In order to improve the treatment of cardiovascular diseases such as high blood pressure, heart failure, heart attacks or strokes, new drugs or methods are constantly being developed and tested for their effectiveness in clinical trials. The results of these studies are then presented in specialist journals or at congresses. Depending on their size and persuasiveness, the results are then incorporated into so-called guidelines, which the medical profession uses as a guide. This is known as evidence-based medicine (or conventional medicine).
The Congress of the European Society of Cardiology (ESC) took place in Amsterdam in August 2023. To give you a rough idea of what cardiologists are currently working on, here is a brief excursion into the world of modern cardiac medicine.
- Heart failure is a failure of the heart muscle to pump blood around the body. There are two types of pumping force: the so-called systolic phase (ejection of blood) and the diastolic phase (filling of the heart chambers). The
The latter is the subject of much research and until now there have been hardly any convincing treatment approaches. This has now changed. Drugs originally only used for blood glucose disease (SGLT-2 inhibitors, such as dapagliflozin or empagliflozin) were able to reduce the mortality rate or hospital admissions (ESC Guideline Update 2023 on heart failure). - Iron plays a vital role in the body for the transportation of oxygen. Administration of iron infusions in heart failure patients may be necessary. This has been confirmed once again and, according to a new study, led to an improvement in quality of life and should now be used consistently (ESC Guideline Update 2023 on heart failure).
- Pacemakers are used in patients in whom there is no stimulation of the heart muscle to trigger a subsequent contraction. These are programming devices about 5 cm in size under the left shoulder, which deliver short electrical
electrical impulses to the heart. These must be checked regularly by a cardiologist. All types of arrhythmia are recorded. These can also include atrial fibrillation, which should actually be treated with blood thinners.
should actually be treated with blood thinners. And this is where a new comparative study comes into play again: it showed that not all cardiac arrhythmias in the atrium need to be treated with blood thinners (NOAH-AFNET-6 study). - In rare cases, the patient may go into shock after a severe heart attack. This is a life-threatening condition in which the organs are no longer sufficiently supplied with blood, which leads to death without treatment. In addition to opening the blocked vessel in the heart, a cardiovascular machine (ECMO=Extracorporeal Membrane Oxygenation) is often connected to the patient, which temporarily takes over the regulation of blood flow. A large study has now shown that such ECMO offers no advantage for these patients (ECLS-SHOCK study).
- Semaglutide (GLP-1 receptor antagonist), also a drug originally only used to treat diabetics, showed a significant improvement in symptoms and weight loss in patients with heart failure and obesity (STEP-HFpEF). These drugs are also known as "weight loss pills" and are currently very popular, but may only be used in very specific patient groups.
- In the event of a heart attack, the blocked vessel is usually opened with a balloon and a stent (vascular support made of wire) is inserted. An alternative to this would be a surgical bypass by cardiac surgeons. A
study showed that other vessels in the heart that are significantly narrowed but were not necessarily involved in the infarction should also be widened in the same period (FIRE). - There are heart diseases in which proteins are pathologically stored in the heart muscles and thus significantly impair the pumping function. This is the case with amyloidosis and is usually fatal if left untreated. A new drug has been used in over 300 patients with such an impairment. They benefited significantly from the treatment compared to patients without the new drug (ATTRibute-CM).
- Clots occur more frequently with cancer, particularly in the leg veins. Normally, blood thinning (anticoagulation) is then administered in the form of
tablets for three months. However, a study has shown that
cancer patients benefit more from 12 months of treatment and suffer fewer
suffer fewer relapses (ONCO-DVT). - As mentioned above, blood thinning is also essential for atrial fibrillation in order to prevent strokes. For some years now, new drugs (NOACs) have been available that have virtually replaced the conventional, somewhat cumbersome tablets (VKAs, e.g. Marcumar). However, it has now been shown that this is not transferable to older patient groups (average age 83 years) and that the VKAs have performed better here (FRAIL-AF).
As you can see, these are detailed questions. But some of these are life-critical and, as specialists, we have to keep ourselves constantly informed by reading journals, taking part in training courses and exchanging ideas with colleagues.
This is the only way we can offer you the best medicine.
