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New England Journal of Medicine

Tuberculosis Elimination in the United States — The Need for Renewed Action
New England Journal of Medicine, Volume 377, Issue 12, Page 1109-1111, September 2017.
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A Nicotine-Focused Framework for Public Health
New England Journal of Medicine, Volume 377, Issue 12, Page 1111-1114, September 2017.
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The Fate of FDA Postapproval Studies
New England Journal of Medicine, Volume 377, Issue 12, Page 1114-1117, September 2017.
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Antiinflammatory Therapy with Canakinumab for Atherosclerotic Disease
New England Journal of Medicine, Volume 377, Issue 12, Page 1119-1131, September 2017.
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Correction: Altered biophysical properties of the voltage-gated sodium channels in mouse atrial and ventricular cardiomyocytes
O’Brien S, Holmes A, Parnell G, et al. 221 Altered biophysical properties of the voltage-gated sodium channels in mouse atrial and ventricular cardiomyocytes. Heart 2017;103:A143–A144. The author name "Geroge Parnell", should have been spelled "George Parnell".
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Heartbeat: Virtual histopathology after myocardial infarction
Inflammation plays a key role in outcomes after myocardial infarction yet we have few tools to directly visualise the cellular inflammatory response in clinical practice. In this issue of Heart, Stirrat and colleagues1 performed repeated MRI studies in 31 patients after myocardial infarction using ultra-small-super-paramagnetic particles of iron oxide (USPIO) to visualise macrophages within the myocardium. In combination with other MRI imaging sequences, this approach provides a virtual histopathologic view of the myocardium. In the infarcted myocardial segment, USPIO uptake peaked at 2–3 days and resolved by 10–16 days whereas myocardial oedema peaked later (day 3 to 9) and persisted for over 3 months. (figure 1) As the authors suggest: "This imaging technique holds promise as a non-invasive method of assessing and monitoring myocardial cellular inflammation with potential application to diagnosis, risk stratification and assessment of novel anti-inflammatory therapeutic interventions." Figure 1 Examples...
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JACC Instructions for Authors
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Adherence Tradeoff to Multiple Preventive Therapies and All-Cause Mortality After Acute Myocardial Infarction
AbstractBackground Angiotensin-converting enzyme (ACE) inhibitors/angiotensin II receptor blockers (ARB), beta-blockers and statins are recommended after acute myocardial infarction (AMI). Patients may adhere to some, but not all, therapies. Objectives The authors investigated the effect of tradeoffs in adherence to ACE inhibitors/ARBs, beta-blockers, and statins on survival among older people after AMI. Methods The authors identified 90,869 Medicare beneficiaries ≥65 years of age who had prescriptions for ACE inhibitors/ARBs, beta-blockers, and statins, and survived ≥180 days after AMI hospitalization in 2008 to 2010. Adherence was measured by proportion of days covered (PDC) during 180 days following hospital discharge. Mortality follow-up extended up to 18 months after this period. The authors used Cox proportional hazards models to estimate hazard ratios of mortality for groups adherent to 2, 1, or none of the therapies versus group adherent to all 3 therapies. Results Only 49% of the patients adhered (PDC ≥80%) to all 3 therapies. Compared with being adherent to all 3 therapies, multivariable-adjusted hazard ratios (95% confidence intervals [CIs]) for mortality were 1.12 (95% CI: 1.04 to 1.21) for being adherent to ACE inhibitors/ARBs and beta-blockers only, 0.98 (95% CI: 0.91 to 1.07) for ACEI/ARBs and statins only, 1.17 (95% CI: 1.10 to 1.25) beta-blockers and statins only, 1.19 (95% CI: 1.07 to 1.32) for ACE inhibitors/ARBs only, 1.32 (95% CI: 1.21 to 1.44) for beta-blockers only, 1.26 (95% CI: 1.15 to 1.38) statins only, and 1.65 (95% CI: 1.54 to 1.76) for being nonadherent (PDC <80%) to all 3 therapies. Conclusions Patients adherent to ACE inhibitors/ARBs and statins only had similar mortality rates as those adherent to all 3 therapies, suggesting limited additional benefit for beta-blockers in patients who were adherent to statins and ACE inhibitors/ARBs. Nonadherence to ACE inhibitors/ARBs and/or statins was associated with higher mortality.
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"Sticky" Issues for Adherence in Secondary Prevention
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Effect of Definition on Incidence and Prognosis of Type 2 Myocardial Infarction
AbstractBackground Uncertainties regarding the most appropriate definition and treatment of type 2 myocardial infarction (T2MI) due to supply-demand mismatch have contributed to inconsistent adoption in clinical practice. Objectives This study sought a better understanding of the effect of the definition of T2MI on its incidence, treatment, and event-related mortality, thereby addressing an important unmet clinical need. Methods The final diagnosis was adjudicated in patients presenting with symptoms suggestive of myocardial infarction by 2 independent cardiologists by 2 methods: 1 method required the presence of coronary artery disease, a common interpretation of the 2007 universal definition (T2MI2007); and 1 method did not require coronary artery disease, the 2012 universal definition (T2MI2012). Results Overall, 4,015 consecutive patients were adjudicated. The incidence of T2MI based on the T2MI2007 definition was 2.8% (n = 112). The application of the more liberal T2MI2012 definition resulted in an increase of T2MI incidence of 6% (n = 240), a relative increase of 114% (128 reclassified patients, defined as T2MI2012reclassified). Among T2MI2007, 6.3% of patients received coronary revascularization, 22% dual-antiplatelet therapy, and 71% high-dose statin therapy versus 0.8%, 1.6%, and 31% among T2MI2012reclassified patients, respectively (all p < 0.01). Cardiovascular mortality at 90 days was 0% among T2MI2012reclassified, which was similar to patients with noncardiac causes of chest discomfort (0.2%), and lower than T2MI2007 (3.6%) and type 1 myocardial infarction (T1MI) (4.8%) (T2MI2012reclassified vs. T2MI2007 and T1MI: p = 0.03 and 0.01, respectively). Conclusions T2MI2012reclassified has a substantially lower event-related mortality rate compared with T2MI2007 and T1MI. (Advantageous Predictors of Acute Coronary Syndromes Evaluation [APACE] Study; NCT00470587)
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Heart Rhythm