DISEASE INTERVENTION COMPARISON RESULTS
Eur Heart J. 2018 Apr 21;39(16):1330-1393 Consensus, Guideline
IN anticoagulants, oral direct thrombin inhibitors, dabigatran, oral factor Xa inhibitors, apixaban, rivaroxaban The Use of
guidelines for their use in practice
As Treatment, Chronic
Is useful Than
no comparison here
To optimize their use and effectiveness, and avoid bleeding complications
Circulation. 2018 Feb 28. doi: 10.1161/CIRCULATIONAHA.117.031658. [Epub ahead of print] Cohorts
IN anticoagulants, oral direct thrombin inhibitors, dabigatran, oral factor Xa inhibitors, apixaban, rivaroxaban, real-world data, very elderly patients The Use of
these 3 direct oral anticoagulants
As Treatment, Chronic
Is better Than
warfarin
To reduce the risk of intracranial bleeding (0.42 %/year DOAs VS 1.63 % warfarin) with similar effect in stroke and all-type major bleeding.
N Engl J Med. 2013 Dec 12;369(24):2304-12 Randomized Controlled Trial, Multicenter Study
IN anticoagulants, vitamin K antagonists, acenocoumarol, phenprocoumon The Use of
pharmacogenetic guided dosing, using CYP2C9 and VKORC1 genotype, combined with clinical information in an algorithm
As Treatment, Acute
Is equal Than
a dosing algorithm that included only clinical variables
To modify the percentage of time that the INR was in the therapeutic range in the first 12 weeks after initiation of therapy
J Am Coll Cardiol. 2012 Aug 28;60(9):861-7 Cohorts
IN anticoagulants, vitamin K antagonists, bleeding risk The Use of
Any of 3 most commonly employed scores: HAS-BLED, ATRIA and HEMORR2 HAGES
As Prognostic Item
Is better Than
no using any risk score
To predict clinically relevant bleeding events, but only with modest performance, being HAS slightly better: c-index: 0.60 HAS-BLED, 0.55 HEMORR(2)AGES, 0.50 ATRIA
N Engl J Med. 2018 Mar 08;378(10):902-910 Randomized Controlled Trial, Multicenter Study
IN asthma, acute exacerbation The Use of
self-management plan including a temporary quadrupling of the dose of inhaled glucocorticoids when asthma control start to deteriorate
As Treatment, Acute
Is better Than
self-management plan without increase of inhaled corticosteroids
To reduce severe asthma exacerbations at 1 year: 45% with quadrupling VS 52% in the non-quadrupling. More local adverse events with quadrupling.
N Engl J Med. 2018 Jun 13. doi: 10.1056/NEJMoa1800389. [Epub ahead of print] Randomized Controlled Trial, Multicenter Study
IN atherosclerosis, cardiovascular disease, primary prevention, high risk patients The Use of
Mediterranean diet supplemented with extra-virgin olive oil, or with mixed nuts
As Prevention, Primary
Is better Than
simple advice to reduce dietary fat
To reduce cardiovascular events (myocardial infarction, stroke, or cardiovascular death): medit. diet plus olive oil 3.8% VS medit. diet plus nuts 3.4% VS control group 4.4%
N Engl J Med. 2011 Sep 15;365(11):981-92 Randomized Controlled Trial, Multicenter Study
IN atrial fibrillation, non valvular, stroke, ischemic, cerebral infarction, embolic The Use of
anticoagulants, oral factor Xa inhibitors, apixaban, 5 mg twice daily
As Treatment, Chronic
Is better Than
warfarin
To reduce stroke or systemic embolism at 1.8 years (1.3% apixaban VS 1.6% warfarin) witout increasing major bleeding (2.1% apixaban VS 3.1% warfarin). Quite similar rate of all-cause death (3.5% apixaban VS 3.9% warfarin)
JAMA. 2013 Jul 17;310(3):270-9 Randomized Controlled Trial, Multicenter Study
IN cardiac arrest, immediate resuscitation, post-resuscitation care The Use of
combined treatment with vasopressin (20 IU) plus epinephrine (1 mg) each 3 minutes for 5 times, plus 40 mg methylprednisolone IV once, plus hydrocortisone (300 mg/d for 7 days) in patients with shock after resuscitation
As Treatment, Acute
Is better Than
repeated epinephrine (1 mg) alone, without vasopressin nor corticosteroids
To improve survival to hospital discharge with no or little neurological impairment: 14% combined treatment VS 5% epinephrine alone
N Engl J Med. 2018 Apr 18. doi: 10.1056/NEJMoa1713901. [Epub ahead of print] Randomized Controlled Trial, Multicenter Study
IN chronic obstructive pulmonary disease, stable The Use of
triple inhaled therapy (glucocorticoid - fluticasone, long-acting muscarinic antagonist (LAMA) - umeclidinium, and a long-acting β2-agonist (LABA) - vilanterol)
As Treatment, Chronic
Is better Than
any dual therapy combination
To reduce the annual rate of moderate or severe exacerbations: 0.9 triple tt VS. 1.1 dual tt. Higher risk of pneumonia in dual or triple Tt taking glucocorticoids.
PLoS Med. 2014 Nov;11(11):e1001756 Systematic Review
IN cognitive impairment, age related, older people without cognitive impairment The Use of
computerized cognitive training, group based training
As Prevention, Primary
Is better Than
no cognitive training, or computerized unsupervised at-home training
To to modestly improve cognitive peformance (effect size 0.20 to 0.30), specially in working memory, processing speed and visuospacial skills. No significant effects in executive functions and attention
Am J Cardiol. 2013 Jun 15;111(12):1701-7 Diagnostic
IN coronary disease, acute coronary syndrome, myocardial infarction, older patients The Use of
high-sensitive cardiac troponin, increased cutoff at 40-50 ng/L in older patients and renal failure
As Diagnostic Tool
Is better Than
standard cutoff at 14 ng/L
To better diagnose acute coronary syndrome: sensitivity 87% and specificity 87% at 50 ng/Lfor older patients
N Engl J Med. 2006 Mar 23;354(12):1231-42 Randomized Controlled Trial, Multicenter Study
IN depression, unipolar, refractory The Use of
bupropion-SR, sertraline, or venlafaxine-XR
As Treatment, Chronic
Is equal Than
each other
To improve depression after failure of SSRI (no remission or intolerance) : about 25% patients responded with all 3 treatments
Am J Psychiatry. 2007 May;164(5):739-52 Randomized Controlled Trial, Multicenter Study
IN depression, unipolar, refractory The Use of
cognitive therapy
As Treatment, Chronic
Is equal Than
pharmacologic treatment : sustained-release bupropion, buspirone or associating a second antidepressant
To improve depression after SSRI failure (no response or intolerance) : equal number of responders. Pharmacologic augmentation was more rapidly effective but has more adverse effects
Am J Psychiatry. 2011 Jul;168(7):681-8 Systematic Review
IN depression, unipolar, refractory, older patients The Use of
lithium, extended-release venlafaxine and selegiline
As Treatment, Chronic
Is better Than
placebo or other therapeutic options
To improve clinical response : overall 52% of aptients responded
Ann Intern Med. 2017 Feb 07;166(3):191-200 Systematic Review
IN diabetes mellitus, type 2, comorbid conditions contraindicating metformin, kidney disease, chronic, liver failure, chronic, heart failure The Use of
oral hypoglycemic agents, metformin
As Treatment, Chronic
Is better Than
other diabetes treatments no using metformin
To reduce all-cause mortality (chronic kidney disease HR 0.77 ; chronic heart failure HR 0.78), cardiovascular mortality and rehosp because heart failure
Age Ageing. 2013 Mar;42(2):262-5 Descriptive, Cross-Sectional Study
IN elder people, comprehensive geriatric assessment, frailty scores The Use of
PRISMA-7, a short 7-items questionnaire
As Diagnostic Tool
Is better Than
other frailty measures : clinical judgement ot GP, polypharmacy or the Groningen frailty indicator (GFI)
To better diagnose frailty : sensitivity 85% and specificity 73% VS Fried criteria as glod standard
J Neurol Neurosurg Psychiatry. 2011 Aug;82(8):924-7 Randomized Controlled Trial, Multicenter Study
IN epilepsy, generalized, focal, newly diagnosed (first tonic-clonic seizure) The Use of
no treatment, unless seizure recurrs
As Treatment, Chronic
Is equal Than
starting treatment immediatly (carbamazepine, phenytoin, phenobarbital, or sodium valproate)
To modify mortality at 20 years: 10% no Tt VS 9% immediate Tt. Only the presence of aetiological factors for epilepsy predicted a higher mortality (HR 3.4). Most patients died from remote, non primarily neurological diseases.
JAMA. 2018 04 24;319(16):1705-1716 Systematic Review
IN falls, older people The Use of
exercise and multifactorial programs
As Treatment, Acute
Is better Than
no or others interventions
To reduce frequency of falls (IRR 0.79-0.89) and injurious falls (IRR, 0.81). Trials of vitamin D formulations (with or without calcium) showed mixed results
Arch Surg. 2012 Mar;147(3):277-81 Systematic Review
IN hernia, inguinal, asymptomatic The Use of
watchful waiting
As Treatment, Chronic
Is equal Than
routine surgical repair
To symptoms at follow-up were not different but it existed a hight crossover ratio (23% to 72%) from watchful waiting to surgery : most patients will develop symptoms (mainly pain) over time and will require operation
N Engl J Med. 2018 Apr 19;378(16):1509-1520 Cohorts
IN hypertension, essential The Use of
24-hour ambulatory blood pressure measure
As Prognostic Item
Is better Than
blood pressure measured in the clinic
To predict at 5 years all-cause and cardiovascular mortality (HR 1.6 if HTA at 24-hour measure VS HR 1.02 if HTA at clinic measure)
Cochrane Database Syst Rev. 2018 Jul;7:CD010315 Systematic Review, Cochrane Review
IN hypertension, essential The Use of
a more intensive blood-pressure control: target SBP < 135 mmHg
As Treatment, Chronic
Is equal Than
standard blood pressure targets 140 to 160 mmHg
To at 3.6 years there was no difference in total or cardiovascular mortality, nor in serious adverse events
BMJ. 2017 Jun 6;357:j2353. doi: 10.1136/bmj.j2353 Cohorts
IN lifestyle and habits, alcohol The Use of
moderately (14-21 units/week) or high (>30 units/week) alcohol consumtion
As Etiologic risk factor
Is worse Than
no alcohol consumtion, or light drinking (1 - 7 units/week)
To predict hypoccampal atrophy at 30 years of follow-up (OR 6 high drinkers, OR 3.4 moderate drinkers)
Br J Sports Med. 2015 Jun;49(11):743-8 Cohorts
IN lifestyle and habits, exercise, old patients The Use of
regular exercise, 30 mins of moderate to vigorous physical activity per 6 days a week
As Prevention, Primary
Is better Than
sedentary, no physical activity
To reduce overall mortality (40% reduction from 73 to 85 years old, with a 5 years increase in lifetime)
Med Educ. 2010 Jan;44(1):94-100 Systematic Review
IN medical thinking, errors, diagnostic The Use of
encouraging both kinds of reasoning, system 1 (non-analytical) and system 2 (analytical)
As Methodology procedure
Is better Than
only attempting to be systematic and analytical
To improve physicians diagnostic accuracy: it yields small, but consistent, improvements. Errors result from multiple causes. Little evidence associates diagnostic errors with over-reliance on System 1 (non-analytical) reasoning.
Neurology. 2014 Jan 7;82(1):41-8 Randomized Controlled Trial
IN multiple sclerosis, first demyelinating attack The Use of
Bacille Calmette-Guerin (BCG) vaccine
As Treatment, Acute
Is better Than
placebo
To reduce at 6 months the number of CNS gadolinium-enhancing lesions and reduce at 5 years the probability of clinically definite multiple sclerosis (HR 0.52)
Cochrane Database Syst Rev. 2012;5(0):CD008165 Systematic Review, Cochrane Review
IN older patients, geriatric pharmacology, inappropriate prescription, multiple medications The Use of
multifaceted pharmaceutical care provided in a variety of settings
As Treatment, Acute
Is better Than
no intervention
To reduce inappropriate drug prescription and possibly (only 3 studies repporting) the number of adverse drug events (RR 0.65). Effect on hospital admissions (four studies) was conflicting.
