Less Is More

Simpler & Better Medicine

Comparative effectiveness of exercise and drug interventions on mortality outcomes. — January 15, 2019

Comparative effectiveness of exercise and drug interventions on mortality outcomes.

Summary: For patients recovering from a stroke, exercise interventions are associated with lower mortality rates than drug interventions; while for patients with coronary heart disease and “prediabetes” there appear to be no statistically detectable differences in mortality reduction between exercise and drug interventions.

https://www.ncbi.nlm.nih.gov/m/pubmed/24473061/

Strength of Recommendation = A

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Pharmacotherapy for mild hypertension — December 18, 2018

Pharmacotherapy for mild hypertension

Summary: For patients with mild hypertension (BP 140/90 – 150/99) and no cardiovascular disease (CVD) an approach of avoiding antihypertensive treatment may not be associated with any higher risk of mortality, coronary heart disease or stroke compared to an approach of treating mild hypertension, but treatment of mild hypertension may be associated with a higher risk of adverse events.

https://www.ncbi.nlm.nih.gov/m/pubmed/22895954/

Strength of Recommendation = A

Antihypertensive Treatment in Low-Risk Patients With Mild Hypertension. — December 11, 2018

Antihypertensive Treatment in Low-Risk Patients With Mild Hypertension.

Summary: For patients with mild hypertension (untreated blood pressure of 140/90-159/99 mm Hg) and no history of cardiovascular disease (CVD) or CVD risk factors, an approach of avoiding antihypertensive medications may not be associated with any higher risk of subsequent mortality and CVD as an approach of treating mild hypertension, while treatment of mild hypertension may be associated with an increased risk of low blood pressure, syncope, electrolyte disturbances, and kidney injury.

https://www.ncbi.nlm.nih.gov/m/pubmed/30383082/

Strength of Recommendation = B

Oxygen therapy for acutely ill medical patients. — November 27, 2018

Oxygen therapy for acutely ill medical patients.

Summary: For acutely ill medical patients, avoiding use of supplemental oxygen when peripheral capillary oxygen saturation (SpO2) is > 96% may be associated with lower risk of mortality than an approach of administering supplemental oxygen when SpO2 is > 96%; for patients with myocardial infarction or stroke, there are probably no benefits to initiating oxygen therapy when SpO2 is > 92% and supplemental oxygen when SpO2 is > 92% may be associated with harm.

https://www.ncbi.nlm.nih.gov/m/pubmed/30355567/

Strength of Recommendation = A

One-Year Outcomes after different PCI Strategies in Cardiogenic Shock. — November 13, 2018

One-Year Outcomes after different PCI Strategies in Cardiogenic Shock.

Summary: For patients with acute myocardial infarction and cardiogenic shock due to multi-vessel coronary artery disease, an approach of culprit-lesion-only percutaneous coronary intervention (PCI) may be associated with lower rates of death or severe renal failure at 30-day follow-up compared to an approach of  immediate multivessel PCI, and the two approaches do not appear to result in significantly different rates of death at 1 year followup.

https://www.ncbi.nlm.nih.gov/m/pubmed/30145971/

Strength of Recommendation = B

Six-Month Outcomes after Restrictive or Liberal Transfusion for Cardiac Surgery. — November 6, 2018

Six-Month Outcomes after Restrictive or Liberal Transfusion for Cardiac Surgery.

Summary: For patients having cardiac surgery and at moderate-to-high risk for death, a more restrictive threshold for transfusion may be associated with the same risks of death, myocardial infarction, stroke, or new-onset renal failure over the following six months as a more liberal threshold for transfusion.

https://www.ncbi.nlm.nih.gov/m/pubmed/30146969/

Strength of Recommendation = B

Rivaroxaban for Thromboprophylaxis after Hospitalization for Medical Illness. — October 23, 2018

Rivaroxaban for Thromboprophylaxis after Hospitalization for Medical Illness.

