Cardiology Digest podcast: Episode #8

Study #1

First, we have the Amiodarone Enigma: An observational study in the Annals of Internal Medicine has brought up some concerns regarding the use of amiodarone in patients with heart failure, coronary disease, and renal failure. But is everything as it seems? Dive into the nuances of this study with us, as we explore whether the observed excess bleeding is truly due to the drug, or the elevated bleeding risk in these patients. Is it time to change our practice, or do we need more compelling evidence?

"The team compared bleeding-related hospitalizations in patients taking amiodarone with those taking other antiarrhythmic drugs, namely flecainide or sotalol. Their sample? A whopping 91 590 patients."

Ray, WA, Chung, CP, and Stein, CM. 2023. Risk for bleeding-related hospitalizations during use of amiodarone with apixaban or rivaroxaban in patients with atrial fibrillation: A retrospective cohort study. Ann Intern Med. 6: 769–778. (https://doi.org/10.7326/M22-3238)

Study #2

Second, we re-evaluate aspirin for older patients, thanks to the ASPREE study that was recently published in JAMA Network Open. It looks like it’s time to reassess our recommendations and consider whether we’re truly informed about the pros and cons of aspirin as a risk-reduction strategy.

"Over the years, the initial enthusiasm for aspirin's preventive properties has waned. A significant contributor to this shift in perspective was the Aspirin in Reducing Events in the Elderly (ASPREE) study."

Cloud, GC, Williamson, JD, Thao, LTP, et al. 2023. Low-dose aspirin and the risk of stroke and intracerebral bleeding in healthy older people: Secondary analysis of a randomized clinical trial. JAMA Netw Open. 7: e2325803. (https://doi.org/10.1001/jamanetworkopen.2023.25803)

Study #3

Lastly, we find out if there are health benefits to being a “weekend warrior”. Have you ever had patients question the health benefits of their active weekends? This study from JAMA sheds light on the potential importance of exceeding the 150-minute weekly threshold of moderate-to-vigorous physical activity. But just how beneficial is it? Tune in to find out!

"Roughly 40% fell into the "weekend warrior" category, cramming at least half of their 150 minutes of exercise per week into just 1 or 2 days. About 25% were regular exercisers, spreading their activity throughout the week, while the remaining 35% were largely inactive, not hitting the 150-minute mark."

Khurshid, S, Al-Alusi, MA, Churchill, TW, et al. 2023. Accelerometer-derived “weekend warrior” physical activity and incident cardiovascular disease. JAMA.  3: 247–252. (https://doi.org/10.1001/jama.2023.10875)

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