JAMA Pediatr. 2017 May 01;171(5):426-434 Meta-Analysis
IN pain, abdominal, acute, appendicitis, children The Use of
antibiotic treatment
As Treatment, Acute
Is equal Than
appendectomy
To obtain clinical success (91% on antibiotics). But appendicitis with appendicolith had a high failure rate: probably surgery better in this case
Cochrane Database Syst Rev. 2018 Apr 10;4(XX):CD007094 Systematic Review, Cochrane Review
IN respiratory infection, upper airways, cough, children The Use of
honey
As Treatment, Acute
Is better Than
no treatment, placebo or diphenhydramine, and equal than dextromethorphan
To achieve better symptomatic relief of cough (mean extra reduction of 1 to 1.6 points in a 7-points Likert scale)
J Hosp Med. 2013 Sep;8(9):530-40 Meta-Analysis
IN sepsis, any bacterial infection, critically ill patients, respiratory tract infections The Use of
procalcitonin, treating with antibiotics according to serum procalcitonin levels
As Diagnostic Tool
Is better Than
empirical treatment with antibiotics
To reduced antibiotic duration by 2 days without increasing morbidity or mortality
N Engl J Med. 2017 Jun 08;376(23):2223-2234 Meta-Analysis
IN sepsis, septic shock The Use of
early, goal-directed therapy
As Treatment, Acute
Is equal Than
usual care
To reduce mortality at 90 days and 1 year
JAMA Intern Med. 2017 Apr 01;177(4):563-570 Cohorts
IN stroke, haemorrhagic, intracerebral hemorrhage, traumatic, patients with atrial fibrillation The Use of
resuming warfarin afterwards
As Treatment, Chronic
Is better Than
definitively stopping warfarin, no oral anticoagulant treatment
To reduce at 1 year stroke or systemic embolism (HR 0.5 warfarin) but increasing recurrent intracranial HRR (HR 1.3) with a final reduction in overall mortality (HR 0.5 in stroke HRR, HR 0.35 in traumatic HRR with warfarin)
N Engl J Med. 2018 02 22;378(8):708-718 Randomized Controlled Trial, Multicenter Study
IN stroke, ischemic, cerebral infarction, 6 to 16 h of onset, proximal arterial occlusion in the anterior cerebral circulation, volume of ischemic tissue on perfusion imaging to infarct volume of 1.8 or more The Use of
endovascular treatment: thrombectomy, late
As Treatment, Acute
Is better Than
standard care
To improve at 3 months functional independence (45% thrombectomy VS 17% controls). Mortality was also some improved (14% thrombectomy VS 26% controls, p=0.05)
Heart. 2018 Mar 23. doi: 10.1136/heartjnl-2017-312571. [Epub ahead of print] Systematic Review
IN therapeutics, adherence to drug treatment, cardiovascular disease The Use of
3 interventions: short message service, fixed-dose combination pill, community health worker intervention
As Treatment, Acute
Is better Than
usual care
To improve medication adherence: 44% to 99% in the intervention groups VS 13% to 96% in usual care groups
Lancet. 2014 Mar 8;383(9920):880-8 Randomized Controlled Trial, Multicenter Study
IN thromboembolic disease, deep venous thrombosis, post-thrombotic syndrome The Use of
active compression stockings
As Treatment, Chronic
Is equal Than
placebo (fake compression stockings)
To modify incidence of post-thrombotic syndrome at 2 years: 14% active stockings VS 13% placebo
Cochrane Database Syst Rev. 2017 09 26;9:CD004174 Systematic Review, Cochrane Review
IN thromboembolic disease, deep venous thrombosis, post-thrombotic syndrome The Use of
compression therapy, compression stockings
As Treatment, Chronic
Is better Than
no intervention
To reduce the incidence of post-thrombotic syndrome: RR 0.62, but no clear reduction in the incidence of severe PTS. Low-quality evidence because heterogeneity
N Engl J Med. 2006 Jun 15;354(24):2564-75. Epub 2006 May 21 Randomized Controlled Trial, Multicenter Study
IN acute respiratory distress syndrome, acute lung injury, adults The Use of
fluid restriction
As Treatment, Acute
Is better Than
liberal fluid administration
To improve oxygenation index and shorten the duration of mechanical ventilation (15.9 days restriction VS 13.4 liberal) But not to reduce mortality at 60 days (25.5% restriction VS 28.4% liberal, p .30)
Lancet. 2018 Apr 28;391(10131):1693-1705 Systematic Review
IN acutely ill adults, emergency care The Use of
conservative oxygen therapy with a SpO2 of 94-96% as objective
As Treatment, Acute
Is better Than
liberal oxygen therapy, with SpO2 > 96%
To reduce overall mortality at 30 days and longuer: liberal oxygen therapy increased mortality (RR 1.14 at 30 days)
J Intern Med. 2017 May 4. doi: 10.1111/joim.12627. [Epub ahead of print] Cohorts
IN ageing, maximum lifespan The Use of
length of life of centenarian people
As Undefined
Is useful Than
no comparison here
To mortality reaches a plateau at particularly old ages: 50% at 103 years old, with no improvement amongst centenarians in the past 30 years. Rise in life expectancy is driven by reductions in mortality below the age of 100.
Cell. 2013 Jun 6;153(6):1194-217 Review (Narrative)
IN aging The Use of
nine tentative hallmarks: genomic instability, telomere attrition, epigenetic alterations, loss of proteostasis, deregulated nutrient sensing, mitochondrial dysfunction, cellular senescence, stem cell exhaustion, and altered intercellular communication
As Etiologic risk factor
Is useful Than
no comparison here
To help understand and study aging
JAMA. 2008 Jan 2;299(1):39-52 Randomized Controlled Trial
IN aging, hormonal decline The Use of
testosterone supplementation
As Treatment, Chronic
Is equal Than
placebo
To modify at 6 months functional mobility, muscle strength, cognitive function or bone mineral density. Lean body mass increased and metabolic effects were mixed.
PLoS One. 2015;10(7):e0132909 Cohorts
IN aging, pathological, old people, multimobidity patterns The Use of
four multimorbidity patterns: Cardiovascular, Induced Dependency (around cognitive decline and dementia), Falls and Osteoarticular
As Etiologic risk factor
Is useful Than
no comparison done
To identify diseases and/or geriatric syndromes that cluster into patterns
N Engl J Med. 2017 06 29;376(26):2513-2522 Cohorts
IN air pollution, overall mortality The Use of
air pollution: fine particulate matter (particles with a mass median aerodynamic diameter of less than 2.5 μm [PM2.5]) and ozone
As Etiologic risk factor
Is useful Than
no or lower pollution
To predict overall mrotality in populations affected: Increases of 10 μg/m3 in PM2.5 and of 10 ppb in ozone were associated with (relative) increases in all-cause mortality of 7.3% and 1.1% respectively
BMJ. 1998 Dec 12;317:1624-1629 Meta-Analysis
IN allergic rinitis The Use of
intranasal corticosteroids
As Treatment, Acute
Is better Than
oral H1 receptor antagonists, antihistaminics
To greater relief of nasal blockage and total nasal symptoms
N Engl J Med. 2007 Jun 7;356(23):2361-71 Cohorts
IN amyloidosis, AA type, associated to chronic inflammatory disorders The Use of
serum amyloid A (SAA) concentration during follow-up
As Prognostic Item
Is useful Than
-
To predict long term evolution: renal dysfunction - which was the predominant disease manifestation - and mortality if SAA was low-normal (< 4 mg)
N Engl J Med. 2007 Jun 7;356(23):2349-60 Randomized Controlled Trial
IN amyloidosis, AA type, associated to chronic inflammatory disorders The Use of
eprodisate, interfere with interactions between amyloidogenic proteins and glycosaminoglycans
As Treatment, Chronic
Is better Than
placebo
To reduce at 2 years progression of renal failure: 27% eprodisate VS 40% placebo.
BMJ. 2015 Mar 24;350(350):h1354 Systematic Review
IN anemia, acute, bleeding or not The Use of
a restrictive transfusion strategy
As Treatment, Acute
Is equal Than
a liberal transfusion strategy
To modify the risk of death, overall morbidity or myocardial infarction, while using less blood cells units per patient
Ann Intern Med. 2012 Jul 3;157(1):49-5 Consensus, Guideline
IN anemia, red blood cells transfusion The Use of
a restrictive transfusion strategy in stable patients: 7 to 8 g/dL, 8 g/dL or symptoms when preexisting cardiovascular disease. No data for acute coronary syndrom
As Treatment, Acute
Is better Than
a more liberal transfusion strategy
To use more effectively red blood cells transfusions
Am J Med. 2008 Apr;121(4):324-331.e6 Systematic Review
IN ankle sprain, lateral The Use of
long-term clinical course
As Prognostic Item
Is useful Than
no comparison here
To know that 5 to 33% of patients still had pain at 1 year, and 5-25% staill at 3 years. Instability and re-sprain were also frequent: 3-34% of patients.
Chest. 2007 Oct;132(4):1131-9 Meta-Analysis
IN anticoagulants, heparins, low molecular weight heparins, unfractionated heparin The Use of
low molecular weight heparins
As Treatment, Acute
Is equal Than
unfractionated heparin
To risk of thrombocytopenia: 1.2% with LMWH VS 1.5% with UH. Severe heparin-induced thrombocytopenia with thrombosis was too low to make an adequate comparison.
Gastroenterology. 2013 Jul;145(1):105-112.e15 Systematic Review
IN anticoagulants, oral direct thrombin inhibitors, dabigatran, oral factor Xa inhibitors, apixaban, rivaroxaban, edoxaban The Use of
these direct oral anticoagulants
As Treatment, Chronic
Is worse Than
warfarin
To cause a higher risk of gastrointestinal bleeding: OR 1.58 dabigatran, 1.48 rivaroxaban, 1.23 apixaban (non-significant), 0.31 edoxaban (non-significant for superiority)
Stroke. 2017 Sep;48(9):2494-2503 Cohorts
IN anticoagulants, oral direct thrombin inhibitors, dabigatran, oral factor Xa inhibitors, apixaban, rivaroxaban, real-world data The Use of
these direct oral anticoagulants
As Treatment, Chronic
Is better Than
warfarin
To reduce mortality (for dabigatran and apixaban (HR 0.65 both)), achieve similar rate of ischemic stroke or embolism, reduce intracranial bleeding (all 3 drugs, HR 0.40 to 0.65) but increasing gastrointestinal bleeding (except apixaban)
N Engl J Med. 2015 Aug 6;373(6):511-20 Cohorts
IN anticoagulants, oral direct thrombin inhibitors, dabigatran, patients who had serious bleeding or required an urgent procedure The Use of
idarucizumab, an dabigatran-specific antibody fragment
As Treatment, Acute
Is better Than
no comparison done
To normalize hemostasis tests in 88 to 98% of the patients in minutes. One thrombotic event occurred within 72 hours after idarucizumab administration.
N Engl J Med. 2016 Aug 30;(): Clinical Trial (non-controlled, non-randomized)
IN anticoagulants, oral factor Xa inhibitors, apixaban, rivaroxaban, patients with acute major bleeding The Use of
andexanet alfa, a recombinant modified human factor Xa decoy protein, IV bolus and subsequent 2-hour infusion
As Treatment, Acute
Is good Than
no comparison group
To quickly reduce anti-factor Xa activity after administration (90% reduction) and achieve effective clinical hemostasis at 12h (79% of patients). However, thrombotic events in 18% patients at 30-day follow-up.
Am J Med. 2012 Nov;125(11):1095-102 Cohorts
IN anticoagulants, oral, vitamin K antagonists, novel anticoagulants The Use of
seven different scoring systems
As Etiologic risk factor
Is equal Than
physician, subjective assessment
To predict the risk of major bleeding at 12 months (6.8% globally) : c-statistics ranged 0.54 to 0.61
Arch Intern Med. 2000 Feb 28;160(4):470-8 Cohorts
IN anticoagulants, vitamin K antagonists The Use of
age > 75 years
As Prognostic Item
Is useful Than
-
To predict bleeding rate (9.9% elders VS 6.6% youngs)
Arch Intern Med. 2010 Sep 13;170(16):1433-41 Cohorts
IN anticoagulants, vitamin K antagonists, antiplatelet drugs, aspirin, clopidogrel, bleeding risk The Use of
aspirin and/or clopidogrel associated to warfarin
As Treatment, Chronic
Is worse Than
warfarin alone
To risk of fatal and nonfatal bleeding: 14% per patient-year with warfarin plus clopidogrel, 16% with warfarin plus aspirin plus clopidogrel
Circulation. 2012 Sep 4;126(10):1185-93 Cohorts
IN anticoagulants, vitamin K antagonists, antiplatelet drugs, aspirin, clopidogrel, bleeding risk The Use of
vitamin K antagonist (VKA) +aspirin +clopidogrel
As Treatment, Chronic
Is worse Than
vitamin K antagonist +1 antiplatelet, or dual antiplatelet therapy with aspirin +clopidogrel
To cause bleeding events, specially in the first 30-90 days: 23 events per 100 person-years with triple therapy, 20 with VKA +1 antiplatelet, 14 with dual antiplatelet. Triple therapy was not more effective than VKA +1 antiplatelet
Am J Med. 2010 Jul;123(7):638-645.e4 Systematic Review
IN anticoagulants, vitamin K antagonists, atrial fibrillation The Use of
frequency of use of anticoagulants, vitamin K antagonists
As Treatment, Chronic
Is worse Than
frequency of use recommended by guidelines
To oral anticoagulants are largely underused in patients with AF and previous AIT or stroke (<70% patients anticoagulated in 25/29 studies, range 19-81%)) or CHADS2 > 2 (<70% patients anticoagulated in 7/9 studies, range 39-92%)
N Engl J Med. 2015 Aug 27;373(9):823-33 Randomized Controlled Trial, Multicenter Study
IN anticoagulants, vitamin K antagonists, atrial fibrillation, periprocedure interruption of anticoagulation The Use of
no bridging anticoagulation, just stopping warfarin 5 days before the procedure and resuming it within 24 hours afterwards
As Treatment, Acute
Is better Than
bridging anticoagulation with full-dose low-molecular-weight heparin (LMWH)
To avoid major bleeding (1.3% just stop Vs 3.2% bridging) while having similar incidence of arterial thromboembolism (0.4% just stop VS 0.3% bridging)
Arch Intern Med. 2004 Oct 11;164(18):2044-50 Cohorts
IN anticoagulants, vitamin K antagonists, bleeding risk, elder patients The Use of
insufficient therapeutic education, polypharmacy, and INR above therapeutic range
As Etiologic risk factor
Is useful Than
no comparison done
To predict increase risk of bleeding: insufficient education ([OR, 8.83), polypharmacy (OR, 6.14), and INR above range (OR 1.08). Low rate of major bleeding despite frequent comobidities and cognitive impairment: 2.4 events per 1000 patient-months
J Thromb Haemost. 2016 Sep;14(9):1715-24 Cohorts
IN anticoagulants, vitamin K antagonists, bleeding risk, elder patients The Use of
Any of 3 most commonly employed scores: HAS-BLED, ATRIA and HEMORR2 HAGES
As Prognostic Item
Is bad Than
no comparison here
To predict major bleeding: All three scores were associated with major bleeding in the elderly, but had poor predictive abilities: C-statistics < 0.60 all. Only 2 (anemia and antiplatelet therapy) of the classical risk factors were associated with bleeding
J Am Coll Cardiol. 2011 Jan 11;57(2):173-80 Cohorts
IN anticoagulants, vitamin K antagonists, bleeding risk, elder patients The Use of
HAS-BLED score: Hypertension, Abnormal Renal/Liver Function, Stroke, Bleeding History or Predisposition, Labile INR, Elderly, Drugs/Alcohol Concomitantly (1 point each, 0 = low risk, 1-2 = moderate, >=3 = high risk)
As Prognostic Item
Is better Than
other available scores
To predict risk of major haemorrhage under chronic warfarin: low risk 0.9% per patient-year, moderate 3.7%, high 6.7%.
J Gen Intern Med. 2005 Nov;20(11):1008-13 Cohorts
IN anticoagulants, vitamin K antagonists, bleeding risk, elder patients The Use of
outpatient bleeding risk index (BRI): 1 point for: age>65, history of stroke, history gastrointestinal bleeding, any of following (diabetes, recent myocardial infartion, anemia, creat>1.5mg/L)
As Prognostic Item
Is useful Than
intuitive assesment of bleeding risk
To predict risk of major haemorrhage under chronic warfarin: high-risk 10.6% per patient-year, intermediate 2.5%, and low-risk only 0.8% per year.
