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Specialty: Internal Medicine
Source: Evidence-Based Medicine
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Total 156 results found since Jan 2013.
Coronary artery bypass surgery continues to remain the treatment of choice for multivessel coronary artery disease even in the era of new-generation drug-eluting stents
Commentary on: Park SJ, Ahn JM, Kim YH, et al; BEST Trial Investigators. Trial of everolimus-eluting stents or bypass surgery for coronary disease. N Engl J Med 2015;372:1204–12. Context Multivessel coronary artery disease (MVCAD) may be found in patients subjected to coronary angiography. It is treated with coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI). The expanded use of PCI, following development of drug-eluting stents (DES), necessitated comparison of its outcomes with CABG (gold standard therapy). The SYNTAX (SYNergy between PCI with TAXUS and Cardiac Surgery) trial favoured...
Source: Evidence-Based Medicine - July 24, 2015 Category: Internal Medicine Authors: Mohr, F. W., Davierwala, P. M. Tags: Clinical trials (epidemiology), Drugs: cardiovascular system, Stroke, Interventional cardiology, Ischaemic heart disease, Venous thromboembolism, Radiology, Clinical diagnostic tests, Radiology (diagnostics) Therapeutics/Prevention Source Type: research
High-sensitivity cardiac troponin T in isolation has limited diagnostic utility in identifying cardiac causes of syncope
This study examines the diagnostic accuracy of high-sensitivity cardiac troponin T (cTnThs) for cardiac syncope and its predictive value for short-term (30 days) or medium-term (180 days) adverse events. Methods This was a secondary analysis of pre-existing prospective observational data of adult syncope patients from a single-centre...
Source: Evidence-Based Medicine - July 24, 2015 Category: Internal Medicine Authors: Thiruganasambandamoorthy, V., Perry, J. J. Tags: EBM Diagnosis, Drugs: cardiovascular system, Stroke, Ischaemic heart disease, Venous thromboembolism, Pulmonary embolism, Surgical diagnostic tests Source Type: research
The mortality rate in England between 2007 and 2012 was not associated with the quality of primary care in an established pay for performance programme
This study aimed to examine the relationship between primary care performance of quality indicators included in the QOF and changes in mortality. Methods This was an analysis of a longitudinal data...
Source: Evidence-Based Medicine - July 24, 2015 Category: Internal Medicine Authors: Fleetcroft, R. Tags: EBM Quality improvement, Medical management, Clinical trials (epidemiology), Epidemiologic studies, General practice / family medicine, Drugs: cardiovascular system, Stroke, Hypertension, Diet, Ischaemic heart disease, Renal medicine, Guidelines Source Type: research
Potential cost-savings may be considerable with management of hypertension according to updated US hypertension guidelines, but for women aged 35-44 years these benefits are unlikely
Commentary on: Moran AE, Odden MC, Thanataveerat A, et al. Cost-effectiveness of hypertension therapy according to 2014 guidelines. N Engl J Med 2015;372:447–55. Context The number of people with hypertension is anticipated to increase despite greater awareness of the condition as a risk factor for cardiovascular disease (CVD) and more options for treatment. Clinical guidelines are evidence-based recommendations used to inform clinician practice when treating an individual patient. Regular updates of guidelines are important to ensure their ongoing relevance. Moran and colleagues investigated the potential cost impli...
Source: Evidence-Based Medicine - July 24, 2015 Category: Internal Medicine Authors: Cadilhac, D. A., Kim, J. Tags: Health policy, Drugs: cardiovascular system, Stroke, Hypertension, Health economics, Health service research, Guidelines Economic analysis Source Type: research
Prolonged dual antiplatelet therapy after drug-eluting stent reduces the risk of stent thrombosis and major cardiovascular events but increases the rate of bleeding
This study is an international, randomised, placebo-controlled trial that was designed to determine the benefits and risks of continuing DAPT beyond 1 year after the placement of a coronary stent. The study enrolled 9961 patients. After 12 months of DAPT, patients were randomly assigned to continue thienopyridine treatment or to receive placebo for another 18 months, all...
Source: Evidence-Based Medicine - May 22, 2015 Category: Internal Medicine Authors: Helft, G. Tags: Epidemiologic studies, Drugs: cardiovascular system, Stroke, Interventional cardiology, Ischaemic heart disease, Venous thromboembolism, Guidelines Therapeutics/Prevention Source Type: research
Using the Watchman device to close the left atrial appendage reduces risk of stroke in atrial fibrillation, compared to using warfarin
Commentary to: Reddy VY, Sievert H, Halperin J, et al.; PROTECT AF Steering Committee and Investigators. Percutaneous left atrial appendage closure vs warfarin for atrial fibrillation: a randomized clinical trial. JAMA 2014;312:1988–98 . Context Atrial fibrillation (AF) is a common arrhythmia in clinical practice. The major complication of AF is thromboembolic stroke. Patients with AF have a fivefold higher risk of stroke and a twofold increase in mortality.1 As complete cure for AF is never certain, the aims of AF therapy are symptom relief and prevention of thromboembolic events. The latter can be managed by vitami...
