Oxygen and stroke is an example of too much medicine that has been shown from the results of a randomised trial Carl Heneghan There seem to be a plethora of trials recently on Oxygen. I blogged about its use here in MI, and we published in BMJ EBM in patients without hypoxia in ST elevation MI […]
Latest articles
Undertreatment of mitral regurgitation
“All evidence, especially our lifelong population-based data, point towards a substantial unmet need for treatment of mitral regurgitation.” Jack O’Sullivan Despite being the most common heart valvular disease, it is unclear how often patients with mitral regurgitation are treated. This is concerning because early treatment is beneficial [1]. A recent study, published in the […]
Evidence Watch: Can clinical decision support tools optimise anticoagulant therapy?
High baseline adherence rates for guidelines recommendations means that a clinical decision support system makes only a small difference in clinical outcomes for atrial fibrillation patients. Carl Heneghan The evidence for the association of atrial fibrillation with stroke risk is clear. However, there remain persistent levels of under treatment in clinical practice. Clinical decision […]
Weight loss drugs effects on CVD remains unproven.
Approved weight-loss medications have only modest effects on cardiovascular risk. Igho Onakpoya One rationale for the development and marketing of weight loss drugs is that their use will improve cardiac risk factors. In a recent systematic review and network meta-analysis [1] of 28 randomised controlled trials (29,018 participants), the authors concluded that the effects […]
Evidence Watch: Is the smartphone useful for diagnosis?
The smartphone could prove to be a useful aid to diagnostics, but it is essential we take a critical approach to evidence that claims benefit for such applications. Carl Heneghan It isn’t long ago that a phone did just one thing but now it’s a mobile computer. It was with this in mind that a […]
Evidence Watch: should ‘rooming in’ be the norm?
Evidence suggests rooming-in should be the norm in hospitals but what factors will limit uptake Carl Heneghan Here’s what we selected this week: Daily vs intermittent antituberculosis therapy for pulmonary tuberculosis in patients with HIV a randomized clinical trial. JAMA Internal Medicine, 178(4), 485–493. Bottom line: HIV-positive patients with pulmonary TB receiving antiretroviral therapy, do […]
Frailty’s impact on mortality
A systematic review concludes that frailty is a predictor of mortality, but does it aid decision making in practice? Carl Heneghan A recent systematic review included 18 cohort studies including 65,048 participants. The results suggested that higher Frailty index was significantly associated with higher mortality risk. For every 0.01 increase in the index the […]
Adverse effects of antidepressants in younger adults
SSRIs might have higher rates of fracture than tricyclic antidepressants but lower mortality and adverse reactions. Carl Heneghan Antidepressants are commonly prescribed. Yet, in those under 65, there is scant evidence on the risks associated with their use. A recent publication in BMC looked at these risks in a cohort of 20 to 64-year […]
Do I need the drugs, doc? Heart failure drugs with preserved ejection fraction.
Evidence suggests heart failure patients with preserved ejection fraction could benefit from beta-blocker treatment, guidelines do not. Jack O’Sullivan There is a well-established list of medications that work in heart failure with a reduced ejection fraction. However, it is unclear if these drugs are clinically effective in patients with heart failure with a preserved […]
Falls and fractures with Z drugs
Z-drugs might be associated with an increased risk of fractures, falls, and injuries and their use should be considered in the context of overall risk of falls in an individual Carl Heneghan Zolpidem, zopiclone, eszopiclone and zaleplon, are known as the ‘Z-drugs’. They even have their own Wikipedia page. They are a group of […]