Atrial Fibrillation

NEW YORK -- Inpatients cared for by full-time hospitalists were likely to be discharged almost a day sooner than those in the care of nonhospitalists, but there was no significant difference in readmission rates or mortality, researchers found.

AMSTERDAM -- Treatment regimens for type 2 diabetes that include pioglitazone (Actos) were associated with lower risk of stroke and myocardial infarction, claimed investigators for the drug's maker.

CALGARY, Alberta -- Nocturnal dialysis at home six times a week markedly reduced left ventricular hypertrophy in patients with end-stage renal disease compared with conventional treatment, according to a preliminary study.

SAN DIEGO -- With PET-guided lead placement, cardiac resynchronization therapy (CRT) can achieve significant clinical improvement in patients with severe ischemic heart failure, even in the presence of extensive scarring, investigators reported here.

Congestive heart failure and cirrhosis are the most common causes of transudative pleural effusions, while pneumonia and malignancy are responsible for the majority of exudative effusions. Plain chest films are valuable in confirming the presence of an effusion, providing clues to the cause, and directing the method of pleural fluid sampling. Thoracentesis is safe and simple, and it is diagnostic in about 75% of cases. Pleural biopsy is indicated for unexplained exudative effusions, most of which are found to result from malignancy or tuberculosis. Medical thoracoscopy, if available, is the procedure of choice for patients with these effusions. Thoracoscopy permits visually directed pleural biopsies and allows for therapeutic intervention at the time of diagnosis, obviating the need for subsequent invasive procedures.

Ischemic infarcts of the brain are usually caused by vascular disease, but 1 in 5 results from emboli that arise in the heart. The largest contributor to cardioembolic stroke is non-valvular atrial fibrillation, which is associated with a 5-fold increased risk of cerebral infarction.

SAN DIEGO -- Positron emission tomography (PET) can identify patients with ischemic heart failure who are most likely to benefit from cardiac resynchronization therapy, investigators reported here.

PHILADELPHIA -- The beta-blocker carvedilol (Coreg) does not appear to benefit children or adolescents with symptomatic systolic heart failure, suggest preliminary trial results.

CLEVELAND -- Meta-analyses of the two FDA-approved thiazolinediones for diabetes -- rosiglitazone (Avandia) and pioglitazone (Actos) -- left neither drug unscathed.

SAN FRANCISCO -- Neoadjuvant trastuzumab (Herceptin) may improve breast cancer chemotherapy response rates, but at what some oncologists called an unacceptable price in cardiac toxicity.

LOS ANGELES -- Dronedarone, an investigational drug, proved significantly more effective than placebo in maintaining sinus rhythm and in reducing the ventricular rate during recurrent atrial fibrillation.

NEW YORK -- Experiments in mice suggest that the type 2 diabetes drugs rosiglitazone (Avandia) and pioglitazone (Actos) increase uptake of both glucose and triglycerides in cardiac tissue, causing or exacerbating heart failure.

VIENNA -- The anti-anginal drug ranolazine (Ranexa) may reduce episodes of ventricular tachycardia and supraventricular tachycardia, researchers here reported.

PHILADELPHIA -- Limiting the working hours of residents did not increase patients' death rates, as some had feared, nor did it save lives significantly, as others had hoped, according to two large national studies.

DALLAS -- A fatty heart, cardiac steatosis, can occur in patients on the road to type 2 diabetes and in the presence of normal left ventricular dysfunction, investigators here have determined.

Heparin-induced thrombocytopenia (HIT) is a common and serious complication of heparin therapy, occurring in about 1% to 5% of patients.1 It occurs more often with unfractionated heparin than with low molecular weight heparin. Complications of HIT include venous thromboembolism, arterial thrombosis, skin necrosis, and limb gangrene.2,3 Before the introduction of the direct thrombin inhibitors, the mortality rate associated with HIT was 20% to 25%.4-6

A 68-year-old woman with hypertension complains of intermittent dyspnea and light-headedness. She is asymptomatic during the evaluation. Vital signs are normal, but an irregularly irregular pulse is noted on examination as well as on the telemetry monitor. The 12-lead ECG is shown here; the ECG machine printout reads "atrial fibrillation." The patient has no history of this arrhythmia.

HOUSTON -- For older patients on dialysis, the phosphate binder sevelamer (Renagel) may be associated with a lower death rate compared with calcium-based phosphate binders, investigators reported.

WASHINGTON -- A left-ventricular assist device that provides a steady rather than pulsed blood flow may serve as an effective bridge to transplant, found a multicenter team.

BOSTON -- Childhood hypertension is there, if only pediatricians would look for it. Most of the time, they don't, investigators here reported.

EAST HANOVER, N.J. -- The FDA has approved a once-yearly intravenous formulation of zoledronic acid (Reclast) for osteoporosis in postmenopausal women, Novartis announced.

ROCKVILLE, Md. -- The FDA today changed the label for warfarin (Coumadin) to make clinicians aware of two tests for gene variants that may affect the risk of bleeding after initial dosing.

ROCKVILLE, Md. -- The makers of rosglitazone (Avandia) and pioglitazone (Actos), have agreed to add a black box warning to the type 2 diabetes drugs' labels about an increased risk of heart failure, the FDA said today.

LONDON -- Headache patients receiving prophylactic high-dose verapamil face a risk of heart rhythm disturbances that warrants EKG monitoring of all patients on the therapy, investigators here concluded.

BIRMINGHAM, England -- Warfarin's stroke prevention benefits extend to the elderly -- without increasing the risk of major bleeds.