The findings from this analysis of post-procedure event rates suggest that LAA ligation with the Lariat device effectively closes the LAA and may be a beneficial approach to reduce the risk of embolic events in AF patients ineligible to oral anticoagulation therapy. However, future randomized clinical trials are needed to verify these results and to determine device and procedural safety.

Background: There has been limited evidence about frailty in older patients with acute coronary syndrome (ACS) in Vietnam. Aim: (1) To investigate the prevalence of frailty in older patients hospitalised with ACS and its associated factors; (2) To investigate the impact of frailty on percutaneous coronary intervention (PCI) and adverse outcomes in this population. Methods: Patients aged ≥60 with ACS admitted to two teaching hospitals in Vietnam were recruited from 9/2017 to 4/2018. Frailty was defined by the Reported Edmonton Frail Scale. Multivariate logistic regression was applied to investigate the associated factors of frailty and the impact of frailty on PCI and adverse outcomes. Results: There were 324 participants, mean age 73.5±8.3, 39.2% female. The prevalence of frailty was 48.1%. Advanced age, female gender, history of hypertension, heart failure, stroke and chronic kidney disease were significantly associated with a frailty status. Overall, 50.3% of the participants received PCI (58.3% in the non-frail vs 41.7% in the frail, p=0.003). However, frailty did not have an independent impact on PCI (adjusted OR 0.66, 95% CI 0.41-1.08). Frailty was significantly associated with increased risk of having arrhythmia during hospitalisation (adjusted OR 2.24, 95% CI 1.32-3.80), hospital-acquired pneumonia (adjusted OR 2.27, 95% CI 1.24-4.17), in-hospital mortality (adjusted OR 3.02, 95% CI 1.35-6.75), 30-day mortality (adjusted OR 3.28, 95% CI 1.59-6.76), and 30-day readmission (adjusted OR 2.53, 95% CI 1.38-4.63). Conclusion: In this study, frailty was present in nearly half of older patients with ACS and was associated with increased adverse outcomes. These findings suggest that frailty screening should be performed in older patients with ACS in Vietnam.

Hepatic hydrothorax is defined as a pleural effusion in patients with liver cirrhosis in the absence of cardiopulmonary disease. The estimated prevalence among patients with liver cirrhosis is approximately 5-6%. The pathophysiology involves the passage of ascitic fluid from the peritoneal cavity to the pleural space through diaphragmatic defects. The diagnosis is made from clinical presentation and confirmed by diagnostic thoracentesis with pleural fluid analysis. The initial medical management is sodium restriction and diuretics, but liver transplantation provides the only definitive therapy. For patients who are not transplant candidates and those who await organ availability, other therapeutic modalities that are to be considered include transjugular intrahepatic portosystemic shunt placement, videoassisted thoracoscopic surgery repair, pleurodesis, and vasoconstrictors (eg, octreotide and terlipressin). The primary therapeutic goals are to reduce ascitic fluid production and improve symptoms to bridge the time for liver transplantation.

Cardiovascular disease (CVD) is one of the leading causes of morbidity and mortality worldwide, particularly in older people. 1 The combination of the ageing process, altered metabolic and hemodynamic function, and reduced physical activity in patients with CVDs can lead to muscular loss and sarcopenia. 2 Sarcopenia is described as an age-related decline in skeletal muscle mass and muscle function. 3 Sarcopenia may result in adverse outcomes such as reduced physical capability, poorer quality of life, increased risk of falls, disability, mortality and high health care expenditure. 3 In 2016, sarcopenia received its own International Classification of Diseases 10th Revision (ICD-10) code, which highlights the need for the recognition of sarcopenia by practising clinicians. 4 Studies in Western countries showed that the prevalence of sarcopenia was around 20% among people aged ≥65 years and up to 50%-60% in people aged ≥80. 5 In Asia, studies from Japan, Korea, China, Taiwan and Thailand have shown that the prevalence of sarcopenia in older people ranged from around 10% to 30%. 3 Vietnam is a country in SouthEast Asia experiencing rapid urbanisation and an ageing population. Due to the population ageing and the population size, the impact of sarcopenia in Vietnam may be high, especially in older people with CVD. However, there has been no study of sarcopenia

Thromboembolic stroke from the left atrial appendage (LAA) is the most feared complication in patients with atrial fibrillation (AF). The cornerstone for the management of chronic non-valvular AF is stroke reduction with oral anticoagulation (OAC). However, poor compliance, maintaining a narrow therapeutic window, and major side effects such as bleeding have severely limited their use, which creates a therapeutic dilemma. As much as 20% of AF patients are not receiving OAC due to contraindications and less than half of AF patients are not on OAC due to reluctance of the prescribing physician and/or patient non-compliance. Fortunately, over the past decade, there have been great interests in providing an alternative strategy unbeknownst to the practicing internist. The introduction of percutaneous approaches for LAA occlusion has added a different dimension to the management of chronic AF in patients with OAC intolerance. Occlusion devices such as the Amplatzer Cardiac Plug and WATCHMAN device are currently being investigated for stroke prophylaxis. More recently, the LARIAT device may provide an alternative means for potential stroke prophylaxis without the need for short-term post-procedural OAC. We aim to review the current literature and bring attention to an alternative strategy for high-risk AF patients intolerant to OAC.