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Randomized trials in cardiology

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https://www.readbyqxmd.com/read/29208494/bleeding-in-advanced-ckd-patients-on-antithrombotic-medication-a-critical-appraisal
#1
Alexandru Burlacu, Simonetta Genovesi, David Goldsmith, Patrick Rossignol, Alberto Ortiz, Philip A Kalra, Jolanta Małyszko, Maciej Banach, Mehmet Kanbay, Adrian Covic
Patients with advanced chronic kidney disease (CKD) are at an increased risk of bleeding, especially in the context of the complex therapeutic schemes of coronary artery disease (CAD) (from stable angina to acute coronary syndromes), atrial fibrillation or venous thromboembolism. The bleeding issue increases morbidity and mortality, a serious problem in daily medical practice. However, these patients are largely excluded from major randomized clinical trials, which results in the lack of medical evidence-based foundation for specific recommendations regarding antithrombotic treatment in a high bleeding risk setting...
December 2, 2017: Pharmacological Research: the Official Journal of the Italian Pharmacological Society
https://www.readbyqxmd.com/read/29188357/-management-of-valvular-heart-disease-esc-eacts-guidelines-2017
#2
REVIEW
M Haude
After 5 years the European Society of Cardiology and the European Association for Cardio-Thoracic Surgery have released an update on the guidelines for the management of valvular heart diseases. In recent years published results of randomized trials in patients with aortic valve stenosis have resulted in updated recommendations for catheter-based prosthesis implantation (TAVI), which is now extended to patients presenting without a low risk for conventional surgical valve replacement. In mitral or tricuspid valvular disease, the recommendations for catheter-based therapies are less strong because of a lack of supportive scientific data...
December 2017: Herz
https://www.readbyqxmd.com/read/29185617/percutaneous-intervention-in-st-elevation-myocardial-infarction-culprit-only-or-complete-revascularization
#3
Ana Paula Susin Osório, Alexandre Schaan de Quadros, José Luiz da Costa Vieira, Vera Lucia Portal
The best approach of multivessel coronary artery disease in the context of acute myocardial infarction with ST segment elevation and primary percutaneous coronary intervention is one of the main reasons for controversy in cardiology. Although the main global guidelines do not recommend routine complete revascularization in these patients, recent randomized clinical trials have demonstrated benefit of this approach in reducing cardiovascular outcomes. For this reason, an adequate review of this evidence is essential in order to establish scientifically based strategy and achieve better outcomes for these patients who present with acute myocardial infarction...
November 27, 2017: Arquivos Brasileiros de Cardiologia
https://www.readbyqxmd.com/read/29182745/unmet-need-for-primary-prevention-in-individuals-with-hypertriglyceridaemia-not-eligible-for-statin-therapy-according-to-european-society-of-cardiology-european-atherosclerosis-society-guidelines-a-contemporary-population-based-study
#4
Christian M Madsen, Anette Varbo, Børge G Nordestgaard
Aims: To identify individuals at high risk of atherosclerotic cardiovascular disease (ASCVD), who are not definite statin eligible according to the 2016 European Society of Cardiology/European Atherosclerosis Society (ESC/EAS) guidelines, based on high concentrations of plasma triglycerides. Methods and results: From the Copenhagen General Population Study (2003-2015) 58 547 individuals aged 40-65 and free of ASCVD, diabetes, and statin use at baseline were included...
November 22, 2017: European Heart Journal
https://www.readbyqxmd.com/read/29169764/female-specific-survival-advantage-from-transcatheter-aortic-valve-implantation-over-surgical-aortic-valve-replacement-meta-analysis-of-the-gender-subgroups-of-randomised-controlled-trials-including-3758-patients
#5
Vasileios F Panoulas, Darrel P Francis, Neil Ruparelia, Iqbal S Malik, Andrew Chukwuemeka, Sayan Sen, Jonathan Anderson, Petros Nihoyannopoulos, Nilesh Sutaria, Edward L Hannan, Zaza Samadashvili, Paola D'Errigo, Gerhard Schymik, Roxana Mehran, Alaide Chieffo, Azeem Latib, Patrizia Presbitero, Julinda Mehilli, Anna Sonia Petronio, Marie-Claude Morice, Corrado Tamburino, Hans G H Thyregod, Martin Leon, Antonio Colombo, Ghada W Mikhail
Transcatheter aortic valve implantation (TAVI) for severe aortic stenosis (AS) is the first area of interventional cardiology where women are treated as often as men. In this analysis of the gender specific results of randomised controlled trials (RCTs) comparing TAVI with surgical aortic valve replacement (SAVR) we aimed to determine whether gender affects the survival comparison between TAVI and SAVR. We identified all RCTs comparing TAVI versus SAVR for severe AS and reporting 1 and/or 2year survival. Summary odds ratios (ORs) were obtained using a random-effects model...