Lancet. 2016 Jun 04;387(10035):2302-2311 Randomized Controlled Trial, Multicenter Study
IN anticoagulants, vitamin K antagonists, direct oral anticoagulants, bleeding risk The Use of
a new bleeding risk score : ABC-bleeding : age, previous bleeding, haemoglobin, high-sensitivity cardiac troponin T and growth differentiation factor-15 (GDF-15)
As Prognostic Item
Is better Than
other bleeding risk scores, HAS-BLED, ORBIT
To predict the risk of major bleeding at 1 year for patients on warfarin, apixaban or dabigatran
Ann Intern Med. 2009 Mar 3;150(5):293-300 Randomized Controlled Trial, Multicenter Study
IN anticoagulants, vitamin K antagonists, excessive anticoagulation, without major bleeding The Use of
low dose oral vitamin K (1.25mg)
As Treatment, Acute
Is equal Than
placebo
To reduce any bleeding (15.8% vit VS 16.3% placebo) or major bleedings (2.5 % vit K VS 1.1% placebo)
Arch Intern Med. 2003 Nov 10;163(20):2469-73 Randomized Controlled Trial
IN anticoagulants, vitamin K antagonists, excessive anticoagulation, without major bleeding The Use of
oral vitamin K1 (2.5mg if INR 6-10, 5mg if INR > 10)
As Treatment, Acute
Is equal Than
intravenous vitamin K1 (0.5mg if INR 6-10, 1mg if INR > 10)
To correct INR: response to intravenous phytonadione was more rapid at 6 and 12 hours, but at 24 hours INR values were similar for both groups and more patients in the IV group were overcorrected (INR < 2: 8.7% in PO group VS 29% in IV group)
Lancet. 2006 Feb 4;367(9508):404-11 Meta-Analysis
IN anticoagulants, vitamin K antagonists, monitoring The Use of
patient self-monitoring of anticoagulation
As Dosage Scheme
Is better Than
standard monitoring by a health professional
To reduce thromboembolic events (OR 0.45, NNT aprox 38), all-cause mortality (OR 0.61, NNT aprox 67), and major haemorrhage (OR 0.65, NNT aprox 67)
Ann Intern Med. 2011 Apr 5;154(7):472-82 Meta-Analysis
IN anticoagulants, vitamin K antagonists, monitoring The Use of
patient self-monitoring of anticoagulation, with or without self-management
As Dosage Scheme
Is better Than
usual care and monitoring by a health professional
To reduce thromboembolic events (OR 0.58) and total mortality (OR 0.74), with no excess of major bleedings (OR 0.89)
BMJ. 2002 Nov 9;325(7372):1073-5 Descriptive
IN anticoagulants, vitamin K antagonists, monitoring The Use of
INR values in excess
As Prognostic Item
Is useful Than
No control
To hight INRs are associated with an excess mortality. With an increase of 1 unit of INR above 2.5, the risks of death from cerebral bleeding (149 deaths / 42 451 patients) and from any cause were about doubled
N Engl J Med. 2008 Mar 6;358(10):999-1008 Descriptive
IN anticoagulants, vitamin K antagonists, warfarin The Use of
genetic variants of vitamin K epoxide reductase (VKORC1), the target of warfarin
As Diagnostic Tool
Is better Than
genetic variants of cytochrome P-450 2C9 (CYP2C9), which metabolises warfarin
To predict the time to the first INR within the therapeutic range or in excess
Circulation. 2007 Nov 27;116(22):2563-70 Randomized Controlled Trial
IN anticoagulants, vitamin K antagonists, warfarin The Use of
pharmacogenetic guided dosing, using CYP2C9 and VKORC1 genotype
As Dosage Scheme
Is equal Than
standard empirical dosing
To reduce time of out-of-range INR (31% genotyping VS 33% standard) or proportion of patients reaching therapeutic INR at day 5 or 8.
J Am Coll Cardiol. 2011 Feb 1;57(5):612-8 Cohorts
IN anticoagulants, vitamin K antagonists, warfarin The Use of
pharmacogenetic guided dosing, using CYP2C9 and VKORC1 genotype, combined with clinical information in a formal algorithm
As Dosage Scheme
Is better Than
methods using only clinical information (empiric or a formal clinical algorithm), or methods using only genetic data
To improve the proportion of patients whose predicted doses were within 20% of their actual therapeutic doses: 52% pharmacogenetic algorithm, 43% genetic data, 39% clinical algorithm, 37% empiric dosing.
N Engl J Med. 2005 Jun 2;352(22):2285-93 Clinical Trial (non-controlled, non-randomized)
IN anticoagulants, vitamin K antagonists, warfarin The Use of
vitamin K epoxide reductase complex 1 (VKORC1) haplotipes
As Dosage Scheme
Is useful Than
no comparison here
To stratify patients into low-, intermediate-, and high-dose warfarin groups
N Engl J Med. 2013 Dec 12;369(24):2283-93 Randomized Controlled Trial, Multicenter Study
IN anticoagulants, vitamin K antagonists, warfarin The Use of
pharmacogenetic guided dosing, a dosing algorithm that included both clinical variables and genotype data
As Treatment, Acute
Is equal Than
a dosing algorithm that included only clinical variables
To modify the percentage of time that the INR was in the therapeutic range from day 4 through day 28 of therapy
N Engl J Med. 2013 Dec 12;369(24):2294-303 Study type to be defined
IN anticoagulants, vitamin K antagonists, warfarin The Use of
pharmacogenetic guided dosing, using CYP2C9 and VKORC1 genotype, combined with clinical information in an algorithm
As Treatment, Acute
Is better Than
standard empirical dosing of warfarin
To improve the percentage of time that the INR was in the therapeutic range in the first 12 weeks after initiation of therapy: 67% with pharmacogenetics VS 60% clinical
Ann Intern Med. 2003 May 6;138(9):714-9 Randomized Controlled Trial
IN anticoagulants, vitamin K antagonists, warfarin, thromboembolic disease The Use of
higher starting dose: 10 mg/day
As Treatment, Acute
Is better Than
usual starting dose: 5 mg/day
To reduce time to achieve therapeutic INR at day 5 (83% with 10mg VS 46% with 5mg, overall reduction by 1.5 days). No significant differences in major bleeding, coagulation excess (INR > 5.0), recurrent events and survival.
N Engl J Med. 2006 Jun 8;354(23):2443-51 Cohorts
IN antihypertensive drugs, angiotensin converting enzyme (ACE) inhibitors, adverse effects, congenital malformations The Use of
angiotensin converting enzyme (ACE) inhibitors during pregnancy, first trimester
As Treatment, Chronic
Is worse Than
other antihypertensive drugs
To increase the risk of major congenital malformations (RR, 2.71; 95 %CI, 1.72 to 4.27) as compared with no exposure to antihypertensive medications.
Clin Infect Dis. 1997;24(5):796-809 Meta-Analysis
IN antimicrobials, aminoglycosides The Use of
once-a-day dosing aminoglycosides
As Dosage Scheme
Is Than
To
Clin Infect Dis. 1997;24(5):786-795 Meta-Analysis
IN antimicrobials, aminoglycosides The Use of
once-a-day dosing aminoglycosides
As Dosage Scheme
Is Than
To
BMJ. 1996;312:338-345 Meta-Analysis
IN antimicrobials, aminoglycosides The Use of
once-a-day dosing aminoglycosides
As Dosage Scheme
Is Than
To
Am J Med. 1998 Sep; 105(3):182-91 Randomized Controlled Trial
IN antimicrobials, aminoglycosides The Use of
once-a-day dosing, gentamicin
As Dosage Scheme Scheme
Is better Than
three-times-a-day dosing
To avoid renal toxicity, with equal clinical or microbiologic efficacy
Lancet. 2017 07 29;390(10093):490-499 Cohorts
IN antiplatelet drugs, aspirin, bleeding risk The Use of
any anitplatelet drug, mainly aspirin (95% of included patients)
As Treatment, Chronic
Is worse Than
no antipaltelet therapy
To increase the risk of bleeding. Bleeding rate increased with age from 70 years on, specially major and life-threatening bleeding. Localizations, by frequency: gastrointestinal, genitourinary, intracranial, epistaxis, others
Arch Intern Med. 2010 Feb 22;170(4):321-31 Systematic Review
IN anxiety symptoms, patients with a chronic illness The Use of
exercise training
As Treatment, Chronic
Is better Than
no training
To to modestly improve anxiety symptoms: mean effect Delta 0.29
Arch Intern Med. 2006 Jul 10;166(13):1350-6 Systematic Review
IN aortic dissection, thoracic The Use of
transesophageal echocardiography, helical computed tomography (CT), and magnetic resonance imaging (IRM)
As Diagnostic Tool
Is equal Than
reference gold standard (angiography)
To diagnose this condition: sensitivity (98%-100%) and specificity (95%-98%) were comparable between all 3 imaging techniques. LR+ was some better for IRM (24) than for echography or CT (14) but without major clinical implications.
JAMA. 2007 Apr 4;297(13):1478-88 Systematic Review
IN arthritis, acute, septic The Use of
synovial fluid white blood cell count > 50.000/mcl and polymorphonuclear count > 90%
As Diagnostic Tool
Is better Than
any clinical sign or smptom
To diagnose septic arthritis: respective LR+ of 7,7 and 3,4
JAMA. 2008 Mar 12;299(10):1166-78 Systematic Review
IN ascitis, portal hypertension, liver failure, spontaneous bacterial peritonitis The Use of
1) bedside inoculation of ascitic fluid into blood culture bottles and PMN count >250 cells/microL; 2) serum-ascites albumin gradient < 1.1 g/dL
As Diagnostic Tool
Is useful Than
no comparison
To diagnose: 1) spontaneous bacterial peritonitis (LR+ 9); 2) portal hypertension as ascitis cause (LR- 0.06)
N Engl J Med. 1998 Oct 22;339(17):1194-200 Cohorts
IN asthma The Use of
natural history, follow-up of ventilatory function, FEV1
As Prognostic Item
Is useful Than
-
To Among both men and women, smokers and nonsmokers, subjects with asthma had greater declines in FEV1 over time (38 ml per year) than those without asthma (22 ml per year)
N Engl J Med. 2007 May 17;356(20):2040-52 Randomized Controlled Trial, Multicenter Study
IN asthma The Use of
combination of inhaled corticosteroids and long-acting beta2-agonists (beclomethasone, albuterol) as on-demand reliever Tt
As Treatment, Chronic
Is better Than
only short-acting b2-agonists on-demand
To reduce at 6 months number of exacerbations (numbers not stated in abstract). But it was NOT better than regular inhaled corticoids plus on-demand or than regular combined treatment
Am J Respir Crit Care Med. 2005 Jan 15;171(2):129-36 Randomized Controlled Trial
IN asthma The Use of
combination of inhaled corticosteroids and long-acting beta2-agonists (budesonide, formoterol) as on-demand reliever Tt
As Treatment, Chronic
Is better Than
inhaled short-acting beta2-agonist as on-demand reliever Tt
To lower exacerbation risk (hazard ratio, 0.55), prolonged the time to the first exacerbation requiring medical intervention and improve symptoms.
Lancet. 2000 May 13;355(9216):1675-79 Randomized Controlled Trial
IN asthma The Use of
inhaled beta2 agonist, long-term fixed regular use
As Treatment, Chronic
Is better Than
placebo and inhaled beta2 agonist, as needed
To improving diurnal peak expiratory flow. No differences in the annual rate, timing, or duration of exacerbations.
Chest. 1999 Sept;116(3):595-602 Randomized Controlled Trial
IN asthma The Use of
inhaled beta2 agonist, long-term fixed regular use
As Treatment, Chronic
Is better Than
placebo and inhaled beta2 agonist, as needed
To improving FEV1 and symptoms. No differences in the annual rate, timing, or duration of exacerbations.
Am J Med. 2010 Apr;123(4):322-8.e2 Meta-Analysis
IN asthma The Use of
inhaled long-acting beta2 agonist, long-term regular use
As Treatment, Chronic
Is worse Than
placebo or inhaled corticosteroids alone
To prevent asthma-related intubation or death: they increase the risk by 2 folds OR 2.10
Ann Intern Med. 2006 Jun 20;144(12):904-12. Epub 2006 Jun 5 Meta-Analysis
IN asthma The Use of
inhaled long-acting beta2-agonists
As Treatment, Chronic
Is worse Than
placebo
To prevent exacerbations: they increased hospitalisations by asthma exacerbation (OR, 2.6; absolute increase 0.7%) and life-threatening exacerbations (OR, 1.8)
Chest. 2006 Jan;129(1):15-26 Randomized Controlled Trial, Multicenter Study
IN asthma The Use of
inhaled short-acting beta2-agonist (salmeterol) as on-demand reliever Tt, added to usual treatment
As Treatment, Chronic
Is worse Than
placebo
To reduce, at 28 weeks, respiratory-related deaths (0.2% salbutamol VS 0.1% placebo)
Ann Intern Med. 2015 Sep 22; doi: 10.7326/M15-1059 [Epub ahead of print] Systematic Review
IN asthma The Use of
leukotriene antagonists
As Treatment, Chronic
Is better Than
placebo
To reduce the risk of exacerbations (RR 0.60) and increase FEV1. In 4 trials employed as add-on therapy to inhaled corticosteroids, the RR for exacerbation was 0.80 (CI, 0.60 to 1.07)
Am J Respir Crit Care Med. 2005 Jun 1;171(11):1231-6 Randomized Controlled Trial
IN asthma, acute exacerbation The Use of
corticosteroids, inhaled, fluticasone
As Treatment, Acute
Is better Than
parenteral IV corticosteroids
To improve PEF and FEV1 (30 to 46% more improvement with inhaled VS. IV corticosteroids) and reduce hospital admisions - all at 3 hours (very short term)
JAMA. 1999 Jun 9;281(22):2119-26 Randomized Controlled Trial
IN asthma, acute exacerbation The Use of
corticosteroids, inhaled, high dose, budesonide
As Treatment, Acute
Is better Than
placebo
To reducing symptoms and relapses, as unscheduled visits to physician, but not overall low rate of hospitalization. Improving quality of life.
BMJ. 1998 Oct 10;317:971-977 Meta-Analysis
IN asthma, acute exacerbation The Use of
inhaled anticholinergics added to inhaled beta-agonists
As Treatment, Acute
Is better Than
inhaled beta-agonists alone
To reduce the risk of hospital admission by 30% (RR 0.72, NNT 11) in children and adolescents with severe exacerbations
Am J Med. 1999 Oct;107:363-70 Meta-Analysis
IN asthma, acute exacerbation The Use of
inhaled anticholinergics added to inhaled beta-agonists
As Treatment, Acute
Is better Than
inhaled beta-agonists alone
To reducing hospitalization rate
N Engl J Med. 2012 Sep 2. [Epub ahead of print] Randomized Controlled Trial, Multicenter Study
IN asthma, persistent despite treatment with inhaled glucocorticoids and long-acting beta-agonists The Use of
inhaled long-acting anticholinergics, tiotropium
As Treatment, Chronic
Is better Than
placebo
To increase time to the first severe exacerbation (282 days vs. 226 days), and reduce risk of severe exacerbation (HR, 0.79). No deaths. Patients with cardiac disease were excluded: safety of tiotropium there?
