New Insight with Dr. Veeral Sheth

Diabetes Dialogue

Don’t Miss a Beat

Crisis Point

Patrick Campbell is the managing editor of HCPLive. Formerly the editorial lead of Endocrinology Network, Practical Cardiology, and Rheumatology Network, Patrick has spent years spearheading coverage surrounding cardiometabolic health and rheumatic disease for MJH Life Sciences. He now helps to lead coverage in each of these respective areas for HCPLive. Before joining MJH Life Sciences in 2019, he spent time as a beat reporter with the Pocono Record in Stroudsburg, PA, and Star News Group in Manasquan, NJ. He also touts experience in multimedia, having spent time as a multimedia specialist with NJ Advance Media and multimedia coordinator at the Pocono Record. Follow him on Twitter @RealPatCampbell or reach him via email at PCampbell@mjhlifesciences.com.

An analysis of data from a dozen randomized clinical trials encompassing more than 2400 patients offers an overview of the comparative effects of catheter ablation for 

 with reduced ejection fraction (HFrEF) relative to their counterparts with heart failure with preserved ejection fraction (HFpEF).

Results of the study suggested use of catheter ablation for atrial fibrillation was associated with a reduced risk of heart failure events among those with HFrEF, but this benefit was not observed among those with HFpEF.

“To our knowledge, this systematic review and meta-analysis has for the first time pooled the most up-to-date randomized evidence to compare the differential efficacy of catheter ablation in the reduction of [heart failure]-related outcomes according to [heart failure] phenotype,” wrote investigators.

 “The currently available randomized evidence suggests that catheter ablation for [atrial fibrillation] was associated with reduced risk of [heart failure] events in patients with HFrEF but with no or limited efficacy in patients with HFpEF.”

Management of heart failure has undergone a transformation since the turn of the century thanks to advancements in understanding of pathophysiology and therapeutics, including the ARNI and SGLT2 inhibitor classes, which have been examined in both HFrEF and HFpEF. Still, despite having new medications with specific indications for HFpEF, management has proven difficult.

Citing a lack of studies comprehensively summarizing and comparing randomized evidence on differential efficacy of ablation on heart failure outcomes for people with HFpEF relative to their counterparts with HFrEF, a team of investigators led by Alireza Oraii, MD, of Penn Medicine, launched the current study to fill this knowledge gap. Oraii and colleagues designed their systematic review and meta-analysis to leverage data obtained from a literature search in the MEDLINE, Embase, and Cochrane Central Register of Controlled Trials for studies published from inception to September 3, 2023.

The primary outcome of interest for the systematic review and meta-analysis was difference in risk of heart failure events with catheter ablation relative to conventional rate or rhythm control therapies in those with HFrEF and HFpEF. Investigators defined heart failure events as heart failure hospitalization, clinically significant worsening of heart failure, or unscheduled visits to a clinician for treatment intensification. Secondary outcomes of interest included cardiovascular and all-cause mortality.

Studies of interest for the systematic review and meta-analysis included parallel-group randomized clinical trials comparing catheter ablation with conventional rate or rhythm control therapies in patients with heart failure, New York Heart Association functional class II or greater, and a history of paroxysmal or persistent atrial fibrillation. From their initial search, 7531 titles and abstracts were identified for review. Among these, 12 randomized clinical trials and 4 substudies met inclusion criteria.

These 12 studies included 2465 participants, with 1552 having HFrEF and 913 having HFpEF. The overall cohort had a mean age of 65.3 (Standard Deviation [SD], 9.7) years and 26.7% were female.

Results of the meta-analysis indicated catheter ablation was associated with a reduced risk of heart failure events in HFrEF compared to use of conventional rate or rhythm control (Risk Ratio [RR], 0.59; 95% Confidence Interval [CI], 0.48 to 0.72). However, this benefit was not observed among those with HFpEF (RR, 0.93; 95% CI, 0.65 to 1.32; 

 for interaction = .03). Analysis of cardiovascular death revealed catheter ablation associated with reduced risk compared with conventional therapies in HFrEF (RR, 0.49; 95% CI, 0.34 to 0.70), but no such benefit observed in HFpEF (RR, 0.91; 95% CI, 0.46 to 1.79; 

 for interaction = .12). For all-cause mortality, there was no difference observed for benefit of catheter ablation relative to conventional therapies in those with HFrEF (RR, 0.63; 95% CI, 0.47 to 0.86) and HFpEF (RR, 0.95; 95% CI, 0.39-2.30; 

Before concluding investigators called specific attention to limitations of their study to consider when interpreting results, including an elevated level of heterogeneity observed with pooled effect estimates, variable definitions for HFpEF across the studies, and limited available randomized evidence published to date in patients with HFpEF.

