TLDR;
This podcast episode covers a range of cardiology-related topics, including listener feedback on DNR orders, public preferences for statin therapy, updates on GLP-1 drugs, the relationship between spontaneous echo contrast and outcomes after left atrial appendage closure, and cautionary notes on PFA AF ablation.
- Discussion on the complexities of DNR orders and the importance of clear communication and patient-centered care.
- Analysis of a study on public preferences for statin therapy, highlighting the discrepancy between patient and specialist perspectives.
- Updates on GLP-1 drugs, including a new trial testing semaglutide as an antiarrhythmic drug.
- Examination of a Japanese registry study on left atrial appendage closure, revealing the association between spontaneous echo contrast and adverse outcomes.
- Cautionary notes on PFA AF ablation, including concerns about its superiority over thermal ablation, potential for myocardial damage, and cost.
Introduction [0:00]
John Mandola from the heart.org Medscape Cardiology introduces the topics for this week's podcast, which include listener feedback on CPR and DNR orders, patient preferences for statins, updates on GLP1 drugs, a left atrial appendage closure story, and cautionary notes on PFA AF ablation.
Listener Feedback on DNR Orders [0:44]
Dr. Tammy Peg, a New Zealand cardiologist, shares her perspective on DNR orders, emphasizing that CPR should be viewed as a medical intervention with benefit-risk considerations for the clinical team. She suggests updating DNR orders to "do not attempt CPR" to avoid restricting other resuscitative measures in the peri-arrest period. Dr. Peg also highlights the importance of clear communication with patients about CPR, especially those with advanced cancer, and provides a link to a helpful YouTube video on the topic.
Public Preferences for Statin Therapy [5:23]
A research letter from JAMAMA Internal Medicine discusses public preferences for statin therapy, revealing that many individuals are unwilling to take statins even with significant risk reduction. The study, which surveyed US and Japanese adults, found that the smallest worthwhile difference (SWD) in risk reduction was often much larger than the actual risk reduction provided by statins. The findings suggest a discrepancy between patient and specialist perspectives on statin therapy, highlighting the need for better communication and shared decision-making.
GLP1 News [11:36]
The Lancet published the Lily-sponsored achieve three trial, comparing the efficacy and safety of orphoglyphron, a new GLP1 drug, against oral semaglutide in patients with type 2 diabetes. Orphoglyphron demonstrated non-inferiority and superiority in reducing hemoglobin A1C and also resulted in greater weight loss compared to semaglutide, but with more GI side effects and a slight increase in heart rate. Additionally, a new trial called the seminal AF trial is testing whether semaglutide can be an antiarrhythmic drug, with the primary endpoint being time to AIB event.
Left Atrial Appendage Closure Story [15:28]
A Japanese registry study examined the relationship between spontaneous echo contrast and outcomes after left atrial appendage closure with watchman devices. The study found that patients with severe spontaneous echo contrast experienced a greater incidence of ischemic stroke, TIA, systemic embolism, and device-related thrombus (DRT). The authors emphasize that spontaneous echo contrast is a marker of severe atrialopathy, and stroke prevention in atrial fibrillation remains a problem of atrial disease biology. The findings suggest that left atrial appendage closure may not be effective in patients with severe atrial disease, and anti-coagulation may still be necessary.
Concluding Remarks on PFA AF Ablation [23:02]
The speaker shares cautionary notes on PFA AF ablation, highlighting five enthusiasm reducers: lack of superiority over thermal ablation, potential for unthinking myocardial destruction leading to hemolysis and acute kidney injury, reports of late unexplainable sudden cardiac death, high cost, and the possibility of diminishing the thinking part of EP. The speaker also critiques zero floral ablation and concomitant left atrial appendage closure at the time of ablation, questioning the bias of the option trial.
