Less Is More

Simpler & Better Medicine

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

Effect of antihypertensive treatment at different blood pressure levels in patients with diabetes mellitus — May 24, 2016

Effect of antihypertensive treatment at different blood pressure levels in patients with diabetes mellitus

Summary: For patients with type 2 diabetes (T2DM) and a systolic blood pressure less than 140 mmHg, avoiding additional antihypertensive treatment is associated with a lower risk of cardiovascular mortality compared to adding additional antihypertensive treatment to patients with T2DM and a SBP < 140 mmHg.

(Note: For patients with T2DM and a SBP > 140, this meta-analysis demonstrates benefits for all-cause mortality with treatment to further lower BP).

http://www.ncbi.nlm.nih.gov/m/pubmed/26920333/

Strength of Recommendation = A

Compression Stockings for Preventing the Postthrombotic Syndrome in Patients with Deep Vein Thrombosis — May 17, 2016

Compression Stockings for Preventing the Postthrombotic Syndrome in Patients with Deep Vein Thrombosis

Summary: For patients with lower-extremity deep-vein thrombosis (DVT), moderate-quality evidence suggests that those who do not use elastic compression stockings appear to have the same risks of postthrombotic syndrome,  DVT recurrence, acute post-DVT pain, and mortality as those who do use compression stockings. (In other words, use of compression stockings after a DVT does not seem to reduce the likelihood of post-thrombotic syndrome, DVT recurrence, pain, or mortality).

http://www.ncbi.nlm.nih.gov/m/pubmed/26747198/

Strength of Recommendation = B

Use of dietary linoleic acid for secondary prevention of coronary heart disease and death: re-evaluation of the Sydney Diet Heart Study — May 6, 2016

Use of dietary linoleic acid for secondary prevention of coronary heart disease and death: re-evaluation of the Sydney Diet Heart Study

Summary: Older data suggests that for men with a recent coronary event, avoiding replacement of saturated fats with omega 6 linoleic acid might actually be associated with lower rates of death, cardiovascular disease, and coronary heart disease. (In other words, for men with a recent coronary event, a diet replacing saturated fats with omega 6 linoleic acid from safflower oil and safflower oil polyunsaturated margarine may be associated with HIGHER rates of death, cardiovascular disease, and coronary heart disease).

http://www.ncbi.nlm.nih.gov/m/pubmed/23386268/

Strength of Recommendation = C

Re-evaluation of the traditional diet-heart hypothesis and data from Minnesota Coronary Experiment — May 3, 2016

Re-evaluation of the traditional diet-heart hypothesis and data from Minnesota Coronary Experiment

Summary: Older data suggests that while a diet that replaces saturated fat with linoleic acid from corn oil and corn oil polyunsaturated margarine appears to reduce serum levels of LDL cholesterol, it may also be associated with a higher risk of death, especially in those over 65.

http://www.ncbi.nlm.nih.gov/m/pubmed/27071971/

Strength of Recommendation = C

Transcatheter or Surgical Aortic-Valve Replacement in Intermediate-Risk Patients — April 29, 2016

Transcatheter or Surgical Aortic-Valve Replacement in Intermediate-Risk Patients

Summary: For patients with severe aortic stenosis and cardiac symptoms who are at estimated to be at intermediate risk for surgical complications, transcatheter aortic-valve replacement (TAVR) may provide the same reduction in the 2-year risk of death or disabling stroke as surgical aortic valve replacement, with shorter duration of ICU stay and hospital admission. (However, the relative rates of other outcomes and adverse effects between TAVR and surgical AVR also require careful consideration).

http://www.ncbi.nlm.nih.gov/m/pubmed/27040324/

Strength of Recommendation = B

Amiodarone, Lidocaine, or Placebo in Out-of-Hospital Cardiac Arrest. — April 26, 2016

Amiodarone, Lidocaine, or Placebo in Out-of-Hospital Cardiac Arrest.

