Steven Lubitz, M.D., MPH, cardiac electrophysiologist, Massachusetts General Hospital, presented the late-breaking VITAL-AF Trial at the 2020 American Heart Association (AHA) virtual meeting this week. The study looked at screening for atrial fibrillation (AF) in older adults at primary care visits using the AliveCor single-lead electrocardiogram (ECG) device that interfaces with a smartphone or iPad.

The study found screening for AF using a single-lead ECG at primary care visits was not associated with a significant increase in new AF diagnoses among individuals aged 65 years or older compared to usual care. However, screening may be associated with an increased likelihood of diagnosing AF among individuals aged 85 years or older. 

Undiagnosed AFib is associated with increased risk of stroke. There is uncertainty about how best to screen for AF and guidelines differ regarding screening using ECGs. Methods: We conducted a cluster-randomized trial to evaluate whether screening using single-lead ECGs at primary care visits is effective for diagnosing AF. 

Sixteen clinics were randomized 1:1 to an AF screening intervention which offered an AliveCor single-lead ECG to patients aged 65 years or older during routine vital sign assessments, or usual care. AliveCor readings were over-read by cardiologists. Confirmatory diagnostic testing and treatment decisions were made by the primary care provider. 

New AF diagnoses were ascertained based on electronic case identification and manually adjudicated by a clinical endpoint committee. Results: 35,308 patients were included in the trial (n=17,643 intervention [91% screened], n=17,655 control). Patient characteristics were well-balanced between the intervention and control groups, including 12.7% versus 13.2% with prevalent AF, respectively. At one year, 1.52% of individuals in the screening group had new AF diagnosed versus 1.39% in the control group (relative risk [RR] 1.10; 95% confidence interval [CI] 0.92-1.30; P=0.30). New AF diagnoses in the screening and control groups varied by age (0.95% versus 1.00% for age 65-74; P=0.74; 1.84% versus 1.70% for age 75-84; P=0.58; 4.05% versus 2.68% for age 85+; P=0.02) (see figure). New anticoagulation was prescribed in 2.98% versus 2.90% of individuals in the screening and control groups, respectively, overall (RR 1.03; 95%CI 0.91-1.18; P=0.61), and in 72.8% versus 71% with new AF diagnoses (RR 1.02; 95%CI 0.92-1.14; P=0.70).

Find more AHA news, video and late-breakers

Dean Kereiakes, M.D., medical director, The Christ Hospital Heart and Vascular Center, medical director, The Christ Hospital Research Institute, and professor of clinical medicine at The Ohio State University, explains the late-breaking Disrupt CAD III study at the 2020 Transcatheter Cardiovascular Therapeutics (TCT) Connect virtual meeting. 

The trial will likely pave the way for U.S. Food and Drug Administration (FDA) clearance for intravascular lithotripsy to be used in the coronary arteries. He offers details on the data and and use of this technology in the cath lab compared to the current techniques of atherectomy, cutting balloons and high pressure balloons that can cause vessel trauma, leading to poorer outcomes. 

The lithotripsy technology breaks up calcium in the vessel walls without trauma, using a compliant balloon and relying on sonic waves to bust the calcium rather than brute force. He said this could be a paradigm shift in how calcified lesions are treated.

Read more on this trial and the technology in the article Shockwave Technology to Sonically Bust Calcified Coronary Lesions Shows Safety and Efficacy in U.S. Pivotal IDE Trial.

Find additional TCT 2020 news, video and late-breaking studies

The COMPARE CRUSH Trial looked at the effect of pre-hospital crushed prasugrel tablets in patients with STEMI planned for primary percutaneous coronary intervention (PCI).[1] This video is of the press conference presentation of this late-breaking study by doctor George Vlachojannis, from UMC Utrecht, at the 2020 Transcatheter Cardiovascular Therapeutics (TCT) Connect virtual meeting. 

The idea was to crush the tablets to enable faster antiplatelet inhibition, but the findings of this study showed it did not improve TIMI 3 flow on first angiography or ST-segment resolution at 1 hour post PCI.

