Todays discussion centered on management of CHF/A-fib management issues.
One discussion concerned the CAFE-II (NEJM Jun 19, 2008) study . Despite the fact that atrial fibrillation is poorly tolerated in heart failure patients, working to restore sinus rhythm did not improve outcomes compared to rate control alone.
http://content.nejm.org/cgi/content/abstract/358/25/2667
A Lancet article 11 Aug 2007 published results of the BAFTA trial analyzing the use of warfarin in elderly patients with atrial fibrillation. 20% of study subjects were >85 years old, and in all subsets the benefit appeared to outweigh the harm. You can get full text Lancet access through science direct in the hopsital.
http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6T1B-4PCSC5S-12&_user=2763990&_coverDate=08%2F17%2F2007&_rdoc=1&_fmt=high&_orig=search&_sort=d&_docanchor=&view=c&_acct=C000058752&_version=1&_urlVersion=0&_userid=2763990&md5=b766d43281583dd9944244e897cf5559
Also, be sure to remember the CHADS-2 score:
CHF, Age >75, HTN, and diabetes 1 point each, with 2 points for prior stroke or TIA. 3 points is a roughly 6% stroke rate per year and goes up with each additional risk factor. Handy on-line tool linked below.
http://www.mdcalc.com/chads2-score-for-atrial-fibrillation-stroke-risk
Review of topics covered in morning report, M&m, and core conferences with links to supplemental reading material.
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