Dr RR Baliga's "Got Knowledge Doc" Podkast

🚨 New Trial Alert 🚨

Can we safely stop anticoagulation after AF ablation? The ALONE-AF Trial 🫀 suggests yes—in selected patients with no AF recurrence, stopping DOACs reduced major bleeding 🌟 without increasing stroke risk 🧠.

📉 0.3% vs 2.2% for the composite outcome (P = .02)

📍 Carefully monitored, low-risk patients may benefit most.

📝 Editorial: Recommends shared decision-making 🤝 & individualized rhythm monitoring.

📚 A potential shift in post-ablation care.

🔗 #AFib #Anticoagulation #EPTrials #CardioTwitter #StrokePrevention #JAMA #ALONEAF #Electrophysiology #SharedDecisionMaking #ClinicalTrials

🚨 New Findings from the HELP-MI Trial! 🇸🇪🧪

Can routine Helicobacter pylori screening during acute myocardial infarction (MI) hospitalization prevent upper gastrointestinal bleeding (UGIB)?

💉 Over 18,000 patients across 35 Swedish hospitals

📉 Result: No significant reduction in UGIB overall (RR 0.90; P=0.18)

🔍 BUT: Clear benefit in patients with anemia (RR 0.44–0.64) and chronic kidney disease (RR 0.75)

🧠 Key Takeaway: Routine screening isn't broadly warranted—but targeted testing in high-risk AMI patients may be the smarter path forward.

📊 #Cardiology #Gastroenterology #HPylori #HELPMI #EvidenceBasedMedicine #SWEDEHEART #MI #GIbleeding #RCT #PrecisionMedicine

🩺 New Insights on Apixaban for VTE!

📢 The HI-PRO trial challenges the old 3-month rule for provoked VTE.

📉 Extended low-dose apixaban (2.5 mg BID) reduced recurrent VTE from 10.0% ➡️ 1.3% with minimal major bleeding.

🎯 Editorial in NEJM urges a shift from binary labels ("provoked vs unprovoked") to a patient-centered, risk-adapted approach.

🧠 Art meets evidence in the decision to extend anticoagulation.

💬 Let's rethink how we label, risk-stratify, and treat.

📚 #VTE #Apixaban #Anticoagulation #NEJM #HI_PRO #Thrombosis #PrecisionMedicine #SharedDecisionMaking #EvidenceBasedMedicine #Cardiology

🌏 Zhu Xi (1130–1200), a master of Neo-Confucianism, reshaped Chinese philosophy with his focus on rationality, self-cultivation & education. His commentaries on the Four Books guided civil service exams for centuries across East Asia. 📚✨

#Leadership #Philosophy #History #Confucianism

Just read the latest from NEJM? The PIpELINe Trial 🇮🇹 changes how we approach cardiac rehab in older adults post-MI! 🧓❤️

🎯 A 12-month, multidomain intervention — risk factor control, nutrition 🥗, and Otago-based exercise 👟 — cut CV death/hospitalization from 20.6% → 12.6% (P=0.01)!

📉 Hospitalizations for heart failure dropped 7.1% → 1.5%. No serious adverse events. And yes — better gait speed, handgrip strength, and quality of life too.

This is how we shift from survival ➡️ functional independence in aging populations. 🙌

👇 Would you apply this model to your older patients post-MI? #CardioRehab #AgingWell #NEJM

🚨 New Meta-Analysis Alert! 💊🫀

Can β-blockers benefit patients post-MI with mildly reduced ejection fraction (LVEF 40–49%)?

📊 An individual patient data meta-analysis (REBOOT, BETAMI, DANBLOCK, CAPITAL-RCT) shows a 25% reduction in the composite outcome of death, MI, or HF with β-blockers vs. control (HR 0.75; p=0.031) — even in the absence of clinical heart failure.

🌍 Consistent across trials and countries. Most benefit seen in patients

📚 This could shift guidelines for a large overlooked population.

🔗 Read more in The Lancet (Aug 30, 2025)

#Cardiology #BetaBlockers #MyocardialInfarction #LVEF #EvidenceBasedMedicine #MetaAnalysis #HeartHealth 💓📉

🚫💊 Should We Rethink Beta-Blockers Post-MI?

In the landmark REBOOT trial (NEJM, 2025), beta-blockers failed to reduce mortality, reinfarction, or heart failure hospitalizations in post-MI patients with preserved ejection fraction (>40%).

💡 A modern, pragmatic trial across 109 centers (Spain + Italy 🇪🇸🇮🇹) with 8438 patients — shaking the foundation of our long-held post-MI practices.

👩‍⚕️ Signals of potential harm in women and STEMI subgroups raise questions, not answers.

📉 Should guidelines change? Or should practice just evolve?

#Cardiology #REBOOTTrial #BetaBlockers #NEJM #PrecisionMedicine #MedicalEducation #HeartAttack #LVEF #Guidelines #ClinicalTrials #InternalMedicine #EvidenceBasedMedicine #Revascularization

🚨 New NEJM Study Alert! 🩺💔

Do beta-blockers still help after a heart attack if there's no heart failure? 🤔

In the BETAMI–DANBLOCK trial (🇩🇰+🇳🇴, n=5574), beta-blocker therapy in post-MI patients with preserved or mildly reduced LVEF (≥40%) modestly reduced the composite outcome of death or major cardiovascular events 🧠📉

📌 Primary endpoint: 14.2% (BB) vs. 16.3% (no BB) → HR 0.85, p=0.03

💡 Especially lowered risk of recurrent MI (HR 0.73)

🧠 Even in the era of PCI, DAPT & statins, beta-blockers may still bring benefit — especially in patients with mildly reduced LVEF (40–49%) 🫀

🔗 [Add your slide link or DOI here]

#Cardiology #NEJM #HeartAttack #BetaBlockers #PostMI #EvidenceBasedMedicine #LVEF #PrecisionMedicine #ClinicalTrials

💥 New NEJM Trial Alert!

A modest 0.3 mmol/L rise in potassium (via MRA, KCl, or diet) significantly reduced arrhythmias, ICD shocks, and hospitalizations in high-risk ICD patients ⚡🫀

📉 HR 0.76 for the composite endpoint

🔢 NNT = 12.3 over 3.3 years

🍌 Safe, scalable, and globally relevant

👉 Time to rethink "normal" K⁺ levels in cardiology!

#Cardiology #Electrophysiology #NEJM #ICD #Potassium #POTCAST

🚨 New RCT Alert from the NEJM!

Can an old 💊 make a comeback in modern 💓 failure care?

📌 The DIGIT-HF trial showed that digitoxin, a cardiac glycoside with hepatic clearance, reduced the combined endpoint of all-cause death or HF hospitalization in HFrEF patients on contemporary guideline-directed therapy — including ARNI, beta-blockers, MRAs & SGLT2i.

🩺 HR = 0.82; p = 0.03 📉

👩‍⚕️ Safe in CKD, consistent benefit in women.

⚠️ Serious AEs slightly higher (4.7% vs 2.8%)

📥 NNT = 22.

💡Is it time to reconsider digitoxin in advanced HFrEF?

#CardioTwitter #HFrEF #HeartFailure #Digitoxin #NEJM #Cardiology #SGLT2i #GuidelineTherapy