Review of the top 5 cardiology studies of 2023

Abstract

Introduction

Remaining informed and up-to-date with the vast amount of medical literature published every year in the discipline of cardiology is an ongoing challenge for pharmacists who practice in general or outpatient settings, including ambulatory, primary care, or community-based practices. This article presents a brief synopsis of the “top 5” cardiology-related studies that were published in 2023–24, as identified by pharmacists as being most relevant to primary care practice and thus likely to affect patient care.

Methods

The method used was similar to previous iterations of this review.¹ A total of 14 cardiology-related studies potentially relevant to community-based pharmacists were identified by 2 authors (A.R.B. and R.B.). An online survey was created that included the name, citation, and conclusion for each study using the University of British Columbia survey tool (Qualtrics). Respondents were invited to select up to 5 studies that they believed were most relevant to pharmacists practicing in general or outpatient settings. The survey link was posted on the Primary Care Pharmacy Specialty Network (PSN) of the Canadian Pharmacists Association/Canadian Society of Healthcare-System Pharmacy (CSHP), which is a volunteer forum of pharmacists (192 members) with an interest in primary care practice, and the Cardiology PSN of CSHP (306 members). The survey link was also posted on the X (formerly Twitter) account of the lead author (@ArdenBarry; 2057 followers). Finally, the survey link was shared by the authors with colleagues who they believed would be appropriate to complete the survey. The survey was open for 2 weeks (January 20, 2025 to February 3, 2025).

Results

A total of 31 survey respondents provided 148 votes. The voting frequency is included in Appendix Table S1, available in the online version of this article available under Supplementary Materials. The top 5 studies were randomized controlled trials (RCTs) that covered a variety of topics relevant to general or outpatient settings. A summary of the trials is included in Table 1. The study with the highest number of votes investigated use of a glucagon-like peptide-1 (GLP-1) receptor agonist in patients with atherosclerotic cardiovascular disease (ASCVD) and obesity, but without diabetes. Other topics included blood pressure (BP) targets in patients at high cardiovascular risk, duration of antiplatelet therapy after acute coronary syndrome (ACS), use of beta-blockers after myocardial infarction (MI), and switching oral anticoagulants in older patients with atrial fibrillation (AF).

Table 1

Summary of the top 5 cardiology studies of 2023–24

		Duration (years)	Main results
Study	Intervention and control	Duration (years)	Outcome	NNT
SELECT⁴	Semaglutide vs placebo in patients with obesity and ASCVD	3.3	Cardiovascular composite endpoint*	67
SELECT⁴	Semaglutide vs placebo in patients with obesity and ASCVD	3.3	Cardiovascular death	NS
ESPRIT⁹	SBP <120 mmHg vs <140 mmHg in patients with hypertension and high cardiovascular risk	3.4	Cardiovascular composite endpoint*	72
ESPRIT⁹		3.4	All-cause death	125
ULTIMATE-DAPT¹⁴	Ticagrelor monotherapy vs DAPT for 11 months (after 1 month of DAPT) in patients post-ACS with PCI	1	Clinically relevant bleeding*	40
ULTIMATE-DAPT¹⁴		1	Major adverse cardiovascular or cerebrovascular events*	NS
REDUCE-AMI¹⁷	Beta-blocker vs no beta-blocker in patients post-MI with LVEF ≥50%	3.5	All-cause death or recurrent MI	NS
REDUCE-AMI¹⁷		3.5	Cardiovascular death	NS
FRAIL-AF²¹	Continuing VKA vs switching to DOAC in frail older adults	1	Major and clinically relevant non-major bleeding*	17
FRAIL-AF²¹	Continuing VKA vs switching to DOAC in frail older adults	1	All-cause death	NS

ACS, acute coronary syndrome; ASCVD, atherosclerotic cardiovascular disease; DAPT, dual antiplatelet therapy; DOAC, direct-acting oral anticoagulant; LVEF, left ventricular ejection fraction; MI, myocardial infarction; NNT, number needed to treat; NS, not significant; PCI, percutaneous coronary intervention; SBP, systolic blood pressure; VKA, vitamin K antagonist.

Refer to text for specific definition.