Summary: For patients hospitalized for a medical illness who remain at increased risk of venous thromboembolism (VTE) after discharge, an approach of NOT using rivaroxaban for post-hospital VTE prophylaxis may not associated with any higher risk of symptomatic VTE or death from VTE compared to an approach of using rivaroxaban for up to 45 days after discharge; while an approach of not using rivaroxaban may be less costly.

https://www.ncbi.nlm.nih.gov/m/pubmed/30145946/

Strength of Recommendation = B

Aspirin or Rivaroxaban for VTE Prophylaxis after Hip or Knee Arthroplasty. — October 2, 2018

Aspirin or Rivaroxaban for VTE Prophylaxis after Hip or Knee Arthroplasty.

Summary: For patients having total knee (TKA) or hip (THA) arthroplasty  and receiving rivaroxaban 10 mg daily for venous thromboembolism (VTE) prophylaxis until postoperative day 5, treating subsequently with aspirin 81 mg daily for 9 more days (TKA) or 30 more days (THA) may be associated with the same rates of VTE and major bleeding as treating prophylactically with rivaroxaban for an entire course of 14 days (TKA) or 35 days (THA); however the approach of following 5 days of rivaroxaban with a course of aspirin may be associated with much less expense.

https://www.ncbi.nlm.nih.gov/m/pubmed/29466159/

Strength of Recommendation = B

Blood pressure targets for the treatment of people with hypertension and cardiovascular disease — September 25, 2018

Blood pressure targets for the treatment of people with hypertension and cardiovascular disease

Summary: For adults with hypertension (including adults with hypertension and a history of myocardial infarction, stroke, angina or peripheral vascular disease), treatment to blood pressure targets of less than 140-160/90-100 is associated with the same risks of overall mortality, cardiovascular mortality and cardiovascular events over an average follow-up period of 3.7 years as treatment to more aggressive blood pressure targets of less than 135/85; while treatment to the higher targets of < 140-160/90-100 is associated with fewer treatment withdrawals and use of fewer medications compared to treatment to the lower target of < 135/85.

https://www.ncbi.nlm.nih.gov/m/pubmed/30027631/

Strength of Recommendation = A

Aspirin for the health elderly: Cardiovascular events, Disability, and Bleeding. — September 18, 2018

Aspirin for the health elderly: Cardiovascular events, Disability, and Bleeding.

Summary: For adults over age 70 who are healthy (no cardiovascular disease, dementia, or physical disability), an approach of not taking a daily aspirin is associated with lower rates of major hemorrhage over 4.7 years of follow up compared to an approach of taking 100 mg enteric coated aspirin daily, without any increase in the likelihood of death, dementia, physical disability, or cardiovascular disease.

https://www.ncbi.nlm.nih.gov/m/pubmed/30221595/

https://www.ncbi.nlm.nih.gov/m/pubmed/30221596/

https://www.ncbi.nlm.nih.gov/m/pubmed/30221597/

Strength of Recommendation = B

Initial Laryngeal Tube Insertion vs Endotracheal Intubation for Out-of-Hospital Cardiac Arrest — September 11, 2018

Initial Laryngeal Tube Insertion vs Endotracheal Intubation for Out-of-Hospital Cardiac Arrest

Summary: For adults experiencing out-of-hospital cardiac arrest, use of a laryngeal tube (LT) for initial airway management may be associated with a higher likelihood of success at initial airway placement, 72 hour survival, return of spontaneous circulation (ROSC),  hospital survival, and favorable neurological status at discharge compared to use of an endotracheal tube for initial airway management; without any higher risk of airway injury, pneumonia, or pneumonitis.

https://www.ncbi.nlm.nih.gov/m/pubmed/30167699/

Strength of Recommendation = B

Exercise electrocardiography with or without myocardial perfusion single photon emission computed tomography in women with suspected coronary artery disease — September 4, 2018

Exercise electrocardiography with or without myocardial perfusion single photon emission computed tomography in women with suspected coronary artery disease

Summary: For women with suspected coronary artery disease (CAD), use of exercise stress electrocardiography alone to rule out CAD is associated with the same likelihood of being free of a major adverse cardiovascular event (MACE) at 2 years as used of exercise stress testing + myocardial perfusion imaging, but at about 1/2 the cost.

https://www.ncbi.nlm.nih.gov/m/pubmed/21844080/

Strength of Recommendation = B

First-line drugs for hypertension. — July 24, 2018

First-line drugs for hypertension.