Source: Evidence-Based Medicine - May 22, 2015 Category: Internal Medicine Authors: Swaans, M. J., Alipour, A., Boersma, L. V. Tags: Clinical trials (epidemiology), Epidemiologic studies, Drugs: cardiovascular system, Stroke, Arrhythmias Therapeutics/Prevention Source Type: research
Timing of thrombolysis for acute ischaemic stroke: the earlier the treatment the better the outcome, irrespective of age or stroke severity
This study looked at how treatment delay, patient age and stroke severity influence the effect of t-PA in AIS in terms of functional outcome, mortality and intracranial haemorrhage (ICH). Methods This was a preplanned meta-analysis of individual patient data from nine randomised clinical trials of intravenous alteplase for AIS. The primary efficacy measure was the proportion of patients who achieved a 3–6 month...
Source: Evidence-Based Medicine - May 22, 2015 Category: Internal Medicine Authors: Lorenzano, S. Tags: Epidemiologic studies, Stroke, Radiology, Clinical diagnostic tests Therapeutics/Prevention Source Type: research
Invasive revascularisation in patients with moderate intermittent claudication provides a significant improvement in quality of life compared with conservative treatment
Commentary on: Nordanstig J, Taft C, Hensäter M, et al. Improved quality of life after 1 year with an invasive versus a noninvasive treatment strategy in claudicants: one-year results of the Invasive Revascularization or Not in Intermittent Claudication (IRONIC) Trial. Circulation 2014;130:939–47 . Context In cases of severe intermittent claudication (IC), successful revascularisation provides significant symptomatic improvement. In cases of mild IC, revascularisation has exceedingly high risks. The choice between invasive revascularisation and non-invasive treatments for moderate severity IC is often diffi...
Source: Evidence-Based Medicine - May 22, 2015 Category: Internal Medicine Authors: Kurklinsky, A. K. Tags: Epidemiologic studies, Pain (neurology), Stroke Therapeutics/Prevention Source Type: research
Angina may trump ischaemia in predicting stable coronary artery disease outcomes, but most cardiovascular events occur in patients without angina or asymptomatic ischaemia
Commentary on: Steg PG, Greenlaw N, Tendera M, et al., Prospective Observational Longitudinal Registry of Patients With Stable Coronary Artery Disease (CLARIFY) Investigators. Prevalence of anginal symptoms and myocardial ischemia and their effect on clinical outcomes in outpatients with stable coronary artery disease: data from the International Observational CLARIFY Registry. JAMA Intern Med 2014;174:1651–9 . Context The presence of angina portends a poor prognosis. Greater attention has recently been directed to asymptomatic ischaemia, the severity of which plays a role in development of chest pain1 and is a robus...
Source: Evidence-Based Medicine - May 22, 2015 Category: Internal Medicine Authors: Kones, R., Rumana, U. Tags: EBM Prognosis, Epidemiologic studies, Drugs: cardiovascular system, Pain (neurology), Stroke, Interventional cardiology, Ischaemic heart disease Source Type: research
Vitamin K antagonist-experienced patients with a history of stroke/transient ischaemic attack who switched from warfarin to dabigatran increased their rate of recurrent stroke/transient ischaemic attack compared with those on warfarin
Commentary on: Larsen TB, Rasmussen LH, Gorst-Rasmussen A, et al. Dabigatran and warfarin for secondary prevention of stroke in atrial fibrillation patients: a nationwide cohort study. Am J Med 2014;127:1172–8 . Context Randomised trials have shown that patients with atrial fibrillation (AF) who are treated with a non-vitamin K antagonist oral anticoagulant (NOAC), compared with warfarin, have similar or lower rates of stroke and major bleeding, markedly reduced rates of intracranial bleeding and a consistent pattern of reduced mortality.1 Dabigatran 150 mg two times a day is the only NOAC that can significantly...
Source: Evidence-Based Medicine - May 22, 2015 Category: Internal Medicine Authors: Eikelboom, J. W., Bosch, J. Tags: Epidemiologic studies, Time-to-event methods, Drugs: cardiovascular system, Stroke, Arrhythmias Aetiology/Harm Source Type: research
Meta-analysis compares anticoagulant strategies in patients with acute myocardial infarction undergoing primary percutaneous coronary intervention
Commentary on: Bangalore S, Toklu B, Kotwal A, et al. Anticoagulant therapy during primary percutaneous coronary intervention for acute myocardial infarction: a meta-analysis of randomised trials in the era of stents and P2Y12 inhibitors. BMJ 2014;349:g6419 Context Optimal anticoagulant therapy in patients receiving primary intervention for acute myocardial infarction (MI) is widely debated. Prior studies have been heterogeneous in doses and concomitant treatments such that it has been unclear whether effects have been those of newer medication or a result of changes in these co-interventions. A meta-analytic approach can ...
