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Audio Summary
doi : 10.1016/S0735-1097(21)08089-X
Volume 78, Issue 25, 21–28 December 2021, Page e315
Contents
doi : 10.1016/S0735-1097(21)08091-8
Volume 78, Issue 25, 21–28 December 2021, Pages e317-e320
Randomized Trial of Metoprolol in Patients With Obstructive Hypertrophic Cardiomyopathy
Anne M.DybroMDabTorsten B.RasmussenMD, PhDabRoni R.NielsenMD, PhDabMads J.AndersenMD, PhDaMorten K.JensenMD, PhDaSteen H.PoulsenMD, DMSciab
doi : 10.1016/j.jacc.2021.07.065
Volume 78, Issue 25, 21–28 December 2021, Pages 2505-2517
The use of ?-adrenergic receptor blocking agents in symptomatic patients with obstructive hypertrophic cardiomyopathy (HCM) rests on clinical experience and observational cohort studies.
Effect of Mavacamten on Echocardiographic Features in Symptomatic Patients With Obstructive Hypertrophic Cardiomyopathy
Sheila M.HegdeMDaSteven J.LesterMDbScott D.SolomonMDaMichelleMichelsMDcPerry M.ElliottMDdSherif F.NaguehMDeLubnaChoudhuryMDfDavidZemanekMDgDonna R.ZwasMD, MPHhDanielJacobyMDiAndrewWangMDjCarolyn Y.HoMDaWanyingLiPhDkAmy J.SehnertMDkIacopoOlivottoMDlTheodore P.AbrahamMDm
doi : 10.1016/j.jacc.2021.09.1381
Volume 78, Issue 25, 21–28 December 2021, Pages 2518-2532
EXPLORER-HCM (Clinical Study to Evaluate Mavacamten [MYK-461] in Adults With Symptomatic Obstructive Hypertrophic Cardiomyopathy) demonstrated that mavacamten, a cardiac myosin inhibitor, improves symptoms, exercise capacity, and left ventricular outflow tract (LVOT) obstruction in patients with obstructive hypertrophic cardiomyopathy (oHCM).
A New Dawn in HCM: Rise of the RCTs?
AhmadMasriMD, MS
doi : 10.1016/j.jacc.2021.10.025
Volume 78, Issue 25, 21–28 December 2021, Pages 2533-2536
Characterization of Primary Mitral Regurgitation With Flail Leaflet and/or Wall-Impinging Flow
SethUretskyMDaDonna Chelle V.MoralesMDaLillianAldaiaMDaAnujMedirattaMDaKonstantinosKoulogiannisMDaLeoMarcoffMDaSakulSakulMDaSteven D.WolffMD, PhDbLinda D.GillamMD, MPHa
doi : 10.1016/j.jacc.2021.09.1382
Volume 78, Issue 25, 21–28 December 2021, Pages 2537-2546
Echocardiography guidelines note that a flail leaflet is a specific criterion for severe mitral regurgitation (MR) and that regurgitant severity is underestimated in wall-impinging jets (Coand? effect). Both findings are often considered to be pathognomonic of severe MR.
Not All Flails Are Created Equal?
Dipan J.ShahMDK. CarlosEl-TallawiMD
doi : 10.1016/j.jacc.2021.10.026
Volume 78, Issue 25, 21–28 December 2021, Pages 2547-2549
Early Hospital Discharge Following PCI for Patients With STEMI
Krishnaraj S.RathodPhDabcKatrinaComerBSccOliverCasey-GillmanBSccLizzieMooreBSccGordonMillsBSccGordonFergusonBScSotirisAntoniouMPHARM, MScdRiyazPatelPhDcSadeerFhadilMPHARMdTasleemDamaniMPHARMdPaulWrightMPHARM, MScdMickOzkorMDbcDebashishDasMDbcOliver P.GuttmannMDbcAndreasBaumbachMDabcR. AndrewArchboldMDbcAndrewWraggPhDbcAjay K.JainMDbcFizzah A.ChoudryPhDabcAnthonyMathurPhDabcDaniel A.JonesPhDabc
doi : 10.1016/j.jacc.2021.09.1379
Volume 78, Issue 25, 21–28 December 2021, Pages 2550-2560
Regional heart attack services have improved clinical outcomes following ST-segment elevation myocardial infarction (STEMI) by facilitating early reperfusion by primary percutaneous coronary intervention (PCI). Early discharge after primary PCI is welcomed by patients and increases efficiency of health care.