Summary: For patients with hypertension, low-dose thiazide diuretics are more effective than other medications for reducing mortality, stroke, coronary heart disease and total cardiovascular events over 3-5 years follow up; and thiazide diuretics are generally much less expensive than other medications used for hypertension.

https://www.ncbi.nlm.nih.gov/m/pubmed/29667175/

Strength of Recommendation = A

Wrist-worn optical and chest strap heart rate comparison in healthy individuals and people with coronary artery disease. — June 26, 2018
Restrictive or Liberal Red-Cell Transfusion for Cardiac Surgery — June 5, 2018

Restrictive or Liberal Red-Cell Transfusion for Cardiac Surgery

Summary: For patients undergoing cardiac surgery who were assessed to be at moderate-to-high risk for death, a restrictive red-cell transfusion threshold (hemoglobin level <7.5 g per deciliter, starting from induction of anesthesia) may be associated with no higher risk of death, myocardial infarction, stroke, or new-onset renal failure compared to a more liberal red-cell transfusion threshold (hemoglobin level <9.5 g per deciliter in the operating room or intensive care unit [ICU] or <8.5 g per deciliter in the non-ICU ward); but the more restrictive threshold may be associated with a much lower likelihood of receiving a transfusion.

https://www.ncbi.nlm.nih.gov/m/pubmed/29130845/

Strength of Recommendation = B

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Home versus in-patient treatment for deep vein thrombosis. — April 3, 2018

Home versus in-patient treatment for deep vein thrombosis.

Summary: For patients with deep vein thrombus (DVT), treatment at home with low-molecular weight heparin (LMWH) appears to be associated with a lower likelihood of recurrence of venous thromboembolism (VTE), and may be associated with greater improvements in quality of life, compared to hospital treatment of DVT with unfractionated heparin (UFH) or LMWH.

https://www.ncbi.nlm.nih.gov/m/pubmed/29315455/

Strength of Recommendation = B

Aspirin or Rivaroxaban for VTE Prophylaxis after Hip or Knee Arthroplasty. — March 13, 2018

Aspirin or Rivaroxaban for VTE Prophylaxis after Hip or Knee Arthroplasty.

Summary: For patients undergoing total knee arthroplasty (TKA) or total hip arthroplasty (THA) , postoperative venous thromboembolism (VTE) prophylaxis with rivaroxaban for 5 days followed by aspirin for an additional 9 days after TKA or an additional 30 days after THA may be associated with the same risk of VTE as full course of VTE prophylaxis with rivaroxaban for 14 days after TKA or 35 days after THA; however prophylaxis with aspirin is much less expensive.

https://www.ncbi.nlm.nih.gov/m/pubmed/29466159/

Strength of Recommendation = B

Comparison of the unstructured clinician gestalt, the wells score, and the revised Geneva score to estimate pretest probability for suspected pulmonary embolism. — March 6, 2018

Comparison of the unstructured clinician gestalt, the wells score, and the revised Geneva score to estimate pretest probability for suspected pulmonary embolism.

Summary: For patients with suspected pulmonary embolism (PE), “clinical gestalt” may be more accurate than at predicting which patients are at low risk of PE than either the Wells or Geneva scores, and may be more accurate at predicting which patients are at high risk of PE than the Wells score; and for both situations clinical gestalt may be arrived at more quickly than a calculated risk score.

https://www.ncbi.nlm.nih.gov/m/pubmed/23433653/

Strength of Recommendation = B

Pulmonary Embolism Rule-Out Criteria (PERC) and Subsequent Thromboembolic Events Among Low-Risk Emergency Department Patients — February 27, 2018

Pulmonary Embolism Rule-Out Criteria (PERC) and Subsequent Thromboembolic Events Among Low-Risk Emergency Department Patients

Summary: For patients who seem to be clinically at low risk of pulmonary embolism (PE), use of the pulmonary embolism rule-out criteria (PERC) to determine whether further testing is needed may be just as effective as conventional care at reducing the risk of subsequent PE, but use of PERC may be associated with a lower likelihood of receiving CT pulmonary angiography.

https://www.ncbi.nlm.nih.gov/m/pubmed/29450523/

Strength of Recommendation = B

Bed rest or early ambulation in the management of pulmonary embolism and deep vein thrombosis. — February 20, 2018

Bed rest or early ambulation in the management of pulmonary embolism and deep vein thrombosis.