Obesity

SELECT: Semaglutide and cardiovascular outcomes in obesity without diabetes (N Engl J Med 2023)

Background: The excess adipose tissue associated with obesity can lead to complications, including diabetes and ASCVD. Glucagon-like peptide-1 receptor agonists have revolutionized management for patients with diabetes and high risk of ASCVD following the publication of the LEADER and SUSTAIN-6 trials, which demonstrated that liraglutide and semaglutide reduced major adverse cardiovascular events in these patients.^2,3 The SELECT multicentre, double-blind, placebo-controlled trial sought to determine whether semaglutide reduced cardiovascular outcomes in patients with an elevated body mass index (BMI) but without diabetes.⁴

Patients: Eligible patients were ≥45 years of age, had a BMI ≥27 kg/m², and had pre-existing ASCVD (defined as a previous MI, stroke, or symptomatic peripheral artery disease). Patients were excluded if they had a history of diabetes, a glycated hemoglobin (A1C) ≥6.5%, or treatment with glucose-lowering medications.

Intervention and control: Patients were randomized to semaglutide 2.4 mg subcutaneously weekly or placebo. Semaglutide was initiated at 0.24 mg subcutaneously weekly and dose-adjusted every 4 weeks, as tolerated, until the 2.4 mg dose was achieved.

Outcomes: The primary outcome was a composite of death from cardiovascular causes, non-fatal MI, or non-fatal stroke. Cardiovascular death was a secondary outcome.

Results: A total of 17,604 patients were included with a follow-up of 3.3 years. The mean age was 62 years and participants were predominantly male (72%) with a mean BMI of 33 kg/m². A majority of patients had an A1C of ≥5.7% and a previous MI. Semaglutide significantly reduced the primary outcome compared with placebo (6.5% vs 8.0%; hazard ratio [HR], 0.80; 95% confidence interval [CI], 0.72–0.90). This corresponds to a number needed to treat (NNT) of 67. However, the therapy did not significantly reduce cardiovascular death. In addition to the primary outcome, semaglutide lowered A1C, BP, and body weight. Despite a lower rate of serious adverse events, semaglutide had a higher rate of permanent discontinuation (16.6% vs 8.2%; p < 0.001), mainly attributed to gastrointestinal disorders (10.0% vs 2.0%; p < 0.001; number needed to harm [NNH] of 13).

Implications for practice: The SELECT trial supports use of semaglutide among patients with an elevated BMI and established ASCVD, but without diabetes. To date, this is the first trial to show reduced major cardiovascular events with a GLP-1 receptor agonist in non-diabetic patients with obesity, as previous trials identified only reductions in weight.⁵ Currently, no major obesity management guidelines have updated their recommendations based on the results of this trial. Another recently published trial demonstrated a reduction in cardiovascular events with tirzepatide, a combined GLP-1 and glucose-dependent insulinotropic polypeptide receptor agonist, in patients with obesity. The SUMMIT trial randomized 731 patients with a BMI ≥30 kg/m² and heart failure with preserved ejection fraction, of whom about 50% had diabetes.⁶ Compared with placebo, tirzepatide (dosed up to 15 mg subcutaneously weekly) reduced the composite primary outcome of cardiovascular death or worsening heart failure (NNT 19) over 2 years, although about 6% of patients discontinued therapy primarily due to gastrointestinal adverse events. Two additional trials (STEP-HFpEF and STEP-HFpEF DM) assessed the effect of semaglutide in patients with heart failure with preserved ejection fraction with or without diabetes.^7,8 Both trials demonstrated an improvement in clinical symptoms and physical ability but were not powered to assess major adverse cardiovascular events. Additional trials are underway to confirm the observed cardiovascular benefit with GLP-1 receptor agonists.

Hypertension

ESPRIT: Lowering systolic blood pressure to less than 120 mmHg versus less than 140 mmHg in patients with high cardiovascular risk with and without diabetes or previous stroke (Lancet 2024)

Background: This multicentre RCT aimed to determine whether an intensive, rather than a standard, systolic BP (SBP) target would improve cardiovascular outcomes in high-risk individuals regardless of diabetes status or history of stroke.⁹

Patients: Included were patients in China aged ≥50 years with SBP 130–180 mmHg who were considered to have high cardiovascular risk defined as established ASCVD or ≥2 risk factors (older age, diabetes, dyslipidemia, or current smoking). Patients were excluded if they had secondary hypertension, standing SBP <110 mmHg, left ventricular ejection fraction (LVEF) <35%, or estimated glomerular filtration rate (eGFR) <45 mL/min/1.73 m².

Intervention and control: Patients were randomized to an intensive SBP (<120 mmHg) or standard SBP (<140 mmHg) treatment target. This open-label study used a standardized treatment algorithm as a guide; however, investigators could independently choose from 10 study-provided antihypertensive medications from 5 different classes to treat their patients.