January 1, 2018: International Journal of Cardiology
https://www.readbyqxmd.com/read/29146534/systematic-review-for-the-2017-acc-aha-aapa-abc-acpm-ags-apha-ash-aspc-nma-pcna-guideline-for-the-prevention-detection-evaluation-and-management-of-high-blood-pressure-in-adults-a-report-of-the-american-college-of-cardiology-american-heart-association-task
#6
David M Reboussin, Norrina B Allen, Michael E Griswold, Eliseo Guallar, Yuling Hong, Daniel T Lackland, Edgar Pete R Miller, Tamar Polonsky, Angela M Thompson-Paul, Suma Vupputuri
OBJECTIVE: To review the literature systematically and perform meta-analyses to address these questions: 1) Is there evidence that self-measured blood pressure (BP) without other augmentation is superior to office-based measurement of BP for achieving better BP control or for preventing adverse clinical outcomes that are related to elevated BP? 2) What is the optimal target for BP lowering during antihypertensive therapy in adults? 3) In adults with hypertension, how do various antihypertensive drug classes differ in their benefits and harms compared with each other as first-line therapy? METHODS: Electronic literature searches were performed by Doctor Evidence, a global medical evidence software and services company, across PubMed and EMBASE from 1966 to 2015 using key words and relevant subject headings for randomized controlled trials that met eligibility criteria defined for each question...
November 7, 2017: Journal of the American College of Cardiology
https://www.readbyqxmd.com/read/29133355/systematic-review-for-the-2017-acc-aha-aapa-abc-acpm-ags-apha-ash-aspc-nma-pcna-guideline-for-the-prevention-detection-evaluation-and-management-of-high-blood-pressure-in-adults-a-report-of-the-american-college-of-cardiology-american-heart-association-task
#7
REVIEW
David M Reboussin, Norrina B Allen, Michael E Griswold, Eliseo Guallar, Yuling Hong, Daniel T Lackland, Edgar Pete R Miller, Tamar Polonsky, Angela M Thompson-Paul, Suma Vupputuri
OBJECTIVE: To review the literature systematically and perform meta-analyses to address these questions: 1) Is there evidence that self-measured blood pressure (BP) without other augmentation is superior to office-based measurement of BP for achieving better BP control or for preventing adverse clinical outcomes that are related to elevated BP? 2) What is the optimal target for BP lowering during antihypertensive therapy in adults? 3) In adults with hypertension, how do various antihypertensive drug classes differ in their benefits and harms compared with each other as first-line therapy? METHODS: Electronic literature searches were performed by Doctor Evidence, a global medical evidence software and services company, across PubMed and EMBASE from 1966 to 2015 using key words and relevant subject headings for randomized controlled trials that met eligibility criteria defined for each question...
November 13, 2017: Hypertension
https://www.readbyqxmd.com/read/29120880/culprit-versus-multivessel-coronary-intervention-in-st-segment-elevation-myocardial-infarction-a-meta-analysis-of-randomized-trials
#8
Satyanarayana R Vaidya, Arman Qamar, Sameer Arora, Santhosh R Devarapally, Ashok Kondur, Prashant Kaul
BACKGROUND: The 2015 American College of Cardiology/American Heart Association update on primary percutaneous coronary intervention (PCI) in patients with ST-segment elevation myocardial infarction (STEMI) recommended PCI of the non-infarct-related artery at the time of primary PCI (class IIb recommendation). Despite evidence supporting complete revascularization in STEMI, its benefit on mortality rates is uncertain. METHODS: We searched all available databases for randomized controlled trials comparing complete multivessel percutaneous coronary intervention (CMV PCI) with infarct-artery-only revascularization in patients with STEMI...
