June 24th, 2013

Selections from Richard Lehman’s Literature Review: June 24th

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  19 June 2013  Vol 309

Time to Treatment with Intravenous tPA and Outcome from Acute Ischemic Stroke (pg. 2480): Here is an outcome analysis of thrombolysis for stroke which leads the authors to call for even greater effort to ensure that stroke patients get intravenous tissue-type plasminogen activator (tPA) as quickly as possible. That’s one way of looking at it. The odds ratios are pitifully small and the cost implications are huge.

General Health Checks in Adults for Reducing Morbidity and Mortality from Disease (pg. 2489): The indefatigable Peter Gøtzsche is ever one for taking the battle to the enemy. Here he and two colleagues present the findings of their Cochrane review of regular health checks. Until recently this would have been the equivalent of launching a paintball attack on the Statue of Liberty. “There were no statistically significant favourable or harmful associations of general health checks with these outcomes [cardiovascular disease, cancer]. There was no association with hospital admission rates, disability, worry, additional physician visits, or absence from work.” Americans, this is one health cost you can cut right away.

NEJM  20 June 2013  Vol 309

Rapid BP Lowering in Patients with Acute Intracerebral Hemorrhage (pg. 2355): Here’s what you might call a tick-off trial: one that disposes of an intervention in one good randomized go. Does intensive blood pressure lowering in acute haemorrhagic stroke improve outcomes? Take 2839 patients and compare: there is no significant difference in outcomes between the normally treated and intensively treated groups.

BMJ  22 June 2013  Vol 346

Telemonitoring-Based Service Redesign for the Management of Uncontrolled Hypertension: Just what is telemedicine for? Is it trying to improve communication with patients, or avoid communication with patients? And what is the most important goal in hypertension research? Is it to put more people on more treatment with a number-needed-to-treat of 500, or to identify the 499 who will never benefit from their treatment? I am only an aged GP asking simple questions: I don’t know the answers. I’m glad to see the modest reporting of this trial of telemonitoring in the management of uncontrolled hypertension: “Supported self monitoring by telemonitoring is an effective method for achieving clinically important reductions in blood pressure in patients with uncontrolled hypertension in primary care settings. However, it was associated with increase in use of National Health Service resources. Further research is required to determine if the reduction in blood pressure is maintained in the longer term and if the intervention is cost effective.” And then, perhaps, some hard end-points? No, no, that would take much too long.

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