{"id":41712,"date":"2014-02-17T16:16:49","date_gmt":"2014-02-17T21:16:49","guid":{"rendered":"http:\/\/blogs.nejm.org\/cardioexchange\/?post_type=voices&p=41712"},"modified":"2014-02-17T16:16:49","modified_gmt":"2014-02-17T21:16:49","slug":"selections-from-richard-lehmans-literature-review-february-17th","status":"publish","type":"post","link":"https:\/\/blogs.nejm.org\/cardioexchange\/2014\/02\/17\/selections-from-richard-lehmans-literature-review-february-17th\/","title":{"rendered":"Selections from Richard Lehman\u2019s Literature Review: February 17th"},"content":{"rendered":"

CardioExchange is pleased to reprint this selection from Dr. Richard Lehman\u2019s\u00a0weekly journal review blog<\/a>\u00a0at\u00a0BMJ.com<\/a>. Selected summaries are relevant to our audience, but we encourage members to engage with the\u00a0entire blog<\/a>.<\/em><\/p>\n

JAMA Internal Medicine<\/strong><\/p>\n

Rates of Complications and Mortality in Older Patients With Diabetes Mellitus (pg. 251):<\/strong> Goodness, it\u2019s taken a long time for the diabetes community to come to terms\u00a0with the obvious. A study<\/a> of people over 60 with diabetes finds that the main ill\u00a0effects of their condition in old age are coronary artery disease and hypoglycaemia.\u00a0In people who develop diabetes after the age of 60, microvascular disease is so\u00a0uncommon it is hardly a consideration: whereas the commonest treatments given to\u00a0lower sugar frequently cause hypoglycaemia and have little or no effect on coronary\u00a0disease. Step back, guys: treating type 2 diabetes is a whole different ball game in\u00a0a 65 year old as compared with a 35 year old. One size does not fit all ages. In fact,\u00a0each patient of any age needs to be treated in accordance with his or her own goals\u00a0and informed preferences. People with diabetes have for so long been misinformed\u00a0about the benefits and harms of treatment that I suspect we often keep them on\u00a0drugs out of sheer embarrassment at admitting we didn\u2019t know what we were doing.\u00a0And it\u2019s still going on: we \u201cput people on\u201d drugs like incretin mimetics when we\u00a0haven\u2019t a clue what they do to long-term outcomes, and then congratulate ourselves\u00a0just because their HbA1c has gone down.<\/p>\n

Hospital Variation in the Use of Noninvasive Cardiac Imaging and Its Association With Downstream Testing, Interventions, and Outcomes (online):<\/strong> Another week, another great paper from a Yale medical student. If this is\u00a0beginning to sound like advertising, I don\u2019t care: I wish every medical school had a\u00a0Harlan Krumholz and Joe Ross who would encourage attached students to produce\u00a0work of such quality. This time the student\u2019s name is Kyan Safavi, and he did a\u00a0massive survey<\/a> of data about variation in non-invasive cardiac imaging for suspected\u00a0ischaemia across US hospitals. \u201cHospitals with higher imaging rates did not have\u00a0substantially different rates of therapeutic interventions or lower readmission rates\u00a0for AMI but were more likely to admit patients and perform angiography.\u201d So non-invasive imaging leads to invasive imaging without showing any clear benefit in\u00a0patient outcomes. Those Americans, eh? But I bet you would find exactly the same\u00a0variation in the UK, especially between district general and teaching hospitals.<\/p>\n

The Lancet<\/strong><\/p>\n

Percutaneous Renal Denervation in Patients with Treatment-Resistant Hypertension (pg. 622)<\/strong> In this paper<\/a>, the abstract conclusion (called Interpretation) can afford\u00a0to be laconic: \u201cChanges in blood pressure after renal denervation persist long term\u00a0in patients with treatment-resistant hypertension, with good safety.\u201d This is indeed\u00a0true of the 88 out of 153 patients who had full follow-up data at 36 months in this\u00a0Medtronic-funded Symplicity HTN-1 trial. These were people whose blood pressure\u00a0remained high despite treatment with an average of five different agents. And the\u00a0drop in BP following percutaneous radiofrequency ablation of the renal nerve supply\u00a0was little short of spectacular: a mean fall of 32 mm Hg in systolic and 14.4 mm\u00a0diastolic. So something really big is happening here, and you could say that this is\u00a0the kind of intervention which did not get a randomized trial because it didn\u2019t need\u00a0one. What it did need, however, was tighter follow-up. I know this is something\u00a0Medtronic are keen to carry out in the future, and to be fair they didn\u2019t design this trial\u00a0themselves: it was instigated by a company they bought up half way through. But it\u00a0was a missed opportunity to do better from the outset in the evaluation of a treatment\u00a0which looks to have immense potential.<\/p>\n

 <\/p>\n","protected":false},"excerpt":{"rendered":"

This week’s topics include hospital variation in noninvasive cardiac imaging, percutaneous renal denervation in patients with treatment-resistant hypertension, and more.<\/p>\n","protected":false},"author":475,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1],"tags":[2173,2174,581,2175,469],"class_list":["post-41712","post","type-post","status-publish","format-standard","hentry","category-general","tag-hospital-variation","tag-non-invasive-cardiac-imaging","tag-renal-denervation","tag-treatment-resistant-hypertension","tag-type-2-diabetes"],"_links":{"self":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/posts\/41712","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/users\/475"}],"replies":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/comments?post=41712"}],"version-history":[{"count":0,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/posts\/41712\/revisions"}],"wp:attachment":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/media?parent=41712"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/categories?post=41712"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/tags?post=41712"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}