November 8, 2017: Coronary Artery Disease
https://www.readbyqxmd.com/read/29109195/sleep-apnea-and-cardiovascular-disease-lessons-from-recent-trials-and-need-for-team-science
#9
REVIEW
Luciano F Drager, R Doug McEvoy, Ferran Barbe, Geraldo Lorenzi-Filho, Susan Redline
Emerging research highlights the complex interrelationships between sleep-disordered breathing and cardiovascular disease, presenting clinical and research opportunities as well as challenges. Patients presenting to cardiology clinics have a high prevalence of obstructive and central sleep apnea associated with Cheyne-Stokes respiration. Multiple mechanisms have been identified by which sleep disturbances adversely affect cardiovascular structure and function. Epidemiological research indicates that obstructive sleep apnea is associated with increases in the incidence and progression of coronary heart disease, heart failure, stroke, and atrial fibrillation...
November 7, 2017: Circulation
https://www.readbyqxmd.com/read/29097318/systematic-review-for-the-2017-aha-acc-hrs-guideline-for-management-of-patients-with-ventricular-arrhythmias-and-the-prevention-of-sudden-cardiac-death-a-report-of-the-american-college-of-cardiology-american-heart-association-task-force-on-clinical-practice
#10
Fred M Kusumoto, Kent R Bailey, Ahmad Sami Chaouki, Abhishek J Deshmukh, Sandeep Gautam, Robert J Kim, Daniel B Kramer, Litsa K Lambrakos, Naseer H Nasser, Dan Sorajja
BACKGROUND: Although large randomized clinical trials have found that primary prevention use of an implantable cardioverter-defibrillator (ICD) improves survival in patients with cardiomyopathy and heart failure symptoms, patients who receive ICDs in practice are often older and have more comorbidities than patients who were enrolled in the clinical trials. In addition, there is a debate among clinicians on the usefulness of electrophysiological study for risk stratification of asymptomatic patients with Brugada syndrome...
October 25, 2017: Heart Rhythm: the Official Journal of the Heart Rhythm Society
https://www.readbyqxmd.com/read/29097297/systematic-review-for-the-2017-aha-acc-hrs-guideline-for-management-of-patients-with-ventricular-arrhythmias-and-the-prevention-of-sudden-cardiac-death-a-report-of-the-american-college-of-cardiology-american-heart-association-task-force-on-clinical-practice
#11
Fred M Kusumoto, Kent R Bailey, Ahmad Sami Chaouki, Abhishek J Deshmukh, Sandeep Gautam, Robert J Kim, Daniel B Kramer, Litsa K Lambrakos, Naseer H Nasser, Dan Sorajja
BACKGROUND: Although large randomized clinical trials have found that primary prevention use of an implantable cardioverter-defibrillator (ICD) improves survival in patients with cardiomyopathy and heart failure symptoms, patients who receive ICDs in practice are often older and have more comorbidities than patients who were enrolled in the clinical trials. In addition, there is a debate among clinicians on the usefulness of electrophysiological study for risk stratification of asymptomatic patients with Brugada syndrome...
October 24, 2017: Journal of the American College of Cardiology
https://www.readbyqxmd.com/read/29096024/antithrombotic-therapy-in-atrial-fibrillation-associated-with-valvular-heart-disease-a-joint-consensus-document-from-the-european-heart-rhythm-association-ehra-and-european-society-of-cardiology-working-group-on-thrombosis-endorsed-by-the-esc-working-group
#12
Gregory Y H Lip, Jean Philippe Collet, Raffaele de Caterina, Laurent Fauchier, Deirdre A Lane, Torben B Larsen, Francisco Marin, Joao Morais, Calambur Narasimhan, Brian Olshansky, Luc Pierard, Tatjana Potpara, Nizal Sarrafzadegan, Karen Sliwa, Gonzalo Varela, Gemma Vilahur, Thomas Weiss, Giuseppe Boriani, Bianca Rocca
Atrial fibrillation (AF) is a major worldwide public health problem, and AF in association with valvular heart disease (VHD) is also common. However, management strategies for this group of patients have been less informed by randomized trials, which have largely focused on 'non-valvular AF' patients. Thrombo-embolic risk also varies according to valve lesion and may also be associated with CHA2DS2VASc score risk factor components, rather than only the valve disease being causal. Given marked heterogeneity in the definition of valvular and non-valvular AF and variable management strategies, including non-vitamin K antagonist oral anticoagulants (NOACs) in patients with VHD other than prosthetic heart valves or haemodynamically significant mitral valve disease, there is a need to provide expert recommendations for professionals participating in the care of patients presenting with AF and associated VHD...
