A Shock to The Heart: Risk Factors and Cardiovascular Events in T2DM and Cardioversion in AFib

Andre Maddison, General Internal Medicine (GIM) fellow at Western University, is hosting this week’s episode on The Rounds Table alongside his wife, Emily Wilson, family physician in London and adjunct professor at Western University. Together they are covering risk factors, death, and cardiovascular events in patients with type 2 diabetes mellitus (T2DM) and early or delayed cardioversion in new atrial fibrillation.

Patients with T2DM are at a higher risk for myocardial infarction and cerebrovascular events. Interventions are targeted at modifying the key risk factors that lead to such events.  Emily shares an article that examines the excess risk of death and cardiovascular events in patients with type 2 diabetes mellitus with risk factors modified to the acceptable ranges, compared to the general population.

There are practice variations in terms of how to best manage acute, symptomatic, new-onset but stable atrial fibrillation in the Emergency Department.  Next, Andre discusses an article comparing early cardioversion to the “wait-and-see” approach (delayed cardioversion) looking at the outcome of sinus rhythm after four weeks.

Finally, the Good Stuff segment.  Emily tells listeners about the Climate Change Toolkit for Health Professionals which contains practical advice for practitioners to be more environmentally conscious.  Andre shares a perspective piece called “At Baseline” on the factors that lead to the goal on inpatient medicine of bringing a patient back “to baseline” and the effect of that on trainee’s approach to testing and management.

Like what you hear?  Rate us on iTunes!  Chat with us on Twitter at @roundstable and tweet at Andre Madison @MaddisonAndre and Emily Wilson @emilywilson_MD.

Interested in helping us evaluate our podcast episodes? We’re currently recruiting a panel of residents to serve as regular reviewers for the show. If you’re interested, email wkwong@qmed.ca.

The Papers

1. Risk Factors, Mortality, and Cardiovascular Outcomes in Patients with T2DM https://www.nejm.org/doi/full/10.1056/NEJMoa1800256

2. Early or Delayed Cardioversion in Recent-Onset Atrial Fibrillation https://www.nejm.org/doi/full/10.1056/NEJMoa1900353

Good Stuff

1. Climate Change Toolkit for Health Professionals – https://cape.ca/campaigns/climate-health-policy/climate-change-toolkit-for-health-professionals/

2. At Baseline – https://www.nejm.org/doi/full/10.1056/NEJMp1900543

3. Hypertension Hot Potato – https://www.nejm.org/doi/full/10.1056/NEJMp1901657

Music Credits

The Rounds Table Theme Music by Brendan Quinn, Creative Director and Composer, Vapor RMW

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  1. James Wilson

    Well done. Congratulations
    Thank you for drawing our attention to the challenges of making conclusions based on incidental data points (BP, A1c, ECG tracing) when we know that these variables are not stable.

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