Outcomes: The primary outcome was a composite of major adverse cardiovascular events including MI, revascularization, heart failure hospitalization, stroke, or cardiovascular death. Secondary outcomes included death from any cause and a composite of adverse kidney outcomes (defined as sustained decline to an eGFR <10 mL/min/1.73 m², >40% decrease in eGFR from baseline, or death from renal causes).

Results: The study included 11,255 patients (mean age 65 years, 41% female, 39% with diabetes, 27% with a history of stroke). At baseline, mean SBP in both groups was 147 mmHg. Over a follow-up of 3.4 years, mean SBP decreased to 119 mmHg in the intensive treatment group and 135 mmHg in the standard treatment group. The mean number of medications was higher in the intensive (2.8) compared with the standard treatment group (2.1). The primary outcome occurred in 9.7% of the intensive treatment group and 11.1% of the standard treatment group (HR, 0.88; 95% CI, 0.78–0.99; NNT 72). These results were consistent across various subgroup analyses, including among individuals with diabetes or a previous stroke. Death from any cause was significantly lower in the intensive treatment group (NNT 125). The overall rates of serious adverse events did not significantly differ between groups. However, serious syncopal events, although rare, were 3-fold higher in the intensive vs standard treatment group (0.4% vs 0.1%; NNH 334). The composite of adverse kidney events was significantly higher in the intensive vs standard treatment group (3% vs 1.8%; NNH 84).

Implication for practice: This trial extends the findings from the landmark SPRINT trial, which demonstrated that in high-risk patients with hypertension but without diabetes or a history of stroke, an intensive SBP target of <120 mmHg improved cardiovascular outcomes.¹⁰ However, the single-country enrollment and open-label design of the ESPRIT trial limit the generalizability of the results. The most recent iteration of the Hypertension Canada guidelines was published before this trial, wherein patients with diabetes were recommended an SBP target of <130 mmHg.¹¹ However, the findings from the ESPRIT trial may lead to the more intensive SBP target of <120 mmHg being recommended for a broader range of patients.

Acute coronary syndromes

ULTIMATE-DAPT: Ticagrelor alone versus ticagrelor plus aspirin from month 1 to month 12 after percutaneous coronary intervention in patients with acute coronary syndromes (Lancet 2024)

Background: After an ACS with percutaneous coronary intervention (PCI), the standard duration of dual antiplatelet therapy (DAPT) with acetylsalicylic acid (ASA) and a P2Y12 inhibitor is 12 months.¹² Studies have demonstrated that a shorter duration of DAPT (≤6 months) reduces bleeding events without increasing the risk of ischemic events, yet few of these trials tested only 1 month of DAPT in a double-blind fashion.¹³ This placebo-controlled, double-blind RCT evaluated the effect of ticagrelor monotherapy vs DAPT for 11 months (after 1 month of DAPT) in patients with an ACS who underwent PCI.¹⁴

Patients: Individuals aged ≥18 years who presented with an ACS and underwent PCI with a contemporary drug-eluting stent were included if they were event-free (i.e., no major ischemic or bleeding events) after 1 month of DAPT with ticagrelor and ASA. Excluded were patients who were receiving an oral anticoagulant or had risk factors for bleeding.

Intervention and control: Patients were randomized to continue ticagrelor 90 mg twice daily with either ASA 100 mg daily or matching placebo for an additional 11 months.

Outcomes: The primary safety composite endpoint was clinically relevant bleeding based on the Bleeding Academic Research Consortium (BARC) criteria. The primary efficacy composite endpoint was major adverse cardiovascular or cerebrovascular events (MACCE), which consisted of cardiac death, MI, ischemic stroke, definite stent thrombosis, or clinically driven target vessel revascularization. Time to first occurrence of a composite of net adverse clinical events (any BARC bleeding or MACCE) was the key secondary endpoint.

Results: A total of 3400 patients (mean age 63 years, 74% male) were randomized. Sixty percent presented with an acute MI and 40% with unstable angina. During the 12-month follow-up period, ticagrelor monotherapy reduced clinically relevant bleeding compared with DAPT (2.1% vs 4.6%; HR, 0.45; 95% CI, 0.30–0.66; NNT 40). The rate of MACCE was similar between groups (3.6% vs 3.7%; p = 0.89). Net clinical adverse events were also reduced with ticagrelor monotherapy vs DAPT (5.7% vs 8.2%; HR, 0.68; 95% CI, 0.53–0.88; NNT 40).

