From the great Hospital Medicine Quick Hits blog:

This was in NEJM this week--I like the concept of "lenient" atrial fibrillation control as easier to achieve and no worse for patients than strict control of heart rate.  Looks like 110 is the new speed limit in atrial fibrillation.

I wanted to call attention to this excellent post, which not only reviews a pertinent clinical question, but also provides citations and is reviewed by an NYU faculty member.

The site is called Clinicalcorrelations.org, and this week, they take on the tough question of why some patients delay coming in to the hospital for a suspected heart attack or stroke.

WSJ had a long piece today about the recommendations for aspirin for prevention of disease.

In there is an audio podcast of Dr. Ned Calonge of USPSTF talking about that organization's guidelines for aspirin.

Seemingly big news today in cardiology: patients with hard-to-control atrial fibrillation were better off getting a catheter ablation than trying different medical therapy.

As if there aren't enough people taking Plavix already ($6 billion in sales per year) researchers published a study today showing incremental benefit to adding plavix to aspirin in atrial fib patients deemed not candidates for coumadin. The issue is this: coumadin has long been shown to be superior to aspirin for preventing stroke in atrial fibrillation. Coumadin's bleeding risk is similar to asprin but only if properly managed in a compliant patient.

Unexpected development: a small study reports good efficacy of a cage-like device implanted in the hearts of patients with atrial fibrillation. Right now we give people a medicine coumadin to prevent strokes from atrial fibrillation (a common heart arrhythmia). A company has introduced a device that evidently accomplishes the same goal. Complications were up around 7% which is more toxic than coumadin which has about a 1% per year serious bleed risk (about the same as aspirin). The Reuter's article calls coumadin "notoriously difficult to manage " as if it were some sort of villain.

Family history big predictor of clot risk hardly seems like news but Annals of Internal Medicine is playing this familiar song again this week with a new research study. I can remember the famous Dr. Rosendaal talking about the critical importance of family history of blood clots in his 2003 lecture at the American Society of Hematology meeting. People with family history of thrombosis were at least twice as likely as other folks to get a blood clot. This compares to similar numbers for the famous Factor V Leiden or Prothrombin Gene Mutation 20210.

Researchers have published in the prestigious journal PNAS that music therapy may assist the recovery of stroke victims with cognitive defects. Wired.com's blog had a nice article on this finding dubbed the "Kenny Rogers Effect" by one researcher. Key quote: "When emotional areas light up and are activated the attentional system seems to be more effective as well." The findings are preliminary so take it with a grain of salt. Still this is potentially good news and a story worth keeping an eye on. http://blog.wired.com/wiredscience/2009/03/musicheals.html

This may not come as news to cardiologists but the rest of us (ok me) were impressed that statins appear to reduce the severity of strokes. Patients taking statins before a stroke seemed to have less severe strokes and took less time to recover. This is perhaps evidence that statins are doing more than just reducing cholesterol; much has been made of their anti-inflammatory properties as well and maybe preventing inflammation after a stroke is critical to a faster recovery.

Looks like clopidogrel/Plavix genetic testing is a reality. A test called 2C19 Genotyping can predict which patients have faulty metabolism of this blood thinner leading to treatment failures and clotting problems. I got a nice review of two recent clinical trials in this area from the testing company Genelex. The testing has never previously been available to us clinicians but looks like it has come to the office setting. In the interest of disclosure I have worked with this company on projects in the past but we have never had a monetary relationship.