Summary: For patients with acute pulmonary embolism (PE) or deep vein thrombosis (DVT) an approach of anticoagulation + early ambulation is associated with the same risk of new PE as an approach of anticoagulation + bed rest, and early ambulation might be associated with a lower risk of of new PE.

https://www.ncbi.nlm.nih.gov/m/pubmed/18691773/

Strength of Recommendation = A

Genotype-guided or clinical dosing of warfarin — January 16, 2018

Genotype-guided or clinical dosing of warfarin

Summary: For patients being treated with warfarin anticoagulation, dosing of warfarin based on clinical protocols is associated with the same percentage of time with the INR in the desired therapeutic range, the same risk of an INR greater than 4, and the same likelihood of major bleeding or thromboembolism as “genotype guided” dosing of warfarin; while protocol-based dosing might be associated with lower initial costs.

https://www.ncbi.nlm.nih.gov/m/pubmed/24935087/

Strength of Recommendation = A

Catheter-Directed Thrombolysis for DVT. — January 2, 2018

Catheter-Directed Thrombolysis for DVT.

Summary: For patients with acute proximal deep-vein thrombosis (DVT), an approach of anticoagulation alone is associated with a lower short-term risk of major bleeding compared to an approach of using using pharmacomechanical catheter-directed thrombolysis (PCDT) + anticoagulation; but there appears to be no difference between the two approaches in overall occurrence of post-thrombotic syndrome at 24 months, recurrent DVT at 24 months, or improvement in quality of life at the end of 24 months.

https://www.ncbi.nlm.nih.gov/m/pubmed/29211671/

Strength of Recommendation = B

HEART vs GRACE vs TIMI score to predict MACE in chest pain patients at the ED. — December 12, 2017

HEART vs GRACE vs TIMI score to predict MACE in chest pain patients at the ED.

Summary: For patients presenting to emergency care with chest pain, use of the 5 item HEART score allows better discrimination between those at high and low risk of major adverse cardiac events (MACE) over the next 6 weeks compared to use of either the 7 item TIMI score or the 8-item GRACE score.

https://www.ncbi.nlm.nih.gov/m/pubmed/27810290/

Strength of Recommendation = B

Endovascular vs open repair for ruptured abdominal aortic aneurysm. — December 5, 2017

Endovascular vs open repair for ruptured abdominal aortic aneurysm.

Summary: For patients with a clinical diagnosis of ruptured abdominal aortic aneurysm (AAA), a strategy of endovascular repair may be associated with fewer days in hospital, lower average costs, and improved 3-year survival compared to a strategy of open surgical repair.

https://www.ncbi.nlm.nih.gov/m/pubmed/29138135/

Strength of Recommendation = B

Auscultation While Standing May Help Exclude a Pathologic Heart Murmur in Children. — November 21, 2017

Auscultation While Standing May Help Exclude a Pathologic Heart Murmur in Children.

Summary: For children (between ages 2 and 18 years old) with a heart murmur detected on seated physical exam, complete disappearance of the murmur on standing may be more highly predictive that the murmur is benign and that additional testing is not needed than other traditionally-taught clinical features used to distinguish physiologic from pathologic murmurs.

https://www.ncbi.nlm.nih.gov/m/pubmed/29133490/

Strength of Recommendation = C

Oxygen Therapy in Suspected Acute Myocardial Infarction — September 12, 2017

Oxygen Therapy in Suspected Acute Myocardial Infarction

Summary: For patients with suspected acute myocardial infarction (AMI) and an oxygen saturation 90% or higher at baseline, an approach of providing ambient air only (ie, no supplemental oxygen) may be associated with no difference in the risk of death from any cause within 1 year or rehospitalization with AMI within 1 year compared to an approach of providing supplemental oxygen (6 liters per minute for 6 to 12 hours).

https://www.ncbi.nlm.nih.gov/m/pubmed/28844200/

Strength of Recommendation = B

Effect of Natriuretic Peptide-Guided Therapy on Hospitalization or Cardiovascular Mortality in Patients With Heart Failure. — August 29, 2017

Effect of Natriuretic Peptide-Guided Therapy on Hospitalization or Cardiovascular Mortality in Patients With Heart Failure.

