March 28, 2023

Benefit of apixaban was seen across all TTR. Longer detection interval in ICD had fewer inappropriate shocks. Fish oil and secondary prevention.

Well this week’s cardiology countdown we’ll talk about atrial fibrillation and anticoagulation also what’s the appropriate programming for icds and fish oil a big new study published in the new england journal so to begin with we have a sub analysis of the aristotle trial that looked at the new anticoagulant apixaban factor 10a inhibitor is compared with warfarin

In patients with nonvalvular atrial fibrillation and this analysis compared the benefit seen with a pic seban over warfarin based on the time and therapeutic range or a ttr of warfarin with the idea of exploring whether there’s still a benefit when warfarin is well adjusted and the patient spends a lot of time in the therapeutic range so they found consistent

Benefit with reductions in stroke or systemic embolism in mortality and in major bleeding that were not different across the different ttr groups so they split the patients into quartiles by how well the center did looking at all of that centers time and therapeutic range in the warfarin group or in individual patients and had very similar results showing a benefit

Again with reductions in each of those three major endpoints and so these data with similar results from other trials reaffirm the fact that it’s really a benefit of the new agents to see improvements over warfarin in this case both on the clotting and the bleeding side next up is an analysis of a randomized trial called advanced three that looked at how long the

Detection interval should be in an icd program with either anti tachycardic pacing or defibrillation and a slightly longer detection interval was compared to the standard and in this case in nineteen hundred patients had an improvement in the number of inappropriate shocks that were delivered with a reduction almost in half it went from eleven point six percent

Per 100 patient-years down to 5.1 percent inappropriate shocks fortunately the appropriate shocks were were on par and so overall mortality and syncope and an arrhythmia were not different and so it looks like this may become a new approach to program the icd device in the number one pick this week is a study published in the journal another large trial looking

At fish oil this was done in italy in a general practice population looking at patients who had atherosclerosis or myocardial infarction use one gram of fish oil versus placebo that was olive oil and looked at cardiovascular death of my stroke or cardiac rehabilitation and found absolutely no benefit over a five-year period on that primary composite or any of the

Components of the of the second of the primary endpoint and and other secondary endpoints and so this had been an area where early on there was the gist preven seoni also from italy that had shown benefit of one gram of fish oil the jealous trial looking at a higher dose also showed a benefit but then more recently in the origin trial in diabetics and now in this

Study the risk and prevention study collaborative group really no benefit scene of fish oil there continued to be epidemiologic studies suggesting benefit of eating fish and and that still is likely recommended in our guidelines but adding fish oil appears not to be as great a benefit as we had thought so for this week’s cardiology countdown scanner you

Transcribed from video
Cardiology Countdown | ARISTOTLE, ADVANCE III and Fish Oil By American College of Cardiology