N Engl J Med. 2005 Apr 14;352(15):1519-28 Randomized Controlled Trial
IN asthma, persistent, mild The Use of
as-needed corticosteroids, intermittent short-courses of inhaled or oral corticosteroids
As Treatment, Chronic
Is equal Than
as-needed inhaled corticoisteroids added to either daily inhaled corticosteroids or oral zafirlukast
To improve rate of asthma exacerbations or quality of life, taking much lesser doses of corticosteroids
Cochrane Database Syst Rev. 2013;2:CD009611 Systematic Review, Cochrane Review
IN asthma, persistent, mild The Use of
intermitent, as needed inhaled corticosteroids
As Treatment, Chronic
Is equal Than
daily inhaled corticosteroids, continuous
To modify the number of exacerbations, adverse effects, hospitalisations, emergency department visits or quality of life. In children, daily corticosteroid were associated with some lesser growth
N Engl J Med. 2011 May 5;364(18):1695-707 Randomized Controlled Trial
IN asthma, persistent, mild The Use of
leukotriene antagonists
As Treatment, Chronic
Is equal Than
inhaled glucocorticoid for first-line asthma-controller therapy, or a long-acting beta(2)-agonist as add-on therapy
To improve asthma-related quality of life at 2 months (MiniAQLQ score improvement of about 1 point) but not at 2 years (-0.11 points for leukotriene antag).
N Engl J Med. 2007 May 17;356(20):2027-39 Randomized Controlled Trial, Multicenter Study
IN asthma, persistent, mild The Use of
once daily inhaled corticosteroids
As Treatment, Chronic
Is better Than
leukotriene antagonist, once daily monlelukast
To reduce, at 4 months, treatment failure (20% inhaled corticoids VS 30% montelukast)
N Engl J Med. 2016 Sep;375(9):850-860 Randomized Controlled Trial, Multicenter Study
IN asthma, persistent, moderate to severe The Use of
long-acting beta(2)-agonists, formoterol added to inhaled corticoisteroids, budesonide
As Treatment, Chronic
Is better Than
inhaled corticoisteroids, budesonide alone
To reduce the number of exacerbations (HR 0.8) while not modifying the number of serious asthma-related events (<1%)
JAMA. 2013 Mar 27;309(12):1278-88 Systematic Review
IN asthma, rhinoconjunctivitis, allergic The Use of
sublingual immunotherapy
As Treatment, Chronic
Is better Than
placebo
To improves asthma symptoms (8 of 13 studies reported > 40% improvement)
Chest. 1998 Nov;114(5):349-1356 Clinical Trial (non-controlled, non-randomized)
IN asthma, severe, steroid dependent The Use of
IV immunoglobulin
As Treatment, Chronic
Is useful Than
no control
To reducing oral steroid requirements and steroid side effects
Lancet. 2004 Oct 23;364(9444):1505-12 Randomized Controlled Trial, Multicenter Study
IN asthma, treatment resistance The Use of
a genetic polymorphism of the beta2-adrenergic receptor (Arg/Arg homocygote at residue 16)
As Prognostic Item
Is useful Than
-
To induce resistence to or inversion of the bronchodilator effects of inhaled beta-2 agonists.
JAMA. 2006 Feb 8;295(6):655-66 Randomized Controlled Trial, Multicenter Study
IN atherosclerosis, cardiovascular disease, primary prevention The Use of
intensive dietary intervention to reduce fat intake and increased intakes of vegetables, fruits, and grains
As Prevention, Primary
Is equal Than
providing diet-related education materials
To reduce at 8 years coronary heart disease (0.64% both groups), stroke (0.27%), in spite of mild reductions in fat intake and blood lipids
Cochrane Database Syst Rev. 2012;5:CD002137 Systematic Review, Cochrane Review
IN atherosclerosis, cardiovascular disease, primary prevention The Use of
reduction of dietary saturated fat by partially replacing by unsaturatef fats
As Prevention, Primary
Is better Than
no modification of diet
To modestly reduce cardiovascular events (RR 0.86) but not to reduce total or cardiovascular mortality
Cochrane Database Syst Rev. 2013;1:CD004816 Systematic Review, Cochrane Review
IN atherosclerosis, cardiovascular disease, primary prevention The Use of
statins
As Prevention, Primary
Is better Than
placebo
To reduce all cause mortality (OR 0,86), and cardiovascilar death and events (OR 0,73 to 0,78), after at least 1 year of treatment
N Engl J Med. 2018 Aug 26. doi: 10.1056/NEJMoa1804988. [Epub ahead of print] Randomized Controlled Trial, Multicenter Study
IN atherosclerosis, cardiovascular disease, primary prevention, high risk patients, diabetes mellitus, type 2 The Use of
aspirin, 100 mg daily
As Treatment, Chronic
Is better Than
placebo
To reduce at 7.4 years cardiovascular events (8.5% VS 9.5% placebo), but it increased major bleeding (4% aspirin VS 3% placebo), most of the excess being gastrointestinal bleeding and other extracranial bleeding.
BMJ. 2014;349(iss):g4379 Meta-Analysis
IN atherosclerosis, cardiovascular disease, primary prevention, high risk patients, high cholesterol The Use of
drug treatments targeted to increase high density lipoprotein: niacin, fibrates, and cholesteryl ester transfer protein (CETP) inhibitors
As Prevention, Primary
Is equal Than
placebo or no treatment
To modify cardiovascular events (all cause mortality, coronary heart disease mortality, non-fatal myocardial infarction, and stroke)
JAMA. 2014 Sep 17;312(11):1136-44 Systematic Review
IN atherosclerosis, cardiovascular disease, primary prevention, high risk patients, high cholesterol, older patients The Use of
statins
As Prevention, Primary
Is undefined Than
no statin treatment
To reduce cardiovascular events. No RCT in patients older than 80 years was found
Lancet. 2002 Nov 23;360(9346):1623-30 Randomized Controlled Trial, Multicenter Study
IN atherosclerosis, cardiovascular disease, primary prevention, high risk patients, high cholesterol, older patients The Use of
statins, pravastatin 40 mg/d
As Prevention, Primary
Is better Than
placebo
To to reduce at 3 years cardiovascular events: 14% pravastatine VS 16% placebo. Reduction was due to reduction in non-fatal myocardial infaction, no significant difference in stroke and death
J Am Coll Cardiol. 2013 Dec 3;62(22):2090-9 Meta-Analysis
IN atherosclerosis, cardiovascular disease, primary prevention, high risk patients, older patients The Use of
statins
As Prevention, Primary
Is better Than
placebo
To reduce myocardial infarction (RR 0.60) and stroke (RR 0.76) but it did not reduced mortality (either total or cardiovascular)
N Engl J Med. 2016 May 26;374(21):2021-31 Randomized Controlled Trial, Multicenter Study
IN atherosclerosis, cardiovascular disease, primary prevention, intermediate risk patients, normal or high cholesterol The Use of
statins, rosuvastatin 10 mg/day for > 5 years
As Prevention, Primary
Is better Than
placebo
To reduce cardiovascular events (cardiovascular death, nonfatal myocardial infarction or stroke) at 5.6 years: 3.7% rosuvastatin VS 4.8% placebo. No difference in mortality: 2.8-2.9% both. Muscle symptoms in 5.8% of patients on rosuvastatin.
JAMA Intern Med. 2017 Jul 01;177(7):955-965 Randomized Controlled Trial, Multicenter Study
IN atherosclerosis, cardiovascular disease, primary prevention, low to moderate risk patients, older patients The Use of
statin, pravastatin, 40 mg/d
As Prevention, Primary
Is equal Than
usual care
To modify, after 6 years, mortality or coronary disease
N Engl J Med. 2008 Nov 20;359(21):2195-207 Randomized Controlled Trial, Multicenter Study
IN atherosclerosis, cardiovascular disease, primary prevention, normal cholesterol, elevated C-reactive protein The Use of
statins, rosuvastatin
As Prevention, Primary
Is better Than
placebo
To reduce the incidence of major cardiovascular events at 2 years: 0.77% per year statin VS 1.4% per year placebo.
Cochrane Database Syst Rev. 2018 07 18;7:CD003177 Systematic Review, Cochrane Review
IN atherosclerosis, cardiovascular disease, primary prevention, secondary prevention The Use of
omega-3 fatty acids
As Treatment, Chronic
Is equal Than
placebo
To polyunsaturated fatty acids from oily fish had little or no effect on mortality or cardiovascular health (high-quality evidence). Alpha-linolenic acid from plants may slightly reduce CVD events and mortality (low-quality evidence)
J Am Coll Cardiol. 2002 Oct 16;40(8):1408-13 Cohorts
IN atherosclerosis, coronary disease, ischemic stroke The Use of
chronic infections, sropositivity to helicobacter pylori, clamidia pneumoniae, citomegalovirus
As Prognostic Item
Is useless Than
-
To predict risk for cardiovascular disease
J Am Coll Cardiol. 2005 Nov 15;46(10):1855-62. Epub 2005 Oct 24 Meta-Analysis
IN atherosclerosis, coronary disease, ischemic stroke, high or normal cholesterol The Use of
statins
As Treatment, Chronic
Is equal Than
interventions to primarily lower LDL cholesterol, if equal reduction
To The regression lines for non-statin and statin trials were similar and consistent with a one-to-one relationship between LDL-cholesterol lowering and coronary disease and stroke reduction.
Lancet. 2005 Oct 8;366(9493):1267-78. Epub 2005 Sep 27 Meta-Analysis
IN atherosclerosis, coronary disease, ischemic stroke, high or normal cholesterol The Use of
statins
As Treatment, Chronic
Is better Than
placebo
To reduce coronary and all-cause mortality (RRR 12%), and reduce major vascular events (vascular death, infarction, revascularization or stroke): RRR 21%.
Arch Intern Med. 2007 Jun 11;167(11):1122-9 Cohorts
IN atherosclerosis, coronary disease, ischemic stroke, peripheral arterial disease The Use of
chronic kidney disease measures (anemia, microalbuminuria, and GFR of <60 mL/min)
As Etiologic risk factor
Is useful Than
added to classical vascular risk factors
To idependently predict the risk of cardiovascular disease: OR about 1.30 for each one of the 3 measures, OR 1.98 for chronic kidney disease.
BMJ. 2002 Jan 12;324(7329):71-86 Meta-Analysis
IN atherosclerosis, coronary disease, ischemic stroke, peripheral arterial disease The Use of
antiplatelet drugs, aspirin, low-dose (75-150 mg/d), adenosine diphosphate (ADP) receptor inhibitors, clopidogrel
As Treatment, Chronic
Is better Than
placebo
To reduce recurrence of ischemic coronary and cerebral events, with absolute reductions of 3 to 4%, depending on specific conditions
Ann Intern Med. 2009 Mar 17;150(6):405-10 Systematic Review
IN atherosclerosis, coronary disease, stroke, ischemic, cardiovascular death The Use of
aspirin
As Prevention, Primary
Is better Than
placebo
To reduce cardiovascular events (myocardial infarction in men and strokes in women) but not cardiovascular death or overall mortality. Aspirin use increases serious bleeding events.
Lancet. 2009 May 30;373(9678):1849-60 Meta-Analysis
IN atherosclerosis, coronary disease, stroke, ischemic, cardiovascular death The Use of
aspirin
As Prevention, Primary
Is better Than
placebo
To reduce, both as primary or secondary prevention, serious cardiovascular events but increasing major bleeding. Benefit for primary prevention was limited: 0.51% events aspirin VS 0.57% placebo, 0.10% major bleedings aspirin VS 0.07% placebo
Lancet. 1996 Nov 16;348(9038):1329-39 Randomized Controlled Trial, Multicenter Study
IN atherosclerosis, coronary disease, stroke, ischemic, peripheral arterial disease, or multiple risk factors The Use of
antiplatelet drugs, P2Y12 inhibitors, clopidogrel (75 mg/d)
As Treatment, Chronic
Is better Than
antiplatelet drugs, aspirin (325 mg/d)
To marginally reduce ischemic events (stroke, myocardial infarction or vascular death): 5.32% per year clopidogrel VS 5.83% per year aspirin, ARR 0.51% x year. Adverse effects was similar, i.e. intracraneal (0.33-0.47%) & GI bleeding (0.52-0.72%)
N Engl J Med. 2006 Apr 20;354(16):1706-17. Epub 2006 Mar 12 Randomized Controlled Trial, Multicenter Study
IN atherosclerosis, coronary disease, stroke, ischemic, peripheral arterial disease, or multiple risk factors The Use of
combined antiplatelet drugs, P2Y12 inhibitors, clopidogrel (75 mg/d) added to low-dose aspirin
As Treatment, Chronic
Is equal Than
antiplatelet drugs, low-dose aspirin (75 to 160 mg/d) alone
To reduce, at 2 years, cardiovascular events (myocardial infarction, stroke, or cardiovascular death): 6.8% clopidogrel plus aspirin VS 7.3% aspirin alone. Bleeding was not significantly different. Combined treatment worse for non-symptomatic patients
N Engl J Med. 2007 Oct 11;357(15):1477-86 Randomized Controlled Trial, Multicenter Study
IN atherosclerosis, hypercholesterolemic adults and NOT coronary disease The Use of
statins, pravastatin
As Prevention, Primary
Is better Than
placebo
To reduce death from cronory heart disease, at 5 years of treatment and 10 years after: 11.8% for the entire 15 years period with statin VS 15.5% placebo
Lancet. 2002 Jul 6;360(9326):7-22 Randomized Controlled Trial, Multicenter Study
IN atherosclerosis, normo-cholesterol adults with coronary disease, other occlusive arterial disease, or diabetes The Use of
statins, simvastatin, for 5 years
As -
Is better Than
placebo
To reduce coronary death rate (5.7% intv. / 6.9% cont.) and all-cause mortality (12.9% intv. / 14.7% cont.). Reduce major vascular events after the first year.
Lancet. 2005 Nov 26;366(9500):1849-61 Randomized Controlled Trial, Multicenter Study
IN atherosclerosis, normo-cholesterol adults with type 2 diabetes The Use of
fibrates, fenofibrate 200 mg daily
As Treatment, Chronic
Is equal Than
placebo
To prevent coronary events (combined myocardial infarction or coronary death: 5.9% with placebo VS 5.2% with fibrates) or to reduce total mortality.
