This Week in Cardiology: Heart Failure, AFib, and Exercise

From the New England Journal of Medicine, a systematic review and network meta-analysis evaluated oral traditional Chinese medicines containing Astragalus alone or in combination with other drugs versus Western medicine alone in 1584 patients ^[1].

The authors describe findings where Astragalus Granule plus Western medicine ranked best for overall clinical efficacy in heart failure, suggesting that adding Astragalus-containing TCM to Western medicine may improve outcomes pending further validation.

Meanwhile, attention turned to stroke prevention strategies in atrial fibrillation. A meta-analysis of RCTs in adults with non-valvular AF found that percutaneous left atrial appendage closure achieved noninferiority for primary efficacy in three trials and significantly reduced bleeding compared to NOACs ^[2].

The researchers note a trend toward stroke reduction, though they advise considering LAAC as a shared decision-making alternative while acknowledging the need to interpret these results carefully.

Elsewhere this week, researchers examined specific risk factors within the atrial fibrillation population. In the Journal of the American Heart Association, a post hoc analysis of the ELDERCARE-AF RCT included 427 very old Japanese patients with atrial fibrillation and high bleeding risk ^[5].

Higher edoxaban trough concentrations and PT >13 seconds were identified as predictors for major bleeding in this specific demographic. The authors suggest that PT >13 seconds could serve as a potential marker for increased bleeding risk in very old Japanese AF patients on low-dose edoxaban, but recognize this is exploratory.

We also saw research in Frontiers in Medicine addressing lifestyle factors and physical exertion. A mini review synthesized evidence on sudden cardiac death and coronary artery disease in marathon runners ^[3].

The authors note that risk is higher in men, older runners, and full-marathon participants, though absolute incidence remains low. In a separate study within the same journal, a systematic review and meta-analysis evaluated dynamic resistance training for lowering resting blood pressure across populations with varying baseline levels ^[4].

The analysis of 18 studies found that dynamic resistance training significantly reduces resting blood pressure, although the authors note limited safety data in this context.