In an editorial comment, Kristen Patton, MD, of the University of Washington, and Clyde Yancy, MD, MSc, of Northwestern University, commended investigators for their contributions and noted how their calls for more research are echoed by others in the community.

“AF ablation in [heart failure] is an established standard of care. However, we concur with the authors and further assert that the durability of the mortality benefit per se in HFrEF and the evidence of important clinical benefit, including mortality, in HFpEF remain uncertain,” wrote the pair.

 “Clearly, more outcomes from rigorous, randomized clinical trials better elucidating the role of ablation in patients with both HFrEF and HFpEF are warranted. Simply put, we need more data.”

Oraii A, McIntyre WF, Parkash R, et al. Atrial Fibrillation Ablation in Heart Failure With Reduced vs Preserved Ejection Fraction: A Systematic Review and Meta-Analysis. 

 Published online April 24, 2024. doi:10.1001/jamacardio.2024.0675

Patton KK, Yancy CW. Atrial Fibrillation Ablation in Heart Failure—More Data Are Needed. 

 Published online April 24, 2024. doi:10.1001/jamacardio.2024.0684

Articles


A meta-analysis of 12 trials suggests catheter ablation for atrial fibrillation reduces heart failure events in HFrEF patients but not in HFpEF.

News

news page, resources on the topics of disease- and specialty-specific medical news and expert insight can be found. Content includes articles, interviews, videos, podcasts, and breaking news on health care research, treatment, and drug development.

Clinical

clinical page is a resource for content on every specialty, disease, and topic available on our medical news site.

Heart Failure

The HCPLive heart failure page is a resource for medical news and expert insights on HF. This page features expert-led coverage, articles, videos and research on the therapies and development of treatments for heart disease, reduced and preserved ejection fraction, and more.

Arrhythmia

Cardiology

Cardiology condition center page is a comprehensive resource for clinical news and insights on cardiovascular and cardiometabolic diseases. This page consists of interviews, articles, podcasts, and videos on the research, treatment and development of therapies for heart disease and cardiovascular events, as well as associated diabetes, renal failure, and more...

Catheter Ablation for AFib Shows Little to No Benefit in HFpEF, Despite Positive Effect in HFrEF

Experts conclude the series discussing how to approach switching psoriasis treatments.

When to Switch a Drug Class in Psoriasis Treatment

Dermatologists discuss their approach to managing patients who have experienced treatment failure. They debate whether to switch to a different class of drug or remain within the same class based on factors such as primary versus secondary failure and individual patient response. They also mention specific drugs within the class, like bimekizumab, and discuss the efficacy and considerations of different options. The conversation highlights the complexity of decision-making in dermatology regarding treatment selection for patients who have not responded to TNF blockers.

Video synopsis is AI-generated and reviewed by HCPLive® editorial staff.

Videos

Peer Exchange

HCPLive® Peer Exchange panel discussions feature authoritative insights, opinions, and perspectives on important issues facing today's care professionals.

Plaque Psoriasis

The HCPLive plaque psoriasis page is a resource for medical news and expert insights on psoriasis. This page features expert-led coverage, articles, videos and research on the therapies and development of treatments for psoriatic disease, and more.

Dermatology

The HCPLive dermatology page is a resource for medical news and expert insights on skin disease. This page features expert-led coverage, articles, videos and research on the therapies and development of treatments for dermatologic conditions, and more.

A new national survey found many parents experience 

The survey, conducted by the Ohio State University Wexner Medical Center, ultimately found roughly two-thirds of respondents reported the demands of parenthood sometimes or often felt isolating and lonely. Furthermore, 62% felt burned out by parental responsibilities.

In total, 2 in 5 parents (38%) reported feeling like they receive a lack of support regarding these exhausting demands. About 4 in 5 (79%) respondents said they would like to connect with other parents outside of work and home.

“I work from home full-time, and I actually have a job where I’m on camera a lot, and I’m Zoom calling people very often,” said Anne Helms, a mother of 2 young children, in a press release. “However, you don’t get the small talk, so you don’t get the: ‘How are your children? How’s it going?’ And you don’t get a lot of genuine answers when you do ask, ‘How is it going?”

Not talking to her coworkers about her parenthood burdens leaves Helms in frequent isolation.

“There are some days where the most chit-chat or idle talk that I get is with my dog because I work alone,” she added.

Attending a virtual meeting is a stark difference from an in-person meeting, said Kate Gawlik, DNP, associate clinical professor at The Ohio State University College of Nursing, a researcher on parental burnout and a mother of four young children, in the press release. She added how, with virtual meetings, parents miss out on small interactions in the hallway, eliminating personal touch.

“Even the places that I do try and seek out other parents, it’s kind of like we’re lost in the shuffle because it’s at daycare drop-off or pick-up where everyone just has tunnel vision,” Helms said.