Find additional TCT 2020 news, video and late-breaking studies

Reference:

1. Vlachojannis GJ, Vogel RF, Wilschut JM, Lemmert ME, Delewi R, Diletti R, van Vliet R, van der Waarden N, Nuis RJ, Paradies V, Alexopoulos D, Zijlstra F, Montalescot G, Angiolillo DJ, Krucoff MW, Van Mieghem NM, Smits PC. COMPARison of pre-hospital CRUSHed vs. uncrushed Prasugrel tablets in patients with STEMI undergoing primary percutaneous coronary interventions: Rationale and design of the COMPARE CRUSH trial. Am Heart J. 2020 Jun;224:10-16. doi: 10.1016/j.ahj.2020.03.005. Epub 2020 Mar 11.

Roxana Mehran, M.D., and Marco Valgimiggle, M.D., present the results of the Xience 90/28 trials that evaluated the use of shortened 3-month and 1-month dual-antiplatelet therapy (DAPT) in high-risk bleeding patients. This is the press conference at the 2020 Transcatheter Cardiovascular Therapeutics (TCT) Connect virtual meeting. It is followed by an expert panel discussion on the merits and meaning of the results.

The use of short duration DAPT has been a big topic of discussion at TCT the past few years. The first FDA cleared indication for shortened DAPT was was granted in late September 2020 for the Medtronic Endeavor stent. The data from these two trials will likely lead the Xience to a similar FDA indication expansion. 

Find additional TCT 2020 news, video and late-breaking studies

Gregg Stone, M.D., presents the results of a pooled analysis of randomized trials of bivalirudin virus heparin in acute myocardial infarction patients in a press conference at the 2020 Transcatheter Cardiovascular Therapeutics (TCT) Connect virtual meeting.

The study looked at periprocedural anticoagulation during percutaneous corona intervention in AMI patients. There has been conflicting results reported between several trials looking at which drug is best for anticoagulation during cath procedures.

This study pooled data from 8 studies that included more than 27,000 patients. The data included both STEMI and NSTEMI patients.

The pool analysis found STEMI patients, bivalirudin was associated with reductions mortality, serious bleeding and NACE events, despite higher rates of myocardial infarction  (MI) and stent thrombosis compared with heparin. The mortality benefit of bivalirudin was pronounced in patients with a post-PCI bivalirudin infusion to mitigate MI and stent thrombosis risks. 

In NSTEMI patients, bivalirudin was associated with a reduction in 30 day serious bleeding events, but similar rates of mortality, MI and stent thrombosis compared to heparin.

Find additional TCT 2020 news, video and late-breaking studies

The late-breaking MitraBridge Study was presented at Transcatheter Cardiovascular Therapeutics (TCT) 2020 meeting showed the transcatheter MitraClip mitral leaflet repair system can be used as bridge therapy to heart transplantation. About 25 percent of patients in this study were actually taken off the transplant list because they became asymptomatic.[1] 

This is the press conference for the study presented by Cosmo Godino, M.D., an interventional cardiologist from San Raffaele Hospital, Milan, Italy. It is followed by a discussion by several well-known interventional cardiologists and structural heart experts.

The MitraBridge Study showed the transcatheter MitraClip mitral leaflet repair system can be used as bridge therapy for patients on the heart transplant list. It was used to reduce the amount of mitral regurgitation to help ease symptoms in advanced heart failure who need a need a heart transplant, but may have to wait long periods before a heart becomes available.  

The 119-patient study found it not only helped improve patient symptoms for the majority of patients, but 23.5 percent of patients in this study improved so much they were actually taken off the transplant. 

There is a large and growing imbalance between the demand and supply of donor hearts, Godino explained. With the expansion of waiting lists and prolonged waitings times are generally more than a year and it becomes difficult to manage these patients, resulting in a one-year mortality rate of 15 percent. 

Patients selected for MitraClip had advanced/end stage heart failure and concomitant, severe mitral regurgitation with a median left ventricular ejection fraction of 26%. These patients make up between 1 to 10% of the overall heart failure population, Godino said.

