DOACs vs warfarin for valvular AF

Direct oral anticoagulants (DOACs) appear to be more effective and safer than warfarin for people with valvular atrial fibrillation (AF), a US study has found.

A retrospective cohort study involving 56,336 patients with valvular AF matched on propensity score found that after median follow-up of 134 days the use of DOACs was associated with lower risk for ischaemic stroke or systemic embolism (hazard ratio [HR], 0.64 [95% CI, 0.59 to 0.70]) compared to new users of warfarin. Similarly, DOAC users had a lower risk of major bleeding events (HR, 0.67 [CI, 0.63 to 0.72]) compared to warfarin users

The results for safety and effectiveness were consistent for apixaban and rivaroxaban, but for dabigatran the results were consistent only for the major bleeding outcome (HR, 0.81 [CI, 0.68 to 0.97]) but not for effectiveness (HR, 1.03 [CI, 0.81 to 1.31]).

The findings are published in Annals of Internal Medicine.

Coronary calcium scans provide prognosis in remote populations

Calcium scoring on CT coronary angiography (CTCA) may be a useful tool to stratify people for cardiovascular risk in remote and Indigenous populations, a study from the Northern Territory suggests.

In a study involving 347 patients (39% Indigenous) at the Alice Springs hospital, a normal CTCA conferred an excellent two year cardiovascular prognosis for both Indigenous and non-Indigenous individuals. Half of the participants exhibited coronary calcification, with non-obstructive disease seen in 42.9%, and obstructive disease seen in 17.6% of patients.

Over 4.6 years of follow-up, coronary calcification and obstructive coronary artery disease were associated with 5-fold and 6-fold greater hazards of MACE respectively, the study authors reported in International Journal of Cardiology.

Three cardiology research programs win funding

Three cardiovascular research projects are among 10 newly funded programs from the National Health and Medical Research Council’s Partnership Project scheme

The research projects cover genetic risk scores for more targeted strategies to prevent heart disease; electronic data systems and integrated care teams for patient-centred management of acute myocardial infarction to overcome variation in outcomes, and heart failure guidelines for hospitals and clinics in regional Australia without specialist medical teams.

Cardiologist Professor Gemma Figtree of Sydney University receives $1.4 million for the Partnership for Precision Prevention In CAD (PPP-CAD)

Professor John Beltrame of Adelaide University receives $1.5 million for the Personalising Acute Myocardial Infarction Care to improve Outcomes (PAMICO Project) in coronary artery disease.

Professor Andrea Driscoll of Deakin University, Victoria receives $1.27 million for the I-HEART (Implementation of HEArt failure guidelines in Regional AusTralia) program.