According to a Coram Family and Childcare poll, some parents may feel lonelier than others, such as mothers (30%) feeling more left out than fathers (16%), young parents aged 18 – 24 years (37%) feel more of a lack of companionship than parents aged 25 – 34 years (21%), and parents with lower incomes (33%) feel more isolated than parents with greater incomes (16%).

 The poll surveyed 529 UK parents aged ≥ 18 years who had children aged 0 – 5 years.

Loneliness affects both an individual’s physical and mental health.

 For instance, for physical health, loneliness can increase the risk of cardiovascular disease, cognitive decline, and the immune system. Loneliness can also increase the risk of depression and anxiety.

Being in social isolation for a long time is so unhealthy for the body that it is equivalent to smoking about 15 cigarettes a day.

Since parents face isolation, loneliness, and burnout, Gawlik created a 6-week parenting program to bring parents together, helping them bond over challenges and support each other. Helms joined the program, and it made her no longer feel alone. The program allowed her to understand that it is normal to feel burned out if you are a conscientious parent.

Gawlik and Helms both believe having someone you can relate to in your life promotes a healthier lifestyle. Parents can connect with other parents by searching for groups in their community online, which can be hosted through community centers or their employers. Parents can also meet other parents at playgroups, book clubs, and recreational sports leagues or start talking to the parents about scheduling playdates with their child’s friends from daycare.

“It makes you a better spouse, parent, friend,” Helms said. “I think that it just enriches our lives… just like parenting does, but it just makes you level up.”

Survey Finds Loneliness Epidemic Runs Deep Among Parents. 

https://osuwmc.multimedia-newsroom.com/index.php/2024/04/24/survey-finds-loneliness-epidemic-runs-deep-among-parents/

Loneliness Among Parents of Young Children. 

chrome-extension://efaidnbmnnnibpcajpcglclefindmkaj/https://www.familyandchildcaretrust.org/sites/default/files/Resource%20Library/Loneliness%20among%20parents%20of%20young%20children_271119.pdf. Accessed April 26, 2024.

Many parents experience high levels of isolation, loneliness, and burnout, feeling like there is no one to talk to about their struggles in their daily lives.

Psychiatry

Psychiatry condition center page is a comprehensive resource for clinical news and insights on mental illnesses. This page consists of interviews, articles, podcasts, and videos on the research, treatment and development of therapies for depression, schizophrenia, bipolar disorder, anxiety, and more.

Connecting with Other Parents May Ease Parental Loneliness for Many

Experts discuss package warnings associated with bimekizumab and how they inform patients of them.

Warnings and Precautions for Newer Psoriasis Treatments

Regarding the warnings in the bimekizumab package insert, specifically about suicidal ideation and elevated liver enzymes, different approaches are taken by physicians in discussing these potential side effects with patients, but each aim to address those concerns with their patients.

Regarding suicidal ideation, some physicians proactively address it with patients, discussing the very rare occurrence of suicidal behavior observed in clinical trials in order for complete transparency. They may reassure patients that no causal association has been established and encourage open communication if any changes in mood or symptoms are noticed. Others may not explicitly mention this warning but address the broader impact of psoriasis on mental health, even directly asking patients about their mental wellbeing, and encouraging patients to report any concerns.

Concerning elevated liver enzymes, physicians acknowledge the recommendation for monitoring but may customize the frequency based on individual patient factors such as comorbidities and suspicion of liver disease. They emphasize the need for initial screening before treatment initiation and potentially more frequent monitoring in high-risk patients. Despite the warning, physicians highlight that elevations in liver enzymes are typically mild and manageable, often related to factors such as fatty liver or alcohol consumption.

Expert dermatology physician assistants share how to select the appropriate therapy for your patient with plaque psoriasis in an expanding treatment landscape.

Selecting appropriate therapy in an evolving treatment landscape of plaque psoriasis 

In this series, dermatologists TJ Chao and Kristine Kucera delve into recent developments in plaque psoriasis treatment, including the emergence of TYK2 inhibitors. They highlight the evolving role of physician assistants in managing plaque psoriasis and discuss its recognition as a systemic disease. The conversation covers lab and monitoring requirements for TYK2 inhibitors like deucravacitinib, alongside a review of short- and long-term clinical trial data. Chao and Kucera offer insights into patient selection and the patient experience with oral systemic agents, providing guidance for selecting appropriate therapies in the expanding treatment landscape.

This summary was AI-generated and edited for clarity.

Selecting Appropriate Therapy in the Evolving Treatment Landscape of Plaque Psoriasis

Experts discuss bimekizumab for the treatment of psoriasis highlighting is efficacy over other treatments.