November 1, 2017: Europace: European Pacing, Arrhythmias, and Cardiac Electrophysiology
https://www.readbyqxmd.com/read/29072054/the-effect-of-thriphala-a-herbal-ayurveda-formulation-on-serum-lipids-in-patients-on-a-maintenance-dose-of-atorvastatin-for-hyperlipidaemia-a-randomized-controlled-trial
#13
R A Ekanayaka, A D Rupasinha, M R Sooriyarachchi, C Goonaratna
Introduction: Thriphala, a herbal medicinal formulation, is a bedrock of Ayurveda therapeutics with many postulated benefits. Objectives: We performed a clinical trial to test the effects of Swastha Thriphala®, a proprietary preparation of thriphala, on serum lipid parameters in patients receiving atorvastatin. Methods: Consenting adults receiving a maintenance dose of atorvastatin 10mg (Atorlip®) daily from a clinic of the Institute of Cardiology, National Hospital of Sri Lanka for lipid regulation, were randomly assigned, after counselling, to receive either the proprietary herbal medicinal product Swastha Thriphala® (Treatment Group, n= 101) or a placebo (Control Group n= 97), at the stipulated dose daily, for three calendar months...
September 30, 2017: Ceylon Medical Journal
https://www.readbyqxmd.com/read/29067761/what-have-we-learned-about-heart-failure-with-mid-range-ejection-fraction-one-year-after-its-introduction
#14
REVIEW
Jan F Nauta, Yoran M Hummel, Joost P van Melle, Peter van der Meer, Carolyn S P Lam, Piotr Ponikowski, Adriaan A Voors
The 2016 European Society of Cardiology heart failure guidelines introduced the term 'heart failure with mid-range ejection fraction' (HFmrEF) to refer to patients with heart failure and a mildly reduced ejection fraction of 40-49%. About 20% of heart failure patients fall in this category. One of the main reasons for the introduction of this category was to stimulate research into this grey area. This review aims to highlight the key findings that have been published so far. Firstly, HFmrEF more closely resembles heart failure with reduced (HFrEF) than preserved ejection fraction (HFpEF) with regard to ischaemic aetiology, which is more frequent in both HFmrEF and HFrEF compared to HFpEF...
October 24, 2017: European Journal of Heart Failure
https://www.readbyqxmd.com/read/29042191/roadmap-to-achieve-25-hypertension-control-in-africa-by-2025
#15
Anastase Dzudie, Brian Rayner, Dike Ojji, Aletta E Schutte, Marc Twagirumukiza, Albertino Damasceno, Seringe Abdou Ba, Abdoul Kane, Euloge Kramoh, Jean Baptiste Anzouan Kacou, Basden Onwubere, Ruth Cornick, Karen Sliwa, Benedict Anisiuba, Ana Olga Mocumbi, Elijah Ogola, Mohamed Awad, George Nel, Harun Otieno, Ali Ibrahim Toure, Samuel Kingue, Andre Pascal Kengne, Pablo Perel, Alma Adler, Neil Poulter, Bongani Mayosi
BACKGROUND: The Pan-African Society of Cardiology (PASCAR) has identified hypertension as the highest area of priority action to reduce heart disease and stroke on the continent. OBJECTIVES: The aim of this PASCAR roadmap on hypertension was to develop practical guidance on how to implement strategies that translate existing knowledge into effective action and improve detection, treatment and control of hypertension and cardiovascular health in sub-Saharan Africa (SSA) by the year 2025...
October 14, 2017: Global Heart
https://www.readbyqxmd.com/read/29020259/report-of-an-esc-eapci-task-force-on-the-evaluation-and-use-of-bioresorbable-scaffolds-for-percutaneous-coronary-intervention-executive-summary
#16
Robert A Byrne, Giulio G Stefanini, Davide Capodanno, Yoshinobu Onuma, Andreas Baumbach, Javier Escaned, Michael Haude, Stefan James, Michael Joner, Peter Jüni, Adnan Kastrati, Semih Oktay, William Wijns, Patrick W Serruys, Stephan Windecker
A previous Task Force of the European Society of Cardiology (ESC) and European Association of Percutaneous Cardiovascular Interventions (EAPCI) provided a report on recommendations for the non-clinical and clinical evaluation of coronary stents. Following dialogue with the European Commission, the Task Force was asked to prepare an additional report on the class of devices known as bioresorbable scaffolds (BRS). Five BRS have CE-mark approval for use in Europe. Only one device-the Absorb bioresorbable vascular scaffold-has published randomized clinical trial data and this data show inferior outcomes to conventional drug-eluting stents (DES) at 2-3 years...
