April 27th, 2015

Selections from Richard Lehman’s Literature Review: April 27th

CardioExchange is pleased to reprint this selection from Dr. Richard Lehman’s weekly journal review blog at BMJ.com. Selected summaries are relevant to our audience, but we encourage members to engage with the entire blog.

JAMA Intern Med Apr 2015

A Contemporary Appraisal of the Heart Failure Epidemic in Olmsted County, Minnesota, 2000 to 2010 (OL): In a couple of week’s time I’m due to give a talk entitled “Heart Failure and Other Misnomers.” The epidemiology of heart failure is a mass of perplexity. Rule number one is to forget the systolic ejection fraction and go by clinical criteria like those from Framingham. The EF may help align your management strategy with the clinical trials (usually very inaccurately), but you will then ignore at least half of the patients who have the clinical syndrome. Let me shut up now and commend the Olmsted County cohort to your attention. Between 1 January 2000, and 31 December 2010, the age—and sex—adjusted incidence of HF declined by 37.5%. Do you hear this shouted with joy by every cardiologist in the land? No, because they are all Jeremiahs, or rather Jonahs, like the Old Testament prophet who went into a sulk when his preaching succeeded so well that God didn’t have to smite the people of Nineveh. But the people who got heart failure in Olmstead continued to die at the same rate. Why? Because heart failure is a signal for the gradual approach of death, and our treatments for it, though numerous, are largely futile in the elderly. We fail to switch our humanity on and address it as a form of dying. We are incentivized to pile on drugs and monitor everything by the day. Personally I would prefer to die with less molestation and more kindness, accepting mortality as inevitable and wishing for an honourable truce rather than a pointless battle. And in fact most of these patients, though they died as surely as in the past, ended up with something other than “heart failure” as their primary cause of death.

Lancet Apr 14 2015

Ex-Vivo Perfusion of Donor Hearts for Human Heart Transplantation (OL): I prefer the title of another editorial on the website: “Donor heart preservation: straight up, or on the rocks?” As you might have guessed, it’s about a study of donor hearts flown in on ice versus fresh local hearts. The chilled ones can work very nicely if carefully prepared. Oh, and could I have a twist of lemon with mine, please.



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