The Rhythm | Issue 29

Issue 29 | Week of 19 October 2026

Cardiology Intelligence Briefing: what the headline doesn't tell you

Every week, cardiology is handed a set of headline numbers. This week's papers are a reminder that the headline is where reading begins, not where it ends.

Start with what gets counted. In ST-segment elevation myocardial infarction (STEMI) with multivessel disease, treating every narrowed artery in one sitting appeared to prevent myocardial infarction (MI), but the benefit rested on infarctions caused by the procedure itself.¹ Spontaneous heart attacks did not differ, and all-cause death was higher with the immediate strategy: a signal too fragile to call harm, and too important to ignore.¹ A factor XIa inhibitor added to antiplatelet therapy after non-cardioembolic ischaemic stroke showed no statistically significant increase in major bleeding, yet produced more lower gastrointestinal bleeding.⁴ An early-discharge strategy built on a wearable subcutaneous diuretic pump gave patients more days at home, while heart failure readmissions ran at 14% against 6%.² Getting patients home sooner is not the same as getting them better.²

Then ask who was studied. In dilated cardiomyopathy, genotype exposed arrhythmic risk that ejection fraction missed, even in patients with a left ventricular ejection fraction (LVEF) of 50% or higher.³ Across 56 heart failure trials, women made up 21.0% of participants in trials of heart failure with reduced ejection fraction, so the drugs we prescribe them every day were tested largely in men.⁵

None of this makes the week's evidence weak. It makes it demanding. Our view is simple: before any result changes a decision, ask what was counted and who was counted. The headline tells you a study's answer; only a closer reading tells you its question.