August 12th, 2013
Selections from Richard Lehman’s Literature Review: August 12th
CardioExchange is pleased to reprint this selection 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.
Lancet 10 Aug 2013 Vol 382
BP Targets in Patients with Recent Lacunar Stroke (pg. 507): “Small subcortical brain infarcts, commonly known as lacunar strokes, comprise about 25% of ischaemic strokes. Most result from disease of the small penetrating arteries.” The SP3 trial looked at the effect of blood pressure lowering to a systolic blood pressure target above or below 130 in this specific type of stroke. There was no significant difference in outcomes. Nonetheless, the authors hold to the principle “the lower the better” because for recurrent stroke and cardiovascular death the trend was towards reduction, and “treatment-related serious adverse events were infrequent.” I can go with this so far, but when you are talking about giving stroke patients lifelong medication on the basis of numbers-needed-to-treat which are incalculably large, even non-serious adverse effects such as tiredness, cough, polyuria and dizziness on getting up are hard to justify. Treat the patient, not the target.
Effectiveness of Intermittent Pneumatic Compression in Reduction of Risk of DVT in Patients Who have had a Stroke (pg. 516): CLOTS 3 is the acronym of a trial of intermittent pneumatic compression to reduce DVT on patients immobilized by stroke. If you try really hard you can extract these letters from “Clots in Legs Or sTockings after Stroke.” Going by initials, that should really be CILOSAS; but enough of acronyms, which provide innocent fun for researchers in the hope that they will help readers remember the trial. Preventing DVT after severe stroke is probably worthwhile, and these inflating stockings do reduce venous clots by about a third. The median age of the patients was 76, and a lot of them died: 33 fewer in the intervention group, which was not statistically significant given the large size of this UK trial.
BMJ 10 Aug 2013 Vol 347
Effect of Telephone Health Coaching on Hospital Use and Associated Costs: “2698 patients (were) recruited from local general practices before 2009 with heart failure, coronary heart disease, diabetes, or chronic obstructive pulmonary disease; and a history of inpatient or outpatient hospital use.” They were then individually randomized to usual care or “telephone health coaching (which) involved a personalised care plan and a series of outbound calls usually scheduled monthly.” The aim was to reduce hospital admissions. The result was to increase them. Since then, the most popular research idea seems to be to hand out iPads for education and monitoring to reduce admissions for chronic disease. Will this have any effect? Yes, I think it will increase disease awareness, anxiety, and iPad ownership.