There was an 87.5% procedural success rate and no deaths at 30-day. Two thirds of patients remained free of development of composite adverse events at one-year. Of those that improved, 15.5% become eligible for a heart transplant. nearly a quarter could be removed from the list for HTx due to clinical improvement
 

Find additional TCT 2020 news, video and late-breaking studies

Reference:

1. Cosmo Godino, Andrea Munafò, Andrea Scotti, et al. MitraClip in secondary mitral regurgitation as a bridge to heart transplantation: 1-year outcomes from the International MitraBridge Registry. The Journal of Heart and Lung Transplantation. Published September 16, 2020. DOI: https://doi.org/10.1016/j.healun.2020.09.005.

Ernest Garcia, Ph.D., MASNC, FAHA, endowed professor in cardiac imaging, director of nuclear cardiology R&D laboratory, Emory University, developer of the Emory Cardiac Tool Box used in nuclear imaging and past-president of the American Society of Nuclear Cardiology (ASNC), explains the use of artificial intelligence (AI) in cardiac imaging. He said there is a tsunami of new AI applications that are starting to flood the FDA for market approval, and there are several examples of AI already in use in cardiac imaging. He spoke on this topic in a keynote session at the 2020 ASNC meeting.

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For more AI in cardiology content

Matthew Budoff, M.D., director of cardiovascular CT at The Lundquist Institute, and professor of medicine at the David Geffen School of Medicine at UCLA, presented the  EVAPORATE Study final results at the European Society of Cardiology (ESC) 2020 Congress. He explains how cardiac CT was used to monitor patients taking icosapent ethyl (Vascepa) showed it showed a 17 percent reversal of low attenuation plaques in the coronary arteries.

Final results from Effect of Icosapent Ethyl on Progression of Coronary Atherosclerosis in Patients with Elevated Triglycerides on Statin Therapy (EVAPORATE) Trial showed a significant reduction in the primary endpoint of icosapent ethyl reducing LAP plaque volume from baseline. Whereas there was a progression of LAP plaque volume in the placebo group. There were significant differences between icosapent ethyl and placebo at study end for secondary endpoints of other types of plaque volume changes, including and sequentially total, total non-calcified, fibrofatty, and fibrous plaque volumes. All regressed in the icosapent ethyl group and progressed in the placebo group, (p<0.01 for all). The only secondary endpoint which did not achieve a significant difference between groups in multivariable modeling was dense calcium (p=0.053).

Read more in the article "Icosapent Ethyl Significantly Reduces Coronary Plaque in EVAPORATE Study."

Find more ESC news

This is a tutorial video on how to perform an artificial intelligence (AI) automated cardiac ejection fraction measurement using the GE Healthcare Vscan Extend point-of-care ultrasound (POCUS) system and the LVivo EF app, developed and licensed by DiA Imaging Analysis. This FDA-cleared app enables an automated edge detection of left ventricular endocardium and calculates end-diastolic, end-systolic volumes and ejection fraction, using apical 4-chamber view.

the LVivo EF app was showcased by GE Healthcare in its virtual booth at the American Society of Echocardiography (ASE) 2020 virtual meeting. POCUS imaging has emerged as a primary imaging modality for bedside assessment of COVID-19 patients in 2020.

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GE Highlights New Echocardiography Technologies at ASE 2020

Other ASE news and video

Todd Villines, M.D., FACC, FAHA, MSCCT, explains how artificial intelligence (AI) might be used in the near future to automatically calculate CT calcium scoring and radiomic feature assessments. This was a key take away during the Society of Cardiovascular Computed Tomography (SCCT) 2020 virtual meeting. 

Villines is the Julian Ruffin Beckwith Professor of Medicine, Division of Cardiovascular Medicine, University of Virginia, editor-in-chief of the Journal of Cardiovascular CT (JCCT),  and SCCT past-president.

