The edition · Top Clinical Updates
Stopping beta-blockers years after an uncomplicated MI met non-inferiority
Pooled data from two trials support deprescribing when ejection fraction is preserved. Also: shorter antibiotics for endocarditis at a cost in relapse, KDIGO's new anaemia guideline, iron before cardiac surgery, and ECG monitoring after unexplained syncope.
The edition in brief
A pooled analysis of the ABYSS and SMART-DECISION trials (6238 patients) found that stopping beta-blockers in stable patients a median 3.6 years after myocardial infarction, with ejection fraction of 40% or more and no heart failure, was non-inferior to continuing them (HR 1.09 for the primary composite). In POET II, stopping antibiotics once patients with left-sided endocarditis had stabilised gave 13 more antibiotic-free days and non-inferior safety, but relapse rose from 1.6% to 5.1%. KDIGO's 2026 guideline on anaemia in chronic kidney disease prefers intravenous iron in haemodialysis, erythropoiesis-stimulating agents over HIF-PHIs as first line, and an upper haemoglobin target below 11.5 g/dL. In ITACS, 1000 mg of intravenous iron before elective cardiac surgery in anaemic adults reduced transfusion (61.1% vs 68.2%) and added about one day alive and at home by 90 days. In ASPIRED, 14-day ambulatory ECG monitoring after unexplained syncope in the emergency department did not reduce syncope episodes at one year. Today's pearl: review every long-term cardiovascular prescription for a current indication, not just the original one.
Stopping antibiotics once endocarditis stabilises: fewer antibiotic days, more relapse
Six weeks of antibiotics is no longer fixed for stable left-sided endocarditis, but stopping early raises relapse, so decide duration with the infection team and follow closely.
KDIGO 2026: anaemia in chronic kidney disease
In anaemic patients with CKD, check iron studies and treat reversible causes first; if an ESA is started, keep haemoglobin below 11.5 g/dL.
Intravenous iron before cardiac surgery reduced transfusion in anaemic adults
Check for anaemia when patients are listed for major elective surgery, and give intravenous iron in time to reduce transfusion.
Two weeks of ECG monitoring after unexplained syncope did not reduce further episodes
Reserve ambulatory ECG monitoring after unexplained syncope for patients with red flags rather than ordering it routinely.
Ask what each long-term cardiovascular drug is for now
At each medication review, ask what each long-term cardiovascular drug is doing for the patient now, and record the answer.
Beta-blockers can be stopped after an uncomplicated MI with preserved ejection fraction
Offer to taper and stop a beta-blocker in stable patients more than six months after MI with ejection fraction of 40% or more and no other indication.
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