J Am Coll Cardiol. 2005 Jun 7;45(11):1832-9 Meta-Analysis
IN atrial fibrillation The Use of
angiotensin converting enzyme (ACE) inhibitors or angiotensin II receptor blockers
As Prevention, Primary
Is better Than
placebo
To reduce the incidence of new onset atrial fibrillation (most cumulated studies: RRR of 28%) and reduce its recurrence after conversion (2 studies)
N Engl J Med. 2011 Mar 10;364(10):928-38 Randomized Controlled Trial, Multicenter Study
IN atrial fibrillation The Use of
angiotensin II receptor blockers, irbesartan
As Treatment, Chronic
Is equal Than
placebo
To reduce at 4 years cardiovascular events (stroke, myocardial infarction, or death): 5.4% per years in both groups. Neither it reduced AF recurrences in patients in sinus rhythm at baseline
N Engl J Med. 2011 Sep 8;365(10):883-91. Epub 2011 Aug 10 Randomized Controlled Trial, Multicenter Study
IN atrial fibrillation The Use of
anticoagulants, oral factor Xa inhibitors, rivaroxaban, 20 mg once daily
As Treatment, Chronic
Is equal Than
dose-adjusted warfarin
To reduce stroke or systemic embolism (2.1% per year rivaroxaban VS 2.4% warfarin), or cause clinically relevant bleeding, major or nonmajor (15% per year both)
Stroke. 2009 Apr;40(4):1410-6 Meta-Analysis
IN atrial fibrillation, anticoagulants, vitamin K antagonists, bleeding risk, elder patients, stroke, ischemic, cerebral infarction, embolic The Use of
age
As Etiologic risk factor
Is useful Than
-
To predict an increased risk of stroke (HR per decade 1.45), major bleeding (HR per decade 1.61) and cardiovascular events (HR per decade 1.45). However the relative benefit of warfarin for preventing stroke persisted, while that of aspirin decreased
Lancet. 2007 Aug 11;370(9586):493-503 Randomized Controlled Trial, Multicenter Study
IN atrial fibrillation, elder patients, not high haemorrahgic risk, not high stroke risk, anticoagulants, vitamin K antagonists, bleeding risk, elder patients The Use of
warfarin, antivitamin K
As Treatment, Chronic
Is better Than
aspirin
To reduce all-type strokes: 1.8% warfarin versus 3.8% aspirin. No increase at all in major haemorrhages.
N Engl J Med. 2004 Dec 2;351(23):2373-83 Clinical Trial (non-controlled, non-randomized)
IN atrial fibrillation, heart failure, non-pharmacological treatment The Use of
catheter ablation, radiofrequency
As Treatment, Acute
Is good Than
no comparison group in this trial
To restore and maintain sinus rhythm: after 12 months 70% of patients maintained SR. Improve ejection fraction in those patients with heart failure (average of plus 20% at 12 months)
N Engl J Med. 2018 02 01;378(5):417-427 Randomized Controlled Trial, Multicenter Study
IN atrial fibrillation, heart failure, reduced ejection fraction, non-pharmacological treatment The Use of
catheter ablation
As Treatment, Acute
Is better Than
medical-therapy only
To reduce mortality from any cause (13%] ablation VS 25%), hospitalization for worsening heart failure (21% ablation VS 36%) or death from cardiovascular causes (11% ablation VS 22%)
Circulation. 2007 Jun 19;115(24):3050-6 Cohorts
IN atrial fibrillation, lone (no structural heart disease) The Use of
knowing natural history
As Prognostic Item
Is useful Than
no comparison here
To predict long-term (30 years) evolution : 30% progressed to permanent AF, mortality similar to general population, heart failure and stroke more frequent than general pop. but less than other AF, linked to HTA and comorbidities.
Circulation. 2011 May 31;123(21):2363-72 Randomized Controlled Trial, Multicenter Study
IN atrial fibrillation, non valvular, anticoagulants, oral direct thrombin inhibitors, risk of bleeding, elder patients The Use of
oral direct thrombin inhibitors, dabigatran, 110 or 150 mg twice daily fixed dose
As Treatment, Chronic
Is equal Than
warfarin
To risk of major bleeding, in patients >75 years, with the 110mg dose (4.43% dabigatran VS 4.37% warfarin) but a trend to more bleedings with 150mg dose (5.1% dabigatran versus 4.4% warfarin). Both doses had less bleedings in <75 years old
Eur Heart J. 2016 May 21;37(20):1582-90 Randomized Controlled Trial, Multicenter Study
IN atrial fibrillation, non valvular, stroke, ischemic, cerebral infarction, embolic The Use of
a new stroke risk score: ABC (Age, Biomarkers, Clinical history) combining: age, NT-proBNP, high-sensitivity troponine, prior stroke/transient ischaemic attack
As Prognostic Item
Is better Than
CHA2DS2-VASc score
To better predict the risk of stroke at a mean 2 years follow-up (c-indice 0.66 ABC vs. 0.58 CHA2DS2-VASc)
Am J Cardiol. 2012 Aug 1;110(3):453-60. Epub 2012 Apr 24 Meta-Analysis
IN atrial fibrillation, non valvular, stroke, ischemic, cerebral infarction, embolic The Use of
anticoagulants, oral direct thrombin inhibitors, dabigatran, oral factor Xa inhibitors, apixaban, rivaroxaban
As Treatment, Chronic
Is better Than
anticoagulants, antivitamine K, warfarin
To decrease risk for all-cause stroke and systemic embolism (RR 0.78) and all-cause mortality (RR 0.88), while reducing risk of intracranial bleeding (RR 0.88) but not of all major bleeding
J Am Coll Cardiol. 2012 Aug 21;60(8):738-46. Epub 2012 May 9 Meta-Analysis
IN atrial fibrillation, non valvular, stroke, ischemic, cerebral infarction, embolic The Use of
anticoagulants, oral direct thrombin inhibitors, dabigatran, oral factor Xa inhibitors, apixaban, rivaroxaban
As Treatment, Chronic
Is equal Than
anticoagulants, oral direct thrombin inhibitors, dabigatran, oral factor Xa inhibitors, apixaban, rivaroxaban
To modify the risk of stroke and systemic embolism (no significant differences between drugs). Apixaban seemed to have less major bleedings than dabigatran 150mg or rivaroxaban (RR 0.74 and 0.66)
Canadian Agency for Drugs and Technologies in Health - CADTH. 2013 Mar: 1(1B); 1-142 Systematic Review
IN atrial fibrillation, non valvular, stroke, ischemic, cerebral infarction, embolic The Use of
anticoagulants, oral direct thrombin inhibitors, dabigatran, oral factor Xa inhibitors, apixaban, rivaroxaban, antiplatelet drugs, aspirin, clopidogrel
As Treatment, Chronic
Is equal Than
anticoagulants, antivitamine K, warfarin, aspirin
To modify stroke, embolism or bleedings : there are some differences in some cases but with little absolute risk reduction
Lancet. 2014 Mar 15;383(9921):955-62 Meta-Analysis
IN atrial fibrillation, non valvular, stroke, ischemic, cerebral infarction, embolic The Use of
anticoagulants, oral direct thrombin inhibitors, dabigatran, oral factor Xa inhibitors, apixaban, rivaroxaban, edoxaban
As Treatment, Chronic
Is better Than
anticoagulants, antivitamine K, warfarin
To reduce reduced stroke or embolic events (RR 0.81), mainly driven by a reduction in haemorrhagic stroke (RR 0.49). New oral anticoagulants also reduced all-cause mortality (RR 0.90) but increased gastrointestinal bleeding (RR 1.25)
N Engl J Med. 2009 Sep 17;361(12):1139-51. Epub 2009 Aug 30 Randomized Controlled Trial, Multicenter Study
IN atrial fibrillation, non valvular, stroke, ischemic, cerebral infarction, embolic The Use of
oral direct thrombin inhibitors, dabigatran, 110 or 150 mg twice daily fixed dose
As Treatment, Chronic
Is better Than
warfarin, INR adjusted dose
To reduce at 2 years ischemic strokes (1.53% - 1.11% per year 110 - 150 mg dabigatran VS 1.69% warfarin), with similar major bleedings (2.71% - 3.36% per year) and less haemorrhagic strokes (0.10% per year dabigatran VS 0.38% warfarin)
J Am Coll Cardiol. 2015 Jun 23;65(24):2614-23 Meta-Analysis
IN atrial fibrillation, non valvular, stroke, ischemic, cerebral infarction, embolic The Use of
percutaneous left atrial appendage closure
As Treatment, Chronic
Is equal Than
anticoagulants, antivitamine K, warfarin
To lodify all cause stroke or systemic embolism per year: 1.75% closure VS 1.87 warfarine. More ischemic but less hemorrhagic strokes with the device. Device had also less nonprocedural bleedings.
Cochrane Database Syst Rev. 2018 Mar 06;3:CD008980 Systematic Review, Cochrane Review
IN atrial fibrillation, non valvular, stroke, ischemic, cerebral infarction, embolic, all-cause mortality The Use of
direct oral anticoagulants, oral factor Xa inhibitors, apixaban, edoxaban, rivaroxaban, idraparinux
As Treatment, Chronic
Is better Than
oral anticoagulants, vitamin K antagonists, warfarin
To Results to be defined
Circulation. 2014 Jul 8;130(2):138-46 Randomized Controlled Trial, Multicenter Study
IN atrial fibrillation, non valvular, stroke, ischemic, cerebral infarction, embolic, older patients The Use of
anticoagulants, oral factor Xa inhibitors, rivaroxaban
As Treatment, Chronic
Is equal Than
vitamine K antagonists, warfarin
To modify, in patients > 75 years, stroke (2.29% rivaroxaban VS 2.85% warfarin per 100 patient-years) or major bleeding (4.86% rivaroxaban versus 4.40% warfarin per 100 patient-years). Older patients had more strokes and major bleedings than young ones
N Engl J Med. 2011 Mar 3;364(9):806-17. Epub 2011 Feb 10 Randomized Controlled Trial, Multicenter Study
IN atrial fibrillation, non valvular, stroke, ischemic, cerebral infarction, embolic, patients not suitable for vitamine K antagonists, warfarin The Use of
anticoagulants, oral factor Xa inhibitors, apixaban
As Treatment, Chronic
Is better Than
aspirin
To reduce stroke or systemic embolism (1.6% per year apixaban VS 3.7% aspirin) while not increasing major bleeding (1.4% per year apixaban VS 1.2% aspirin)
Ann Intern Med. 2012 Dec 4;157(11):796-807 Systematic Review
IN atrial fibrillation, non valvular, stroke, ischemic, cerebral infarction, embolic, thromboembolic disease The Use of
anticoagulants, oral direct thrombin inhibitors, dabigatran, oral factor Xa inhibitors, apixaban, rivaroxaban
As Treatment, Chronic
Is better Than
anticoagulants, antivitamine K, warfarin
To reduce mortality in atrial fibrillation (RR 0.88) but not in venous thromboembolism. Fatal bleeding was reduced (RR 0.60) but not major bleeding and bleeding risk may be increased in older people
Circulation. 2015 Jul 21;132(3):194-204 Systematic Review
IN atrial fibrillation, non valvular, stroke, ischemic, cerebral infarction, embolic, thromboembolic disease, old patients The Use of
anticoagulants, oral direct thrombin inhibitors, dabigatran, oral factor Xa inhibitors, apixaban, rivaroxaban, edoxaban
As Treatment, Chronic
Is equal Than
anticoagulants, antivitamine K, warfarin
To reduce thrombo-embolic events, but with different bleeding patterns: dabigatran was associated with a higher risk of gastrointestinal bleeding, risk of intracranial bleeding was lower, apixaban and edoxaban associated lower risk of major bleedings
Arch Intern Med. 2008 Mar 24;168(6):581-6 Systematic Review
IN atrial fibrillation, non-pharmacological treatment The Use of
catheter ablation, radiofrequency
As Treatment, Acute
Is better Than
cardioversion and chronic antiarrhythmic drugs
To reduce at 1 year recurrence of AF (24.% abalation VS 81.2% antiarrhythmics) and reduce adverse events. No other clinical outcome assessed (mortality? heart failure?)
Circ Arrhythm Electrophysiol. 2014 Oct;7(5):853-60 Systematic Review
IN atrial fibrillation, non-pharmacological treatment, selected patients The Use of
catheter ablation
As Treatment, Acute
Is better Than
cardioversion and chronic antiarrhythmic drugs
To recurrence of AF (28% ablation VS 65% antiarrhythmics), either as firts-line or second-line therapy
N Engl J Med. 2009 Apr 16;360(16):1606-17 Randomized Controlled Trial, Multicenter Study
IN atrial fibrillation, paroxysmal The Use of
angiotensin II receptor blockers (ARB), valsartan
As Prevention, Secondary
Is equal Than
placebo
To reduce recurrences of AF: 51.4% valsartan VS 52% placebo.
JAMA. 2005 Jun 1;293(21):2634-40 Randomized Controlled Trial, Multicenter Study
IN atrial fibrillation, paroxysmal, non-pharmacological treatment The Use of
catheter ablation, radiofrequency
As Treatment, Acute
Is better Than
chronic antiarrhythmic drug therapy
To reduce symptomatic AF recurrence (13% with ablation VS 63% with drugs) and hospitalizations (9% VS 54%). Pulmonary vein stenosis in 6% patients with ablation.
J Am Coll Cardiol. 2006 Dec 5;48(11):2340-7 Randomized Controlled Trial
IN atrial fibrillation, paroxysmal, refractory, non-pharmacological treatment The Use of
catheter ablation, circumferential pulmonary vein ablation
As Treatment, Chronic
Is better Than
change to another antiarrhythmic drug
To reduce, at 1 year, recurrences of AF: 7% with ablation VS 65% with drugs. Ablation was repeated in 9% patients and 2 severe adverse effects.
N Engl J Med. 2010 Apr 15;362(15):1363-73 Randomized Controlled Trial, Multicenter Study
IN atrial fibrillation, permanent, rate control strategy The Use of
lenient rate control (resting heart rate <110 beats/min)
As Treatment, Chronic
Is equal Than
strict rate control (resting heart rate <80 beats/min and during moderate exercise <110 beats/min)
To modify at 2 years a composite of cardiovascular events: 12.9% lenient VS 14.9% strict (NS). Symptoms and adverse effects were also similar.
