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Background: About half of all patients with heart failure are diagnosed with heart failure preserved ejection fraction (HFpEF). Until now, studies have failed to show that medical treatment improves the prognosis of patients with HFpEF., Objectives: To evaluate changes in exercise capacity of patients with HFpEF compared to those with heart failure with reduced ejection fraction (HFrEF) following an exercise training program., Methods: Patient data was retrieved from a multi-center registry of patients with heart failure who participated in a cardiac rehabilitation program. Patients underwent exercise testing and an echocardiogram prior to entering the program and were retested6  months later., Results: Of 216 heart failure patients enrolled in the program, 170 were diagnosed with HFrEF and 46 (21%) with HFpEF. Patients with HFpEF had lower baseline exercise capacity compared to those with HFrEF. Participating in a 6 month exercise program resulted in significant and similar improvement in exercise performance of both HFpEF and HFrEF patients: an absolute metabolic equivalent (MET) change (1.45 METs in HFrEF patients vs. 1.1 in the HFpEF group, P = 0.3)., Conclusions: An exercise training program resulted in similar improvement of exercise capacity in both HFpEF and HFrEF patients. An individualized, yet similarly structured, cardiac rehabilitation program may serve both heart failure groups, providing safety and efficacy.

Background: The reasons for admission to the Acute Coronary Care Unit (ACCU) have changed in the past few years. The classical cause of acute coronary syndrome sets aside the causes of acute heart failure and post-procedural complications. There is also a change in the demographic characteristics and co-morbidities of the admitted patients., Objectives: The aim of this study is to illustrate the current causes of admission and complications during hospitalization in a tertiary center., Method: We compiled a computerized prospective registry during the months of January to March 2014. The registry includes the cause of admission, demographic characteristics, co-morbidities, interventions and clinical outcomes., Results: A total of 257 patients were admitted to the ACCU with a calculated sum of 937 hospitalization days. The average age was 67 ± 15; a third of the patients were above the age of 75 and a third were female; 100 patients have presented with other co-morbidities such as COPD, chronic renal failure, CVA or malignancy; and 46% of the patients were admitted due to acute coronary syndrome (ACS). Other causes were acute heart failure, shock and post-procedural complications. The average length of hospitalization was 2.9 ± 1.7 days for ACS patients compared to 4.3 ± 5 days due to other causes. Approximately 25% had developed acute heart failure during their hospital stay; most of them were older with higher rates of co-morbidities. The duration of hospitalization was longer in those patients, 5.5 ± 5 days, compared to 3.2 ± 4 (p < 0.005); 20% of the patients needed mechanical ventilation; 8.3% had acute renal failure; 4.7% acquired infection while hospitalized; 3.1% had major bleeding and 1.9% had arrhythmias. The total mortality rate was 2.3%. Patients who presented with ACS had a mortality rate of 1% compared to patients who were admitted due to heart failure or shock who had a mortality rate of 10.4% in this period., Conclusion: We have presented the current trend of admission to the ACCU with a shift from ACS to other cardiac causes such as acute heart failure, shock or peri-procedural complications. The rate of co-morbidities and hospital complications is increasing as the patients' age increases. This shift of patients' characteristics requires a re-examination of the role of the medical staff in this new era. There is a need to increase funding for acquiring new technology, staff education and reinforcing current staff.

Platelet activation and aggregation play a major role in the pathogenesis of acute coronary syndrome (ACS) and thrombotic complications following percutaneous coronary interventions (PCI). Antiplatelet therapy with aspirin (ASA) and/or clopidogrel remains one of the most effective therapies for the treatment of ACS and prevention of thrombotic complications following PCI. Nevertheless, not all patients achieve the desired laboratory and/or clinical effect following antiplatelet therapy. These patients have been termed "aspirin resistant" or "clopidogrel resistant". In recent years, several studies regarding clopidogrel resistance have been conducted, and a number of pharmacological therapies, together with new treatments, have been suggested. This review aims to provide an overview of the epidemiology, prevalence, clinical significance and potential solutions regarding clopidogrel resistance.

Background: Many patients present to the emergency department with chest pain. While in most of them chest pain represents a benign complaint, in some patients it underlies a life-threatening illness., Objectives: To assess the routine evaluation of patients presenting to the ED with acute chest pain by means of a cardiologist-based chest pain unit using different noninvasive imaging modalities., Methods: We evaluated the records of 1055 consecutive patients who presented to the ED with complaints of chest pain and were admitted to the CPU. After an observation period and according to the decision of the attending cardiologist, patients underwent myocardial perfusion scintigraphy, multidetector computed tomography, or stress echocardiography., Results: The CPU attending cardiologist did not prescribe non-invasive evaluation for 108 of the 1055 patients, who were either admitted (58 patients) or discharged (50 patients) after an observation period. Of those remaining, 444 patients underwent MDCT, 445 MPS, and 58 stress echocardiography. Altogether, 907 patients (86%) were discharged from the CPU. During an average period of 236 +/- 223 days, 25 patients (3.1%) were readmitted due to chest pain of suspected cardiac origin, and only 8 patients (0.9%) suffered a major adverse cardiovascular event., Conclusions: Utilization of the CPU enabled a rapid and thorough evaluation of the patients' primary complaint, thereby reducing hospitalization costs and occupancy on the one hand and avoiding misdiagnosis in discharged patients on the other.