Exploring Innovation: Recent Approvals and Novel Approaches to Psoriasis Treatment

TJ Chao and Kristine Kucera, PA’s share their insights into the patient experience with oral systemic agents for plaque psoriasis.

Ophthalmology

Ophthalmology page, resources on the topics of medical news and expert insight into ophthalmic disease can be found. Content includes articles, interviews, videos, podcasts, and breaking news on eye disease research, treatment, and drug development.

Patient Experience With Oral Systemic Treatments

Abigail Brooks is an assistant editor for 

She joined MJH Life Sciences in August 2023 shortly after graduating from Monmouth University where she earned her BA in Communication with a concentration in Public Relations/Journalism and later an MA in Interactive Digital Media. She enjoys traveling, running, and reading books. She can be reached at abrooks@mjhlifesciences.com.

Results showed a negative correlation between serum Gd-IgA1 and kidney function but found no association with several validated IgAN prognostic risk factors.

Nephrology

The HCPLive nephrology page is a resource for medical news and expert insights on kidney disease. This page features expert-led coverage, articles, videos and research on the therapies and development of treatments in nephrology, and more.

IgA Nephropathy

The HCPLive Berger disease page is a resource for medical news and expert insights on IgA nephropathy. This page features expert-led coverage, articles, videos and research on the therapies and development of treatments in Berger disease, and more.

Study Highlights Serum Gd-IgA1 as Potential Prognostic Biomarker for IgA Nephropathy

Dermatologists Drs Tina Bhutani and Scott Boswell and patient Kanya Oul share resources and tools available to cope with generalized pustular psoriasis (GPP).

Tips for Managing Generalized Pustular Psoriasis (GPP)

Physician assistants TJ Chao and Kristine Kucera share their knowledge on which patients make good candidates for TYK2 inhibitors.

Good Candidates for TYK2 Inhibitors

Coping With and Support for Generalized Pustular Psoriasis (GPP)

A patient and 2 dermatologists discuss the impact of generalized pustular psoriasis (GPP) on patient’s quality of life.

Impact of Generalized Pustular Psoriasis (GPP) on the Quality of Life

Tim Smith joined the MJH Life Sciences team as an assistant editor for HCPLive in August 2022. He graduated from UC Berkeley with a degree in political science, working in multimedia journalism as a staff writer prior to joining MJH. In his spare time, he enjoys reading, watching TV, listening to podcasts, and rock climbing. You can contact him at 

This discussion with Ohuabunwa was held at the ACP conference and covered inpatient geriatrics assessment tips for internal medicine physicians.


Internal Medicine

Internal Medicine condition center page, resources on the topics of medical news and expert insight into internal medicine can be found. Content includes articles, interviews, videos, podcasts, and breaking news on internal medicine research, treatment, and drug development.

Geriatrics

Geriatric medicine condition center page is a comprehensive resource for clinical news and insights on frequent geriatric-related diseases and conditions. This page consists of interviews, articles, podcasts, and videos on the research, treatment and development of therapies for sleep disorder, dementia, Alzheimer's disease, and more.

Conference

 conference coverage page features articles, videos, and expert-led live coverage from major medical meetings throughout the year.

Ugochi Ohuabunwa, MD: Tips for Inpatient Geriatric Management, Frailty Assessment

Larry Ereshefsky, PharmD, discussed the effects of brilaroxazine on inflammatory cytokines and neuroinflammation and how this can impact future schizophrenia treatment.

Schizophrenia

The HCPLive schizophrenia page is a resource for medical news and expert insights on the mental disorder. This page features expert-led coverage, articles, videos and research on the therapies and development of treatments for schizophrenia, and more.

Larry Ereshefsky, PharmD: Brilaroxazine Improves Schizophrenia Symptoms

Connor Iapoce is an associate editor for 

 and joined the MJH Life Sciences team in April 2021. He graduated from The College of New Jersey with a degree in Journalism and Professional Writing. He enjoys listening to records, going to concerts, and playing with his cat Squish. You can reach him at 

Areas with socioeconomic disadvantage often face concentrated poverty, poor walkability, and few healthcare facilities, creating challenges in eye care follow-up.

Diabetic Macular Edema

The HCPLive diabetic macular edema page is a comprehensive resource for clinical news and insights on DME. This page consists of interviews, articles, podcasts, and videos on the research, treatment and development of therapies for the leading cause of blindness, and more.

Latest News

Catheter Ablation for AFib Shows Little to No Benefit in HFpEF, Despite Positive Effect in HFrEF

When to Switch a Drug Class in Psoriasis Treatment

Connecting with Other Parents May Ease Parental Loneliness for Many

Warnings and Precautions for Newer Psoriasis Treatments

Selecting Appropriate Therapy in the Evolving Treatment Landscape of Plaque Psoriasis