{"title":"Adherence to pharmacotherapy for secondary prevention of coronary heart disease: A registry-based prospective study","authors":"Aradhai Bana , Krishna Kumar Sharma , Soneil Guptha , Rajeev Gupta","doi":"10.1016/j.ihj.2025.02.009","DOIUrl":"10.1016/j.ihj.2025.02.009","url":null,"abstract":"<div><h3>Background and objective</h3><div>There is limited data on secondary prevention medications following acute coronary syndrome (ACS) in India. We performed a registry-based study to evaluate adherence to recommended medications following ACS hospitalisation.</div></div><div><h3>Methods</h3><div>Consecutive patients admitted with ACS were recruited. Data on demographics, baseline characteristics, in-hospital interventions, and prescribed secondary prevention therapies (antiplatelets, statins, beta-blockers, angiotensin-converting enzyme inhibitors (ACEI), angiotensin receptor blockers (ARB), and calcium channel blockers (CCB) at discharge were recorded. 6-months follow-up was conducted to evaluate adherence using validated tools.</div></div><div><h3>Results</h3><div>716 patients were recruited; the mean age was 60.4 ± 11 years, percutaneous coronary angioplasty (PCI) was performed in 714 (99.7 %) and bypass surgery in none. At hospital discharge, the cardioprotective medications were: aspirin 97.3 %, dual antiplatelets 99.7 %, statins 99.7 %, beta-blockers 74.2 %, ACEI/ARB 38.8 % and CCB 10.9 %. Follow-up data were available for 554 patients; 15 (2.1 %) died and 147 (20.5 %) were lost to follow-up. Medication status and change at 6 months was aspirin 83.9 % (−15.9 %); dual antiplatelets 70.2 % (−29.5 %), statins 70.0 % (−29.8 %), beta-blockers 50.4 % (−32.1 %), ACEI/ARB 22.4 % (−42.3 %) and CCB (−36.7 %) (<em>p</em> < 0.05). Use of high-intensity statins declined from 92.0 % to 45.7 % (−50.3 %). At follow-up, good adherence (>80 %) was 42.7 %, low adherence 24.4 % and non-adherence 10.2 %. Patients with government-sponsored insurance had better adherence than privately insured and self-paying.</div></div><div><h3>Conclusions</h3><div>Following acute coronary syndrome and PCI, the adherence to prescribed pharmacotherapy is sub-optimal at 6 months with a decline in various medications of 16–42 %. Strategies to increase adherence to secondary prevention therapies are required.</div></div>","PeriodicalId":13384,"journal":{"name":"Indian heart journal","volume":"77 2","pages":"Pages 84-88"},"PeriodicalIF":1.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143531399","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Efficacy of Angiotensin Receptor Neprilysin Inhibitor (ARNI) in right ventricular systolic dysfunction and preserved LV ejection fraction: A randomized clinical trial","authors":"Rohit Mathur , Anil Baroopal , Chaina Ram Chaudhary , Afjal Hakim , Manoj Verma","doi":"10.1016/j.ihj.2025.01.002","DOIUrl":"10.1016/j.ihj.2025.01.002","url":null,"abstract":"<div><div>Angiotensin Receptor Neprilysin Inhibitor (ARNI) has not shown to be promising in Heart failure with preserved LVEF. Role of ARNI in Right ventricular systolic dysfunction with preserved LVEF needs to be evaluated. We took 50 patients with isolated RV systolic dysfunction and divided them into two groups of 25 patients each- Conventional treatment and ARNI in addition to conventional treatment. We found that the ARNI group showed a significant improvement in NYHA class, all the echo parameters of RV size, RV function and NT-pro BNP levels at 4 weeks and 12 weeks.</div></div>","PeriodicalId":13384,"journal":{"name":"Indian heart journal","volume":"77 1","pages":"Pages 42-44"},"PeriodicalIF":1.