Summary: For adults with unwitnessed out-of-hospital cardiac arrest due to shock-refractory ventricular fibrillation or pulseless ventricular tachycardia, there appears to be no difference in rates of survival to hospital discharge between patients treated with placebo, and patients treated with amiodarone or lidocaine; however patients treated with amiodarone may be more likely to require temporary cardiac pacing.

http://www.ncbi.nlm.nih.gov/m/pubmed/27043165/

Strength of Recommendation = B

Aliskiren, Enalapril, or Aliskiren and Enalapril in Heart Failure — April 22, 2016

Aliskiren, Enalapril, or Aliskiren and Enalapril in Heart Failure

Summary: For patients with chronic heart failure, treatment with enalapril (plus other standard heart-failure medications) appears to be associated with the same risk of cardiovascular death or heart-failure related hospital admission as treatment with aliskiren or treatment with aliskiren + enalapril, however treatment with aliskiren appears to be associated with higher rates of adverse events (specifically, renal dysfunction and hyperkalemia).

http://www.ncbi.nlm.nih.gov/m/pubmed/27043774/

Strength of Recommendation = B

Early administration of epinephrine (adrenaline) in patients with cardiac arrest with initial shockable rhythm in hospital: propensity score matched analysis. — April 15, 2016

Early administration of epinephrine (adrenaline) in patients with cardiac arrest with initial shockable rhythm in hospital: propensity score matched analysis.

Summary: For adults who have in-hospital cardiac arrest with an initial shockable rhythm, adhering to current American Heart Association (AHA) guidelines to give epinephrine at least two minutes after the first defibrillation attempt is associated with higher odds of survival, return of spontaneous circulation (ROSC), and a good functional outcome. (In other words, epinephrine administered within two minutes after the first defibrillation (which is contrary to AHA guidelines) is associated with lower odds of survival, lower likelihood of return of spontaneous circulation (ROSC) and lower likelihood of a good functional outcome.)

http://www.ncbi.nlm.nih.gov/m/pubmed/27053638/

Strength of Recommendation = B

Outcomes after thrombus aspiration for ST elevation myocardial infarction: 1-year follow-up of the prospective randomised TOTAL trial — March 29, 2016

Outcomes after thrombus aspiration for ST elevation myocardial infarction: 1-year follow-up of the prospective randomised TOTAL trial

Summary: For patients with ST elevation myocardial infarction (STEMI) who are treated with percutaneous coronary intervention (PCI), PCI alone is associated with the same rate of cardiovascular death at one year as PCI + thrombectomy, but PCI alone is associated with a lower rate of stroke at one  year than PCI + thrombectomy.

http://www.ncbi.nlm.nih.gov/m/pubmed/26474811/

Strength of Recommendation = B

Pragmatic Method Using Blood Pressure Diaries to Assess Blood Pressure Control. — February 5, 2016

Pragmatic Method Using Blood Pressure Diaries to Assess Blood Pressure Control.

Summary: For patients with hypertension who monitor blood pressure at home, having 3 or more of the most recent 10 systolic blood pressure readings above 135 mmHg may predict elevated twenty-four-hour ambulatory blood pressure (ABP) and may also predict target organ damage.

http://www.ncbi.nlm.nih.gov/m/pubmed/26755785/

Strength of Recommendation = C

Air Versus Oxygen in ST-Segment-Elevation Myocardial Infarction. — January 29, 2016

Air Versus Oxygen in ST-Segment-Elevation Myocardial Infarction.

Summary: For patients with acute ST-elevation-myocardial infarction (STEMI) who are not hypoxic, avoiding administration of supplemental oxygen may be associated with having a smaller infarct size (as measured by mean peak creatine kinase level and by cardiac MRI 6 months later), a lower rate of recurrent myocardial infarction, and a lower frequency of cardiac dysrhythmia. (In other words, administration of supplemental oxygen to non-hypoxic STEMI patients may lead to a larger infarct size and a higher risk of  dysrhythmia and recurrent infarction)

http://www.ncbi.nlm.nih.gov/m/pubmed/26002889/

Strength of Recommendation = B

Cardiac auscultation training of medical students: a comparison of electronic sensor-based and acoustic stethoscopes. — January 26, 2016

Cardiac auscultation training of medical students: a comparison of electronic sensor-based and acoustic stethoscopes.