Implications for practice: This study demonstrated that in patients with ACS who received PCI and who did not have any thrombotic or bleeding events after 1 month of DAPT, ticagrelor monotherapy for an additional 11 months reduced the rate of clinically relevant bleeding without increasing the risk of adverse cardiovascular events. The 2023 Canadian Cardiovascular Society antiplatelet guidelines recommend DAPT for 1–3 months in patients who undergo PCI for an ACS and are at high risk of bleeding.¹² However, the results of this trial support a 1-month course of DAPT in post-ACS patients who undergo PCI with a newer generation drug-eluting stent, although it is unclear whether guidelines will adopt a recommendation to shorten the standard duration of DAPT in this population.

REDUCE-AMI: Beta-blockers after myocardial infarction and preserved ejection fraction (N Engl J Med 2024)

Background: Previous guidelines recommended the routine use of long-term beta-blocker therapy in all patients following an MI.^15,16 This recommendation was based on historical trials that demonstrated a mortality reduction with beta-blockers in post-MI patients with high cardiovascular risk (e.g., patients with an LVEF ≤40%). With advancements in coronary reperfusion strategies and pharmacotherapy, the role of beta-blockers in lower risk post-MI patients is less well-established. The objective of this multicentre, registry-based, open-label RCT was to determine whether long-term beta-blocker therapy, compared with no beta-blocker, reduced all-cause death and cardiovascular outcomes in patients with an LVEF ≥50% who received contemporary post-MI care.¹⁷

Patients: Enrolled were patients aged ≥18 years with an acute MI within 7 days and an LVEF ≥50%. Patients were excluded if they had another indication for, or contraindication to, beta-blocker therapy.

Intervention and control: Patients were randomized to beta-blocker therapy (metoprolol titrated to ≥100 mg daily as the first choice or bisoprolol titrated to ≥5 mg daily as an alternative) vs no beta-blocker therapy. Patients who were receiving a beta-blocker at baseline were tapered off over 2–4 weeks prior to randomization.

Outcomes: The primary outcome was a composite of all-cause death or recurrent MI. Secondary outcomes included cardiovascular death or hospitalization for heart failure or AF.

Results: In total, 5020 patients were included. Most patients (95%) were enrolled from Sweden. The median age was 65 years, 23% were female, 35% presented with an ST-segment elevation MI, and 96% underwent PCI. Ninety-nine percent and 96% of patients, respectively, received a statin and P2Y12 inhibitor. Median follow-up was 3.5 years. At 1 year, approximately 82% of patients in the treatment group and 14% of patients in the control group were receiving beta-blocker therapy. The primary outcome was not significantly different between groups (7.9% with beta-blocker therapy vs 8.3% with no therapy; HR, 0.96; 95% CI, 0.79–1.16). There was no significant difference in any of the secondary outcomes, including cardiovascular and all-cause death. Safety outcomes (e.g., hypotension, syncope, heart block, hospitalization for bradycardia) were also similar between groups.

Implications for practice: This study demonstrated that in post-MI patients with an LVEF ≥50%, beta-blocker therapy did not reduce the risk of all-cause death or recurrent MI. This trial, however, had a lower than anticipated event rate, which limits its statistical power and, as such, a small beneficial effect of beta-blockers in this population cannot be ruled out. The most recent European ACS guidelines¹⁸ provide a relatively weak recommendation for the routine use of beta-blockers in all post-MI patients regardless of their LVEF, although this may be further downgraded based on the results of this trial. Beta-blocker therapy is still a strong recommendation in post-MI patients with an LVEF ≤40% or with other compelling indications, such as arrhythmias. There are several ongoing trials of beta-blocker therapy post-MI of similar design that will further explore these findings.¹⁹

Atrial fibrillation

FRAIL-AF: Safety of switching from a vitamin K antagonist to a non-vitamin K antagonist oral anticoagulant in frail older patients with atrial fibrillation (Circulation 2024)

Background: The most recent Canadian Cardiovascular Society AF guidelines recommend using a direct-acting oral anticoagulant (DOAC) over a vitamin K antagonist (VKA) as initial thromboprophylaxis for stroke prevention in patients with non-valvular AF.²⁰ However, it is not known whether older patients already treated with a VKA would benefit from switching to a DOAC. This open-label, multicentre RCT sought to determine whether switching from a VKA to a DOAC would reduce bleeding in frail patients who were not well-represented in landmark trials.²¹

Patients: Included were patients who (1) were ≥75 years of age with AF; (2) were receiving a VKA with their international normalized ratio (INR) managed by a specialized anticoagulation clinic; (3) had an eGFR ≥30 mL/min/1.73 m²; and (4) had some degree of frailty (based on a Groningen Frailty Indicator score of ≥3). Notable exclusion criteria were patients with mechanical heart valves or valvular AF.

