New Study: Blood Thinners May Not Be Needed for Some with AFib

Excellent IPD analysis presented at the AHA regarding Beta-Blockers after Myocardial Infarction with Normal Ejection Fraction - New England Journal of Medicine - needing a little bit of nuance for doctors treating MI patients. “My concern is that the current narrative risks portraying beta-blocker withdrawal as broadly safe, while in fact this is true only for a small subset of carefully selected, low-risk patients. Many others—those with larger infarcts, mild LV dysfunction <50%, incomplete revascularization, or concomitant hypertension—continue to derive clear benefit. In these subgroups, discontinuation could be harmful.” https://lnkd.in/epkQp44k

Internal medicine, pulmonology, and cardiology are specialties at the center of America’s chronic-disease burden — diabetes, COPD, hypertension, obesity, asthma, heart failure, arrhythmias, and more. As patient volume grows and care shifts beyond the clinic walls, three forces are reshaping specialty care: ✅ Telehealth ✅ Remote Patient Monitoring (RPM/RTM) ✅ AI-powered revenue cycle management 📧 info@everestar.com 🌐 Visit: www.everestar.com Blog URL: https://lnkd.in/d5wvV6t6

Remember when physicians had time to listen, and patients had the luxury of telling their story? I do. That was a while ago and it feels like that balance keeps eroding. The science is improving faster than the systems to deliver it. One of the things I’ve always loved about cardiology is that it’s never stagnant. Renal denervation is the latest example — finally a treatment option for hypertension that doesn’t layering more pharmaceuticals. Over the years, we’ve seen so many new drug classes, doses, and combinations. Yet persistent hypertension remains one of the most common diagnoses in every clinic. When a new therapy promises to provide a new fix, it’s exciting — until we start assessing how to deliver it. Each new procedure adds to the workload of physicians who already lack time for patients, families, and themselves. The population base keeps growing but the pipeline of new physicians doesn’t. We’ve already cut visits to 15 minutes — far from ideal for anyone. Is the hope that AI will start rooming patients, turning visits into eight-minute encounters? APPs are incredible assets, but they aren’t physicians and they need support from the physicians. Patients still arrive clothed and have to get through the maze of hallways and doors all the way to one tiny exam room. There’s only so much time we can “optimize.” Progress is essential. But if every innovation adds as much pressure as it does relief, we risk losing the very thing that makes care meaningful — the human connection. What’s next — and how will you make sure patient care still feels like care? #healthcareleadership #cardiology #practiceinnovation https://lnkd.in/gp3JHSHb

Many patients are willing to spend their free time at altitude, generally below 3500 m, but it is unknown whether this is safe. Heart failure (HF) is a syndrome that often presents with relevant comorbidities, such as pulmonary hypertension, COPD, unstable cardiac ischemia, and anemia. These comorbidities alone can make a safe stay at altitude difficult. Exercise at simulated altitude is associated with decreased performance, which is greater in patients with HF than in healthy individuals and even greater in patients with more severe HF. Practical experience with HF patients at altitude is limited to subjects transported by vehicle to 3454 m for a few hours. The data showed a reduction in exercise capacity similar to that observed at simulated altitudes. The optimal treatment of heart failure (HF) in patients spending time at altitude likely differs from the optimal treatment at sea level, especially with regard to beta-blockers. In conclusion, spending time at altitude (<3500 m) is safe for patients with heart failure, provided they do not have comorbidities that could directly interfere with altitude adaptation. Finally, patients with heart failure should undergo altitude-specific treatment to avoid pharmacological interference with altitude adaptation mechanisms.

I’m delighted to announce that our research article, “Effectiveness of Home-Based Caregiver-Assisted Tele-Physiotherapy Program Versus Conventional Outpatient Physiotherapy for Upper-Limb Function in Chronic Stroke Survivors,” has been published in the Journal of Rare Cardiovascular Diseases. https://lnkd.in/gBS_jBEc