AI is already commercially used to improve CT image reconstruction to increase the diagnostic quality of the images, especially from low-dose scans. AI is now being applied to automate time-consuming tasks in CT image reads, such as manually calculated calcium scores and automated contouring and quantification of anatomy and function of the heart.

Another area that is seeing a lot of research in in radiomics, where AI is being used to sift through thousands of CT scans to look for subtle imaging traits that may indicate the early development or worsening of disease. These subtle changes may not be evident to radiologists reading the scans, but AI software can identify similarities in patients as a trend and alert researchers to look at that specific trait as a potential imaging biomarker.

Other Key Trends and Technology at SCCT:

Top 9 Cardiovascular CT Studies in Past Year 

VIDEO: Photon Counting Detectors Will be the Next Major Advance in Computed Tomography

VIDEO: Increased Use of Cardiac CT During the COVID-19 Pandemic

VIDEO: Key Cardiac CT Papers Presented at SCCT 2020

Low-attenuation Coronary Plaque Burden May Become Next Big Cardiac Risk Assessment

Impact of Cardiac CT During COVID-19

VIDEO: Artificial Intelligence to Automate CT Calcium Scoring and Radiomics

Todd Villines, M.D., FACC, FAHA, MSCCT, explains some of most influential cardiac CT clinical papers from the past year at the Society of Cardiovascular Computed Tomography (SCCT) 2020 virtual meeting. Among these were the ISCHEMIA Trial, others showing the value of CT is assessing chest pain patients and its ability to act as a gate keeper to the cath lab, and the 2019 European Society of Cardiology (ESC) guidelines that now list cardiac as a preferred imaging modality.

Villines is the Julian Ruffin Beckwith Professor of Medicine, Division of Cardiovascular Medicine, University of Virginia, editor-in-chief of the Journal of Cardiovascular CT (JCCT), and SCCT past-president.

Other Key Trends and Technology at SCCT:

Top 9 Cardiovascular CT Studies in Past Year 

VIDEO: Increased Use of Cardiac CT During the COVID-19 Pandemic

VIDEO: Coronary Plaque Quantification Will Become Major Risk Assessment

VIDEO: Photon Counting Detectors Will be the Next Major Advance in Computed Tomography

VIDEO: Artificial Intelligence to Automate CT Calcium Scoring and Radiomics

Low-attenuation Coronary Plaque Burden May Become Next Big Cardiac Risk Assessment

Impact of Cardiac CT During COVID-19

Todd Villines, M.D., FACC, FAHA, MSCCT, explains some of the discussion on CT used for COVID-19 patients at the Society of Cardiovascular Computed Tomography (SCCT) 2020 virtual meeting in July. He is the Julian Ruffin Beckwith Professor of Medicine, Division of Cardiovascular Medicine, University of Virginia; editor-in-chief of the Journal of Cardiovascular CT (JCCT), and SCCT past-president. 

Early on in the COVID-19 pandemic in China, CT emerged as a key imaging modality and was found to be able to detect COVID ground glass lesions in the lungs sometimes prior to positive genetic PCR test results. Supporters of CT say the modality offers a way to get detailed anatomical and functional information using a short exam time and limits the exposure of staff to potential or known COVID-19 positive patients.

One area where cardiac CT is seeing a lot of increased his is for the evaluation of thrombus in the left atrial appendage (LAA). This is traditionally done using transesophageal echo (TEE), but it required very close contact with the patient and direct exposure of staff to bodily fluids and potential viral shed from the patient exhaling with each breath.

