| By Topic Circulatory System ABCD rule predicts 7- and 30-day stroke risk in pts with TIA ABCD score predicts 7 day stroke risk in patients with TIA Abnormal nuchal translucency does not = abnormal child ACC/AHA: Fewer patients require prophylaxis for endocarditis ACE = ARB, but ACE + ARB worsens renal outcomes (ONTARGET) ACE = ARB for secondary CV prevention; combination worse (ONTARGET) ACE inhibitors effective in CAD without CHF ACS risk similar with normal ECG performed during presence or absence of chest pain Aggressive early tx after TIA/minor stroke improves outcomes (EXPRESS) Alexander technique reduces low back pain disability Alpha-blocker or nifedipine may help pass kidney stones Anticholinergics, pelvic floor muscle exercises improve urinary incontinence in women Antiplatelet agents prevent preeclampsia Apolipoprotein levels no better than standard methods to evaluate CVD risk ARBs reduce BP in prehypertensive patients ARB treatment of high CV risk patients ASA+dipyridamole better than ASA for cerebral ischemia (ESPRIT) ASA effective in secondary prevention of vascular disease, uncertain in primary prevention Aspirin + dipyridamole = clopidogrel for recurrent stroke prevention (PROFESS) Aspirin = enoxaparin for prevention of recurrent miscarriage Aspirin dose >81mg daily not beneficial for secondary prevention of CVD Aspirin prevents vascular events in patients with PAD Atrial fibrillation recurrence higher with episodic treatment with amiodarone Bleeding risk with warfarin high among elderly, especially older than 80 BMI poor predictor of mortality in patients with CAD BNP misleading in patients with a history of HF Botulinum might be more effective than nitroglycerine in anal fissure BP and cholesterol are associated with vascular mortality BP lowering by any means is beneficial in most Cardiac resynchronization therapy effective for NYHA class 3 and 4 heart failure Carotid bruits are associated with AMI and CV death Carotid stent inferior to carotid endarterectomy Carvedilol decreases mortality, slightly improves QOL (COMET) Carvedilol not beneficial for children and adolescents with heart failure Catheter ablation of AF prevents recurrence but has minimal impact on QOL Cholesterol lowering benefits patients at risk for CHD Cholesterol lowering cost-effective in high-risk elderly Clopidogrel + ASA for afib: less strokes, more hemorrages (ACTIVE) Clopidogrel + ASA no better than ASA alone for high-risk patients Coffee does not increase risk of developing CAD Continued BP control important in T2DM (UKPDS) Coumadin + aspirin no better than aspirin alone for PAD CPAP and NIPPV no better than O2 in acute pulmonary edema (3CPO) CPAP associated with decreased CV risk CV interventions in old elderly are not useful (DEBATE) D-dimer can identify high-risk group for extended anticoagulation (PROLONG) Diet, exercise, drugs may prevent diabetes in high-risk patients Diet and exercise prevent diabetes Different SSRIs associated with specific birth defects; fluoxetine safest Don't add aspirin to warfarin therapy except with mechanical heart valve Door-to-balloon time important in STEMI Dressing choice unimportant for leg ulcers Dronedarone prevents AF recurrence but effect on symptoms unknown Early angiography not crucial in low risk NSTEMI patients (TIMACS) Early initiation of statins following ACS does not improve outcomes Early invasive therapy better for non-ST ACS Effective methods for preventing pressure ulcers Emergency department management decreases A Fib admissions Enoxaparin > UFH for STEMI, with or without clopidogrel Enoxaparin > UFH for STEMI treated with fibrinolysis then PCI Escitalopram (Lexapro) reduces risk of poststroke depression Excess enoxaparin increases adverse outcomes in non-ST elevation ACS Excessive lowering of BP causes more harm than good Ezetimibe does not slow progression of coronary disease (ENHANCE) Fenofibrate reduces laser photocoagulation (FIELD) Fibromyalgia treatment guidelines from EULAR First-degree AV block associated with increased risk of adverse outcomes Fixed-dose, subcutaneous, unfractionated heparin effective for VTE Folate prevents stroke Folic acid supplementation does not reduce CVD risk nor mortality Furosemide doesn't prevent acute renal failure Glitazones may be beneficial post-PCI Guidelines for managing VTE (AAFP, ACP) Guidelines for the clinical diagnosis of VTE (AAFP, ACP) Helium-oxygen improves exercise tolerance in pts with COPD High-dose atorvastatin reduces recurrent stroke, not mortality (SPARCL) High volume of AAA repairs associated with lower mortality Homocysteine lowering not helpful in women at high risk for CVD Hypertension treatment effective even after age 80 Hypnotherapy effective for noncardiac, non-GERD chest pain Idraparinux effective for DVT but not for PE Immediate transfer for angioplasty after fibrinolysis beneficial for STEMI (TRANSFER-AMI) In ACS, 5 yrs of invasive tx decreases MI but not all cause mortality (FRISC-II) Incidental findings common on brain MRI in adults Inhaled anticholinergics associated with increased risk of CVD in COPD Intensive lipid lowering adds additional benefit Intensive lipid lowering reduces mortality following ACS Invasive strategy best only for men and high-risk women with unstable angina/non-ST elevation MI IV iloprost may reduce healing time for venous ulcers Lab-based = non-lab-based models for CVD prediction Less bleeding with fondaparinux vs enoxaparin for ACS with PCI Little benefit to revascularization over intensive medical treatment in DM with CAD Little information on racial differences between antihypertensives LMWH = UFH for thrombocytopenia LMWH better than UFH for acute DVT LMWH better than unfractionated heparin for preventing DVT in medical patients Lowering