Summary: For patients with chronic heart failure and an ejection fraction ≤40%, outpatient management in accordance with published guidelines may be associated with the same time-to-first HF hospitalization and the same likelihood of cardiovascular mortality as outpatient management guided by titrating therapy with a goal of achieving a target NT-proBNP of less than 1000 pg/mL.

https://www.ncbi.nlm.nih.gov/m/pubmed/28829876/

Strength of Recommendation = B

Gluten consumption in adults without celiac disease and risk of coronary heart disease. — May 30, 2017

Gluten consumption in adults without celiac disease and risk of coronary heart disease.

Comparative effectiveness of exercise and drug interventions on mortality outcomes — May 16, 2017

Comparative effectiveness of exercise and drug interventions on mortality outcomes

Summary: For patients who have had a stroke, exercise-based rehabilitation (including cardiorespiratory and muscle strengthening exercises) is more effective than medication (either anti-platelet agents or anticoagulants) for reducing mortality; while for patients with established coronary artery disease both medications and exercise-based rehabilitation provide the same (small) reduction in mortality; and for patients with pre-diabetes neither exercise-based rehabilitation nor medications are effective at reducing mortality.

https://www.ncbi.nlm.nih.gov/m/pubmed/26476429/

Strength of Recommendation = A

Blood-Pressure Lowering in Patients with Acute Cerebral Hemorrhage — March 7, 2017

Blood-Pressure Lowering in Patients with Acute Cerebral Hemorrhage

Summary: For patients with acute intracerebral hemorrhage, less-intense lowering of blood pressure to a target systolic blood pressure (SBP) range of 140 to 179 mm Hg may lead to a lower likelihood of adverse renal events (and possibly a lower overall likelihood of serious adverse events) than more-intense lowering blood pressure to a target SBP range of 110 to 139 mm Hg, and the less-intense SBP target appears to be associated with the same rate of death or disability as the more-intense SBP target.

https://www.ncbi.nlm.nih.gov/m/pubmed/27276234/

Strength of Recommendation = B

Shared decision making in patients with low risk chest pain. — December 13, 2016

Shared decision making in patients with low risk chest pain.

Summary: For patients with “low-risk” chest pain (ie, patients with chest pain being considered for observation and further cardiac testing, but without ischemic ECG changes, abnormal troponin levels, known coronary artery disease, recent cocaine use, or other exclusion factors),  use by the the treating physician of a decision aid to guide discussion of further testing and management options may lead to improved patient knowledge and patient engagement in decision making, with lower a likelihood of hospital admission and a lower likelihood of subsequent cardiac stress testing, compared to “usual care.”

https://www.ncbi.nlm.nih.gov/m/pubmed/27919865/

Strength of Recommendation = B

Effect of Hydrocortisone on Development of Shock Among Patients With Severe Sepsis. — November 15, 2016

Effect of Hydrocortisone on Development of Shock Among Patients With Severe Sepsis.

Summary: For adult patients with severe sepsis (but not in septic shock), an approach of not administering glucocorticoids may be associated with the same risks of developing septic shock and of in-hospital or 28-day mortality as an approach of routinely administering a continuous infusion of hydrocortisone for 5 days, but avoiding routine use of glucocorticoids may be associated with a lower risk of hyperglycemia.

https://www.ncbi.nlm.nih.gov/m/pubmed/27695824/

Strength of Recommendation = B

Coffee consumption and mortality after acute myocardial infarction: the Stockholm Heart Epidemiology Program. — November 8, 2016

Coffee consumption and mortality after acute myocardial infarction: the Stockholm Heart Epidemiology Program.

Summary: Among patients admitted to hospital with a confirmed first acute myocardial infarction (MI), a prior history of regularly consuming 3 or more cups of coffee daily may be associated with a lower risk of subsequent postinfarction mortality than a prior history of regularly consuming less than 3 cups of coffee daily (or avoiding coffee altogether).

https://www.ncbi.nlm.nih.gov/m/pubmed/19249420/

Strength of Recommendation = B

Defibrillator Implantation in Patients with Nonischemic Systolic Heart Failure. — November 4, 2016
Levosimendan and Acute Organ Dysfunction in Sepsis. — October 26, 2016

Levosimendan and Acute Organ Dysfunction in Sepsis.

