

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  1. Update from the AHA 2010 Jonathan Silberberg February 2011

  2. Part 1. Trials • Rocket-AF • Closure I • Emphasis-HF • SMART • Fish oil and AF • Symplicity-HTN 2

  3. Rocket-AF • Trial of rivaroxiban in AF • oral Factor Xa inhibitor • Half life 5-12 hours, given once daily • Dose reduction in renal failure

  4. Rocket-AF • High CHAD-2 score ~3.5 ave • 90% >3, cf. previous trials ~2.0 • 55% prior stroke • 63% heart failure, 40% diabetes • N=14,171

  5. Rocket-AF • warfarin-treated target INR 2-3 • Median time in range 58% • Over range12% • Under range 20% • Up to 40 months followup

  6. Rocket-AF Patients were already stable on warfarin before randomisation

  7. conclusions • Warfarin monitoring is suboptimal even in well-funded trials • Under-anticoagulation protects against bleeding; more consistent treatment brings higher bleeding rates • Absolute stroke rates may be overestimated • Benefits of treatment are small

  8. StarFlex Closure I • N=909 • Age 18 to 60 • Cryptogenic stroke and PFO • Open label • ASA or WarfarinvsStarFlex with ASA/clopidogrel

  9. StarFlex Closure I PFO is usually incidental to stroke

  10. Emphasis-1 • Eplerenone in mild heart failure • N=2737, average 5 years CHF • EF <35%; NYHA class II • 65% coronary disease • median 21 mo followup

  11. Emphasis-1

  12. Absolute 15.5% vs 12.5% NNT 33 for 3 years

  13. EMPHASIS-1

  14. SMART • A-V delay in CRT (biventricular pacing) • N=980, CHF with mean EF 24% • Empirical 120 msecvs • H’dynamic max dP/dtvs • Supine echo algorithm

  15. Fish oil and AF • N=542 paroxysmal AF • N=121 persistent AF • 4g omega-3 vs placebo • 24 weeks

  16. Fish oil and AF Participants were at least 18 years old and had a confirmed diagnosis of either symptomatic paroxysmal AF that had never been treated by long-term pharmacological or electrical therapy to terminate an AF episode or had a diagnosis of symptomatic persistent AF, defined as AF that had been previously successfully treated with pharmacological or electrical cardioversion at least 1 time and were currently in normal sinus rhythm.

  17. Fish oil and AF Inclusion required at least 1 suspected or documented episode of symptomatic AF within 3 months of screening and at least 1 electrocardiographically documented episode of symptomatic AF within 12 months of screening.

  18. Symplicity-HTN 2 Ardian device renal denervation SBP >160 despite 3 drugs Omron automatic oscillometry home and office BP 84/190 fell <160 during run-in

  19. Next week...part 2 • Cardiac hypertrophy • Decompensated heart failure • Brown & Goldstein • PHT in heart failure • LDL cholesterol • Thoracic aorta

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