January 7th, 2013
Selections from Richard Lehman’s Literature Review: January 7th
CardioExchange is pleased to reprint selections from Dr. Richard Lehman’s weekly journal review blog at BMJ.com. Selected summaries are relevant to our audience, but we encourage members to engage with the entire blog.
JAMA 2 Jan 2013 Vol 309
Survival of Patients Receiving a Primary Prevention ICD in Clinical Practice vs. Clinical Trials (pg. 55): Now back to the vexed question of implantable cardioverter-defibrillators for systolic heart failure. Two trials—MADITT-2 and SCD-HeFT—selected patients with a reduced ejection fraction and randomized them to receive ICDs or medical therapy. Both trials showed an absolute reduction in mortality of about 5-7%. This sophisticated study from Yale seeks to determine from ICD registries whether similar patients in real life get the same benefit. The problem here, of course, is that you cannot identify a matched comparison group in the community who were denied ICDs. So after much hard work and statistical legerdemain, the study shows that the mortality of real-life heart failure patients after ICD implantation for primary prevention is the same as that in the trials, and less than that of the control patients in the trials. Which I guess is a useful thing to know.
Lancet 5 Jan 2013 Vol 381
Serelaxin for Treatment of Acute Heart Failure (pg. 29): Setting up a good interventional trial in acute heart failure is quite a challenge, and I am quite impressed by this one. I don’t think that by itself it changes practice in any way, but it does show that recombinant human relaxin 2, serelaxin, is an interesting new treatment that deserves further study in heart failure. Decompensated heart failure is the commonest cause for hospital admission, so it was quite unnecessary for Novartis to conduct this trial in 96 centres across 11 countries. But that said, they did recruit 1161 real life elderly patients without regard to systolic ejection fraction: the only atypical entry criterion was a systolic blood pressure above 125 mm Hg after an initial dose of 40mg IV furosemide. All patients received whatever additional treatment their physicians thought necessary, and half of them received an infusion of serelaxin. Those in the latter group were given fewer additional drugs and experienced slightly greater relief of dyspnoea, and more of them were alive at 180 days, though equal numbers ended up back in hospital. If this is a subject that interests you, there is an outstanding editorial by Marvin Konstam to bring you up to speed.