Heart. 2008 Feb;94(2):191-6. Epub 2007 May 4 Cohorts
IN atrial fibrillation, persistent The Use of
digitalis, digoxin
As Treatment, Chronic
Is worse Than
other rate control drugs
To modify mortality: 6.5% digitalis VS 4.1% non-digitalis, HR 1.53 after adjustement for other risk factors
J Am Coll Cardiol. 2005 Mar 1;45(5):705-11 Randomized Controlled Trial, Multicenter Study
IN atrial fibrillation, persistent, hypertension, primary The Use of
angiotensin II receptor blockers, losartan
As Treatment, Chronic
Is better Than
beta-blockers
To reduce cardiovascular events (composite of cardiovascular mortality, stroke, and myocardial infarction): 36/171 patients with losartan VS 67/171 patients with B-blokers, at aprox 4 years
JAMA. 2005 Feb 9;293(6):690-8 Randomized Controlled Trial, Multicenter Study
IN atrial fibrillation, persistent, non valvular, stroke, ischemic, cerebral infarction, embolic The Use of
anticoagulants, direct thrombin inhibitors, ximelagatran
As Treatment, Chronic
Is equal Than
warfarin
To prevent, at 20 months, stroke (of any type): 1.6% xime. VS 1.2% warf. Elevated liver enzymes (>3N): 6% xime. VS 0.8% warf. Major bleeding similar. Finally dropped due to hepatic toxicity.
N Engl J Med. 2006 Mar 2;354(9):934-41 Randomized Controlled Trial
IN atrial fibrillation, persistent, non-pharmacological treatment The Use of
catheter ablation, radiofrequency
As Treatment, Acute
Is better Than
cardioversion and chronic amiodarone
To reduce atrial fibrillation recurrence: 26% with ablation VS 42% amiodarone; and improve symptoms. Complications: atypical atrial flutter.
Arch Intern Med. 2005 Feb 14;165(3):258-62 Meta-Analysis
IN atrial fibrillation, persistent, rate control strategy The Use of
rate control strategy
As Treatment, Chronic
Is equal Than
rhythm control strategy
To reduce all-cause mortality at 2 to 3.5 years: 14.6% rhythm-control vs 13.0% rate-control. A trend existed in favour of rate-control: OR 0.87; 95%CI 0.74-1.02
N Engl J Med. 2002 Dec 5;347(23):1834-40 Randomized Controlled Trial, Multicenter Study
IN atrial fibrillation, persistent, rate control strategy The Use of
rate control strategy
As Treatment, Chronic
Is equal Than
rhythm control strategy
To reduce a composite of cardiovascular and treatment-related events: 17.2% in rate-control VS 22.6% in rhythm-control
Ann Intern Med. 2004 Nov 2;141(9):653-61 Cost-Effectiveness
IN atrial fibrillation, persistent, rate control strategy The Use of
rate control strategy
As Treatment, Chronic
Is better Than
rhythm control strategy
To cost-effectiveness: rate control is always more effective and less costly
Ann Intern Med. 2005 Sep 6;143(5):327-36 Meta-Analysis
IN atrial fibrillation, postoperative, cardiac surgery The Use of
antiarrhythmics, amiodarone
As Prevention, Primary
Is better Than
placebo
To decrease the incidence of atrial fibrillation or flutter (RR 0.64), ventricular arrhythmia (RR 0.42) and stroke (RR 0.39)
Eur Heart J. 2006 Jul;27(13):1584-91. Epub 2006 Jun 7 Randomized Controlled Trial
IN atrial fibrillation, postoperative, cardiac surgery The Use of
prophylaxis using antiarrhythmics, amiodarone, 600 mg oral single dose per day from Day-1 to Day7 plus IV perfusion during surgery
As Prevention, Primary
Is better Than
placebo
To reduce the incidence of post-operative AF: 85% with amiodarone VS 34% placebo. Also reduced hospitalization length of stay. Blood concentrations of amiodarone sig. differed between patients.
Cochrane Database Syst Rev. 2004 Oct 18;(4):CD003611 Systematic Review, Cochrane Review
IN atrial fibrillation, postoperative, cardiac surgery The Use of
several antiarrhythmics (amiodarone, sotalol, beta-blockers) and pacing
As Prevention, Primary
Is better Than
placebo
To reduce the incidence of atrial fibrillation (OR between 0.26 and 0.49) and possibly (non significant) reduces stroke and lenght of stay
Pharmacotherapy. 2007 Mar;27(3):360-8 Meta-Analysis
IN atrial fibrillation, postoperative, cardiac surgery The Use of
amiodarone, total doses > 3 grs, starting before or after surgery
As Treatment, Acute
Is better Than
placebo
To reduce the incidence of post-operative atrial fibrillation (OR 0.50)
N Engl J Med. 2002 Dec 5;347(23):1825-33 Randomized Controlled Trial, Multicenter Study
IN atrial fibrillation, rate control strategy The Use of
rate control strategy
As Treatment, Chronic
Is better Than
rhythm control
To reduce adverse drug effects and hospital admissions, while no difference in mortality (23.8% rate VS 21.3% rhythm control at 5 years)
Eur Heart J. 2005 Oct;26(19):2000-6. Epub 2005 May 4 Meta-Analysis
IN atrial fibrillation, rate control strategy The Use of
rate control strategy
As Treatment, Chronic
Is better Than
rhythm control strategy
To reduce a combined endpoint of all cause death and thromboembolic stroke (OR 0.84 (0.73, 0.98)). No difference in all-cause death, systemic embolism and major bleeding.
N Engl J Med. 2008 Jun 19;358(25):2667-77 Randomized Controlled Trial, Multicenter Study
IN atrial fibrillation, rate control strategy, heart failure, chronic, systolic The Use of
rate control strategy
As Treatment, Chronic
Is equal Than
rhythm control strategy
To modify death from cardiovascular causes (25% rate-control VS 27% rhythm-control) or reduce stroke (4% rate-control VS 3% rhythm-control) or worsening heart failure (31% rate-control VS 28% rhythm-control)
Eur Heart J. 2006 Jan;27(2):216-21. Epub 2005 Oct 7 Randomized Controlled Trial
IN atrial fibrillation, refractory, non-pharmacological treatment The Use of
catheter ablation, radiofrequency AND and antiarrhythmic drugs (various)
As Treatment, Chronic
Is better Than
antiarrhythmic drug therapy alone (various drugs)
To prevent AF recurrence: 44% with ablation VS 91% without. Three (4.4%) major complications were related to ablation: stroke, pericardial effusion and a phrenic paralysis.
Arch Intern Med. 2006 Apr 10;166(7):719-28 Systematic Review
IN atrial fibrillation, rhythm control strategy The Use of
antiarrhythmic drugs, classes IA, IC, III
As Treatment, Chronic
Is worse Than
placebo or no treatment
To reduce mortality, class IA drugs (quinidine, dysopiramide) increased mortality (NNH 109) and the rest did not modify it. All drugs increased adverse effects and pro-arrhythmia (but amiodarone).
N Engl J Med. 2009 May 14;360(20):2066-78 Randomized Controlled Trial, Multicenter Study
IN atrial fibrillation, stroke, ischemic, embolic The Use of
antiplatelet drugs, adenosine diphosphate (ADP) receptor inhibitors, clopidogrel (75 mg/day) plus aspirin
As Treatment, Chronic
Is better Than
aspirin alone
To reduce major cardiovascular events, specially stroke (6.8% clopidogrel+aspirin VS 7.6% aspirin) but increased major haemorrhage (2% clopidogrel+aspirin VS 1.3% aspirin)
Lancet. 2006 Jun 10;367(9526):1903-12 Randomized Controlled Trial, Multicenter Study
IN atrial fibrillation, stroke, ischemic, embolic The Use of
antiplatelet drugs, adenosine diphosphate (ADP) receptor inhibitors, clopidogrel (75 mg/day) plus aspirin (75-100 mg/day)
As Treatment, Chronic
Is worse Than
oral anticoagulation (target INR 2.0-3.0)
To prevent embolic events (stroke, non-CNS systemic embolus, myocardial infarction, or vascular death): annual risk 3.93% with warfarin VS 5.60% with aspirin plus clopidogrel
J Am Geriatr Soc. 2014 May;62(5):857-64 Meta-Analysis
IN atrial fibrillation, thromboembolic disease, old patients, anticoagulants, oral direct thrombin inhibitors, dabigatran, oral factor Xa inhibitors, apixaban, rivaroxaban The Use of
anticoagulants, oral direct thrombin inhibitors, dabigatran, oral factor Xa inhibitors, apixaban, rivaroxaban
As Treatment, Chronic
Is better Than
warfarin
To prevent stroke or VTE recurrence: no numbers given in abstract
Clin Infect Dis. 2002 Jun 1;34(11):1481-90. Epub 2002 May 13 Randomized Controlled Trial
IN bacterial infection, cocci gram positive, Staphylococcus aureus, methicillin resistant The Use of
oxazolidinones antibiotics, linezolid (600mg/12h)
As Treatment, Acute
Is equal Than
vancomycine
To achieve a clinical cure: 73.2% linezolid 73.1% vancomycin. Similar rates of adverse events.
Cochrane Database Syst Rev. 2017 Sep 01;9:CD005186 Systematic Review, Cochrane Review
IN bacterial infection, nosocomial, any The Use of
multimodal interventions to improve hand hygiene compliance
As Prevention, Primary
Is equal Than
simpler interventions to increase hand hygiene compliance
To reduce colonization and infection rates: a few, low quality studies suggest complex interventions could at best slightly reduce infections
Nat Neurosci. 2013 Jan 28;16(2):139-45 Review (Narrative)
IN basic sciences, psychology, neurology, memory The Use of
sleep
As Undefined
Is good Than
Comparison to be defined
To perform a triage of wich information retain and consolidate this as a memory
Lancet. 2008 Jan 5;371(9606):57-63 Randomized Controlled Trial
IN behaviour problems, aggressive challenging behaviour, intellectual disability, not psychosis, not dementia The Use of
first-generation typical neuroleptics, haloperidol, second-generation atypical neuroleptics, risperidone
As Treatment, Acute
Is equal Than
placebo
To improve behaviour: aggression decreased substantially with all 3 treatments by 4 weeks, and placebo group showed the greatest change
Proc Natl Acad Sci U S A. 2007 Sep 18;104(38):15011-6 Descriptive
IN behaviour, regular, mate choices, cognitive process The Use of
women's physical attractiveness, men's overall desirability as a mate
As Prognostic Item
Is better Than
self-perceived, stated preferences in a mate
To predict the actual mate choice in speed dating
Lancet. 1993 Dec 18-25;342(8886-8887):1517-8 Randomized Controlled Trial
IN birth, non complicated The Use of
routine episiotomy
As Treatment, Acute
Is worse Than
selective episiotomy (limited to specified maternal or fetal indications)
To reduce perineal trauma: severe perineal trauma was uncommon in both groups (1.2% routinary VS 1.5% selective) and perineal pain, healing complications, and dehiscence were all more frequent with routinary episiotomy.
CMAJ. 1995 Sep 15;153(6):769-79 Randomized Controlled Trial
IN birth, non complicated, evidence based medicine, bias, physician beliefs influence in patient outcomes The Use of
physicians with favourably views of episiotomy
As Treatment, Acute
Is worse Than
physicians who viewed episiotomy very unfavorably
To reduce perineal trauma (intact perineum 12% in intv. VS 23% in ctrl.) and provide their patients satisfaction with the birth experience. The first stage of labour was 2.3 to 3.5 hours shorter and they used more frequently techniques to expedite labour.
Pediatrics. 2012 Jun;129(6):e1397-403 Randomized Controlled Trial
IN bronchiolitis, acute, viral, acute wheezing, preschool children The Use of
nebulized hypertonic 5% saline solution, 4 times a day
As Treatment, Acute
Is better Than
nebulized isotonic 0,9% saline solution
To reduce hospital adlission rates (62% hypertonic VS 92% isotonic) and lenght of stay at hospital (2 days hypertonic VS 3 days isotonic)
N Engl J Med. 2009 May 14;360(20):2079-89 Randomized Controlled Trial, Multicenter Study
IN bronchiolitis, acute, viral, infants The Use of
combination of nebulized epinephrine (3 ml of epinephrine in a 1:1000 solution, x2 days) and oral dexamethasone (1.0 mg/Kg 1st day and 0.6 mg/Kg for 5 days)
As Treatment, Acute
Is better Than
placebo, or any of both treatment alone
To reduce need for hospital admission: 17% combined Tt VS 26% placebo
Cochrane Database Syst Rev. 2008;(4):CD006458 Systematic Review, Cochrane Review
IN bronchiolitis, acute, viral, infants The Use of
nebulized hypertonic 3% saline solution
As Treatment, Acute
Is better Than
nebulized isotonic 0,9% saline solution
To reduce mean length of hospital stay (-0.94 days) and improve clinical score.
JAMA Pediatr. 2014 Jul 1;168(7):657-63 Randomized Controlled Trial
IN bronchiolitis, acute, viral, infants The Use of
nebulized hypertonic 3% saline solution (plus albuterol)
As Treatment, Acute
Is better Than
nebulized 0.9% normal saline solution (plus albuterol)
To reduce admissions to hospital: 29% hypertonic VS 43% normal saline.
BMJ. 2008 Mar 29;336(7646):701-4 Systematic Review
IN brucellosis The Use of
triple drug regimen with doxycycline, rifampicin and an aminoglycoside (gentamicin or streptomycin)
As Treatment, Acute
Is better Than
1 or 2 drugs regimen, or using quinolones instead doxycycline
To reduce rate of failure: relative risk 2.50 with doxycycline-strepto VS triple drug regimen
Am J Med. 2012 Jun;125(6):560-7 Systematic Review
IN cancer, all types The Use of
aspirin, 75 mg daily or more, for at least 2.8 years
As Prevention, Primary
Is better Than
placebo
To reduce cancer deaths (2% aspirin VS 2.6% placebo) and noncardiovascular mortality (2.3% VS 2.6%)
Lancet. 2011 Jan 1;377(9759):31-41. Epub 2010 Dec 6 Meta-Analysis
IN cancer, all types, gastrointestinal cancers The Use of
aspirin, 75 mg daily or more, for more than 5 years
As Prevention, Primary
Is better Than
placebo
To reduce death due to all cancers (0.79) when treatment maintained for more than 5 years, specially for gastrointestinal cancers (OR 0.46) but also for brain, lung and prostate cancers.
