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Original Article
Warfarin and Aspirin in Patients with Heart Failure and Sinus Rhythm
Chronic heart failure is a major cause of illness and death. Heart failure is associated with a hypercoagulable state, formation of left ventricular thrombus, and cerebral embolism. It is also associated with both sudden death and death resulting from progressive heart failure that may be caused by…
- May 17, 2012
- Homma S., Thompson J.L.P., Pullicino P.M., et al.
- N Engl J Med 2012; 366:1859-1869
- CME
Patients with heart failure and sinus rhythm benefit from anticoagulation. This trial showed no overall difference between warfarin and aspirin; reduced risk of ischemic stroke with warfarin was offset by an increase in major bleeding.
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Editorial
Warfarin in Heart Failure
Despite major advances in the management of heart failure with angiotensin-converting–enzyme inhibitors, beta-blockers, and resynchronization therapy, there are more than 1 million hospitalizations for heart failure in the United States each year, and mortality remains high. As compared with the…
- May 17, 2012
- Eikelboom J.W. and Connolly S.J.
- N Engl J Med 2012; 366:1936-1938
Despite major advances in the management of heart failure with angiotensin-converting–enzyme inhibitors, beta-blockers, and resynchronization therapy, there are more than 1 million hospitalizations for heart failure in the United States each year, and ...
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Original Article
Low-Molecular-Weight Heparin and Mortality in Acutely Ill Medical Patients
Venous thromboembolism is an important complication in hospitalized patients.– It is estimated that if thromboprophylaxis is not administered, objectively diagnosed deep-vein thrombosis — with the potential for fatal pulmonary embolism — will develop in 10 to 20% of medical patients and in 40…
- December 29, 2011
- Kakkar A.K., Cimminiello C., Goldhaber S.Z., et al.
- N Engl J Med 2011; 365:2463-2472
- CME
Thromboprophylaxis with low-molecular-weight heparin is known to prevent deep-vein thrombosis in acutely ill medical patients. This large trial showed no effect of enoxaparin on 30-day mortality, which was virtually identical in the active-treatment and placebo groups.
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Special Article
The Relationship between Hospital Admission Rates and Rehospitalizations
Unplanned readmissions after hospitalization are costly and reflect suboptimal patient outcomes. Policymakers have focused on reducing readmissions as a way to both lower costs and improve outcomes. Evidence of suboptimal care at hospital discharge and shortly thereafter, has prompted clinical…
- December 15, 2011
- Epstein A.M., Jha A.K., Orav E.J.
- N Engl J Med 2011; 365:2287-2295
- Free Full Text
Hospital readmission rates are thought to reflect the quality of transitional care. In this study, readmission rates for congestive heart failure and pneumonia were associated with overall hospitalization rates. Interventions may best be focused on reducing incentives to use hospital services.
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Review Article
Genomic Medicine: Genomics of Cardiovascular Disease
Cardiovascular disease is the leading cause of death in the United States. Considerable progress has been made in the past 50 years to define, identify, and modify risk factors for cardiovascular disease (e.g. hypertension, dyslipidemia, obesity, type 2 diabetes, cigarette smoking, and physical…
- December 1, 2011
- O'Donnell C.J. and Nabel E.G.
- N Engl J Med 2011; 365:2098-2109
- Free Full Text
- Interactive/Multimedia
The authors provide an overview of how genetic and genomic studies have improved our understanding of the cause of cardiovascular disease.
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Special Article
Results of the Medicare Health Support Disease-Management Pilot Program
Management of care for chronic illness, with its focus on high-risk, high-cost patients, is touted as a valuable initiative to improve health outcomes while potentially saving Medicare billions of dollars. Medicare fee-for-service beneficiaries must navigate a health care system structured and…
- November 3, 2011
- McCall N. and Cromwell J.
- N Engl J Med 2011; 365:1704-1712
- Free Full Text
The Medicare Health Support Pilot Program was a study of eight commercial disease-management programs for patients with heart failure, diabetes, or both. The programs did not reduce ER visits or hospitalizations and achieved only small improvements in 14 of 40 measures.
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Clinical Implications of Basic Research
Calcium Handling in the Failing Heart and SUMO — Weighing the Evidence
A key abnormality in heart failure is defective handling of calcium ions by cardiomyocytes. In the healthy heart, the action potential leads to an increase in the level of intracellular calcium (and subsequent systole) through two mechanisms. First, extracellular calcium enters the cell through L…
- November 3, 2011
- McMurray J.J.V. and Smith G.L.
- N Engl J Med 2011; 365:1738-1739
Heart failure has been attributed to a deficiency in a calcium ATPase. A recent study shows that tweaking this enzyme may boost its levels and thus guard against heart failure.