Summary: For medical students who are learning cardiac auscultation skills, training with a (less expensive) conventional stethoscope may result in the same performance on a test of cardiac auscultation as does training on a (more expensive) electronic stethoscope, at lower cost.

http://www.ncbi.nlm.nih.gov/m/pubmed/15882458/

Strength of Recommendation = C

Stethoscope versus point-of-care ultrasound in the differential diagnosis of dyspnea: a randomized trial. — January 12, 2016

Stethoscope versus point-of-care ultrasound in the differential diagnosis of dyspnea: a randomized trial.

Summary: For patients with dyspnea, evidence from a small clinical trial suggests that examination with a stethoscope may be just as effective as point-of-care ultrasound for excluding the diagnosis of heart failure, and for making an affirmative diagnosis of pneumonia, at markedy lower cost.

http://www.ncbi.nlm.nih.gov/m/pubmed/25715019/

Strength of Recommendation = B

Outcomes of Basic Versus Advanced Life Support for Out-of-Hospital Medical Emergencies. — December 14, 2015

Outcomes of Basic Versus Advanced Life Support for Out-of-Hospital Medical Emergencies.

Summary: For older patients requiring emergency medical transport, 90-day survival may be higher after treatment with basic life support (BLS) rather than advanced cardiac life support (ACLS) in cases of trauma, stroke, or respiratory failure (although ACLS may be associated with higher likelihood of 90-day survival for acute MI (AMI)); and neurologic function at 90 days may be better with BLS for trauma, stroke, respiratory failure, and AMI.

http://www.ncbi.nlm.nih.gov/m/pubmed/26457627/

Strength of Recommendation = B

Effect of PCI on Long-Term Survival in Patients with Stable Ischemic Heart Disease. — November 18, 2015
Fasting time and lipid levels in a community-based population: a cross-sectional study. — October 23, 2015
Use and associated risks of concomitant aspirin therapy with oral anticoagulation in patients with atrial fibrillation: insights from the Outcomes Registry for Better Informed Treatment of Atrial Fibrillation (ORBIT-AF) Registry. — October 21, 2015

Use and associated risks of concomitant aspirin therapy with oral anticoagulation in patients with atrial fibrillation: insights from the Outcomes Registry for Better Informed Treatment of Atrial Fibrillation (ORBIT-AF) Registry.

Summary: For patient with atrial fibrillation on oral anticoagulation (OAC), avoiding the use of aspirin (ASA) may be associated with a lower risk of bleeding (compared to treatment with OAC + ASA), without any increased risk of death (however, the statistical power of this observational study was too low to clearly address whether this is also true for patients with previous atherosclerotic disease).

http://www.ncbi.nlm.nih.gov/m/pubmed/23861512/

Strength of Recommendation = B

Beta-Blocker-Associated Risks in Patients With Uncomplicated Hypertension Undergoing Noncardiac Surgery. — October 7, 2015

Beta-Blocker-Associated Risks in Patients With Uncomplicated Hypertension Undergoing Noncardiac Surgery.

Summary: For patients with uncomplicated hypertension undergoing noncardiac surgery, avoiding beta-blocker use appears to be associated with a lower risk of major adverse cardiovascular events (MACEs) and all-cause mortality, especially for patients over 70, for men, and for patients needing acute surgery.

http://www.ncbi.nlm.nih.gov/m/pubmed/26436291/

Strength of recommendation = B

CT coronary angiography in patients with suspected angina due to coronary heart disease (SCOT-HEART): an open-label, parallel-group, multicentre trial. — September 30, 2015

CT coronary angiography in patients with suspected angina due to coronary heart disease (SCOT-HEART): an open-label, parallel-group, multicentre trial.

Summary: For patients with chest pain suspected to be due to stable angina, avoiding the use of CT coronary angiography (CTCA) as part of the initial evaluation may lead to fewer coronary angiogram procedures with out any increase in symptom severity or hospital admissions for chest pain at 6 weeks.

http://www.ncbi.nlm.nih.gov/m/pubmed/25788230/

Strength of Recommendation = C

Bleeding, Recurrent Venous Thromboembolism, and Mortality Risks During Warfarin Interruption for Invasive Procedures. — September 14, 2015

Bleeding, Recurrent Venous Thromboembolism, and Mortality Risks During Warfarin Interruption for Invasive Procedures.