J Gerontol A Biol Sci Med Sci. 2016 Dec;71(12):1653-1660 Cohorts
IN cancer, all types, older patients The Use of
classificating patients in 4 classes: four classes: relatively healthy (LC1), malnourished (LC2), cognitive and mood impaired (LC3), and globally impaired (LC4)
As Prognostic Item
Is useful Than
no classification
To predict overall 1-year mortality and 6-month unscheduled admissions
Lancet. 2009 May 2;373(9674):1532-42 Meta-Analysis
IN cancer, associated chronic anemia The Use of
erythropoietin analogs, recombinant human erythropoiesis-stimulating agents
As Treatment, Chronic
Is worse Than
placebo
To mortality (mean follow-up 6-8 months): 12% with erythropoietin VS 11% with placebo
Health Technol Assess. 2004;8(4):1-176 Systematic Review
IN cancer, bone metastases The Use of
bisphosphonates, regularly administered at high dose IV
As Treatment, Acute, Chronic
Is better Than
placebo
To control hypercalcemia (pamidronate better than clodronate or etidronate) and prevent skeletal related events (fractures, pain) Possible effect to prevent developping bone metastases in breast cancer
N Engl J Med. 2007 Apr 12;356(15):1527-35 Randomized Controlled Trial, Multicenter Study
IN cancer, brain, glioblastoma The Use of
radiotherapy (focal, fractions of 1.8 Gy 5 days per week, total dose 50 Gy).
As Treatment, Acute
Is better Than
supportive care only
To improve survival: median 29 weeks radiotherapy VS 17 weeks supportive care
N Engl J Med. 2016 Apr 7;374(14):1344-55 Randomized Controlled Trial, Multicenter Study
IN cancer, brain, glioma (astrocytoma, oligoastrocytoma, or oligodendroglioma), low-grade The Use of
radiation therapy followed by six cycles of combination chemotherapy: procarbazine, lomustine (also called CCNU), and vincristine, all at the time of initial diagnosis
As Treatment, Acute
Is better Than
radiation therapy alone
To improve median overall survival (13.3 years radiation+chemo VS 7.8 years radiation only). Overall survival at 10 years: 60% combined Tt VS 40% radiation only
Cochrane Database Syst Rev. 2011;1(del):CD001877 Systematic Review, Cochrane Review
IN cancer, breast, screening The Use of
mammography
As Diagnostic Tool
Is better Than
no screening
To reduce, very modestly, mortality from breast cancer (NNT 2 000 throughout 10 years), at the cost of early overdiagnosis of bresat cancer (NNH 200) and many false positive findings (NNH 10)
BMJ. 2014;348():g366 Randomized Controlled Trial, Diagnostic
IN cancer, breast, women aged 40-59 The Use of
mammography screening
As Diagnostic Tool
Is equal Than
physical breast examinations
To modify death from breast cancer after 15 years of follow-up: rates identical in both groups. More cancers were diagnosed in the mammography group resulting in less mortality rate in patients diagnosed with cancer
J Clin Oncol. 2011 Sep 1;29(25):3457-6 Cohorts
IN cancer, chemotherapy, toxicity, risk estimation, older patients The Use of
a risk stratification schema (range 0 to 19) composed of age, anemia, renal failure, bad hearing, >1 fall last 6 months, needing help for taking medocs, reduced walking, decreased social life, polychemotherapy and using standard chemo dose
As Prognostic Item
Is better Than
no systematic assessment
To predict grade 3 (severe), grade 4 (life-threatening or disabling), or grade 5 (death) chemotherapy toxicity: low risk, 0 to 5 points = 30% incidence, intermediate 6 to 9 points = 52%, high risk 10 to 19 points = 83%
PLoS One. 2011;6(6):e20456 Meta-Analysis
IN cancer, colorectal The Use of
high red meat and processed meat consumption
As Etiologic risk factor
Is useful Than
low red meat and processed meat consumption
To predict the risk of colorectal cancer : RR 1.22 for the highest versus the lowest intake, RR 1.14 for every 100 g/day increase in consumption
Lancet. 2010 Nov 20;376(9754):1741-50 Meta-Analysis
IN cancer, colorectal The Use of
aspirin dose, 75 mg daily or more, for more than 5 years
As Prevention, Primary
Is better Than
placebo
To reduce the 20-year risk of colon cancer incidence (HR 0.76) and mortality (HR 0.65), specially of proximal colon cancer.
N Engl J Med. 2003 Mar 6;348(10):883-90 Randomized Controlled Trial, Multicenter Study
IN cancer, colorectal The Use of
aspirin (325 mg daily)
As Prevention, Secondary
Is better Than
placebo
To prevent new colorectal adenomes in colonoscopy, at 12,8 months (17% in intv VS 27% in ctrl)
N Engl J Med. 2005 Dec 22;353(25):2654-66 Descriptive
IN cancer, colorectal The Use of
pathological signs of early metastatic invasion (venous emboli, lymphatic and perineural invasion)
As Prognostic Item
Is useful Than
no comparison
To predict survival: absence of early metastatic invasion was independently associated with increased survival. Tumours without early metastatic invasion had increased markers of T-cells migration, activation, and differentiation
Lancet. 1999 Jan 30;353(9150):345-50 Randomized Controlled Trial
IN cancer, colorectal The Use of
Immunotherapy, individualized tumor vaccine, after resection
As Treatment, Acute
Is better Than
no treatment
To reduce any cancer recurrence at 5 years: 19.5% vaccine VS 31.7% no-vaccine
N Engl J Med. 2004 Jun 3;350(23):2343-51 Randomized Controlled Trial, Multicenter Study
IN cancer, colorectal, adjuvant treatment The Use of
adjuvant chemotherapy after curative resection with oxiplatin added to fluorouracil plus leucovorin alone
As Treatment, Acute
Is better Than
adjuvant chemotherapy with fluorouracil plus leucovorin alone
To improve (moderately) the rate of disease-free survival at 3 years: 78.2% in intv. VS 72.9% in ctrl. No significative increase of adverse effects.
BMJ. 2006 Jul 8;333(7558):69-70. Epub 2006 Jun 21 Cohorts
IN cancer, colorectal, clinical presentation The Use of
new onset rectal bleeding in patients aged 45 or more
As Diagnostic Tool
Is useful Than
no comparison here
To investigate bowel: 5.7% of this patients had colorectal cancer, and 4.9% had colonic adenoma.
BMJ. 2002 Apr 6;324(7341):813 Meta-Analysis
IN cancer, colorectal, follow up after curative resection The Use of
intensive follow up, using frequent computed tomography (CT) and serum carcinoembryonic antigen (CEA)
As Prevention, Secondary
Is better Than
basic follow up
To reduce all cause mortality (absolute risk reduction about 7%), detect earlier all type of recurrences
Cochrane Database Syst Rev. 2002;(1):CD002200 Systematic Review, Cochrane Review
IN cancer, colorectal, follow up after curative resection The Use of
intensive follow up, using more test, including liver imaging
As Prevention, Secondary
Is better Than
basic follow up
To reduce all cause mortality at 5 years, detect earlier all type of recurrences. No useful data on quality of life, harms or cost-effectiveness were available
Arch Surg. 2005 Feb;140(2):183-9 Cohorts
IN cancer, colorectal, metastatic The Use of
prognostic factors: Dukes stage, number of metastases, carcino-embryonic antigen, alkaline phosphatase, and albumin
As Prognostic Item
Is good Than
-
To derive prognoses groups having different survival at 5 years: poor (0% survival), moderate (20% survival), good (62,5% survival)
N Engl J Med. 2004 Jun 3;350(23):2335-42 Randomized Controlled Trial, Multicenter Study, Clinical Trial, Phase III
IN cancer, colorectal, metastatic The Use of
monoclonal antibodies against vascular endothelial growth factor, bevacizumab, added to chemotherapy
As Treatment, Acute
Is better Than
chemotherapy alone (IFL: irinotecan, fluorouracil, and leucovorin in all cases)
To increase the rate of response (45% in intv VS 35% in ctrl) and median survival (20.3 months in intv. VS 15.6 months in ctrl.). Bevacizumab was associated with arterial hypertension (11%)
Lancet. 1997 Sep 6;350(9079):681-6 Randomized Controlled Trial
IN cancer, colorectal, metastatic The Use of
quimioterapia cronomodulada, fluorouracilo, oxiplatino
As Treatment, Acute
Is Than
To
Cancer. 1996 Oct 15;78(8):1639-45 Meta-Analysis
IN cancer, colorectal, metastatic The Use of
quimioterapia regional hepática, vía arterial
As Treatment, Acute
Is Than
To
Lancet. 2000 Jul 29;356(9227):373-78 Meta-Analysis
IN cancer, colorectal, metastatic The Use of
quimioterapia, fluorouracilo, infusión continua
As Treatment, Acute
Is Than
To
Lancet. 2002 May 4;359(9317):1555-63 Randomized Controlled Trial, Multicenter Study
IN cancer, colorectal, metastatic The Use of
quimioterapia, fluorouracilo, infusión continua, raltitrexed
As Treatment, Acute
Is Than
To
BMJ. 2000 Sept 2;321(7260):531-5 Meta-Analysis
IN cancer, colorectal, metastatic The Use of
quimioterapia, quimioterapia regional hepática, fluorouracilo, irinotecan
As Treatment, Acute
Is Than
To
Health Technol Assess. 2001;5(25):1-128 Review, Academic
IN cancer, colorectal, metastatic The Use of
chemotherapy combining irinotecan or oxiplatin with fluorouracil and folinic acid
As Treatment, Acute, First-line
Is better Than
chemotherapy with fluorouracil and folinic acid alone
To extend both median progression-free and overall survival by a few (2-3) months.
Gastroenterology. 2004 Nov;127(5):1300-11 Diagnostic
IN cancer, colorectal, screening in asymptomatic average risk adults The Use of
computed tomographic colonography (virtual colonoscopy)
As Diagnostic Tool
Is equal Than
conventional direct optical colonoscopy
To detect colorectal polypes: sensitivity 90%, specificity 92%, positive predictive value 88%, negative predictive value 93.5%, in per-patient analysis.
N Engl J Med. 2008 Sep 18;359(12):1207-17 Diagnostic
IN cancer, colorectal, screening in asymptomatic average risk adults The Use of
computed tomographic colonography (virtual colonoscopy)
As Diagnostic Tool
Is good Than
conventional direct optical colonoscopy
To detect adenomas and cancers > 10 mm: 90% sensibility, 89% specificity
CMAJ. 2005 Oct 11;173(8):877-81 Randomized Controlled Trial
IN cancer, colorectal, screening in asymptomatic average risk adults The Use of
computed tomographic colonography (virtual colonoscopy)
As Diagnostic Tool
Is worse Than
conventional direct optical colonoscopy
To screening: A CT colonography based strategy plus colonoscopy if abnormalities is less cost-effective: more costly and slight more deaths due to missed adenomas.
N Engl J Med. 2007 Oct 4;357(14):1403-12 Diagnostic
IN cancer, colorectal, screening in asymptomatic average risk adults The Use of
computed tomographic colonography (virtual colonoscopy)
As Diagnostic Tool
Is equal Than
conventional direct optical colonoscopy
To detect advanced colorectal cancer (3.2% scan VS 3.4% colonoscopy) whilst having much less need of colonoscopy (8%), having no perforation and removing much less polyps.
Am J Gastroenterol. 2008 Jun;103(6):1541-9 Systematic Review, Cochrane Review
IN cancer, colorectal, screening in asymptomatic average risk adults The Use of
fecal occult blood test (hemoccult)
As Diagnostic Tool
Is better Than
no screening
To slightly reduce death from colorectal cancer at 12-18 years (0.8% using hemoccult VS 1% no screening, NNT 617) while not reducing overall mortality (31%)
JAMA. 2004 Apr 14;291(14):1713-9 Diagnostic
IN cancer, colorectal, screening in asymptomatic average risk adults The Use of
computed tomographic colonography (virtual colonoscopy)
As Prevention, Primary
Is worse Than
conventional direct optical colonoscopy
To detect colorectal polypes: sensitivity of virtual colonoscopy for detecting patients with lesions >= 6 mm: 39% (conventional colonoscopy 99%) Computed tomographic colonography missed 2 of 8 cancers.
N Engl J Med. 2003 Dec 4;349(23):2191-2200 Diagnostic
IN cancer, colorectal, screening in asymptomatic average risk adults The Use of
computed tomographic colonography (virtual colonoscopy)
As Prevention, Primary
Is better Than
conventional direct optical colonoscopy
To Screening: Sensitivity of virtual colonoscopy was 93.8% for polyps at least 10 mm in diameter, 93.9 % for 8 mm and 88.7% for 6 mm. Specificity was 96.0% for polyps at least 10 mm, 92.2% for 8 mm, and 79.6% for 6 mm. 2 malignant polips were detected
Lancet. 2005 Jan 22-28;365(9456):305-11 Diagnostic
IN cancer, colorectal, screening in asymptomatic high risk adults The Use of
computed tomographic colonography (virtual colonoscopy)
As Diagnostic Tool
Is worse Than
conventional direct optical colonoscopy
To detect colorectal polyps > 6mm: virtual CT: sens. 55%, spec. 89%, +LR 5, -LR 0.51 ; coloscopy: sens. 99%, spec. 99.6%, +LR 248, -LR 0.01 ; barium enema: sens. 41%, spec. 82%, +LR 4.8, -LR 0.58.
Gastroenterology. 2006 Aug;131(2):390-401; quiz 659-60 Systematic Review
IN cancer, gastroesophageal, clinical feautures The Use of
alarm features such as dysphagia, weight loss, or anemia
As Diagnostic Tool
Is worse Than
endoscopy
To diagnose upper GI malignancy: sensitivity varied from 0% to 83%, specificity 40% to 98%, with considerable heterogeneity between studies.
N Engl J Med. 2006 Jul 6;355(1):11-20 Randomized Controlled Trial, Multicenter Study
IN cancer, gastroesophageal, resectable The Use of
perioperative chemotherapy: 3 preoperative and 3 postoperative cycles of epirubicin and cisplatin plus a continuous intravenous infusion of fluorouracil for 21 days
As Treatment, Acute
Is better Than
surgery alone
To improve survival at 5 years: 36% perioperative chemotherapy VS 23% surgery alone.