💡 New Consensus Statement: When Heart Failure & Atrial Fibrillation Collide An important new consensus statement from the European Journal of Heart Failure addresses a common yet challenging scenario: patients with Heart Failure with Reduced Ejection Fraction (HFrEF) and Atrial Fibrillation (AF). Here are the key take-aways: 🔍 Why this matters HFrEF + AF is a “double trouble” combination: the presence of AF markedly worsens outcomes in heart failure patients. Until now, pharmacotherapy (drug-treatment) for heart failure has not always been well-studied in the subgroup of patients who also have AF. The new statement calls for clearer guidance. •We must optimise heart failure therapies even when AF is present — not sideline them. •Clinicians should recognise AF as a major comorbidity, rather than a “side-note”. •The statement emphasises personalised care: considering both the heart failure and rhythm disorder together, not in isolation. •Research gaps remain — the authors call for dedicated studies in this complex patient group. 🔧 What this means for practice •If you treat HFrEF patients, check for AF and assess how it might affect choice/dose of medications. •For AF patients with HFrEF, ensure you’re optimising guideline-directed heart failure therapy — do not assume AF “overrides” it. •Collaborate across disciplines — cardiologists, electrophysiologists, heart-failure specialists — to craft the best plan. •Patients should be informed: having both conditions means extra attention is needed, and the right treatments can still make a big difference. ➡️ Let’s bring this message out into general practice, cardiology clinics, and patient-education: recognising HFrEF + AF as a high-risk pairing, and treating it with full intensity. #HeartFailure #AtrialFibrillation #HFrEF #Cardiology #ConsensusStatement #ClinicalPractice #GuidelineMedicine #PatientCare #gurgaon #gurugram #dlfphase3 #cybercity

Don’t stop early—true exertional dyspnea shows up at peak CPET A new study in Chest highlights that abnormal exertional breathlessness is most accurately identified at peak exercise during symptom-limited cardiopulmonary exercise testing (CPET). Using data from over 1,100 adults in the CanCOLD study, researchers found that 55–60% of individuals with high breathlessness at peak exercise showed normal values at all lower intensities—a pattern seen in those with and without chronic airflow limitation (CAL). For clinicians, this means that submaximal or early-exercise assessments may miss clinically significant abnormalities. To truly understand a patient’s exertional limitation, peak CPET performance remains the gold standard for evaluation and diagnostic accuracy. TLDR: * Peak exercise during CPET is the optimal point to identify abnormal breathlessness * 55–60% with peak breathlessness show normal values at lower intensities * Results apply to patients with and without chronic airflow limitation * Serial submaximal assessments may miss clinically relevant abnormalities Reference: Ekström M, Li PZ, Bourbeau J, Tan WC, and Jensen D; on behalf of the CanCOLD Collaborative Research Group. CHEST; In Press Uncorrected Proof Published online: September 10, 2025

I recently came across an interesting case report in JACC Case Reports : An 83-year-old woman presented with what appeared to be a heart attack but turned out to be Takotsubo cardiomyopathy (stress-induced cardiomyopathy) complicated by an acute ventricular septal defect—a life-threatening condition with typically poor outcomes. The winning strategy: Early diagnosis through comprehensive imaging and hemodynamic assessment , Impella CP device placed within 2 hours, Urgent surgical repair within 32 hours , BiPella (biventricular Impella) support post-operatively , Multidisciplinary team approach The outcome: At 17-month follow-up, the patient showed remarkable recovery with improved left ventricular function and complete resolution of the VSD. Key takeaways for cardiovascular professionals: Early recognition saves lives Mechanical circulatory support can bridge critical patients to definitive treatment Individualized treatment strategies matter, especially in elderly patients with multiple comorbidities Innovation in cardiac support devices continues to expand our treatment options This case reminds us that even in complex, high-risk scenarios, timely intervention combined with advanced technology can lead to outstanding outcomes. Read the full case report: https://lnkd.in/eKkyiBXa

Major update: CMS’s new National Coverage Determination (NCD) for renal denervation marks a pivotal shift in access to treatment for uncontrolled hypertension. Discover what this means for clinicians, hospitals and patients ➡️https://hubs.ly/Q03QLwq30

📢 New Publication Alert Title: Frequency of therapy alerts during the first 30 days of automated peritoneal dialysis and its relationship to time on treatment Authors: Annie Conway, Jarrad Hopkins, Michelle Ovenden, Monique Borlace, David Johnson, Jenny Chen, Kamal Sud, Neil Boudville and Stephen McDonald AM 💡 Could early alerts predict dialysis outcomes? Early therapy alerts during automated peritoneal dialysis (APD) matter. Using linked data from Australia and New Zealand Dialysis and Transplant Registry (ANZDATA) and Vantive’s Sharesource platform, our research shows that a higher alert burden in the first 30 days is linked to increased risk of hemodialysis transfer within 12 months. ✅ Key takeaway: Addressing alerts early could help improve PD continuation and patient outcomes. 🔗 Read more here: https://lnkd.in/ghG4_5xb