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Study Looks at CT Findings of COVID-19 Through Recovery

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Other SCCT Key Trends and New Technology Content:

Top 9 Cardiovascular CT Studies in Past Year 

VIDEO: Coronary Plaque Quantification Will Become Major Risk Assessment

VIDEO: Key Cardiac CT Papers Presented at SCCT 2020

VIDEO: Photon Counting Detectors Will be the Next Major Advance in Computed Tomography

VIDEO: Artificial Intelligence to Automate CT Calcium Scoring and Radiomics

Low-attenuation Coronary Plaque Burden May Become Next Big Cardiac Risk Assessment

Interview with Andrew D. Krahn, M.D.,FHRS, head of the division of cardiology at St. Paul’s Hospital, and professor of medicine at the University of British Columbia, and vice president of the Heart Rhythm Society (HRS). He is an expert in long QT syndrome (LQTS) and is involved with the National Long QT Registry. He explains the issues with the drugs being used to treat coronavirus (COVID-19, SARS-CoV-2) patients and why these combined with the cardiac impact of the virus is causing prolonged ECG QT segment prolongation, leading to deadly arrhythmias. COVID-19 can cause myocarditis that causes QT prolongation and the front-line COVID drugs hydroxychloroquine and azithromycin also cause QT prolongation.

The U.S. Food and Drug Administration (FDA) issued a Drug Safety Communication April 23, 2020, reminding doctors there are serious side effects when using hydroxychloroquine and chloroquine in the off-label use to treat COVID-19 patients. This includes potentially life-threatening heart rhythm problems. The FDA said case reports from the FDA Adverse Event Reporting System database, published medical literature and the American Association of Poison Control Centers National Poison Data System are reporting serious heart-related adverse events and patient deaths. Read more about this alert.

The FDA warning confirmed fears from the American Heart Association (AHA), the American College of Cardiology (ACC) and the Heart Rhythm Society (HRS). These societies April 8 jointly published a new guidance, “Considerations for Drug Interactions on QTc in Exploratory COVID-19 (Coronavirus Disease 19) Treatment,” to detail critical cardiovascular considerations in the use of hydroxychloroquine and azithromycin for the treatment of COVID-19. The societies warned that use of  these agents in a large number of patients in combination would results in arrhythmias and deaths. Read more.

However, there are numerous advocates that argue hydroxychloroquine needs to be used in less sick patients who are not already hypoxic to treat COVID, but it is being used primarily in very sick patients where it is not effective. Advocates also argue the drug can be used to help prevent coronavirus, similar to the drug's effect in preventing malaria. In terms of drug safety, advocates argue the drug has been used in millions of patients for more than 50 years without a high risk of arrhythmias. Several trials are now underway in the United States to test its use against COVID-19, but enrollment has been hampered because of the FDA warning. There will likely be more interest in hydroxychloroquine after it was revealed May 18, 2020, that President Trump is taking the drug for prophylaxis against COVID-19.

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Andrew D. Krahn, M.D., FHRS, head of the division of cardiology at St. Paul’s Hospital, professor of medicine  at the University of British Columbia and vice president of the Heart Rhythm Society (HRS), explains how HRS organized its virtual meeting after its in-person meeting was cancelled by the COVID-19 pandemic.  

Due to the continued global escalation of the novel coronavirus (COVID-19, SARS-CoV-2), HRS has cancelled its large annual in-person electrophysiology meeting in late-March and began planning for a virtual meeting instead. HRS broke its annual meeting into three online learning sessions over the course of May June and July. The first, which included the late-breaking sessions, was held May 5-9, 2020. Others will be held June 12 and July 1.

Using its online learning platform, Heart Rhythm 365 available on the www.hrsonline.org website, HRS is offering all its sessions at no cost.

Watch another interview with Krahn in the VIDEO: Top New EP Technologies at Heart Rhythm Society 2020.
 

Find a complete list of the Heart Rhythm 2020 meeting late-breaking studies with links to articles on each.
 

Thomas Maddox, M.D., MSc, FACC, the chair of the American College of Cardiology (ACC) Science and Quality Committee, explains concerns by ACC in a large drop in ST-elevation myocardial infarction (STEMI) heart attacks and strokes since the U.S. spread of COVID-19. Maddox is also the executive director of the Healthcare Innovation Lab of BJC Healthcare and Washington University School of Medicine, St. Louis. He is also an assistant professor of cardiology at Washington University.