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142983399","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"ANti-Thrombotic strAtegy for the management of nonocclusive thRombus with ST-segment elevation myocardial infarCtion in young pAtients – ANTARTICA study","authors":"Pankaj Jariwala , Arshad Punjani , Harikishan Boorugu , Dilip Gude , Anusha Jariwala","doi":"10.1016/j.ihj.2024.12.003","DOIUrl":"10.1016/j.ihj.2024.12.003","url":null,"abstract":"<div><h3>Introduction</h3><div>Various cardiovascular thrombo-embolic clinical entities use combined ATS for prevention and treatment. After PCI, AF patients are typically prescribed DOAC, DAPT/SAPT, as component of ATS to minimize stroke risk and treat pulmonary embolism and venous thromboembolism. Some small observational studies have shown that a combined ATS can clear small thrombi in LV dysfunction and/or apical aneurysms. Therefore, we present a practical, cost-effective, and proof-of-concept ATS for non-occlusive significant coronary thrombus in young, clinically stable STEMI patients based on the aforementioned experiences.</div></div><div><h3>Methods</h3><div>We retrospectively reviewed 145 stable STEMI cases with nonocclusive thrombus and thrombolysis in myocardial infarction flow 2/3 who received dabigatran and clopidogrel (<strong>ATS arm</strong>). They were compared to 147 comparable patients who received standard-of-care PCI (<strong>Control arm</strong>). At presentation and 6-months after ATS, NYHA functional class and LVEF were measured in all subjects. All the patients in the ATS arm underwent CT-CAG at 6-months. We examined significant safety outcomes like hemorrhage, reinfarction, and cardiac mortality.</div></div><div><h3>Results</h3><div>The primary angiographic outcome demonstrated complete resolution of the thrombus in all the cases of ATS arm. In the ATS arm, the clinical secondary outcome showed a greater improvement in NYHA class, from 3.53 to 1.07, compared to the control group's 3.6 to 1.49 (<em>p</em> = 0.013). Also, the secondary echocardiographic outcome demonstrated a significant improvement in LVEF from a mean of 45.1 %–49.2 % in the ATS arm vs. 44.0 %–44.9 % in the control arm (<em>p</em> < 0.001). Clinical safety indicated TIMI bleeding and reinfarction reductions. There was no mortality in either arm.</div></div><div><h3>Conclusion</h3><div>Delaying PCI and treating STEMI patients with antithrombotic drugs reduced no-reflow, distal embolization, and intraprocedural thrombotic events. The medical intervention improved myocardial preservation alone.</div></div>","PeriodicalId":13384,"journal":{"name":"Indian heart journal","volume":"77 1","pages":"Pages 14-21"},"PeriodicalIF":1.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142876849","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Clonal hematopoiesis of indeterminate potential and cardiovascular diseases: A review","authors":"Nagendra Boopathy Senguttuvan , Vinodhini Subramanian , Muralidharan TR , Kavitha Sankaranarayanan , Vettriselvi Venkatesan , Thanikachalam Sadagopan","doi":"10.1016/j.ihj.2025.01.006","DOIUrl":"10.1016/j.ihj.2025.01.006","url":null,"abstract":"<div><div>Cardiovascular disease (CVD) is a major driver of mortality and declining health worldwide. Cardiovascular diseases (CVD) is the most common cause of morbidity and mortality globally. Although dyslipidemia, smoking, diabetes, hypertension and obesity are some well-known causes of CVD, the overlapping genetic pathways between other diseases and those affecting cardiovascular health have been overlooked.</div><div>In the past decade, mutations in <em>TET2</em>, <em>DNMT3A</em>, <em>ASXL1</em>, and <em>JAK2</em> are found to cause clonal hematopoiesis of intermediate potential (CHIP), a disease associated with age-related haematological malignancies without the presence of cytopenias or dysplasia. Coronary artery disease, heart failure, aortic stenosis, and arrhythmias have been shown to be associated with the presence of CHIP mutations. Addressing the association between CHIP could significantly reduce residual risk patients with CVD. The link between CHIP and CVD can potentially be addressed through inhibitors of inflammasomes, antagonists in the interleukin pathway, or direct antagonists of CHIP mutations.</div></div>","PeriodicalId":13384,"journal":{"name":"Indian heart journal","volume":"77 1","pages":"Pages 51-57"},"PeriodicalIF":1.