Summary: For patients taking warfarin for secondary prevention of venous thromboembolism (VTE) (ie, those taking warfarin following an initial VTE), when warfarin is interrupted for an invasive diagnostic or surgical procedure, NOT using “bridging” anticoagulation may be associated with a lower risk of clinically relevant bleeding without any increased risk of VTE recurrence. (In other words, for patients on warfarin after a VTE, there is a lower risk of bleeding and no increased risk of recurrent VTE if “bridging” anticoagulation with heparins is not used.)

http://www.ncbi.nlm.nih.gov/m/pubmed/26010033/

Strength of Recommendation = B

Beta-Blockade and Operative Mortality in Noncardiac Surgery: Harmful or Helpful? — September 9, 2015

Beta-Blockade and Operative Mortality in Noncardiac Surgery: Harmful or Helpful?

Summary: For non-cardiac surgery, patients without any cardiac risk factors (specifically, no renal failure, coronary artery disease, or diabetes mellitus, and surgery will not be in a major body cavity), avoiding the use of perioperative beta-blockade may be associated with a lower risk of death.

http://www.ncbi.nlm.nih.gov/m/pubmed/26017188/

Strength of Recommendation = B

Fasting and nonfasting lipid levels: influence of normal food intake on lipids, lipoproteins, apolipoproteins, and cardiovascular risk prediction. — August 26, 2015

Fasting and nonfasting lipid levels: influence of normal food intake on lipids, lipoproteins, apolipoproteins, and cardiovascular risk prediction.

Summary: Non-fasting lipid levels appear to perform just as well as fasting lipid levels in predicting the risk of cardiovascular events, and provide a simpler means for cardiovascular risk prediction for patients (since an over-night fast is not required).

http://www.ncbi.nlm.nih.gov/m/pubmed/18955664/

Strength of Recommendation = B

 

Major lipids, apolipoproteins, and risk of vascular disease. — August 21, 2015
A new improved accelerated diagnostic protocol safely identifies low-risk patients with chest pain in the emergency department. — July 15, 2015

A new improved accelerated diagnostic protocol safely identifies low-risk patients with chest pain in the emergency department.

Summary: For patients seeking emergency care for chest pain, using an accelerated diagnostic protocol may safely identify those at sufficiently low risk of acute coronary syndrome to allow discharge without further evaluation (ie, without the traditional “serial troponins” measured over a 12-24 hour hospital observation stay). For a patient to be considered low risk on this protocol, he or she must have 1) a TIMI risk score of 0, AND 2) no new ECG changes, AND 3) normal troponin values at 0 and 2 hours after presentation.

http://www.ncbi.nlm.nih.gov/m/pubmed/22594354/

Strength of Recommendation = B

Comparing hospice and nonhospice patient survival among patients who die within a three-year window. — July 6, 2015
Clinical and cost-effectiveness of compression hosiery versus compression bandages in treatment of venous leg ulcers (Venous leg Ulcer Study IV, VenUS IV): a randomised controlled trial. —

Clinical and cost-effectiveness of compression hosiery versus compression bandages in treatment of venous leg ulcers (Venous leg Ulcer Study IV, VenUS IV): a randomised controlled trial.

Summary: For venous leg ulcers, treatment with two-layer compression hosiery may lead to healing in the same amount of time as treatment with a four-layer bandage (approximately 98 to 99 days), at lower cost.

http://www.ncbi.nlm.nih.gov/m/pubmed/24315520

Strength of Recommendation = B

Perioperative Bridging Anticoagulation in Patients with Atrial Fibrillation. — June 25, 2015

Perioperative Bridging Anticoagulation in Patients with Atrial Fibrillation.

Summary: For patients with atrial fibrillation who need interruption of warfarin therapy for an elective surgery, use of “bridging” anticoagulation with dalteparin (100 IU/kg for 3 days before and then 5 to 10 days after the procedure) may be associated with no improvement in arterial thromboembolism prevention but an increased risk of major bleeding when compared to a no-bridging approach. (In other words, avoiding use of dalteparin “bridging” anticoagulation when warfarin is interrupted for a procedure appears to be associated with LESS risk of bleeding, and is NOT inferior at preventing thromboembolism).

http://www.ncbi.nlm.nih.gov/m/pubmed/26095867/

Strength of Recommendation = B

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