Given the considerable advances in recent years in myocardial infarction diagnosis and management, the European Society of Cardiology (ESC), the American College of Cardiology (ACC), the American Heart Association (AHA), together with the World Heart Federation [WHF] recently published an expert consensus document to establish a universal definition for myocardial infarction. The consensus document recognizes five separate myocardial infarction categories based on the differences in pathophysiology, and whether percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG) surgery is involved. The new consensus document expands the criteria for defining myocardial infarction by adding new ECG criteria and imaging modalities, and also includes patients who present with sudden death. The Israel Heart Society has adopted the new universal definition and recommends its use by clinicians, researchers and epidemiologists. .

We have summarized current knowledge regarding primary and secondary prevention of cardiovasular disease, with an emphasis on aspirin resistance and adverse effects. The use of combined therapy of aspirin and warfarin was discussed and the role of aspirin in patients with AF was reviewed according to the latest guidelines /Table 3/. The issue of primary prevention remains only partially resolved, though it would seem that male patients at moderate to high risk for CVD may benefit. On the other hand, the role of aspirin for secondary prevention in high risk populations and in ACS is well established. A dose of 75-150 mg/day has been validated in numerous studies with higher doses showing no additional effects. Aspirin should not be regarded as an innocent drug, since prolonged use in low risk populations carries the risk of serious adverse events, primarily bleeding. Adverse events seem to increase linearly with increased doses. Patient compliance remains a major issue regarding treatment failure and achieving clinical benefit and should be stressed at every physician-patient encounter. Further research is required to develop testing methods that are reliable, standardized and accurate for aspirin resistance, and currently such testing is not recommended. Withdrawal of aspirin treatment should not be considered an innocent act as it may cause susceptibility to atherothrombotic events.

Background: Unconscious adults with spontaneous circulation after out-of-hospital cardiac arrest should be cooled to 32-34 degrees C (ILCOR recommendations, 2003) when the initial rhythm is ventricular fibrillation., Objectives: To assess the technique, safety and efficacy of mild induced hypothermia in patients after OHCA due to VF., Methods: Patients were cooled using the MTRE CritiCool external cooling system. Cold intravenous fluids were added to achieve faster cooling in 17 patients. Data were collected prospectively and patients were analyzed according to their neurological outcome on discharge, defined by their cerebral performance category., Results: From February 2002 to September 2006, 51 comatose VF patients with OHCA underwent MIH. Treatment was discontinued early in five because of hemodynamic instability; goal temperature was reached in 98% and maintained for an average of 19.5 hours; 61% had a favorable outcome (CPC 1-2) and 37% died. Improved outcome was observed with longer hypothermia time and possibly when time from collapse to return of spontaneous circulation was < 25 minutes., Conclusions: MIH, using an external cooling system, is simple and feasible, reduces mortality and protects neurological function. Four major factors seem to influence outcome: age, co-morbidities, duration of hypothermia, and possibly the length of time from collapse to return of spontaneous circulation.

Background: The diagnosis and management of acute myocardial infarction (AMI) has undergone major changes during the last decade. These changes reflect the results of numerous controlled clinical trials that established the basis for evidence-based guidelines., Aims: The aims of this study were to examine the trends in the characteristics, management and outcome of patients with AMI, hospitalized in all 25 Intensive Care Units (ICCU) operating in Israel during the last decade (1994-2004)., Methods: Data were derived from the biannual two-month national AMI/Acute Coronary Syndrome Israeli Surveys (ACSIS) performed in Israel. During the last decade, there was a continuous increase in the number of AMI patients admitted to the ICCU's operating in Israel - 999 AMI patients in 1994 and 1,534 in 2004. This increase was possibly due to shortening of hospital stay of AMI patients., Results: The mean age of patients (64 years) did not change significantly in the last decade. The ICCU population has been characterized by an increasing number of octogenarians (7% in 1994 and 13% in 2004) and higher numbers of patients with past history of PCI, CABG, CVA and other comorbidities. There have been increases in the use of evidence-based medications during hospital stays and at discharge, reflecting greater adherence to guidelines. The "primary reperfusion" rate increased in the last decade from 60% in 1998 to 64% in 2004. The mode of reperfusion has changed in favor of primary PCI in 2004. In 1998, 88% of STEMI patients who underwent primary reperfusion were treated with thrombolysis and 12% by primary PCI while in 2004, 33% were treated with thrombolysis and 67% by primary PCI. The hospital course of patients with AMI in the last decade is characterized by better outcomes with reductions in rates of reischemia and reinfarction, cardiogenic shock, atrial fibrillation, VT/VF, and AV Block 2 degrees - 3 degrees. The most striking change in the last decade is the significant reduction in short- and long-term mortality with 45% reduction in 7-day mortality and 33% reduction in one-year mortality., Conclusions: This trend of better clinical outcomes and lower mortality in the last decade most probably relates to the use of evidence-based treatment and to better adherence to guidelines in the operating ICCUs in Israel.