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Case Records of the Massachusetts General Hospital
Case 29-2011 — A 66-Year-Old Woman with Cardiac and Renal Failure
Presentation of Case. Dr. Jason E. Faris (Medicine): A 66-year-old woman was admitted to this hospital because of cardiac and renal failure. The patient had been well until approximately 6 months earlier, when dyspnea on exertion and leg edema developed. A diagnosis of congestive heart failure was…
- September 22, 2011
- Raje N.S., Steele D.J.R., Lawrimore T.M., Johri A.M., Sohani A.R.
- N Engl J Med 2011; 365:1129-1138
- CME
Cardiac and renal failure developed in a 66-year-old woman. Echocardiography suggested infiltrative cardiomyopathy, lytic bone lesions were seen on imaging, and elevated serum free light chains were detected. A diagnostic procedure was performed.
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Original Article
Effect of Nesiritide in Patients with Acute Decompensated Heart Failure
Acute decompensated heart failure is a major health problem that is associated with several million hospitalizations worldwide each year, poor short-term outcomes, and high costs.– Despite the magnitude of the problem, rates of early death and rehospitalization have not improved over the past…
- July 7, 2011
- O'Connor C.M., Starling R.C., Hernandez A.F., et al.
- N Engl J Med 2011; 365:32-43
- Free Full Text
Nesiritide was approved by the FDA on the basis of small clinical trials for the treatment of acute heart failure. In this large clinical trial, nesiritide did not improve outcomes in patients with acute heart failure, and it can no longer be recommended for this condition.
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Editorial
The Lost Decade of Nesiritide
The concept of the "lost decade" is typically attributed to the Japanese economy in the 1990s, when there was exceptionally little or weak economic growth, amid unprofitable zombie firms and liquidity traps. With the financial collapse in the United States in 2008, some economists have forecast the…
- July 7, 2011
- Topol E.J.
- N Engl J Med 2011; 365:81-82
The concept of the “lost decade” is typically attributed to the Japanese economy in the 1990s, when there was exceptionally little or weak economic growth, amid unprofitable zombie firms and liquidity traps.¹ With the financial collapse in the United ...
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Original Article
Coronary-Artery Bypass Surgery in Patients with Left Ventricular Dysfunction
It is estimated that 5.8 million patients in the United States and 15 million in Europe have heart failure. Coronary artery disease is the most common substrate for heart failure in industrialized nations. However, the role of coronary-artery bypass grafting (CABG) in the treatment of patients with…
- April 28, 2011
- Velazquez E.J., Lee K.L., Deja M.A., et al.
- N Engl J Med 2011; 364:1607-1616
- Free Full Text
- CME
Patients with CAD and LV dysfunction were assigned to either medical therapy alone or medical therapy plus CABG. At 5 years, there was no significant difference between the two study groups in the rate of death from any cause.
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Original Article
Myocardial Viability and Survival in Ischemic Left Ventricular Dysfunction
Coronary artery disease is an important contributor to the rise in the prevalence of heart failure and in associated mortality and morbidity.– It has not been clearly established whether coronary-artery bypass grafting (CABG) has a role in improving the symptoms and the rate of survival of…
- April 28, 2011
- Bonow R.O., Maurer G., Lee K.L., et al.
- N Engl J Med 2011; 364:1617-1625
- Free Full Text
- CME
Patients with CAD and LV dysfunction were assigned to receive either medical therapy alone or medical therapy plus CABG. There was no evidence of significant interaction between myocardial viability and treatment assignment.
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Editorial
Underestimating Medical Therapy for Coronary Disease . . . Again
The question of how best to treat patients with multivessel coronary artery disease and left ventricular dysfunction has challenged physicians for years. Although most clinicians are comfortable recommending revascularization when there is angina, extensive coronary disease, and a left ventricular…
- April 28, 2011
- Fang J.C.
- N Engl J Med 2011; 364:1671-1673
The question of how best to treat patients with multivessel coronary artery disease and left ventricular dysfunction has challenged physicians for years. Although most clinicians are comfortable recommending revascularization when there is angina, ...
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Original Article
Percutaneous Repair or Surgery for Mitral Regurgitation
Severe mitral regurgitation is associated with progressive left ventricular dysfunction and congestive heart failure. Without intervention, symptomatic patients have an annual rate of death of 5% or more.– Medical management alleviates symptoms but does not alter the progression of the disease.…
- April 14, 2011
- Feldman T., Foster E., Glower D.D., et al.
- N Engl J Med 2011; 364:1395-1406
- Free Full Text
- Interactive/Multimedia
This study compared a percutaneous, catheter-based method, in which a clip is placed to approximate the edges of the two mitral-valve leaflets, with conventional surgery. The procedure obviated the need for open-heart surgery in 80% of the patients who received it.
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Editorial
Mitral Regurgitation — What Is Best for My Patient?
