February 23rd, 2015
Selections from Richard Lehman’s Literature Review: February 23rd
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.
JAMA 17 Feb 2015 Vol 313
Association Between the Use of Fondaparinux vs Low-Molecular-Weight Heparin and Clinical Outcomes in Patients With Non–ST-Segment Elevation Myocardial Infarction (pg. 707): I like it when large observational datasets confirm that what happened in randomized controlled trials actually happens in the hurly-burly of real life practice. The Swedish web system for enhancement and development of evidence based care in heart disease evaluated according to recommended therapies (SWEDEHEART—love it—I shall seek out a swede that is shaped like a heart) registry holds records from 40 616 consecutive patients with NSTEMI who received fondaparinux or low molecular weight heparin between September 1, 2006, through June 30, 2010, with the last follow-up on December 31, 2010. And just as in the OASIS-5 trial, “fondaparinux was associated with lower odds than LMWH of major bleeding events and death both in-hospital and up to 180 days afterward.”
JAMA Intern Med Feb 2015
Treatment With Multiple Blood Pressure Medications, Achieved Blood Pressure, and Mortality in Older Nursing Home Residents (OL): If you revisit John Yudkin’s Ten Commandments, you will see that the last of them reads “Honour thy elderly patient, for although this is where the greatest levels of risk reside, so do the greatest hazards of many treatments.” Here is a study to prove it. A total of 1127 women and men older than 80 years living in nursing homes in France and Italy were recruited, examined, and monitored for 2 years. Among these, people receiving two or more blood pressure lowering drugs and running systolic BPs of 130 and below were 80% more likely to die during the period of the study. Do not dishonour thy elderly patients by poisoning them with pointless and hazardous medication. And remember that people in nursing homes are at greatest risk, because they are constantly fed with medicines that they might otherwise forget to take, or have the good sense to stop taking.