Intervention and control: Patients were randomized to switch to a DOAC or remain on their VKA. The choice of DOAC was at the discretion of the treating physician and was dosed according to product labelling.

Outcomes: The primary outcome was a composite of major and clinically relevant non-major bleeding (any bleeding that was not major but required intervention or face-to-face interaction with a health care professional). Secondary outcomes included all-cause mortality, major bleeding, clinically relevant non-major bleeding, thromboembolic events, and stroke (ischemic or hemorrhagic).

Results: Overall, 1323 patients were included. Mean age was 83 years, 39% were female, median Groningen Frailty Indicator score was 4, median CHA₂DS₂-VASc score was 4, mean eGFR was 63 mL/min/1.73 m², and 15% of patients had a history of major bleeding. Mean follow-up was 12 months. The most common DOAC switched to was rivaroxaban (50%), followed by apixaban (17%). The trial was halted early due to futility, as the primary outcome was higher in the DOAC group vs the VKA group (15.3% vs 9.4%; HR, 1.69; 95% CI, 1.23–2.32; NNH 17), which was mostly driven by clinically relevant non-major bleeding. Numerically, higher instances of gastrointestinal bleeding (2.6% vs 0.6%) and urogenital bleeding (3.0% vs 1.7%) were observed in the DOAC group compared with the VKA group. There were 16 thromboembolic events in the DOAC group and 13 in the VKA group (2.4% vs 2.0%), which was not a significant difference. The rates of stroke and all-cause mortality were similar between groups. Subgroup analyses were consistent across age, sex, frailty score, and eGFR. The estimated time in therapeutic range for patients on a VKA was 65%–74%.

Implications for practice: The overall rate of major and clinically relevant bleeding was lower in patients who continued their VKA as opposed to switching to a DOAC. Thromboembolic events were similar between groups. These results contrast prior studies of DOACs in patients with non-valvular AF, which showed that DOACs overall had a lower rate of stroke or systemic embolism vs VKAs, with a similar or lower rate of major bleeding and lower rate of intracranial hemorrhage.²² The trial population of the FRAIL-AF trial was biased toward patients who were stable and able to tolerate VKA therapy and had their VKA therapy managed by a specialized anticoagulation clinic. A frail elderly population may have comorbidities and polypharmacy that make frequent follow-up of their VKA preferable. Consequently, results may not be as applicable to patients who have their INRs managed in a community setting. ■

Supplemental Material

sj-pdf-1-cph-10.1177_17151635251339445 – Supplemental material for Review of the top 5 cardiology studies of 2023–24

Supplemental material, sj-pdf-1-cph-10.1177_17151635251339445 for Review of the top 5 cardiology studies of 2023–24 by Arden R. Barry, Rosaleen Boswell, Hazal E. Babadagli, June W. Chen, Emily Cowley, Theresa E. Eberhardt and Taryn A. May in Canadian Pharmacists Journal / Revue des Pharmaciens du Canada

Footnotes

Author Contributions:

A. R. Barry coinitiated the project; drafted the list of relevant studies; designed and conducted the survey; revised the introduction, methods, and results; supervised the manuscript writing; reviewed each draft; and revised the final manuscript. R. Boswell coinitiated the project; drafted the list of relevant studies; reviewed the survey prior to dissemination; drafted the introduction, methods, and results; reviewed each draft; and revised the final manuscript. H. E. Babadagli wrote the summary of the REDUCE-AMI trial. J. W. Chen wrote the summary of the ULTIMATE-DAPT trial. E. Cowley wrote the summary of the SELECT trial. T. E. Eberhardt wrote the summary of the FRAIL-AF trial. T. A. May wrote the summary of the ESPRIT trial. All authors reviewed each draft and revised the final manuscript.

Funding:

This review was unfunded.

Statement of Conflicting Interests:

The authors have no financial or other conflicts of interest related to this work.

Ethics Statement:

Not applicable.

ORCID iD:

Arden R. Barry

References

Barry

Boswell

Babadagli

Chen

Pollmann

Zhou

JS.