Summary: For adults in hospital with sepsis, an approach of avoiding use of levosimendan appears to be associated with a higher likelihood of successful weaning from mechanical ventilation and a lower likelihood of supraventricular tachydysrhythmia than an approach of administering levosimendan for treatment of sepsis.

https://www.ncbi.nlm.nih.gov/m/pubmed/27705084/

Strength of Recommendation = B

Nutritional strategies for skeletal and cardiovascular health. — October 25, 2016
Coffee and risk of death after acute myocardial infarction. — October 21, 2016
Effect of Statin Therapy on Mortality in Older Adults Hospitalized with Coronary Artery Disease. — September 23, 2016

Effect of Statin Therapy on Mortality in Older Adults Hospitalized with Coronary Artery Disease.

Summary: For patients over 80 years old admitted to hospital for acute myocardial infarction, unstable angina pectoris, or chronic CAD, retrospective data suggests an approach of not taking a statin after hospital discharge appears to be associated with the same risk of all-cause mortality over the next 3 years as an approach of starting statin therapy at the time of hospital discharge.

http://www.ncbi.nlm.nih.gov/m/pubmed/27295083/

Strength of Recommendation = C

 

Outcomes of Patients Presenting With Hypertensive Urgency in the Office Setting. — September 20, 2016

Outcomes of Patients Presenting With Hypertensive Urgency in the Office Setting.

Summary: For non-pregnant patients with an asymptomatic “hypertensive urgency” (systolic blood pressure  ≥180 mm Hg or diastolic blood pressure ≥110 mm Hg) outpatient management appears to be associated a lower rate of hospitalization over the following 30 days than inpatient management, with no increased risk of major adverse cardiovascular events (ie, acute coronary syndrome, stroke or transient ischemic attack).

http://www.ncbi.nlm.nih.gov/m/pubmed/27294333/

Strength of Recommendation = B

Clinically-indicated replacement versus routine replacement of peripheral venous catheters. — August 19, 2016

Clinically-indicated replacement versus routine replacement of peripheral venous catheters.

Summary: For hospitalized patients with peripheral intravenous (IV) catheters, a practice of waiting until clinically indicated to replace the IV catheter appears to be associated with the same risk of catheter-related bloodstream infection, local thrombophlebitis, or all-cause bloodstream infection, compared to a practice of routine IV catheter replacement every 72 to 96 hours.

http://www.ncbi.nlm.nih.gov/m/pubmed/26272489/

Strength of Recommendation = A

Trendelenburg position or passive leg raising for the initial treatment of hypovolemia — August 9, 2016

Trendelenburg position or passive leg raising for the initial treatment of hypovolemia

Summary: For patients with hypotension, passive leg-raising (supine position with straight passive elevation of both legs at an angle between 10 and 90 degrees) may lead to a more sustained increase in cardiac output than the Trendelenburg position (a total-body head-down tilt between 5 and 60 degrees).

http://www.ncbi.nlm.nih.gov/m/pubmed/23228872/

Strength of Recommendation = C

Blood-Pressure Lowering in Intermediate-Risk Persons without Cardiovascular Disease. — August 2, 2016

Blood-Pressure Lowering in Intermediate-Risk Persons without Cardiovascular Disease.

Summary: In primary prevention patients at intermediate risk of cardiovascular disease (ie, at risk but without known disease), avoiding the addition of candesartan + hydrochlorothiazide appears to be associated with the same risk of cardiovascular death, non-fatal MI, or nonfatal stroke, but lower rates of hypotension, dizziness, or lightheadedness. (In otherwords, for a patients at intermediate risk of cardiovascular disease, treatment with candesartan + hydrochlorothiazide is not associated with any cardiovascular benefit over 5 years but may lead to more hypotension, dizziness, or lightheadedness)

NOTE: The average blood pressure of patients at enrollment in this study was ~ 138/82.

http://www.ncbi.nlm.nih.gov/m/pubmed/27041480/

Strength of Recommendation = B

Trial comparing three month and six month follow up of patients with hypertension by family practitioners — July 29, 2016
Systematic versus opportunistic risk assessment for the primary prevention of cardiovascular disease — July 22, 2016

Systematic versus opportunistic risk assessment for the primary prevention of cardiovascular disease

Summary: Based on evidence of limited quality, it appears that opportunistic risk assessment or case finding of cardiovascular disease (CVD) or associated risk factors may be associated with the same reduction in all-cause and cardiovascular mortality as systematic screening for CVD or associated risk factors.

http://www.ncbi.nlm.nih.gov/m/pubmed/26824223/

Strength of Recommendation = B

Self-monitoring and self-management of oral anticoagulation. — July 19, 2016

Self-monitoring and self-management of oral anticoagulation.

