Background-Prior trials suggest it is safe to defer transfusion at hemoglobin levels above 7-8 g/dL in most patients. Patients with acute coronary syndrome may benefit from higher hemoglobin levels.

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Abstract-African Americans with hypertension are at high risk for adverse outcomes from cardiovascular and renal disease.Patients with stage 3 or greater chronic kidney disease have a high prevalence of left ventricular (LV) hypertrophy and diastolic dysfunction. Our goal was to study prospectively the relationships of LV mass and diastolic function with subsequent cardiovascular and renal outcomes in the African American Study of Kidney Disease and Hypertension cohort study. Of 691 patients enrolled in the cohort, 578 had interpretable echocardiograms and complete relevant clinical data. Exposures were LV hypertrophy and diastolic parameters. Outcomes were cardiovascular events requiring hospitalization or causing death; a renal composite outcome of doubling of serum creatinine or end-stage renal disease (censoring death); and heart failure. We found strong independent relationships between LV hypertrophy and subsequent cardiovascular (hazard ratio, 1.16; 95% confidence interval, 1.05-1.27) events, but not renal outcomes. After adjustment for LV mass and clinical variables, lower systolic tissue Doppler velocities and diastolic parameters reflecting a less compliant LV (shorter deceleration time and abnormal E/A ratio) were significantly (P<0.05) associated with future heart failure events. This is the first study to show a strong relationship among LV hypertrophy, diastolic parameters, and adverse cardiac outcomes in African Americans with hypertension and chronic kidney disease. These echocardiographic risk factors may help identify high-risk patients with chronic kidney disease for aggressive therapeutic intervention. (Hypertension. 2013;62:518-525.)

Abstract-African Americans with hypertensive renal disease represent a high-risk population for cardiovascular events.Although left ventricular hypertrophy is a strong predictor of adverse cardiac outcome, the prevalence and associated factors of left ventricular hypertrophy in this patient population are not well described. The African American Study of Kidney Disease Cohort Study is a prospective, observational study that is an extension of the African American Study of Kidney Disease randomized clinical trial that was conducted from 1994 to 2001 in African Americans with hypertension and mild-to-moderate renal dysfunction. Echocardiograms and 24-hour ambulatory blood pressure monitoring were performed at the baseline visit of the cohort. Of 691 patients enrolled in the cohort study, 599 patients had interpretable baseline echocardiograms and ambulatory blood pressure data. Left ventricular hypertrophy was defined using a cut point for left ventricular mass index Ͼ49.2 g/m 2.7 in men and Ͼ46.7 m/m 2.7 in women. The majority of patients had left ventricular hypertrophy (66.7% of men and 73.9% of women). In a multiple regression analysis, higher average day and nighttime systolic blood pressure, younger age, and lower predicted glomerular filtration rate were associated with left ventricular hypertrophy, but albuminuria was not. These data demonstrate a striking prevalence of left ventricular hypertrophy in the African American Study of Kidney Disease Cohort and identify potential targets for prevention and therapeutic intervention in this high-risk patient population. (Hypertension.

Abstract-We performed a post hoc analysis of the Systolic Hypertension in the Elderly Program database to assess the incidence of atrial fibrillation in the elderly hypertensive population, its influence on cardiovascular events, and whether antihypertensive treatment can prevent its onset. The Systolic Hypertension in the Elderly Program was a double-blind placebo-controlled trial in 4736 subjects with isolated systolic hypertension aged Ն60 years. Atrial fibrillation was an exclusion criterion from the trial. Participants were randomly assigned to stepped care treatment with chlorthalidone and atenolol (nϭ2365) or placebo (nϭ2371). The occurrence of atrial fibrillation and cardiovascular events over 4.7 years as well as the determination of cause of death at 4.7 and 14.3 years were followed. Ninety-eight subjects (2.06%) developed atrial fibrillation over 4.7 years mean follow-up, without significant difference between treated and placebo groups. Atrial fibrillation increased the risk for: total cardiovascular events (RR Key Words: hypertension Ⅲ elderly Ⅲ atrial fibrillation Ⅲ chlorthalidone Ⅲ atenolol Ⅲ incidence Ⅲ death A trial fibrillation (AF) represents a major health problem, affecting more than 2 million patients in the United States. 1 The prevalence of AF increases with age and it is estimated to be around 5% above age 70. 2 In the Framingham study the incidence of AF in the general population approximately doubled for every 10-year increment in age beyond 50 years (approximately 10% in persons who reach age 80 3,4 ), and it was reported as high as 19.2 per 1000 person-years among adults above age 65 in the Cardiovascular Health Study. 5 Arterial hypertension is an independent risk factor for developing AF 3 and for an increased risk of stroke in patients with AF. 6 However, no study addressed specifically the incidence of AF, the relationship of AF on cardiovascular events, and the effect of antihypertensive treatment versus placebo on the incidence of AF in a well-characterized hypertensive population. To answer these questions we performed a posthoc analysis of the Systolic Hypertension in the Elderly Program (SHEP) database. Methods Participants and Study DesignSHEP was a double-blind, randomized, placebo-controlled trial design to test whether long-term administration of antihypertensive treatment to older persons with isolated systolic hypertension (SBP Ͼ160 mm Hg and DBP Ͻ90 mm Hg) reduces the combined incidence of fatal and nonfatal stroke during a 5-year follow-up. A cohort of 4736 men and women aged Ն60 years with hypertension as defined was followed up for an average of 4.7 years. Patients were randomized in a double-blind manner to a once-daily dose of either active drug treatment or matching placebo. The objective of the stepped care treatment program was to use the minimal amount of medication to maintain SBP at or below the goal (decrease in baseline SBP of at least 20 mm Hg and a SBP of less than 160 mm Hg). The first treatment step was chlorthalidone 12.5 mg/d (or matching placebo), ...

