Less Is More

Simpler & Better Medicine

Ticagrelor or aspirin after coronary artery bypass grafting. — January 7, 2020

Ticagrelor or aspirin after coronary artery bypass grafting.

Summary: For patients who have had coronary artery bypass grafting (CABG), treatment with aspirin 100 mg daily may be associated with a lower risk of bleeding and with lower costs compared to ticagrelor (90 mg twice daily); rates of all-cause and cardiovascular mortality do not appear to differ between the treatment approaches.

https://www.ncbi.nlm.nih.gov/m/pubmed/31145798/

Strength of Recommendation = B

Echocardiography for adults after an acute myocardial infarction. — December 24, 2019

Echocardiography for adults after an acute myocardial infarction.

Summary: For hospitals admitting patients with acute myocardial infarction (AMI), lower  rates of trans-thoracic echocardiography (TTE) during hospitalizations for AMI may be associated with slightly shorter length-of-stay compared to hospitals with higher rates of TTE, without any increased rates of mortality or readmission.

https://www.ncbi.nlm.nih.gov/m/pubmed/31206134/

Strength of Recommendation = B

Stenting + medical therapy vs medical therapy alone for stable coronary artery disease. — December 17, 2019

Stenting + medical therapy vs medical therapy alone for stable coronary artery disease.

Summary: For patients with stable coronary artery disease (CAD), using optimal medical therapy without stenting compared to optimal medical therapy WITH stenting may both be associated with the same rates of death (~ 9%), non-fatal myocardial infarction (~8-9%) and persistent angina (~29-33%) over about 4 years of follow up; while an approach of treating stable coronary artery disease with optimal medical therapy alone may be associated with fewer total interventional procedures.

https://www.ncbi.nlm.nih.gov/m/pubmed/22371919/

Strength of Recommendation = A

Early or delayed cardioversion in recent-onset atrial fibrillation. — December 10, 2019

Early or delayed cardioversion in recent-onset atrial fibrillation.

Summary: For adult patients with symptomatic, recent-onset, and hemodynamically stable atrial fibrillation, a “wait-and-see” approach (provision of rate control medications and follow up in approximately 48 hours with cardioversion if still in atrial fibrillation) may be associated with the same likelihood of sinus rhythm at 4 weeks, the same likelihood of hospital admission or return visits to the emergency room, but a lower likelihood of needing electrical or pharmacologic cardioversion compared to an approach of early cardioversion (either electrical or pharmacologic).

https://www.ncbi.nlm.nih.gov/m/pubmed/30883054/

Strength of Recommendation = B

Long-term survival with chest-compression only CPR vs standard CPR. — November 12, 2019

Long-term survival with chest-compression only CPR vs standard CPR.

Summary: For individuals receiving bystander cardiopulmonary resuscitation (CPR) in the community, use of chest compressions alone compared to chest compressions + rescue breathing may be associated with a higher likelihood of survival at 1, 2, and 5 years after arrest (NNT approximately 2 at each outcome interval).

https://www.ncbi.nlm.nih.gov/m/pubmed/23230313/

Strength of Recommendation = B

Linagliptin, Glimepiride and Cardiovascular Outcomes in Patients With Type 2 Diabetes. — November 5, 2019

Linagliptin, Glimepiride and Cardiovascular Outcomes in Patients With Type 2 Diabetes.

Summary: For people with type 2 diabetes and an elevated risk of cardiovascular disease, treatment with glimepiride or treatment with linagliptin may both be associated with the same rate of cardiovascular death, nonfatal myocardial infarction, or nonfatal stroke (about 12%) over approximately 6 years of follow up; however glimepiride is much less expensive than linagliptin.

https://www.ncbi.nlm.nih.gov/m/pubmed/31536101/

Strength of Recommendation = B

Outcomes After Intensifying Antihypertensive Medication Regimens Among Older Adults at Hospital Discharge. — October 15, 2019

Outcomes After Intensifying Antihypertensive Medication Regimens Among Older Adults at Hospital Discharge.