Summary: For patients on oral anticoagulant therapy, self-monitoring and self-management of anticoagulation may lead to a lower likelihood of thromboembolic events compared to standard monitoring and management, and self-management may be associated with a lower risk of all-cause mortality.

http://www.ncbi.nlm.nih.gov/m/pubmed/27378324/

Strength of Recommendation = A

Ticagrelor vs Aspirin in Acute Stroke or Transient Ischemic Attack. — July 15, 2016

Ticagrelor vs Aspirin in Acute Stroke or Transient Ischemic Attack.

Summary: For patients with acute stroke or transient ischemic attack (TIA), use of aspirin as antiplatelet therapy for secondary prevention appears to be associated with the same rate of stroke, myocardial infarction, or death over the next 90 days as is the use of ticagrelor, but at potentially much lower cost.

http://www.ncbi.nlm.nih.gov/m/pubmed/27160892/

Strength of Recommendation = B

Potassium Supplementation, Diet vs Pills: A Randomized Trial in Postoperative Cardiac Surgery Patients. — July 8, 2016

Potassium Supplementation, Diet vs Pills: A Randomized Trial in Postoperative Cardiac Surgery Patients.

Summary: For patients undergoing cardiac surgery who are treated with diuretics, potassium supplementation with potassium-rich foods (eg, raisins, bananas, potatoes) may lead better patient satisfaction and may lead to a shorter hospital stay than potassium supplementation with potassium chloride pills, and without any worsening in serum potassium levels. (While not specifically tested in this study, it also seems a reasonable extrapolation to assume this would apply to other surgical or medical patients treated with diuretics as well).

http://www.ncbi.nlm.nih.gov/m/pubmed/14769716/

Strength of Recommendation = B

Cardiovascular safety of methylphenidate among children and young people with ADHD — June 17, 2016

Cardiovascular safety of methylphenidate among children and young people with ADHD

Summary: While stimulant medications can be effective for reducing impulsiveness and hyperactivity in children, for patients with attention-deficit & hyperactivity disorder (especially those with congenital heart disease), avoidance of methylphenidate may be associated with a lower risk of arrhythmia compared to starting treatment with methylphenidate.

http://www.ncbi.nlm.nih.gov/m/pubmed/27245699/

Strength of Recommendation = B

Outcomes of catheter-directed thrombolysis plus anticoagulation vs anticoagulation alone to treat lower-extremity proximal deep vein thrombosis. — June 14, 2016

Outcomes of catheter-directed thrombolysis plus anticoagulation vs anticoagulation alone to treat lower-extremity proximal deep vein thrombosis.

Summary: For hospitalized patients with deep-vein thrombosis (DVT) of the proximal lower leg or the inferior vena cava, treatment with anticoagulation alone may be associated with lower rates of blood transfusion, pulmonary embolism, and intracranial hemorrhage compared to treatment with anticoagulation + catheter-directed thrombolysis (CDT); and the two procedures appear to be associated with the same risk of in-hospital mortality. (This study also found lower hospital costs and shorter lengths of stay associated with standard anticoagulation alone, compared to anticoagulation + CDT)

http://www.ncbi.nlm.nih.gov/m/pubmed/25047081/

Strength of Recommendation = B

Perioperative Rosuvastatin in Cardiac Surgery. — May 27, 2016

Perioperative Rosuvastatin in Cardiac Surgery.

Summary: For patients  undergoing elective cardiac surgery, avoiding adding peri-operative rosuvastatin may be associated with a lower likelihood of postoperative acute kidney injury, without affecting the risk of postoperative atrial fibrillation or perioperative myocardial damage, compared to adding rosuvastatin perioperatively.

http://www.ncbi.nlm.nih.gov/m/pubmed/27144849/

Strength of Recommendation = B

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