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This case series summarizes our experience of delayed acute myocardial infarction presentations during the coronavirus disease-2019 pandemic predominantly driven by patient fear of contracting the virus in the hospital. Many presented with complications rarely seen in the primary percutaneous coronary intervention era including ventricular septal rupture, left ventricular pseudoaneurysm, and right ventricular infarction. ( Level of Difficulty: Beginner. )

Objectives The optimal timing of coronary artery bypass grafting (CABG) in patients with ST elevated acute myocardial infarction (STEMI) is unclear. The purpose of the study is to evaluate and compare the outcomes in STEMI patients who underwent CABG within the various time intervals within the first 7 days of either emergent or urgent hospital admission. Methods Patients aged 30 years old and older diagnosed with STEMI who underwent CABG within first 7 days after non-elective hospital admission were selected from the National Inpatient Sample 2010–2014 using the appropriate ICD-9-CM diagnosis and procedure codes. These patients were divided into 3 cohorts based on timing of surgery: within 24 h (group A), 2nd-3rd day (group B), and 4th–7th day (group C). The rates of postoperative complications, mortality, and postoperative hospital length of stay (LOS) were compared using the Chi-square test, multivariable logistic regression analysis, and Wilcoxon rank sum test. Results A total of 5963 patients were identified: group A = 28.5%, group B = 36.1%, group C = 35.4%. Mean age overall was 63.1 ± 11.1 years; 76.9% were males and 72.9% were whites. Compared to groups B and C, patients in group A were more likely to develop cardiac complications (OR [odds ratio] =1.33, 95%CI [confidence interval] 1.12–1.59 and OR = 1.39, 95%CI 1.17–1.67, respectively) and respiratory complications (OR = 1.31, 95%CI 1.13–1.51 and OR = 1.53, 95%CI 1.32–1.78, respectively). They were also more likely to have renal complications (OR = 1.31, 95%CI 1.11–1.54) and bleeding (OR = 1.20, 95%CI 1.05–1.37) than patients in group B and had a similar tendency compared to group C. We did not find significant differences in the above complications between groups B and C. Postoperative stroke and sternal wound infection rates were similar between all three groups. In-hospital mortality was also higher in group A (8.2%) compared to group B (3.5%) and group C (2.9%, P < 0.0001 for both); differences between groups B and C were not significant. This was confirmed in the multivariable logistic regression analysis with controlling for age, gender, race, the Elixhauser Comorbidity Index, and complications (group A vs B: OR = 1.85, 95%CI 1.52–2.25; group A vs C: OR = 2.21; 95%CI 1.82–2.68). Patients in group A had a significantly longer postoperative LOS (median 7 days with IQR [interquartile range] 5–10 days) compared to those in group B (median 6 days, IQR 5–8 days) and group C (median 6 days, IQR 4–8 days; P < 0.0001 for both). Conclusions The results of this study show that despite the urgency and severity of STEMI, patients who undergo CABG within the first 24 h after non-elective hospital admission have increased hospital morbidity and mortality. These findings suggest that a delay in surgery beyond the first 24 h may be beneficial to patient outcomes. Furthermore, there is a significant cost effectiveness when the patients delay surgery because the hospital length of stay is reduced as well as the subsequent hospital costs.