Source: Evidence-Based Medicine - March 17, 2015 Category: Internal Medicine Authors: Patti, G. Tags: Clinical trials (epidemiology), Drugs: cardiovascular system, Stroke, Interventional cardiology, Ischaemic heart disease, Venous thromboembolism, Radiology, Clinical diagnostic tests Therapeutics/Prevention Source Type: research
The 'surprise' question may improve the accuracy of GPs in identifying death in patients with advanced stage IV solid-cell cancer
Commentary on: Moroni M, Zocchi D, Bolognesi D, et al.; on behalf of the SUQ-P group. The ‘surprise’ question in advanced cancer patients: a prospective study among general practitioners. Palliat Med 2014;28:,959–64. Context The ‘surprise’ question has been developed in order to improve the ability of clinicians to identify patients who are at risk of dying in the near future. The question, ‘Would I be surprised if this patient died in the next year?’ shifts the focus away from precise identification of dying patients to identifying patients who might be dying.1 This may enable mor...
Source: Evidence-Based Medicine - March 17, 2015 Category: Internal Medicine Authors: Rhee, J., Clayton, J. M. Tags: EBM Prognosis, Pancreas and biliary tract, Palliative care, Epidemiologic studies, General practice / family medicine, Stroke, Prostate Source Type: research
Bypass surgery is more cost-effective than percutaneous coronary interventions for most patients with multivessel or left main coronary artery disease
Commentary on: Cohen DJ, Osnabrugge RL, Magnuson EA, et al; SYNTAX Trial Investigators. Cost-effectiveness of percutaneous coronary intervention with drug-eluting stents versus bypass surgery for patients with 3-vessel or left main coronary artery disease: final results from the Synergy Between Percutaneous Coronary Intervention With TAXUS and Cardiac Surgery (SYNTAX) trial. Circulation 2014;130:1146–57. Context The SYNTAX (SYNergy between percutaneous coronary intervention with TAXus and cardiac surgery) trial compared outcomes of percutaneous coronary intervention (PCI) with drug eluting stents (DES) and coronary a...
Source: Evidence-Based Medicine - March 17, 2015 Category: Internal Medicine Authors: Agarwal, S., Kapadia, S. R. Tags: Health policy, Drugs: cardiovascular system, Stroke, Interventional cardiology, Ischaemic heart disease, Health economics, Health service research Economic analysis Source Type: research
Lung cancer CT screening is cost-effective but implementation matters
Commentary on: Black WC, Gareen IF, Soneji SS, et al.; National Lung Screening Trial Research Team. Cost-effectiveness of CT screening in the National Lung Screening Trial. N Engl J Med 2014;37:1793–802. Context The National Lung Screening Trial (NLST) revealed a 20% reduction in lung cancer mortality from three annual low-dose CT screening scans compared with chest radiographs in high-risk individuals.1 Since up to 10 million individuals in the USA may qualify for annual CT screening, policymakers have legitimately questioned whether the benefits of lung cancer screening justify the potential high costs of large-sca...
Source: Evidence-Based Medicine - March 17, 2015 Category: Internal Medicine Authors: Goulart, B. Tags: Smoking and tobacco, Health policy, Epidemiologic studies, Stroke, Screening (oncology), Radiology, Clinical diagnostic tests, Radiology (diagnostics), Screening (epidemiology), Health economics, Health service research, Health education, Screening (publi Source Type: research
Effects of screening and lifestyle counselling on incidence of ischaemic heart disease in general population are limited
Commentary on: Jorgensen T, Jacobsen RK, Toft U, et al.. Effect of screening and lifestyle counselling on incidence of ischaemic heart disease in general population: Inter99 randomised trial. BMJ 2014;348:g3617. Context While mortality rates from cardiovascular diseases—particularly ischaemic heart disease (IHD)—have been declining in Western countries, IHD still contributes a significant burden to individuals, healthcare systems and society.1 Therefore, IHD prevention efforts could have major impact on societal health. Given the widespread prevalence of IHD and IHD risk factors, population-focused public healt...
Source: Evidence-Based Medicine - January 21, 2015 Category: Internal Medicine Authors: Lear, S. A. Tags: Rehabilitation medicine, Smoking and tobacco, Epidemiologic studies, Drugs: cardiovascular system, Stroke, Diet, Ischaemic heart disease, Screening (epidemiology), Health education, Screening (public health), Smoking Therapeutics/Prevention Source Type: research
