A study found that hospital adherence with six evidence-based guidelines for treatment of MI declined based on age, gender, congestive heart failure, atrial fibrillation, chronic renal insufficiency and chronic dialysis.

Many years from now we may look back at a three-page perspectives article and say: Of course, it is so obvious. But just as the campaign to reduce inhospital infections by integrating hand-washing protocols into caregivers’ practice required time to grow from idea to action, a hypothesis proposed in this week’s New England Journal of Medicine by Yale cardiologist Harlan M. Krumholz may be decades away from reducing hospital readmissions.

Hospital readmissions appear to be an intractable problem, despite efforts to curb rates using interventions, penalties and other strategies. Perhaps providers and public policy leaders are focusing on the wrong target, Harlan M. Krumholz, MD, told Cardiovascular Business. His hypothesis was published Jan. 10 in the New England Journal of Medicine.

Subcutaneous implantable cardioverter-defibrillators (S-ICDs) have the potential to become a breakthrough therapy, according to Robert G. Hauser, MD. But until the technology proves its mettle against its transvenous cousins, it should be limited to a select group of patients, he wrote in the Jan. 8 issue of the Journal of the American College of Cardiology.

The most common adverse effects associated with transcatheter aortic valve replacement (TAVR) are heart block, vascular complications and renal failure. However, Prateek J. Khatri, MD, lead author of the study, told Cardiovascular Business that the CoreValve had a complication rate of 25 percent, compared with 5 percent with the Sapien valve, for the most common complication of heart block, despite a newer-generation CoreValve device used the majority of the time.

Although rates of aldosterone antagonist use are increasing slightly over time, the vast majority of acute MI patients eligible for treatment fail to receive it at hospital discharge. The study authors wrote that the reason for this discrepancy between guideline-based therapy and actual prescribing patterns is unclear and should be further studied.

Endovascular repair of the thoracic aorta appears to offer good protection from aortic-related mortality in patients with aneurysm or dissection, according to a study published Jan. 1 in Circulation. But the high rate of nonaortic-related deaths suggests that more attention needs to be paid to modifiable risk factors in aneurysm patients, according to researchers, while the authors of an accompanying editorial questioned whether aneurysm patients should be treated in the first place.

In STEMI patients, the transradial approach to PCI results in fewer episodes of bleeding and lower risk of in-hospital mortality than femoral access PCI, despite a longer door-to-balloon time, according to a recent observational study by Dmitri V. Baklanov, MD, of Saint Luke’s Mid-America Heart Institute in Kansas City, Mo., and colleagues.