The edition · Cardiology
Raise the potassium, and let the village health worker titrate the blood pressure
A 1200-patient trial says pushing plasma potassium to the high-normal range cuts atrial fibrillation events by a third; half-dose rivaroxaban beats antiplatelet therapy after appendage occlusion on silent embolic lesions; and rural China shows a nurse-led hypertension programme still working three years after the funding stopped.
The edition in brief
Four cardiology findings and a delivery model. A prespecified analysis of POTCAST randomised 1200 adults with an implantable defibrillator or resynchronisation device and a plasma potassium of 4.3 mmol/L or below to potassium-raising treatment or standard care. Potassium rose by 0.3 mmol/L, and over a median 3.3 person-years the composite of atrial fibrillation hospitalisation, cardioversion or ablation, inappropriate shock or amiodarone loading fell from 12.2% to 8.0%, subdistribution hazard ratio 0.65 (95% CI 0.45 to 0.93). HALO-SCE randomised 164 patients 45 days after successful left atrial appendage occlusion to rivaroxaban 10 mg daily or antiplatelet therapy: new silent cerebral embolic lesions on serial diffusion-weighted MRI occurred in 12.2% against 31.7%, with better cognitive scores at a year. An individual patient data network meta-analysis of six trials and 10634 patients with atrial fibrillation undergoing percutaneous coronary intervention found no difference in cardiovascular death, myocardial infarction or stroke across four antithrombotic strategies, but a 14-day landmark analysis showed more early myocardial infarction and stent thrombosis when the second antiplatelet was dropped immediately; a DOAC with a P2Y12 inhibitor halved TIMI major bleeding against warfarin with dual antiplatelet therapy and cut intracranial haemorrhage to a fifth. LUMINARA, a phase 2 dose-ranging trial of the oral relaxin receptor agonist AZD5462 in 375 patients with chronic heart failure, moved haemodynamic surrogates without reaching significance on its reduced-ejection-fraction primary endpoint. And seven-year follow-up of CRHCP shows a non-physician-led intensive blood pressure programme in rural China still cutting cardiovascular events three years after its support was withdrawn.
Pushing potassium to the top of normal cut atrial fibrillation events
Raising plasma potassium into the high-normal range in defibrillator patients cut atrial fibrillation-related events from 12.2% to 8.0% over a median 3.3 person-years, subdistribution hazard ratio 0.65 (95% CI 0.45 to 0.93).
After appendage occlusion, low-dose rivaroxaban beat antiplatelet therapy on brain lesions
In patients still eligible for anticoagulation, rivaroxaban 10 mg daily after left atrial appendage occlusion cut new silent cerebral embolic lesions from 31.7% to 12.2% and preserved cognitive scores better at a year, on a surrogate endpoint in 164 patients.
Atrial fibrillation after PCI: the first fortnight is where dropping aspirin costs you
Across 10634 patients, the antithrombotic strategy did not change one-year ischaemic outcomes, but a DOAC with a P2Y12 inhibitor halved major bleeding - while dropping to a single antiplatelet within days of PCI raised early myocardial infarction and stent thrombosis.
An oral relaxin agonist moves the haemodynamics, not yet the outcomes
The oral relaxin receptor agonist AZD5462 lowered systemic vascular resistance across all doses in heart failure with mildly reduced or preserved ejection fraction, but missed its ventricular volume endpoint in reduced ejection fraction (-5.4 mL/m2, 95% CI -10.9 to 0.1, P=0.054) - phase 2 signal only.
Write the stop date on the second antiplatelet
Write an explicit stop date and a named owner for every antiplatelet in the discharge summary after PCI in a patient on an anticoagulant - unstopped triple therapy causes more harm than the initial choice of regimen.
The village health worker programme still worked three years after the money stopped
A non-physician-led intensive blood pressure programme in rural China cut cardiovascular events by about a quarter over seven years and kept doing so for three years after its subsidies, training and incentives were withdrawn - the trained provider and the protocol were what carried it.
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