Summary: For patients over age 65 hospitalized for non-cardiac conditions, discharge without adding to the pre-hospital list of antihypertensive medications may be associated with a lower risk of 30-day readmission and a lower risk of serious adverse events compared to discharge with increased dosing of or medications for blood pressure control, without any increase in systolic blood pressure or cardiovascular events over the subsequent year.

https://www.ncbi.nlm.nih.gov/m/pubmed/31424475/

Strength of Recommendation = B

Nonfasting vs Fasting Lipid Levels and Major Coronary Events in ASCOT-LLA — October 8, 2019

Nonfasting vs Fasting Lipid Levels and Major Coronary Events in ASCOT-LLA

Summary: For patients having lipid levels measured for coronary risk assessment in primary prevention there may be no significant difference in coronary risk prediction between fasting and non-fasting lipid levels, while using non-fasting lipid levels is an approach that is less burdensome to patients.

https://www.ncbi.nlm.nih.gov/m/pubmed/31135812/

Strength of Recommendation = B

Flexible Family Visitation on Delirium Among Patients in the Intensive Care Unit. — July 30, 2019

Flexible Family Visitation on Delirium Among Patients in the Intensive Care Unit.

Summary: When patients are admitted to the intensive care unit (ICU), a policy of flexible family visitation (up to 12 hours per day) may be associated with lower anxiety and depression scores among family members compared to a policy of restricted visitation (< 4.5 hours per day) without affecting the incidence of ICU delirium ICU-acquired infections, or staff burnout.

https://www.ncbi.nlm.nih.gov/m/pubmed/31310297/

Strength of Recommendation = B

Vena Cava Filters in Severely Injured Patients. — July 23, 2019

Vena Cava Filters in Severely Injured Patients.

Summary: For severely injured patients who cannot receive prophylactic anticoagulation, an approach of not placing a prophylactic vena cava filter within the first 72 hours after admission may be associated with the same risks of symptomatic pulmonary embolism or death within 90 days as an approach of placing a vena cava filter in the first 72 hours after admission (approximately 14 out of 100 patients with either approach).

https://www.ncbi.nlm.nih.gov/m/pubmed/31259488/

Strength of Recommendation = B

Duration of dual antiplatelet therapy after percutaneous coronary intervention with a drug-eluting stent. — July 9, 2019

Duration of dual antiplatelet therapy after percutaneous coronary intervention with a drug-eluting stent.

Summary: For patients with coronary artery disease (CAD) who have had percutaneous coronary intervention (PCI) with a drug-eluting stent (DES), dual-anti-platelet therapy (DAPT)  for less than 6 months may be associated with lower rates of major bleeding than DAPT for 12 months and lower rates of both major bleeding & non-cardiac death than DAPT for longer than 12 months, without any increased risk of cardiac death, all cause mortality, myocardial infarction, or stent thrombosis.

https://www.ncbi.nlm.nih.gov/m/pubmed/31253632/

Strength of Recommendation = A

Dual-antiplatelet therapy for one month vs 12 months. — July 2, 2019

Dual-antiplatelet therapy for one month vs 12 months.

Summary: For patients having percutaneous coronary intervention (PCI), one-month dual-antiplatelet therapy (DAPT) followed by clopidogrel monotherapy may be associated with a lower 12-month rates of major and minor bleeding (~ 4 per 1000) compared to continued DAPT with aspirin + clopidogrel (~15 per 1000), without any excess risk of of cardiovascular death, myocardial infarction (MI), ischemic or hemorrhagic stroke, stent thrombosis.

https://www.ncbi.nlm.nih.gov/m/pubmed/31237644/

Strength of Recommendation = B

Ultra-processed foods and cardiovascular disease — June 19, 2019
Noninvasive Cardiac Testing vs Clinical Evaluation Alone in Acute Chest Pain. — June 4, 2019

Noninvasive Cardiac Testing vs Clinical Evaluation Alone in Acute Chest Pain.

Summary: For patients presenting to emergency care with acute chest pain, use of clinical evaluation alone (history, examination, electrocardiogram, and biomarker assessment) may be associated with shorter lengths of stay in the emergency room,  as well as lower rates of diagnostic testing, lower costs, and lower cumulative radiation exposure over 28 days of follow up compared to an approach of adding noninvasive testing to clinical evaluation as part of the standard emergency care evaluation of chest pain; and use of clinical evaluation alone without non-invasive testing does not appear to be associated with any higher rates of return emergency visits or major adverse cardiac events over 28 days of followup.

https://www.ncbi.nlm.nih.gov/m/pubmed/29138794/

Strength of Recommendation = B

Dabigatran for Prevention of Stroke after Embolic Stroke of Undetermined Source. — May 21, 2019

Dabigatran for Prevention of Stroke after Embolic Stroke of Undetermined Source.