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143038256","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Data presentation in industry-sponsored cardiac device trials","authors":"Baskaran Chandrasekar","doi":"10.1016/j.ihj.2025.01.004","DOIUrl":"10.1016/j.ihj.2025.01.004","url":null,"abstract":"<div><div>Industry's influence on clinical trials is well known and extends to various aspects beyond funding, including industry-affiliated authors and industry-affiliated analysts. An area of potential concern is presentation of analyzed data that does not appear favorable to the desired study outcome. Such important data are at times not accorded prominence in discussion. The present article analyses such concerns in data presentation in the landmark trials of two cardiac devices the use of which has increased markedly in recent years (DanGer Shock trial and COAPT trial). It is seen that important data that did not appear favorable to the intended study outcome were relegated mostly to Supplement Section, where they are likely to receive less attention, with little discussion allocated in the text.</div></div>","PeriodicalId":13384,"journal":{"name":"Indian heart journal","volume":"77 1","pages":"Pages 48-50"},"PeriodicalIF":1.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143046436","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Shobhit Piplani , Anastas Kostojchin , Steve Kong , Aakanksha Sharma , Donclair Brown , Vladimir Jelic , Salil Chaturvedi , Vishal Reddy , Katherine Chang Pieri , Ezekiel Akpan , Tamara Simpson , Wenzhen Xiao , Minas Sakellakis , Aayushi Sharma , Priyanshu Jain , Miroslav Radulovic
{"title":"Percutaneous coronary intervention (PCI) in patients of rheumatoid arthritis(RA): A systematic review and meta-analysis","authors":"Shobhit Piplani , Anastas Kostojchin , Steve Kong , Aakanksha Sharma , Donclair Brown , Vladimir Jelic , Salil Chaturvedi , Vishal Reddy , Katherine Chang Pieri , Ezekiel Akpan , Tamara Simpson , Wenzhen Xiao , Minas Sakellakis , Aayushi Sharma , Priyanshu Jain , Miroslav Radulovic","doi":"10.1016/j.ihj.2024.12.002","DOIUrl":"10.1016/j.ihj.2024.12.002","url":null,"abstract":"<div><h3>Aim</h3><div>The present study aims to investigate the outcomes of Percutaneous coronary intervention (PCI) in patients with Rheumatoid arthritis (RA).</div></div><div><h3>Methods</h3><div>A systemic search was conducted from electronic databases (PubMed/Medline, Cochrane Library, and Google Scholar) from inception to 15th September 2023. All statistical analyses were conducted using Review Manager 5.4.1. Studies meeting inclusion criteria were selected. A random-effect model was used when heterogeneity was seen to pool the studies, and the result was reported in the odds ratio (OR) and the corresponding 95 % confidence interval (CI).</div></div><div><h3>Results</h3><div>Eight observational studies were selected to conduct the analysis. A statistically significant increase in major adverse cardiovascular event (MACE) was seen in RA patients after undergoing PCI as compared to the control group (OR = 1.18 (1.16, 1.21); <em>p</em> < 0.00001; I2 = 0 %). There was no significant difference found in the long-term revascularization outcome between the RA and non-RA patients (OR = 1.18 (0.81, 1.71); <em>p</em> = 0.39; I2 = 93 %). Survival rates of all-cause mortality in the long-term outcome were statistically insignificant among the two groups (OR = 1.21 (0.84, 1.74); <em>p</em> = 0.31; I2 = 99 %).</div></div><div><h3>Conclusion</h3><div>Percutaneous coronary intervention is an important intervention to reduce morbidity and mortality but special precautions and attention should be made when it comes to patients with RA. Different precautions such as close monitoring for medication interaction, and tailored post-procedural care are essential in reducing morbidity and mortality.</div></div>","PeriodicalId":13384,"journal":{"name":"Indian heart journal","volume":"77 1","pages":"Pages 7-13"},"PeriodicalIF":1.