Early Discharge After ST-Segment Elevation Myocardial Infarction: The Days Are Getting Shorter!?
Cindy L.GrinesMDJ. JeffreyMarshallMD
doi : 10.1016/j.jacc.2021.10.019
Volume 78, Issue 25, 21–28 December 2021, Pages 2561-2562
Racial and Ethnic Considerations in Patients With Atrial Fibrillation: JACC Focus Seminar 5/9
Faye L.NorbyPhD, MPHaEmelia J.BenjaminMD, ScMbcAlvaroAlonsoMD, PhDdSumeet S.ChughMDa
doi : 10.1016/j.jacc.2021.04.110
Volume 78, Issue 25, 21–28 December 2021, Pages 2563-2572
Atrial fibrillation (AF) affects at least 60 million individuals globally and is associated with substantial impacts on morbidity, mortality, and health care expenditures. This review focuses on how race and ethnicity influence AF epidemiology, risk prediction, treatment, and outcomes; knowledge gaps in these areas are identified. Most AF studies have predominantly included White populations, with an underrepresentation of racial and ethnic groups, including but not limited to Black, Hispanic, and Indigenous individuals. Enhancement and implementation of AF risk prediction, prevention, and management call for studies that will gather accurate race-based epidemiologic data and evaluate social determinants and genetic factors in the context of multiple races and ethnicities. Available studies highlight inequities in access to treatment as well as outcomes between White individuals and persons of other races/ethnicities. These inequities will need to be addressed by a renewed emphasis on structural and social determinants of health that contribute to AF.
Associations of Race and Ethnicity With Presentation and Outcomes of Hypertrophic Cardiomyopathy: JACC Focus Seminar 6/9
Ntobeko A.B.NtusiMBChB, DPhil, MDabcdKarenSliwaMD, PhDab
doi : 10.1016/j.jacc.2021.10.020
Volume 78, Issue 25, 21–28 December 2021, Pages 2573-2579
Significant racial and ethnicity-based disparities in clinical presentation, management, and outcome of hypertrophic cardiomyopathy (HCM) are reported. Black patients with HCM are more likely to present with heart failure but are less commonly referred for symptom management, sudden cardiac death stratification, surgical septal myectomy, or for implantable cardioverter-defibrillators, all interventions that increase survival. Prevalence of bystander cardiopulmonary resuscitation is lower for Black patients than for White patients. Black patients with HCM have decreased survival after hospital discharge following out-of-hospital cardiac arrest. Biomedical and social interventions are urgently needed to reduce ethnicity-based disparities, which have an impact on outcomes in HCM and other cardiovascular diseases. There is also a need to focus on implementation science to support durable adoption of evidence-based therapies in Black patients and communities.
Impact of Racial and Ethnic Disparities on Patients With Dilated Cardiomyopathy: JACC Focus Seminar 7/9
Ntobeko A.B.NtusiMBChB, DPhil, MDabcdKarenSliwaMD, PhDab
doi : 10.1016/j.jacc.2021.10.021
Volume 78, Issue 25, 21–28 December 2021, Pages 2580-2588
Significant race- and ethnicity-based disparities among those diagnosed with dilated cardiomyopathy (DCM) exist and are deeply rooted in the history of many societies. The role of social determinants of racial disparities, including racism and bias, is often overlooked in cardiology. DCM incidence is higher in Black subjects; survival and other outcome measures are worse in Black patients with DCM, with fewer referrals for transplantation. DCM in Black patients is underrecognized and under-referred for effective therapies, a consequence of a complex interplay of social and socioeconomic factors. Strategies to manage social determinants of health must be multifaceted and consider changes in policy to expand access to equitable care; provision of insurance, education, and housing; and addressing racism and bias in health care workers. There is an urgent need to prioritize a social justice approach to health care and the pursuit of health equity to eliminate race and other disparities in the management of cardiovascular disease.