Summary: For patients with an embolic stroke of undetermined source, use of aspirin for secondary prevention may be associated with a slightly lower risk of “clinically relevant nonmajor bleeding” compared to use of dabigatran for secondary prevention; both aspirin and dabigatran used for secondary prevention appear to have the same risks of risks of stroke recurrence and major bleeding over approximately 1.5 years of follow up.

https://www.ncbi.nlm.nih.gov/m/pubmed/31091372/

Strength of Recommendation = B

Acute chest pain evaluation using coronary computed tomography angiography compared with standard of care. — May 7, 2019

Acute chest pain evaluation using coronary computed tomography angiography compared with standard of care.

Summary: For patients with acute chest pain, initial evaluation with physiologic testing is associated lower rates of invasive angiography and revascularization compared to initial evaluation with coronary CT angiography (CCTA); and initial evaluation with physiologic testing is not associated with any higher rates of all-cause mortality, myocardial infarction or major adverse cardiac events (MACE) compared to initial testing with CCTA.

https://www.ncbi.nlm.nih.gov/m/pubmed/28855273/

Strength of Recommendation = A

Adjunctive Intermittent Pneumatic Compression for Venous Thromboprophylaxis. — April 9, 2019

Adjunctive Intermittent Pneumatic Compression for Venous Thromboprophylaxis.

Summary: For adult patients admitted to a medical intensive care unit (ICU), use of pharmacologic thromboprophylaxis alone appears to be associated with the same rates of new proximal lower-limb deep-vein thrombosis (DVT), overall venous thromboembolism (pulmonary embolism or any DVT) and death as use of intermittent pneumatic compression (IPC) for at least 18 hours each day + pharmacologic thromboprophylaxis with unfractionated or low-molecular-weight heparin; while pharmacologic thromboprophylaxis alone might be associated with less patient dissatisfaction (6.4% of the patients in the IPC group had IPC withheld at patient or family request).

https://www.ncbi.nlm.nih.gov/m/pubmed/30779530/

Strength of Recommendation = B

Intensive or Standard Blood Pressure Control & Probable Dementia. — April 2, 2019

Intensive or Standard Blood Pressure Control & Probable Dementia.

Summary: For patients over age 50 with hypertension but without diabetes or a history of stroke, an approach of treating to a systolic blood pressure goal of less than 140 mmHg appears to be associated with the same risk of dementia over approximately 3 years’ follow up as an approach of treating to a systolic blood pressure goal of less than 120 mmHg (1); however treating to a systolic blood pressure goal of less than 120 mmHg may be associated with a higher risk of hypotension and possibly a higher risk of syncope (2).

(1) https://www.ncbi.nlm.nih.gov/m/pubmed/30688979/

(2) https://www.ncbi.nlm.nih.gov/m/pubmed/29601076/

Strength of Recommendation = B

 

Systolic Blood Pressure and Cognitive Decline in Older Adults With Hypertension — March 19, 2019

Systolic Blood Pressure and Cognitive Decline in Older Adults With Hypertension

Summary: For patients aged 75 years or older with complex health problems, treatment of hypertension to a systolic blood pressure (SBP) > 130 mmHg may be associated with a lower likelihood of cognitive decline over one year than treatment of hypertension to a (SBP) < 130 mmHg.

https://www.ncbi.nlm.nih.gov/m/pubmed/30858252/

Strength of Recommendation = B

Home versus in-patient treatment for deep vein thrombosis. — January 29, 2019

Home versus in-patient treatment for deep vein thrombosis.

Summary: For patients with venous thromboembolism (VTE) home treatment with low molecular weight heparin (LMWH) may be associated with a lower likelihood of recurrence and might be associated with lower costs, compared to in-hospital treatment with unfractionated heparin (UFH) or LMWH.

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

Strength of Recommendation = B

Aspirin dose for the prevention of cardiovascular disease. — January 22, 2019
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

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 healthy elderly: Cardiovascular events, Disability, and Bleeding. — September 18, 2018

Aspirin for the healthy 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

#lessismore

 

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

%d bloggers like this: