In the end it wasn’t wisdom for the ages. The American College of Cardiology said today that it was withdrawing one of its five recommendations in the “Choosing Wisely” campaign. In 2012 the ACC recommended that heart attack patients should have only their culprit artery unblocked. It said that patients and caregivers should question whether complete revascularization of all…
Why Guidelines Should Be Waged Like War
August 22, 2014 by 1 Comment
(Updated) Here’s a modest proposal: we need fewer and shorter guidelines. In fact, I’d like to propose that guidelines, like war, should be waged only when there is absolute consensus and overwhelming evidence. Anyone interested in the subject is aware that guidelines are in a complete mess. Just in the past two weeks I’ve written about…
An Old Study Fuels Debate Over Blood Pressure Guidelines
August 18, 2014 by Leave a Comment
In the last year new guidelines relating to cardiovascular disease have been the subject of intense criticism and debate. The status of the blood pressure guidelines has been particularly contentious, since several different groups have published contradictory guidelines, while several authors of the most prominent group, the Eighth Joint National Committee, published an impassioned dissent…
An Expert’s Perspective: Why Salt Is Not Like Tobacco And Why Guidelines Are Tricky
August 14, 2014 by Leave a Comment
Updated August 15– At the center of this week’s renewed debate on salt was Salim Yusuf, the long influential and occasionally controversial cardiology researcher and clinical trialist based at McMaster University in Hamilton, Ontario. I spoke with Yusuf before the publication of the New England Journal of Medicine papers, which include his own two papers from the PURE study….
New Studies Fuel The Debate Over Sodium
August 13, 2014 by Leave a Comment
Three papers and an editorial in the New England Journal of Medicine are sure to throw fresh fuel on the ongoing fiery debate over sodium recommendations. Current guidelines recommend that people should limit their intake of sodium to 1.5 to 2.4 grams per day, but these recommendations are based on projections and have never been tested in clinical…
Guideline Critics Shift Attacks From Beta Blockers To Statins
August 1, 2014 by Leave a Comment
With the release today of updated European and US guidelines the ongoing controversy regarding beta-blockers appears to be resolved. But that doesn’t necessarily mean there will be an outbreak of guideline peace and harmony. The critics who helped ignite the controversy over beta blockers now say new statin recommendations contained in the guidelines are based on deeply flawed evidence….
Dutch Investigation Finds Serious Flaws In Influential New England Journal Of Medicine Study
July 30, 2014 by Leave a Comment
Erasmus Medical Center says it has wrapped up its investigation of Don Poldermans, the disgraced cardiology researcher who was fired for research misconduct. The full extent of the misconduct has never been known, and from an examination of the Erasmus report it appears likely that it never will be known. One major finding– though downplayed in…
Prophylactic ICDs Appear Effective In Less Severe HF Patients
June 3, 2014 by Leave a Comment
ICDs are routinely implanted in heart failure patients with ejection fractions (EFs) of 35% and lower to prevent sudden cardiac death. However, the benefits in patients at the higher end of the spectrum– between 30% and 35%– have not been well demonstrated in clinical trials, since few patients in this range have been enrolled in…
12.8 Million More Adults Now Eligible For Statin Therapy
March 19, 2014 by Leave a Comment
Millions more people are now eligible for statin therapy under the new cholesterol guideline, according to a new estimate published in the New England Journal of Medicine. … There have been many attempts to quantify just how many more people are now eligible for statin therapy under the new guideline. Now in the new paper in NEJM, Michael Pencina…
Heart Societies Issue New Guidelines For Valve Disease
March 3, 2014 by Leave a Comment
The American Heart Association and the American College of Cardiology today released new practice guidelines [PDF] for the management of patients with valvular heart disease (VHD). Among its most notable features, the new document provides a new system of classification for VHD and lowers the threshold for interventions, including, for the first time, transcatheter as…
Minority Report: Five Guideline Authors Reject Change In Blood Pressure Goal
January 13, 2014 by Leave a Comment
It didn’t seem possible but the guideline situation just got even more confusing. Last December, after years of delay and other twists and turns, the Eighth Joint National Committee (JNC 8) hypertension guideline was published in JAMA. The previous guideline recommended that all adults have a target systolic blood pressure below 140 mm Hg. In the new guideline, the target…
Cardiology in 2013: Like A Wrecking Ball
December 26, 2013 by 1 Comment
Perhaps I’m being overdramatic but I think the best metaphor for the year in cardiology is Miley Cyrus on the wrecking ball. The Guidelines Wrecking Ball: Like Hannah Montana guidelines are supposed to be boring and reliable. But in 2013 the guidelines were more like Miley Cyrus. Like a wrecking ball, the NIH abandoned its long-entrenched and highly influential role in producing…
Missing High Blood Pressure Guideline Turns Up In JAMA
December 18, 2013 by Leave a Comment
After years of delay and many twists and turns, the hypertension guideline originally commissioned by the NIH has now finally been published in JAMA. The evidence-based document contains a major revision of hypertension treatment targets and includes new and somewhat simplified recommendations for drug treatment. The previous US hypertension guideline was published more than a decade ago….