homocysteine with B vitamins doesn't improve cognition Low risk of DVT after knee arthroscopy Many patients using warfarin also take aspirin Medical tx prevents variceal bleeds better Medications help passage of kidney stones Meta-analysis: BP drugs equally effective in young and old Metformin does not harm patients with HF and diabetes Migraine with aura associated with increased risk of CVD in women Minocycline improves stroke outcomes Moderate coffee consumption safe after AMI Modified TIMI score improves CV event prediction Mortality from in-hospital cardiac arrest highest during nights and weekends Most endocarditis prophylaxis no longer necessary: NICE guideline Multidetector CT accurate for PE, but requires clinical context Multifactorial intervention improves outcomes in T2DM (Steno-2) Multislice CT is safe and efficient for evaluation of low-risk chest pain Nesiritide provides no additional benefit in the emergency department New biomarkers add little to current predictors for CAD NICE guidelines for diabetes mellitus, type 2 NICE guidelines for lipid lowering Nonfocal transient neurological attacks increase risk of future stroke and dementia Noninvasive carotid imaging can replace invasive imaging NT-BNP reduces cost and rehospitalization rates in dyspneic patients O2 not helpful in overall QOL in COPD with exertional hypoxia Omega-3 fatty acids have small analgesic effect Omega-3 FFAs not effective for relapse prevention in Crohn disease Once-weekly tai chi decreases rate of falls in the elderly Ondansetron effective for gastroenteritis with vomiting Optimal algorithm for evaluating suspected DVT Optimal dosing for thromboprophylaxis in medical inpatients Optimal medical tx = PCI + optimal medical tx for stable CAD PA-led rapid response team beneficial Patent foramen ovale not necessarily associated with stroke recurrence PCI not useful for occluded vessel after completed STEMI PCI provides short-term quality of life improvement in stable angina (COURAGE) Pedometer-based programs result in modest weight loss Pedometer use increases physical activity and may promote weight loss Pergolide, cabergoline increase risk of heart valve damage Perinatal steroids not associated with adverse CV function 7-10 years later Perindopril+indapamide improves outcomes in high-risk pts with DM (ADVANCE) Perioperative metoprolol: fewer CV events and MIs, more deaths and strokes (POISE) Pharmacist-assisted Web-based care improves hypertension control Phlebotomy decreased cancer risk in patients with PAD Pioglitazone does not increase cardiovascular events (PROactive) PPI use reduces benefit of clopidogrel post-MI Presence of risk factors doesn't predict acute coronary syndrome Prognosis of bicuspid aortic valve depends on age, severity of valve dysfunction Pulmonary Embolism (PE) Severity Index predicts low risk PE patients QI measures increased evidence based therapies and reduced LOS for HF patients Raloxifene decreases breast CA risk, no effect on CVD risk (RUTH) Ranolazine (Ranexa) not effective for ACS Ranolazine adds little to maximum antianginal therapy (ERICA) Rate control improves quality of life in patients with CHF and AF Red hot chili peppers do not worsen hemorrhoid symptoms Reducing homocysteine not beneficial in advanced chronic kidney disease Reducing iron stores does not benefit patients with peripheral arterial disease Repolarization abnormality in athletes is risk factor for cardiomyopathy Rhythm control no better than rate control in AF + CHF Rofecoxib, diclofenac and indomethacin increase risk of CVD Rosiglitazone associated with increased risk of acute MI Rosiglitazone delays developing DM (DREAM) Rosuvastatin does not improve outcomes in HF with average lipids Rosuvastatin has no effect on clinical outcomes in CHF Same-day discharge after PCI is safe Screening for carotid artery stenosis not helpful, may be harmful (USPSTF) Sentinel node biopsy = less lymphedema, better QOL (ALMANAC) Serial proximal vein ultrasonography + D-dimer = whole-leg Doppler for suspected leg DVT Signs and symptoms not helpful in diagnosis of AMI/ACS Sirolimus stents decrease long-term restenosis (RAVEL) Smaller benefit of statins without heart disease Some older patients benefit from statin therapy Specialized training decreases injuries in elite athletes Statin use may reduce risk of cataracts Tibolone prevents osteoporotic fracture, increases stroke risk (LIFT) Tight glycemic control may decrease CV end points in patients with type 2 DM Tolvaptan does not improve long-term HF outcomes Treating prediabetes does not affect progression Troponin predicts adverse outcome in HF (ADHERE) Typical hand gestures not useful for chest pain diagnosis TZDs increase CHF events in pts with DM or with prediabetes Uncertain benefit of aspirin for peripheral artery disease Uncertain role of testing for genetic mutations in adults with VTE or in at-risk family Uncertain value of automated chest compression device for cardiac arrest Under ideal conditions thrombolysis may be helpful within 3 to 4.5 hours USPSTF recommends screening for diabetes in hypertensive patients Vasodilators of little use with aortic insufficiency Vasopressin, steroids, and epinephrine improve in-hospital cardiac arrest survival Vitamin K supplementation improves stability of anticoagulation VTE: Up to 10% with unexplained embolus will have cancer Warfarin: damned if you do, damned if you don't Warfarin > aspirin in preventing strokes in pts older than 75 with A fib (BAFTA) Warfarin can safely be held for the short term Warfarin prevents more strokes than clopidorel+ASA in a fib (ACTIVE) Warfarin superior to antiplatelet treatment for A Fib Work stress has no meaningful effect on BP
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