Mitral regurgitation is common, with 80% of us having some normal valve leakage detectable on echocardiography. Mild regurgitation is well tolerated and rarely leads to overt clinical disease. However, severe regurgitation overloads the left ventricle as blood is pumped both backward across the…
- April 14, 2011
- Otto C.M. and Verrier E.D.
- N Engl J Med 2011; 364:1462-1463
Mitral regurgitation is common, with 80% of us having some normal valve leakage detectable on echocardiography. Mild regurgitation is well tolerated and rarely leads to overt clinical disease. However, severe regurgitation overloads the left ventricle as ...
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Case Records of the Massachusetts General Hospital
Case 11-2011 — A 47-Year-Old Man with Systemic Lupus Erythematosus and Heart Failure
Presentation of Case. Dr. Caroline L. Sokol (Medicine): A 47-year-old man with systemic lupus erythematosus (SLE) and progressive cardiac failure was transferred to this hospital after a cardiac arrest. One year before admission, dyspnea, leg edema, and abdominal distention gradually developed, and…
- April 14, 2011
- Newton-Cheh C., Lin A.E., Baggish A.L., Wang H.
- N Engl J Med 2011; 364:1450-1460
- Video
A 47-year-old man with systemic lupus erythematosus (SLE) was transferred to the hospital after cardiac arrest. Electrocardiography showed ST elevation, a long QT interval, and left ventricular hypertrophy (LVH). Echocardiography showed LVH and mitral-valve regurgitation.
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Original Article
Irbesartan in Patients with Atrial Fibrillation
The most common risk factor for the development of atrial fibrillation is hypertension, and two common complications in atrial fibrillation are stroke and heart failure, both of which are related to elevated blood pressure. Randomized trials of blood-pressure reduction have shown a reduced risk of…
- March 10, 2011
- The ACTIVE I Investigators
- N Engl J Med 2011; 364:928-938
- Free Full Text
In patients with atrial fibrillation, angiotensin-receptor blockade with irbesartan did not reduce the risk of cardiovascular events. The results of this study do not provide support for the use of irbesartan to improve outcomes in patients with atrial fibrillation.
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Original Article
Diuretic Strategies in Patients with Acute Decompensated Heart Failure
Acute decompensated heart failure is the most common cause of hospital admissions among patients older than 65 years of age and is responsible for more than 1 million hospitalizations annually in the United States. Intravenous loop diuretics are an essential component of current treatment and are…
- March 3, 2011
- Felker G.M., Lee K.L., Bull D.A., et al.
- N Engl J Med 2011; 364:797-805
- Free Full Text
- CME
Patients with acute decompensated heart failure received intravenous furosemide at either a low or a high dose and either boluses every 12 hours or continuous infusion. At 72 hours, there was no significant difference in symptoms or in the change in creatinine level from baseline for either comparison.
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Editorial
Comparative Effectiveness of Diuretic Regimens
Acute decompensated heart failure is associated with substantial morbidity, mortality, and health care expenditures. Most patients present with symptoms related to fluid overload, which may be complicated by concomitant renal dysfunction. Treating the signs and symptoms of heart failure while…
- March 3, 2011
- Fonarow G.C.
- N Engl J Med 2011; 364:877-878
Acute decompensated heart failure is associated with substantial morbidity, mortality, and health care expenditures.¹ Most patients present with symptoms related to fluid overload, which may be complicated by concomitant renal dysfunction.² Treating the ...
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Clinical Implications of Basic Research
Reprogramming Fibroblasts into Cardiomyocytes
A deficiency of cardiomyocytes underlies most cases of heart failure, and scientists have long sought to repopulate the heart with new cardiomyocytes. Most attempts at remuscularization have been based on the transplantation of stem cells or their derivatives, and success has been modest to date. A…
- January 13, 2011
- Murry C.E. and Pu W.T.
- N Engl J Med 2011; 364:177-178
The transdifferentiation of one differentiated cell type into another is the focus of much research activity. A recent study shows that mouse fibroblasts can be transdifferentiated, albeit with low efficiency, into cardiomyocytes.
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2012 Certifying Examinations of the American Board of Pediatrics

The general pediatrics examination will be held in various cities, Oct. 16-18. Registration for first-time applicants is ongoing through May 3. Registration for re-registrants is ongoing through May 24. The following subspecialty examinations will be held in various cities: "Hospice and Palliative Medicine" (Oct. 4); "Pediatric Transplant Hepatology" (Oct. 11); "Pediatric Cardiology" (Nov. 7); "Pediatric Pulmonology" (Nov. 8); "Medical Toxicology" (Nov. 12); and "Pediatric Critical Care Medicine" (Nov. 14). Registration for first-time applicants is ongoing through April 30. Registration for re-registrants is ongoing through June 15.

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