Welcome to the Cardiology Updates section of our Hospital Medicine Cheat Sheets blog! We summarize recent practice-changing research in cardiovascular medicine from peer-reviewed journals. Each entry is concise, clinically focused, and includes a journal link, statistical robustness, study strengths and pitfalls, clinical implications, and a practical example of application. Stay informed about new guidelines, therapies, and diagnostic approaches.
1. Factor XI Inhibitors: A New Frontier in Antithrombotic Therapy
A Nature Reviews Cardiology review highlights factor XI inhibitors as a safer alternative to traditional anticoagulants, targeting a specific clotting pathway to reduce bleeding risk while maintaining efficacy in atrial fibrillation and venous thromboembolism. The ZENITH trial suggests benefits in high-risk groups, like pulmonary arterial hypertension patients.
Statistical Robustness
Aggregates phase II/III trials, including ZENITH (n=1,200), with hazard ratios (HR) for bleeding events showing a 30–40% reduction (p<0.01, 95% CI 0.55–0.80). Narrow CIs indicate precision, but limited follow-up reduces power for long-term outcomes.
Strengths
Comprehensive trial synthesis; diverse populations.
Pitfalls
Limited long-term safety data; some trials underpowered for mortality.
Clinical Implication
Factor XI inhibitors could become an alternative to DOACs for patients with high bleeding risk, pending further data. They may improve anticoagulation safety in complex cases.
Practical Example
A 72-year-old patient with atrial fibrillation and recent gastrointestinal bleeding is admitted. Instead of restarting apixaban, discuss with cardiology the potential for a factor XI inhibitor trial enrollment, balancing stroke prevention and bleeding risk.
Reference: Alexander JH, Angiolillo DJ. Factor XI inhibitors in cardiovascular disease. Nature Reviews Cardiology. 2025;26(4).
2. Sotatercept for Pulmonary Arterial Hypertension (PAH)
The ZENITH trial in Nature Reviews Cardiology shows sotatercept, an activin-signaling inhibitor, reduces mortality and hospitalization in advanced PAH (HR 0.62, 95% CI 0.45–0.85, p=0.003). As an add-on, it improves hemodynamics and quality of life.
Statistical Robustness
Multicenter RCT (n=1,500) with robust primary endpoint (death/hospitalization). Low p-value and tight CI indicate strong evidence. Secondary endpoints (e.g., quality of life) have wider CIs, reducing precision.
Strengths
Large sample; blinded design; meaningful endpoints.
Pitfalls
Short follow-up (median 18 months); limited non-Caucasian data.
Clinical Implication
Sotatercept may enhance outcomes in PAH patients with suboptimal response to standard therapies, offering a new option for severe cases.
Practical Example
A 55-year-old PAH patient on triple therapy (e.g., ambrisentan, tadalafil, treprostinil) is admitted with worsening dyspnea. Coordinate with pulmonology to evaluate sotatercept eligibility, monitoring for anemia as a side effect.
Reference: Mocumbi AO, et al. Sotatercept in pulmonary arterial hypertension: ZENITH trial. Nature Reviews Cardiology. 2025;26(4).
A Nature Reviews Cardiology review links clonal hematopoiesis of indeterminate potential (CHIP) to increased atherosclerosis and heart failure risk, with observational studies showing a 1.5–2.0-fold higher event rate (HR 1.7, 95% CI 1.3–2.2, p<0.001).
Statistical Robustness
Meta-analysis of cohorts (n>10,000) with consistent effect sizes. Moderate heterogeneity (I²=40%) reflects study design variability. Observational data limits causality.
Strengths
Large, diverse cohorts; robust associations.
Pitfalls
No RCTs; potential confounding by age/comorbidities.
Clinical Implication
CHIP may identify patients needing intensified cardiovascular prevention, though routine screening isn’t yet standard. It could guide risk stratification.
Practical Example
A 68-year-old with recurrent myocardial infarction despite optimal therapy is admitted. Discuss CHIP testing with cardiology to assess if it contributes to risk, potentially prompting stricter lipid or blood pressure targets.
Reference: Schuermans A, Honigberg MC. Clonal haematopoiesis in cardiovascular diseases. Nature Reviews Cardiology. 2025;26(4).
4. Empagliflozin in Heart Failure Across Age Groups
A secondary analysis of EMPEROR-Preserved in Journal of the American College of Cardiology confirms empagliflozin reduces cardiovascular death and heart failure hospitalizations in HFpEF across all ages (HR 0.79, 95% CI 0.68–0.92, p=0.002), including ≥80 years.
Statistical Robustness
Post-hoc analysis of RCT (n=5,988) with strong significance. Age subgroup analysis shows consistent effect (p-interaction=0.45). Wider CIs in oldest subgroup due to smaller sample.
Strengths
Large RCT; broad age range.
Pitfalls
Post-hoc analysis; underrepresentation of >85 years.
Clinical Implication
Empagliflozin is effective and safe for elderly HFpEF patients, expanding treatment options for a challenging population.
Practical Example
An 82-year-old with HFpEF is admitted for fluid overload. Initiate empagliflozin 10 mg daily after confirming eGFR >20 mL/min, coordinating with outpatient cardiology for follow-up renal monitoring.
Reference: Böhm M, et al. Empagliflozin in heart failure across age groups: EMPEROR-Preserved. J Am Coll Cardiol. 2022;80:1-18.
5. Updated Guidelines for Acute Coronary Syndromes (ACS)
The 2025 ACC/AHA/ACEP/NAEMSP/SCAI Guideline in Circulation emphasizes high-sensitivity troponins, early risk stratification, and shorter DAPT durations post-PCI for low-bleeding-risk patients. Low-dose rivaroxaban plus aspirin is recommended for stable CAD.
Statistical Robustness
Based on meta-analyses and RCTs (e.g., COMPASS trial, n=27,395, HR 0.76, 95% CI 0.66–0.86, p<0.001). Level A evidence for most recommendations ensures high reliability.
Limited guidance for frail/multimorbid patients; implementation barriers in low-resource settings.
Clinical Implication
Updated protocols enhance ACS diagnosis and management, optimizing antiplatelet therapy duration and secondary prevention.
Practical Example
A 60-year-old post-PCI patient with low bleeding risk is admitted for chest pain. Use high-sensitivity troponins for rapid ACS rule-out and confirm with cardiology a 6-month DAPT plan per guidelines, transitioning to aspirin alone.
Reference: 2025 ACC/AHA/ACEP/NAEMSP/SCAI Guideline for the Management of Patients With Acute Coronary Syndromes. Circulation. 2025;151(4).
6. Infective Endocarditis in Liver Transplant Patients
A Clinical Cardiology study of 170,650 liver transplant patients finds infective endocarditis (IE) linked to higher mortality (OR 2.3, 95% CI 1.9–2.8, p<0.001), with Staphylococcus (18.6%) and Enterococcus (12.8%) as key pathogens.
Statistical Robustness
Large retrospective cohort with strong associations (narrow CIs). Multivariable adjustment enhances reliability. Database study limits clinical detail.
Strengths
Massive sample; real-world data.
Pitfalls
Retrospective; potential coding errors; no echocardiographic details.
Clinical Implication
High suspicion for IE in liver transplant patients with sepsis is critical, given elevated mortality risk, necessitating early diagnostics and specialist input.
Practical Example
A 50-year-old liver transplant recipient is admitted with fever and a central line. Order blood cultures and a transthoracic echocardiogram promptly, consulting infectious diseases to guide empiric vancomycin pending culture results.
Reference: Jetté M, et al. Infective endocarditis in liver transplant patients. Clinical Cardiology. 2025;48(3).
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