The edition · Cardiology
Aspirin alone held its own after appendage closure; TAVR cut heart-failure events in moderate stenosis
SIMPLAAFY found aspirin monotherapy non-inferior to dual antiplatelet therapy after left atrial appendage occlusion, with less bleeding. PROGRESS reported fewer deaths or heart-failure events with early TAVR in moderate aortic stenosis, driven by heart failure rather than survival.
The edition in brief
Today's cardiology edition closes on SIMPLAAFY, a three-arm trial of 1857 patients after left atrial appendage occlusion: the six-month composite of death, stroke, systemic embolism or major bleeding was 6.9% with dual antiplatelet therapy, 5.1% with reduced-dose oral anticoagulant and 3.3% with aspirin alone, and both simpler regimens met non-inferiority, with major bleeding of 4.5%, 2.7% and 1.7%. PROGRESS randomised 744 patients with moderate aortic stenosis and an at-risk feature to transfemoral TAVR or surveillance: death or a heart-failure event at two years was 16.7% versus 23.9%, a 7.2-point difference, but all-cause death was not lower (8.4% versus 7.3%). The HELIOS-B open-label extension found that patients on vutrisiran from the start had 37% lower all-cause mortality through 48 months than those who began on placebo. ADHERE-ASCVD, in 20,604 people with lapsed statin adherence, showed that digital reminders raised 14-day refills from 12.0% to 14.4%, and a second reminder helped non-responders. The FDA lists a class II recall of one India-manufactured amlodipine–olmesartan lot for failed dissolution. The pearl covers discordant aortic stenosis grading.
TAVR in moderate aortic stenosis: fewer heart-failure events, no fewer deaths at two years
Discuss moderate aortic stenosis with at-risk features at a heart team meeting; guidelines still recommend surveillance, so this is an option to weigh, not a new indication.
Vutrisiran in ATTR cardiomyopathy: starting early kept a 37% mortality advantage at four years
Look for transthyretin amyloid cardiomyopathy early in older patients with thick-walled hearts, because earlier treatment was associated with better four-year survival.
A text or portal message nudged lapsed statin users to refill, and a second one helped more
Send repeat refill reminders to patients who have lapsed on statins, and follow non-responders with a conversation about why they stopped.
FDA class II recall: an India-made amlodipine–olmesartan lot failed dissolution testing
If blood pressure control slips on a fixed-dose amlodipine–olmesartan tablet, check the brand and batch before escalating treatment.
When valve area and gradient disagree in aortic stenosis, check the flow
Do not file a small valve area with a low gradient as moderate stenosis until flow and calcium have been checked.
After appendage occlusion, aspirin alone was non-inferior to dual antiplatelets and bled less
After uncomplicated left atrial appendage occlusion, aspirin alone is a reasonable regimen to agree with the implanting team, with less bleeding than dual antiplatelets.
Read the rest in the app
You have read your two free briefings this month. The app carries all 27 specialties, every morning, free — and this one is waiting in it.
Scan to keep reading on your phone. No account needed to start.
Tomorrow morning, before your first patient
One edition a day for cardiology, written by the desk, every claim tied to its paper. Six minutes.
Get the app — free