Cardio Round-Up: Lower Blood Pressure Linked to HF Death; and More

Lower Blood Pressure at Hospital Admission Increases the Risk of Heart Failure Death

In hospitalized patients with heart failure (HF), lower admission systolic blood pressure (SBP) is linked to an increased risk of one-year death and readmission. The results were published in ESC Heart Failure. The researchers conducted a large prospective multicentre cohort study of 4,896 patients hospitalized for HF in 52 hospitals from 20 provinces in China between August 2016 and May 2018. “Lower admission SBP was significantly associated with higher risk of all-cause death and there is no threshold, while such an association with HF readmission was only observed when admission SBP was lower than 120 mmHg,” the researchers concluded.

DOAC Dose Linked to Irregular Plasma Levels in Patients with AFib and Extreme Obesity

A new study found that under-dosing of direct oral anticoagulants (DOACs) in patients with extreme obesity and atrial fibrillation (AFib) predicted out-of-range blood plasma levels after treatment. This study was published in Clinical Therapeutics. The researchers enrolled 58 consecutive patients with concomitant AFib and extreme obesity receiving DOAC therapy who were followed-up at Monaldi Hospital in Naples, Italy. “Patients with extreme obesity and AF who were receiving DOAC therapy had DOAC plasma concentrations in the expected range,” wrote the authors in summary. “The inappropriate DOAC underdosing seems to be the only independent clinical factor associated with a plasma concentration of the drug out of the expected range.”

Coagulation Factor Activity May Be Linked to PAD Complications

Patients with atherosclerotic peripheral arterial disease (PAD) have marked increases in coagulability, defined as coagulation factor activity and hemostatic markers of endothelial dysfunction, according to a new study published in Vascular Specialists International. The investigators prospectively enrolled 120 patients aged ≥40 years with Fontaine stages 2b to 3 PAD. Patients underwent either open surgical (n = 40), endovascular (n = 40), or conservative (n = 40) treatment for PAD. “The activities of intrinsic coagulation factors and hemostatic markers of endothelial dysfunction were increased in patients with advanced atherosclerotic PAD. Invasive treatment, including open or endovascular procedures, promotes further hypercoagulability,” wrote the authors in summary. “Increased activity of coagulation factors and altered levels of hemostatic markers of endothelial dysfunction were associated with PAD complications such as graft thrombosis, myocardial infarction, disease progression, and restenosis.”

Cost Evaluations of PAD Treatments May Be Hindered by Poor Data Reporting

A systematic review of clinical data used in economic evaluations for treatments for peripheral artery disease (PAD) found overall high-quality data; however, the authors reported “concern” regarding the quality of reporting and interpretation of results from this data. This study was published in International Journal of Technology Assessment in Health Care. For this study, the researchers performed a systematic review on health economic evaluation studies on the use of these treatments for PAD. Six studies were included in the final analysis, including four cost-effectiveness analyses and two cost-utility analyses. In conclusion, the authors wrote, “The present study demonstrates that clinical data used in economic evaluations of DCBs and DESs in PAD are from clinical studies of high quality in general. However, the quality of reporting represents a concern when interpreting the results provided by these economic studies.”