Key Points Question In patients undergoing lower extremity revascularization, what are the rates of new statin prescription after the procedure and the clinical characteristics associated with statin prescription? Findings In this cross-sectional study of 125 791 patients presenting for peripheral revascularization within the Vascular Quality Initiative registry, only 30% of patients not receiving statin therapy at the time of intervention were discharged with a new statin prescription. Traditional cardiac risk factors and known cardiac disease were associated with new statin prescription. Meaning This study suggests that statin prescription remains suboptimal and may be associated with other comorbid conditions despite evidence of benefit in all individuals with revascularized peripheral artery disease.

Background Information on maternal and fetal outcomes of pregnancy in women with D‐transposition of the great arteries is limited. We conducted a systematic literature review on pregnancies in women with transposition of the great arteries after atrial and arterial switch operations to better define maternal and fetal risk. Methods and Results A systematic review was performed on studies between 2000 and 2021 that identified 676 pregnancies in 444 women with transposition of the great arteries. A total of 556 pregnancies in women with atrial switch operation were tolerated by most cases with low mortality (0.6%). Most common maternal complications, however, were arrhythmias (9%) and heart failure (8%) associated with serious morbidity in some patients. Worsening functional capacity, right ventricular function, and tricuspid regurgitation occurred in ≈20% of the cases. Rate of fetal and neonatal mortality was 1.4% and 0.8%, respectively, and rate of prematurity was 32%. A total of 120 pregnancies in women with arterial switch operation were associated with no maternal mortality, numerically lower rates of arrhythmias and heart failure (6% and 5%, respectively), significantly lower rate of prematurity (11%; P <0.001), and only 1 fetal loss. Conclusions Pregnancy is tolerated by most women with transposition of the great arteries and atrial switch operation with low mortality but important morbidity. Most common maternal complications were arrhythmias, heart failure, worsening of right ventricular function, and tricuspid regurgitation. There was also a high incidence of prematurity and increased rate of fetal loss and neonatal mortality. Outcome of pregnancy in women after arterial switch operations is more favorable, with reduced incidence of maternal complications and fetal outcomes similar to women without underlying cardiac disease.

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Introduction: Recurrent atrial fibrillation (AF) is estimated to occur in at least 20% of patients with paroxysmal or persistent AF who undergo catheter ablation (CA). Recent studies have suggested that extent of left atrial (LA) scar is of prognostic value, but it is unknown whether there is an association with patient co-morbidities. Hypothesis: Patients with structural heart disease or prior thromboembolic events have more LA scar and greater risk of AF recurrence. Methods: We retrospectively studied 117 patients who underwent CA for AF at our institution. Only ablations using the same method for radiofrequency ablation of pulmonary vein antra were included. We evaluated the association between demographic variables, LA volume, history of stroke, AF recurrence (defined as AF relapse more than 3 months after CA) and LA scar quantified by 3D electroanatomic mapping using simple regression and Kaplan-Meier analyses. Results: Mean age was 64 years, 68% were male, 60% had paroxysmal AF, 34% had persistent AF, and 6% had long-standing persistent AF. Recurrence of AF occurred in 22% of patients overall, and was significantly associated with systolic heart failure (HF) (p=0.042), number of prior cardioversions (CV) (p=0.014), left ventricular ejection fraction (LV EF) (p=0.02), LA volume (p=0.032), and atrial flutter (p=0.014). Total LA scar was significantly associated with CHA2DS2-VASc score (p=0.0095) and history of stroke or transient ischemic attack (TIA) (p=0.031). Conclusion: AF recurrence is more likely to occur in patients with LV dysfunction, prior CV, increased LA volume, and atrial flutter during CA. Total LA scar was not associated with clinical AF recurrence. However, we demonstrate a new association between LA scar burden, CHA2DS2-VASc score and history of stroke or TIA. This may explain why patients do not need to be in AF at the time they develop thromboembolic events, as enduring LA scar may contribute to the pathogenesis of stroke.

Per 2012 ACC/AHA Guidelines, patients with stable ischemic heart disease (IHD) should be treated with beta-blockers (BB) to target a resting heart rate (HR) of 55-60 bpm due to associations of higher HR with all-cause mortality. We sought to determine adherence to this in the resident primary care (PC) clinic at our institution. Two hundred twenty-nine patients with a medication list in the electronic medical record (EMR) that includes metoprolol succinate or tartrate or carvedilol who were seen in PC clinic in January 2020 were identified. Of these, 100 had a diagnosis of IHD, and their EMR were reviewed for vital signs; medication changes; and contraindications (CI) to BB titration such as hypotension, bradycardia, and max dosing; during their PC and cardiology visits. We found that 10% (10 of 100) had HR within goal during their PC visit, whereas 6 and 84 had HR below and above goal, respectively. Of the 90 whose HR was not at goal, 24 had some perceivable CI to BB titration. Of those without CI to titration, 9% (6 of 66) had their BB increased, 4.5% (3 of 66) had their BB switched to a different medication, and 85% (56 of 66) did not have their BB changed. Of those whose BB was unchanged, 79% (44 of 56) had no other antihypertensive changed. Moreover, 88% (74 of 84) of those with HR above goal had a HR also above goal at their last two PC visits. Sixty-eight of the 100 patients with IHD were also managed by cardiology, and in contrast, 18% (8 of 45) of those with HR not at goal and without CI to titration had their BB dose adjusted at their last cardiology visit. A chi-square test was performed to examine the relation between BB titration and clinic setting with no statistical significance, X 2 (1, N = 106) = 1.18, p = 0.28. In sum, adherence to guidelines for HR in stable IHD were poor and not significantly different in the PC and cardiology settings. Lack of provider initiative, perhaps due to trainee unfamiliarity with guidelines, may be one of many factors and warrants more investigation to improve quality of care.