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142876851","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Impact of sarcoidosis in patients undergoing aortic valve replacement: Insight from nationwide readmission database 2016–2019","authors":"Kunal N. Patel , Suryansh Bajaj , Monil Majmundar , Vidit Majmundar , Ankit Agrawal , Harshvardhan Zala , Rajkumar Doshi , Karandeep Singh , Avleen Kaur , Vyoma N. Patel , Karthik Gonuguntla , Yasar Sattar , Ankur Kalra","doi":"10.1016/j.ihj.2025.01.003","DOIUrl":"10.1016/j.ihj.2025.01.003","url":null,"abstract":"<div><div>It is not well-known if valve replacement outcomes differ in patients with sarcoidosis, especially in aortic valve intervention, where the pressure gradients are physiologically high. In this retrospective study, we included all patients who underwent surgical/transcatheter aortic valve replacement from the Nationwide Readmission Database (2016–2019), and then divided them into those with and without sarcoidosis. Logistic and cox proportional hazard regression models were used. In-hospital mortality, stroke, acute kidney injury, paravalvular leak, 30-day pacemaker implantation, and 30-day heart failure readmission were similar in patients with and without sarcoidosis. Thus, sarcoidosis did not affect the clinical outcomes in patients undergoing aortic valve replacement. Further prospective studies are needed in this patient subgroup to support clinical decision-making.</div></div>","PeriodicalId":13384,"journal":{"name":"Indian heart journal","volume":"77 1","pages":"Pages 45-47"},"PeriodicalIF":1.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143004832","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Comparison of patient radiation exposure in coronary angiography via the trans-radial versus trans-femoral approach","authors":"Venkatesh Gurajala , Charishma Daruru , Kumar Narayanan , L. Sridhar","doi":"10.1016/j.ihj.2025.01.005","DOIUrl":"10.1016/j.ihj.2025.01.005","url":null,"abstract":"<div><h3>Background</h3><div>Cardiac catheterization via the trans-radial approach (TRA) has shown several advantages over the trans-femoral approach (TFA) but with a concern of higher radiation exposure. Considering the growing experience with TRA, this study compares patient's radiation during coronary angiography using TRA versus TFA.</div></div><div><h3>Methods</h3><div>This study included consecutive patients undergoing coronary angiogram over a year at tertiary hospital performed by experienced operators through radial or femoral access. Parameters compared between the two routes included fluoroscopy time (FT), cineangiography time (CT), cini-sequences (CS), and patient radiation exposure quantified by Air Kerma (AK) and Dose Area Product (DAP).</div></div><div><h3>Results</h3><div>A total of 910 patients were studied, with 461 (50.6 %) undergoing coronary angiography (CAG) via TFA and 449 (49.4 %) via TRA. The mean age was similar between the femoral (54.07) and radial groups (53.7) years (<em>p</em> = 0.33), with slightly lesser proportion of males in the femoral group (74.62 % vs 79.73 %; <em>p</em> = 0.06). The mean (SD) DAP and AK were 15.71 (7.05) Gy·cm<sup>2</sup> and 258.3 (99.9) mGy for the femoral group, compared to 20.76 (9.48) Gy·cm<sup>2</sup> and 352.2 (151.5) mGy for the radial group (both <em>p</em> < 0.001). The mean (SD) FT, CT, and CS were 1.32 (0.94) minutes, 40.4 (9) seconds, and 5.93 (1.22) for the femoral group, compared to 2.19 (1.67) minutes, 44 (10) seconds, and 6.17 (1.26) for the radial group (all <em>p</em> < 0.01).</div></div><div><h3>Conclusion</h3><div>Coronary angiography via TRA is associated with increased patient's radiation. Future studies should investigate strategies to reduce radiation exposure in trans-radial procedures.</div></div>","PeriodicalId":13384,"journal":{"name":"Indian heart journal","volume":"77 1","pages":"Pages 28-35"},"PeriodicalIF":1.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143038260","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}