Review of the top 5 cardiology studies of 2021-22. Can Pharm J (Ott) 2023;156:188-93.

Marso

Daniels

Brown-Frandsen

, et al. Liraglutide and cardiovascular outcomes in type 2 diabetes. N Engl J Med 2016;375:311-22.

Marso

Bain

Consoli

, et al. Semaglutide and cardiovascular outcomes in patients with type 2 diabetes. N Engl J Med 2016;375:1834-44.

Lincoff

Brown-Frandsen

Colhoun

, et al. Semaglutide and cardiovascular outcomes in obesity without diabetes. N Engl J Med 2023;389:2221-32.

Moiz

Levett

Filion

Peri

Reynier

Eisenberg

MJ.

Long-term efficacy and safety of once-weekly semaglutide for weight loss in patients without diabetes: a systematic review and meta-analysis of randomized controlled trials. Am J Cardiol 2024;222:121-30.

Packer

Zile

Kramer

, et al. Tirzepatide for heart failure with preserved ejection fraction and obesity. N Engl J Med 2025;392:427-37.

Kosiborod

Abildstrøm

Borlaug

, et al. Semaglutide in patients with heart failure with preserved ejection fraction and obesity. N Engl J Med 2023;389:1069-84.

Kosiborod

Petrie

Borlaug

, et al. Semaglutide in patients with obesity-related heart failure and type 2 diabetes. N Engl J Med 2024;390:1394-407.

Liu

, et al. Lowering systolic blood pressure to less than 120 mm Hg versus less than 140 mm Hg in patients with high cardiovascular risk with and without diabetes or previous stroke: an open-label, blinded-outcome, randomised trial. Lancet 2024;404:245-55.

10.

The SPRINT Research Group. A randomized trial of intensive versus standard blood-pressure control. N Engl J Med 2015;373:2103-16.

11.

Rabi

McBrien

Sapir-Pichhadze

, et al. Hypertension Canada’s 2020 comprehensive guidelines for the prevention, diagnosis, risk assessment, and treatment of hypertension in adults and children. Can J Cardiol 2020;36:596-624.

12.

Bainey

Marquis-Gravel

Belley-Côté

, et al. Canadian Cardiovascular Society/Canadian Association of Interventional Cardiology 2023 focused update of the guidelines for the use of antiplatelet therapy. Can J Cardiol 2024;40:160-81.

13.

Kuno

Watanabe

Shoji

, et al. Short-term DAPT and DAPT de-escalation strategies for patients with acute coronary syndromes: a systematic review and network meta-analysis. Circ Cardiovasc Interv 2023;16:e013242.

14.

Kan

Gao

, et al. Ticagrelor alone versus ticagrelor plus aspirin from month 1 to month 12 after percutaneous coronary intervention in patients with acute coronary syndromes (ULTIMATE-DAPT): a randomised, placebo-controlled, double-blind clinical trial. Lancet 2024;403:1866-78.

15.

O’Gara

Kushner

Ascheim

, et al. 2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation 2013;127:e362-425.

16.

Amsterdam

Wenger

Brindis

, et al. 2014 AHA/ACC guideline for the management of patients with non-ST-elevation acute coronary syndromes: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol 2014;64:e139-228.

17.

Yndigegn

Lindahl

Mars

, et al. Beta-blockers after myocardial infarction and preserved ejection fraction. N Engl J Med 2024;390:1372-81.

18.

Byrne

Rossello

Coughlan

, et al. 2023 ESC guidelines for the management of acute coronary syndromes. Eur Heart J 2023;44:3720-826.

19.

Steg

PG.

Routine beta-blockers in secondary prevention—on injured reserve. N Engl J Med 2024;390:1434-6.

20.

Andrade

Aguilar

Atzema

, et al. The 2020 Canadian Cardiovascular Society/Canadian Heart Rhythm Society comprehensive guidelines for the management of atrial fibrillation. Can J Cardiol 2020;36:1847-948.

21.

Joosten

LPT

van Doorn

van de Ven

, et al. Safety of switching from a vitamin K antagonist to a non-vitamin K antagonist oral anticoagulant in frail older patients with atrial fibrillation: results of the FRAIL-AF randomized controlled trial. Circulation 2024;149:279-89.

22.

Carnicelli

Hong

Connolly

, et al. Direct oral anticoagulants versus warfarin in patients with atrial fibrillation: patient-level network meta-analyses of randomized clinical trials with interaction testing by age and sex. Circulation 2022;145:242-55.

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