Overestimation of cardiovascular risk and what to do about it

  A New Zealand study sets new standards for predicting cardiovascular risk and questions the validity of pre-existing risk equations  Carl Heneghan Prevention of cardiovascular disease relies on identifying those most at risk. Most cohorts of patients were established many years ago with patients at higher risk. A recent prospective cohort study done in New Zealand representing primary care […]

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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 […]

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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 […]

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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 […]

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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 […]

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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 […]

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