The ACC is concerned about the 35-40 percent drop in STEMI and stroke patients presenting to emergency rooms across the U.S. and internationally since the start of the novel coronavirus (COVID-19, SARS-CoV-2) pandemic. Maddox is alarmed by the drop in cases and suspects patients are deciding to stay home rather than go to the hospitals out of fear about catching COVID-19. ACC launched a public relations campaign April 14, 2020, aimed at the public to get them to call 911 or go to hospitals if they have symptoms of stoke of a heart attack. Maddox said hospitals are still seeing and treating non-COVID-19 patients and the cardiovascular departments are still activating their cath labs to handle and acute cardiac cases that come in. 

He said Spain, which was hit earlier than the U.S. by the virus, saw a STEMI case decrease of about 40 percent. Based on limited U.S. data, he said U.S. cath lab activations are down about 35 percent. A clearer picture of the actual numbers of STEMI and other PCI cases will not be known from the ACC National Cardiovascular Data Registry (NCDR) until later this year, since most hospitals pull this data quarterly.

ACC is offering resources for the public  at www.cardiosmart.org/Coronavirus to evaluate their symptoms and help decide it they should go to the hospital or call 911.

Read the related article "Rapid Drop in Heart Attacks and Stroke at Hospitals Concerns ACC."

Watch another interview with Maddox in the VIDEO: What Cardiologists Need to Know about COVID-19.

Stephen Bloom, M.D., FASNC, director of nonivasive cardiology (cardiac CT, nuclear cardiology and echocardiography) at Midwest Heart and Vascular Associates, Overland Park, Kansas. He is also a member of the American Society of Nuclear Cardiology (ASNC) Board of Directors, explains some of the issues involved and protocols used for cardiac imaging during the COVID-19 pandemic. His discussion includes computed tomography, cardiac ultrasound and nuclear imaging.

Right now, Bloom said it is difficult to test everybody and there is a shortage of masks, gowns and other personal protective equipment (PPE), and the imaging equipment needs to be sanitized each time it is used. He said it is just is not possible to image all the patients who need imaging right now. Hospitals also are trying to limit the number of healthy people people coming into hospitals for routine visits and tests to reduce their potential exposure to the novel coronavirus (COVID-19, SARS-CoV-2) and help containment efforts. 

"The tests should be done, very simply, if it changes the care of the patient. If it doesn't change the care of the patient, and it can be postponed, it should be postponed," Bloom explained. "I would say 80 percent of our cardiac imaging exams have stopped. It has been very dramatic."

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The Cardiac Implications of Novel Coronavirus

Hicham Skali, M.D., a staff cardiologist and member of the Non-invasive Cardiovascular Imaging Program at Brigham and Women’s Hospital (BWH), and at Brigham and Women’s / Massachusetts General Health Care Center at Foxborough, explains the new recommendations from the American Society of Nuclear Cardiology (ASNC) and from imagers in China and Singapore. The ASNC created a best practices document for nuclear cardiology laboratories during the novel coronavirus (COVID-19, SARS-CoV-2) pandemic. The suggestions in the guidelines can ally to any imaging modality, including computed tomography (CT), MRI and ultrasound. 

Skali elaborates on the following points in his discussion, which are specific recommendations in the ASNC and SNMMI COVID-19 guidance document:
   • Rescheduling non-urgent visits
   • Rescheduling elective surgeries and procedures
   • Using separate spaces for patients with known or suspected COVID-19 to prevent spread
   • Ensuring supplies are available
   • Promoting use of telehealth
   • Screen staff, patients and visitors before they enter the department
   • Minimize non-essential visitors into the department
   • Record symptoms at the start of the shift
   • Use personal protective equipment (PPE)for healthcare personnel
   • If available, use PPE for patients due to concern of asymptomatic transmission of COVID-19
   • Maintain strict hand hygiene
   • Maintain 6 feet distance in all patient/staff interactions when possible
   • Work remotely whenever feasible, especially with ready studies
   • Rotating staff schedules for on-site and off-site work
   • Use of rest only studies if possible
   • Use of half-time SPECT to speed exam times
   • Use of PET if available to speed exam times

Skali served as the moderator in for the ASNC on demand webinar COVID-19 Preparedness for Nuclear Cardiology Labs: Insights from the US, China and Singapore.