Dispatch From The Wild Frontier Of The Statin Wars
December 13, 2013 by Leave a Comment
The long simmering controversy over the relative benefits and harms of statins has heated to a high boil with the release of the new AHA/ACC US guidelines. But nowhere is the battle more intense right now than in Australia where, according to the National Heart Foundation, a TV show may be the cause of 2,000 heart attacks…
After Long Wait, Updated US Cardiovascular Guidelines Now Emphasize Risk Instead Of Targets
November 12, 2013 by 1 Comment
Updated cardiovascular health guidelines were released today by the American Heart Association (AHA) and the American College of Cardiology (ACC). The guidelines are designed to provide primary care physicians with evidence-based expert guidance on cholesterol, obesity, risk assessment, and healthy lifestyle. The new guidelines reinforce many of the same messages from previous guidelines, but also…
Observational Study Lends Support to CRT Guidelines
August 13, 2013 by Leave a Comment
A large observational study published in JAMA suggests that patients with left bundle-branch block (LBBB) and longer QRS duration derive the most benefit from a cardiac resynchronization therapy defibrillator (CRT-D). The findings appear to support current, but often criticized, guidelines from the American College of Cardiology, American Heart Association, and the Heart Rhythm Society, in which a class I recommendation…
Hypertension And Cholesterol Guidelines Delayed Again As NHLBI Gets Out Of The Guidelines Business
June 19, 2013 by Leave a Comment
The National Heart, Lung, and Blood Institute (NHLBI) will no longer issue guidelines, including the much-delayed and much-anticipated hypertension (JNC 8) and cholesterol (ATP IV) guidelines. Instead, the NHLBI will perform systematic evidence reviews that other organizations, including the American Heart Association and the American College of Cardiology, will use as a resource for their own guidelines….
New Guidelines Define State-of-the-Art STEMI Care
December 17, 2012 by Leave a Comment
New guidelines published online today in Circulation and the Journal of the American College of Cardiology provide an efficient overview of the best treatments for STEMI patients. (Click here to download the PDFs of the full version (64 pages) or the executive summary (27 pages) of the 2013 ACCF/AHA Guideline for the Management of ST-Elevation Myocardial Infarction.) “We’re looking to a future where more…
Comprehensive Guidelines for Stable Ischemic Heart Disease Released
November 19, 2012 by Leave a Comment
New comprehensive guidelines for the diagnosis and treatment of stable ischemic heart disease have been released by the American College of Cardiology (ACC)/American Heart Association (AHA) Task Force on Practice Guidelines, along with the American College of Physicians (ACP), American Association for Thoracic Surgery (AATS), Preventive Cardiovascular Nurses Association (PCNA), Society for Cardiovascular Angiography and…
Screening For AAA Comes Under Renewed Scrutiny And Criticism
September 18, 2012 by Leave a Comment
A 2007 Medicare initiative to increase AAA (abdominal aortic aneurysm) screening in appropriate patients failed to prevent AAA rupture or reduce all-cause mortality, according to a new study published in Archives of Internal Medicine. The larger implications of the study are unclear, but two accompanying papers, an invited commentary and a perspective, emphasize the darker side of…
Updated Rhythm Device Guidelines Clarify And Expand CRT Criteria
September 11, 2012 by Leave a Comment
A newly released update of 2008 guidelines for device-based therapy of cardiac arrhythmias contains some much-needed clarification about indications for cardiac resynchronization therapy (CRT). The document was developed jointly by the American Heart Association, the American College of Cardiology, and the Heart Rhythm Society. Highlights of the documents include: The Class 1 recommendation for CRT…
Guest Post: Children Should Have Their Cholesterol Checked
August 15, 2012 by Leave a Comment
Editor’s Note: CardioBrief is pleased to publish this guest post written by Samuel Gidding, the head of the cardiology division at the Nemours Cardiac Center at A. I. DuPont Hospital for Children and a professor of pediatrics at Jefferson Medical College. CardioBrief invited Gidding, a member of the NHLBI panel that recommended universal lipid screening at ages 9-11…
Industry PR Efforts Influence Debate On Cholesterol Screening Guidelines For Children
August 3, 2012 by 4 Comments
Note: This post is accompanied by a separate guest post by James Stein. What role should industry play in discussions about guidelines, especially when the debate about those guidelines includes allegations that industry may have influenced the final product of the guidelines? Should a public relations agency that represents a company with a product that…
Guest Post: An Electrophysiologist Looks At The New HRS/ACCF Pacemaker Guidelines
August 2, 2012 by Leave a Comment
Editor’s Note: The following guest post is published with the permission of its author, Edward J. Schloss, MD, (Twitter ID @EJSMD) the medical director of cardiac electrophysiology at Christ Hospital in Cincinnati, OH. Overview of the New HRS/ACCF Pacemaker Guidelines by Edward J Schloss MD Since the development of the first dual chamber pacemakers in the 1980s, doctors…
Has COURAGE been vindicated?
January 6, 2009 by Leave a Comment
The ACC, the AHA, and a whole alphabet soup worth of other cardiovascular organizations (SCAI, STS, AATS, ASNC, ASE, HFSA SCCT) have published (or in some cases just endorsed) a report, called the ACCF/SCAI/STS/AATS/AHA/ASNC 2009 Appropriateness Criteria for Coronary Revascularization. The report will probably provide comfort to those who were big supporters of COURAGE. I’m guessing…
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