August 28, 2017: European Heart Journal
https://www.readbyqxmd.com/read/29018938/heart-failure-with-preserved-ejection-fraction-current-management-and-future-strategies-expert-opinion-on-the-behalf-of-the-nucleus-of-the-heart-failure-working-group-of-the-german-society-of-cardiology-dkg
#17
REVIEW
Carsten Tschöpe, Christoph Birner, Michael Böhm, Oliver Bruder, Stefan Frantz, Andreas Luchner, Lars Maier, Stefan Störk, Behrouz Kherad, Ulrich Laufs
About 50% of all patients suffering from heart failure (HF) exhibit a reduced ejection fraction (EF ≤ 40%), termed HFrEF. The others may be classified into HF with midrange EF (HFmrEF 40-50%) or preserved ejection fraction (HFpEF, EF ≥ 50%). Presentation and pathophysiology of HFpEF is heterogeneous and its management remains a challenge since evidence of therapeutic benefits on outcome is scarce. Up to now, there are no therapies improving survival in patients with HFpEF. Thus, the treatment targets symptom relief, quality of life and reduction of cardiac decompensations by controlling fluid retention and managing risk factors and comorbidities...
October 10, 2017: Clinical Research in Cardiology: Official Journal of the German Cardiac Society
https://www.readbyqxmd.com/read/28982506/palliative-care-in-heart%C3%A2-failure-rationale-evidence-and-future-priorities
#18
REVIEW
Dio Kavalieratos, Laura P Gelfman, Laura E Tycon, Barbara Riegel, David B Bekelman, Dara Z Ikejiani, Nathan Goldstein, Stephen E Kimmel, Marie A Bakitas, Robert M Arnold
Patients with heart failure (HF) and their families experience stress and suffering from a variety of sources over the course of the HF experience. Palliative care is an interdisciplinary service and an overall approach to care that improves quality of life and alleviates suffering for those living with serious illness, regardless of prognosis. In this review, we synthesize the evidence from randomized clinical trials of palliative care interventions in HF. While the evidence base for palliative care in HF is promising, it is still in its infancy and requires additional high-quality, methodologically sound studies to clearly elucidate the role of palliative care for patients and families living with the burdens of HF...
October 10, 2017: Journal of the American College of Cardiology
https://www.readbyqxmd.com/read/28964433/cost-effectiveness-analysis-of-natriuretic-peptide-testing-and-specialist-management-in-patients-with-suspected-acute-heart-failure
#19
Edward A Griffin, David Wonderling, Andrew J Ludman, Abdallah Al-Mohammad, Martin R Cowie, Suzanna M C Hardman, John J V McMurray, Jason Kendall, Polly Mitchell, Aminat Shote, Katharina Dworzynski, Jonathan Mant
OBJECTIVES: To determine the cost-effectiveness of natriuretic peptide (NP) testing and specialist outreach in patients with acute heart failure (AHF) residing off the cardiology ward. METHODS: We used a Markov model to estimate costs and quality-adjusted life-years (QALYs) for patients presenting to hospital with suspected AHF. We examined diagnostic workup with and without the NP test in suspected new cases, and we examined the impact of specialist heart failure outreach in all suspected cases...
September 2017: Value in Health: the Journal of the International Society for Pharmacoeconomics and Outcomes Research
https://www.readbyqxmd.com/read/28956866/-the-importance-of-defining-methodology-for-post-marketing-observational-studies-on-cardiovascular-therapies
#20
Francesco Pelliccia, Francesco Barillà, Gaetano Tanzilli, Nicola Viceconte, Vincenzo Paravati, Enrico Mangieri, Carlo Gaudio
In recent years, a growing number of observational studies in cardiology have been carried out following the criticism that rigid design of randomized clinical trials produces information that is not applicable to the general patient. This approach is very common in several branches of medicine, first of all oncology, but has often been considered marginal in cardiology. The recent introduction of new oral anticoagulants (NOACs) on the market, however, has seen a proliferation of "real-life" studies, drawing the attention of cardiologists to the advantages and limitations of post-marketing studies...
July 2017: Giornale Italiano di Cardiologia
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