VIDEO: Telemedicine in Cardiology and Medical Imaging During COVID-19 — Interview with Regina Druz, M.D., an ASNC Board member and also a speaker during the ASNC webinar.

Find more news and video on relating to COVID-19 and its impact on cardiology

A review of the PARTNER 3 Low-Risk Trial with Michael Mack, M.D., chairman, cardiovascular service line,  Baylor Scott and White Health, Dallas Texas, chairman of the board of the BSW Health Research institute, Dallas, and co-principal investigator of the trial. The PARTNER 3 Low-Risk Trial two-year data were presented as a late-breaking study at the virtual American College of Cardiology (ACC) 2020 annual meeting. The trial offers additional evidence that TAVR performs as well as surgery in select low-risk patients. 

Mack said the trial included patients over the age of 65, and there is still a question about long-term durability of the Sapien 3 TAVR valve used in trial before it is used in younger patients. He said patients in this trial will be tracked out to 10 years, which will offer a lot of information on durability of the current iteration of this valve. In the video, he also elaborates on TAVR issues involved with bicuspid aortic valves and other patient selection issues.

PARTNER 3 enrolled 1,000 patients with severe aortic stenosis and a Society of Thoracic Surgeons (STS) risk score of less than 4 percent. All patients had a tricuspid aortic valve. Half of the participants were randomly assigned to undergo TAVR and half underwent surgery. At two years, 11.5 percent of patients receiving TAVR and 17.4 percent of those receiving surgery died, suffered a stroke or were rehospitalized for cardiovascular problems, a difference in the composite primary endpoint that researchers reported as showing non-inferiority, meaning neither treatment was superior to the other.

In a secondary analysis, rates of death and stroke were found to be not significantly different between the two groups. Death occurred in 2.4 percent of those receiving TAVR and 3.2 percent of those receiving surgery, while stroke occurred in 2.4 percent of those receiving TAVR and 3.6 percent of those receiving surgery. Rehospitalization rates showed a significant difference in favor of TAVR; 8.5 percent of those receiving TAVR and 12.5 percent of those receiving surgery were rehospitalized for cardiovascular reasons during the study period. 

Read more details about this trial 

Read the one year trial results from ACC 2019

Find other ACC news and videos
 

Interview with Thomas Maddox, M.D., MSc, FACC, the chairman of the American College of Cardiology (ACC) Science and Quality Committee, which recently created the ACC document on novel coronavirus (COVID-19) clinical guidance for the cardiovascular care team. He explains the document and what cardiologists and the cardiac care team needs to know about caring for COVID-19 patients. The document points out COVID-19 combined with the comorbidity of cardiovascular disease has the mortality of any comorbidity, as high as 10.5 percent.

He explains the need for more serious attention to protective equipment, cardiovascular complications seen in COVID-19 (SARS‐CoV‐2) patients, suggestions on how to mitigate exposure if an echo or cath is required, and other considerations for the CV care team. He said the document will be updated on a regular bases and the committee is drafting other sets of related COVID-19 guidelines for cardiology departments.

Updates regarding COVID-19 and cardiology will be posted on the ACC COVID-19 Hub page.

Maddox is also the executive director of the Healthcare Innovation Lab of BJC Healthcare and Washington University School of Medicine, St. Louis. He is also an assistant professor of cardiology at Washington University.

Read more on ACC COVID-19 recommendations for the cardiovascular care team.

Additional COVID-19 Resources for Clinicians:

   World Health Organization (WHO) COVID-19 situation reports

   World Health Organization (WHO) coronavirus information page

   U.S. Food and Drug Administration (FDA) COVID-19 information page

   Centers for Disease Control (CDC) COVID-19 information page

   Centers for Medicare and Medicaid Services (CMS) frequently asked questions and answers (FAQs) for healthcare providers regarding COVID-19 related payments
 

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