Race and Ethnicity in Heart Failure: JACC Focus Seminar 8/9
Ileana L.PiñaMD, MPHaShirinJimenezMDbEldrin F.LewisMD, MPHbAlanna A.MorrisMD, MSccAnekweOnwuanyiMDdEdliraTamDO, MSeHector O.VenturaMDf
doi : 10.1016/j.jacc.2021.06.058
Volume 78, Issue 25, 21–28 December 2021, Pages 2589-2598
Heart failure (HF) affects >6 million Americans, with variations in incidence, prevalence, and clinical outcomes by race/ethnicity. Black adults have the highest risk for HF, with earlier age of onset and the highest risk of death and hospitalizations. The risk of hospitalizations for Hispanic patients is higher than White patients. Data on HF in Asian individuals are more limited. However, the higher burden of traditional cardiovascular risk factors, particularly among South Asian adults, is associated with increased risk of HF. The role of environmental, socioeconomic, and other social determinants of health, more likely for Black and Hispanic patients, are increasingly recognized as independent risk factors for HF and worse outcomes. Structural racism and implicit bias are drivers of health care disparities in the United States. This paper will review the clinical, physiological, and social determinants of HF risk, unique for race/ethnic minorities, and offer solutions to address systems of inequality that need to be recognized and dismantled/eradicated.
Increasing Equity While Improving the Quality of Care: JACC Focus Seminar 9/9
Eric C.SchneiderMD, MScaMarshall H.ChinMD, MPHbGarth N.GrahamMD, MPHcLennyLopezMD, MDiv, MPHdShirleneObuobiMDeThomas D.SequistMD, MPHfElizabeth A.McGlynnPhDg
doi : 10.1016/j.jacc.2021.06.057
Volume 78, Issue 25, 21–28 December 2021, Pages 2599-2611
This review summarizes racial and ethnic disparities in the quality of cardiovascular care—a challenge given the fragmented nature of the health care delivery system and measurement. Health equity for all racial and ethnic groups will not be achieved without a substantially different approach to quality measurement and improvement. The authors adapt a tool frequently used in quality improvement work—the driver diagram—to chart likely areas for diagnosing root causes of disparities and developing and testing interventions. This approach prioritizes equity in quality improvement. The authors demonstrate how this approach can be used to create interventions that reduce systemic racism within the institutions and professions that deliver health care; attends more aggressively to social factors related to race and ethnicity that affect health outcomes; and examines how hospitals, health systems, and insurers can generate effective partnerships with the communities they serve to achieve equitable cardiovascular outcomes.
Do Elderly Patients With Advanced Heart Failure Have Better Outcomes After LVAD?
EduardRodenas-AlesinaMDFilioBilliaMD, PhDVivekRaoMD, PhDHeather J.RossMD, MHScNatashaAleksovaMD
doi : 10.1016/j.jacc.2021.09.1373
Volume 78, Issue 25, 21–28 December 2021, Page e321
Reply: Do Elderly Patients With Advanced Heart Failure Have Better Outcomes After LVAD?
DominicEmersonMDJoannaChikweMDPedroCatarinoMDJonKobashigawaMDJames K.KirklinMD
doi : 10.1016/j.jacc.2021.10.017
Volume 78, Issue 25, 21–28 December 2021, Page e323
The Fallacy of OTC Statin Therapy
MaryanneDemasiPhDRobertDuBroffMD
doi : 10.1016/j.jacc.2021.09.1380
Volume 78, Issue 25, 21–28 December 2021, Page e325
Reply: The Fallacy of OTC Statin Therapy
Steven E.NissenMD
doi : 10.1016/j.jacc.2021.10.024
Volume 78, Issue 25, 21–28 December 2021, Page e327