Lancet. 2000 Nov 25;356(9244):1795-9 Cohorts
IN cancer, in general population The Use of
natural cytotoxic activity of peripheral-blood lymphocytes
As -
Is Than
To
Chest. 2000 Mar;117(3):773-8 Diagnostic
IN cancer, lung The Use of
estadiaje, tomografía de emisión de positrones, pet
As Diagnostic Tool
Is Than
To
Cochrane Database Syst Rev. 2000;2(2):CD002139 Systematic Review, Cochrane Review
IN cancer, lung, non-small cell The Use of
chemotherapy containing cisplatin
As Treatment, Acute
Is better Than
only supportive care, only surgery or only radiotherapy
To modestly improve survival: 10% absolute reduction of death at 1 year vs only supportive care
N Engl J Med. 2000 Jul 27;343(4):254-61 Diagnostic, Prospective
IN cancer, lung, non-small-cell The Use of
estadiaje, tomografía de emisión de positrones, pet
As Diagnostic Tool
Is Than
To
N Engl J Med. 2002 Jan 10;346(2):92-8 Randomized Controlled Trial, Multicenter Study
IN cancer, lung, non-small-cell The Use of
quimioterapia, cisplatino, carboplatino
As Treatment, Acute
Is Than
To
N Engl J Med. 2010 Jun 24;362(25):2380-8 Randomized Controlled Trial, Multicenter Study
IN cancer, lung, non-small-cell, advanced The Use of
gefitinib, EGFR tyrosine kinase inhibitor
As Treatment, Acute
Is better Than
carboplatin-paclitaxel chimiotherapy
To improve survival: 30 months gefitinib VS 24 carboplatin. Gefitinib had also less severe adverse effects.
N Engl J Med. 2010 Aug 19;363(8):733-42 Randomized Controlled Trial, Multicenter Study
IN cancer, lung, non-small-cell, advanced The Use of
early palliative care, integrated with standard oncologic care
As Treatment, Chronic
Is better Than
standard oncologic care alone
To improve quality of life and to improve survival (12 months early palliative VS 9 months standard) despite receiving less agressive end-of-life care.
N Engl J Med. 2008 Jun 19;358(25):2698-703 Descriptive
IN cancer, melanome, metastatic The Use of
autologous T-cell therapy, autologous CD4+ T cells against NY-ESO-1
As Treatment, Acute
Is better Than
no treatment
To Results to be defined
Nat Genet. 2013 Sep 26;45(10):1127-1133 Descriptive
IN cancer, oncogenic signature classes The Use of
oncogenic signature classes: patterns of combined genetic and epigenetic features
As Etiologic risk factor
Is useful Than
no comparison here
To various defined oncogenic signature classes are characteristics of multiple cross-tissue groups of tumors
Lancet. 2000 Jul 15;356(9225):190-3 Diagnostic, Prospective
IN cancer, pancreatic The Use of
colangiopancreatografía por resonancia magnética
As Diagnostic Tool
Is Than
To
N Engl J Med. 2018 Apr 05;378(14):1313-1322 Randomized Controlled Trial
IN cancer, pleural, effusion The Use of
talc administered through an indwelling pleural catheter (4 g of talc slurry)
As Treatment, Acute
Is better Than
indwelling pleural catheter alone
To induce pleurodesis: 43% talc VS. 23% catheter only. No significant between-group differences in effusion size, inpatient days, mortality, or number of adverse events
J Clin Oncol. 2007 Aug 20;25(24):3582-8 Decision Model
IN cancer, prostate The Use of
a nomogram including age, ethnicity, family history, urinary symptoms, prostatic specific antigen (PSA), free:total PSA ratio, and digital rectal examination
As Diagnostic Tool
Is better Than
PSA alone
To detect patients with prostate cancer. 24% of patients with PSA < 4 ng/mL had prostate cancer.
J Clin Oncol. 2005 Jul 1;23(19):4322-9. Epub 2005 Mar 21 Decision Model
IN cancer, prostate The Use of
PSA>1.55 ng/mL or >0.165 ng/mL/cc(prostate volume), hypoechoic lesion, age>55y, prostate volume<44cc
As Diagnostic Tool
Is better Than
increase PSA alone
To select patients for prostatic biopsy in search of prostatic cancer: 31% sensibility and 96,6% specificity for prostatic cancer
N Engl J Med. 2005 May 12;352(19):1977-84 Randomized Controlled Trial, Multicenter Study
IN cancer, prostate, early non-metastatic The Use of
radical prostatectomy
As Treatment, Acute
Is better Than
watchful waiting
To decrease - at 8 years - metatasis development, local progression, death due to prostate cancer (8.6% with surgery VS 14.4% waiting) and total mortality (24% with surgery VS 30.5% waiting)
Ann Intern Med. 2008 Mar 18;148(6):435-48 Systematic Review
IN cancer, prostate, early non-metastatic The Use of
radical prostatectomy
As Treatment, Acute
Is better Than
watchful waiting or external-beam radiation
To reduced at 10 years all-cause mortality (24% prostatectomy vs. 30% wacthful) or reduce at 5 years cancer recurrence
N Engl J Med. 2016 Oct 13;375(15):1425-1437 Randomized Controlled Trial, Multicenter Study
IN cancer, prostate, early non-metastatic The Use of
active monitoring
As Treatment, Chronic
Is better Than
radical prostatectomy, or external-beam radiotherapy
To preserve sexual, urinary and bowel functions: sexual and urinary function declined gradually. Prostatectomy was the worst on sexual function and urinary continence. Radiotherapy reduced sexual and bowel functions but did not impact continency
N Engl J Med. 2016 Oct 13;375(15):1415-1424 Randomized Controlled Trial, Multicenter Study
IN cancer, prostate, early non-metastatic The Use of
active monitoring only
As Treatment, Chronic
Is equal Than
radical prostatectomy, or external-beam radiotherapy
To change overral mortality and prostate-cancer-specific deaths at 10 years follow-up: 1.5/1000 persons-year active monitoring VS 1/1000 prostatectomy VS 0.7/1000 radiotherapy. More disease progression and metastases in monitoring only
N Engl J Med. 2003 Jul 17;349(3):215-24 Randomized Controlled Trial, Multicenter Study
IN cancer, prostate, primary prevention in healthy men The Use of
finasteride
As Prevention, Primary
Is better Than
placebo
To prevent development of prostate cancer (2,63%/year in intv VS 3,48%/year), benign prostatic hyperplasia (5,2% VS 8,7%) and have less urinary symptoms. But intv group had more sexual dysfunction and prostatic cancers were high grade more freq(6,4% vs 5,1%)
N Engl J Med. 2009 Mar 26;360(13):1310-9 Randomized Controlled Trial, Multicenter Study
IN cancer, prostate, screening in healthy men The Use of
screeing using annual PSA testing and digital rectal examination for 6 years
As Diagnostic Tool
Is equal Than
usual care, not routine screening
To modify mortality by prostatic cancer (2/10,000 person-years screening VS 1.7/10,000 controls) despite detecting more prostatic cancers (116/10,000 person-years screening VS 95/10,000 controls)
N Engl J Med. 2007 Oct 18;357(16):1579-88 Diagnostic
IN cancer, uterine, cervical, screening The Use of
testing for DNA of oncogenic human papillomaviruses
As Diagnostic Tool
Is better Than
Papanicolaou test
To identify high-grade cervical intraepithelial neoplasia: papillomaviruses DNA: sens 95%, spec 94%; Papanicolau sens 55%, spec 97%.
Lancet. 2005 Oct 22-28;366(9495):1435-42 Randomized Controlled Trial, Multicenter Study
IN candida, systemic infection, non-neutropenic patients The Use of
voriconazole
As Treatment, Acute
Is equal Than
amphotericin B followed by oral fluconazole
To achieve a successful clinical and bacteriological outcome : 65% voriconazole VS 71% amphotericine; 95% CI for difference -10.6% to 10.6%. Dicontinuation by adverse effects equal to amphot.
J Cardiothorac Vasc Anesth.1996(Feb);10(2):178-186 Randomized Controlled Trial
IN cardiac arrest The Use of
active compression-decompression
As Treatment, Acute
Is Than
To
JAMA. 1994 May 11;271(18):1405-1411 Randomized Controlled Trial
IN cardiac arrest The Use of
active compression-decompression
As Treatment, Acute
Is Than
To
JAMA. 1995 Apr 26;273(16):1261-1268 Randomized Controlled Trial
IN cardiac arrest The Use of
active compression-decompression
As Treatment, Acute
Is Than
To
JAMA. 1996 May 8;275(18):1417-1423 Randomized Controlled Trial
IN cardiac arrest The Use of
active compression-decompression
As Treatment, Acute
Is Than
To
Resuscitation. 1999 Nov;42(3):163-72 Randomized Controlled Trial
IN cardiac arrest The Use of
active compression-decompression
As Treatment, Acute
Is Than
To
Resuscitation. 1999 Aug;41(3):249-56 Meta-Analysis
IN cardiac arrest The Use of
active compression-decompression
As Treatment, Acute
Is Than
To
Resuscitation. 1996 Dec;33(2):125-134 Randomized Controlled Trial
IN cardiac arrest The Use of
active compression-decompression
As Treatment, Acute
Is Than
To
Med Klin (Munich). 1997 Jul 15;92(7):381-8 Randomized Controlled Trial
IN cardiac arrest The Use of
active compression-decompression
As Treatment, Acute
Is Than
To
N Engl J Med. 1993 Dec 23;329(26):1918-1921 Randomized Controlled Trial
IN cardiac arrest The Use of
active compression-decompression
As Treatment, Acute
Is Than
To
N Engl J Med. 1999 Aug 19;341(8):569-75 Randomized Controlled Trial
IN cardiac arrest The Use of
active compression-decompression
As Treatment, Acute
Is Than
To
Resuscitation. 1998 May;37(2):119-25 Controlled Clinical Trial
IN cardiac arrest The Use of
active compression-decompression
As Treatment, Acute
Is Than
To
Circulation. 1997 Feb 18;95(4):955-961 Randomized Controlled Trial, Multicenter Study
IN cardiac arrest The Use of
active compression-decompression
As Treatment, Acute
Is Than
To
Anasthesiol Intensivmed Notfallmed Schmerzther. 1994 Dec;29(8):492-500 Randomized Controlled Trial
IN cardiac arrest The Use of
active compression-decompression
As Treatment, Acute
Is Than
To
J Am Coll Cardiol. 1994 Jul;24(1):201-209 Randomized Controlled Trial
IN cardiac arrest The Use of
active compression-decompression
As Treatment, Acute
Is better Than
standard manual chest compression
To improve return of spontaneous circulation and 24-h survival, but not survival to hospital discharge
JAMA. 1992 Nov 18;268(19):2667-2672 Randomized Controlled Trial
IN cardiac arrest The Use of
adrenalina altas dosis
As Treatment, Acute
Is Than
To
N Engl J Med. 1998 Nov 26;339(22):1595-601 Randomized Controlled Trial
IN cardiac arrest The Use of
adrenalina altas dosis
As Treatment, Acute
Is Than
To
N Engl J Med. 2000 May 25;342(21):1546-53 Randomized Controlled Trial
IN cardiac arrest The Use of
chest compression alone
As Treatment, Acute
Is equal Than
chest compression plus mouth-to-mouth ventilation
To survival to hospital discharge (14.6% intv. vs 10.4% ctrl.), difference not statistically significant.
Arch Intern Med. 1994 Nov 14;154(21):2433-2437 Clinical Trial, Retrospective
IN cardiac arrest The Use of
decidiendo parar rcp
As Treatment, Acute
Is Than
To
Br Heart J. 1994 Nov;72(5):408-412 Cohorts, Retrospective
IN cardiac arrest The Use of
out-of-hospital cardiopulmonary resuscitation initiated by a bystander
As Treatment, Acute
Is better Than
waiting for trained medical team
To improving survival to hospital discherge (25% VS 8%) and reducing cerebral damage.
N Engl J Med. 2004 Jan 8;350(2):105-13 Randomized Controlled Trial
IN cardiac arrest The Use of
vasopressin IV
As Treatment, Acute
Is better Than
epinephrine IV
To improving survival to hospital discharge (4.7% intv. VS 1.5% ctrl.) among patients with asystole. There were no differences in patients with ventricular fibrillation or pulseless electrical activity.
Crit Care Med. 2005 Feb;33(2):414-8 Meta-Analysis
IN cardiac arrest, post-resuscitation care The Use of
hypothermia, mild, immediatly after resuscitation
As Treatment, Acute
Is better Than
normothermia
To reduce death at 6 months (RR 1,44) and improve neurological recovery (RR 1,68; NNT 4 - 13)
N Engl J Med. 2002 Feb 21;346(8):549-56 Randomized Controlled Trial, Multicenter Study
IN cardiac arrest, ventricular fibrillation The Use of
hypothermia, mild, immediatly after resuscitation
As Treatment, Acute
Is better Than
standard treatment with normothermia
To reduce mortality at 6 months (41% with hypothermia VS 55% if not)
N Engl J Med. 2008 Jan 3;358(1):9-17 Cohorts
IN cardiac arrest, ventricular fibrillation, in hospital The Use of
rapid defibrillation in less than 2 minutes
As Treatment, Acute
Is better Than
delayed defibrillation in more than 2 minutes
To increase survival to hospital discharge: 39% if in < 2 min VS 22% if not)
N Engl J Med. 1999 Sep 16;341(12):871-8 Randomized Controlled Trial
IN cardiac arrest, ventricular fibrillation, taquicardia ventricular The Use of
amiodarona
As Treatment, Acute
Is Than
To
N Engl J Med. 2017 11 30;377(22):2133-2144 Randomized Controlled Trial, Multicenter Study
IN cardiac surgery, anemia, acute, bleeding or not The Use of
a restrictive transfusion strategy (transfuse if hemoglobin level was <7.5 g/dL)
As Treatment, Acute
Is equal Than
a liberal transfusion strategy (transfuse if hemoglobin level was <9.5 g/dL)
To modify a composite outcome (death, myocardial infarction, stroke, or new-onset renal failure with dialysis) at 28 days (11% restrictive VS 12% liberal)
N Engl J Med. 2000 Jun 15;342(24):1778-85 Cohorts
IN cardiomyopathy, hypertrophic The Use of
magnitude of left ventricle hypertrophy
As Prognostic Item
Is useful Than
0
To predict the risk of sudden death
JAMA. 2011 Mar 2;305(9):913-22 Meta-Analysis
IN cardiovascular death, atherosclerosis, patients with a history of cardiovascular disease or diabetes but without hypertension The Use of
antihypertensive drugs, no information at all about which specific antihypertensive drugs were studied
As Treatment, Chronic
Is better Than
placebo
To reduce stroke (RR 0.77, NNT 129), myocardial infarction (RR 0.80, NNT 75), heart failure (RR 0.85, NNT 23), and all-cause mortality (RR 0.87, NNT 75)
Arch Intern Med. 2006 Dec 11-25;166(22):2446-54 Meta-Analysis
IN cardiovascular death, risk in critically ill patients The Use of
troponin T
As Prognostic Item
Is useful Than
no comparison here
To identify patients with an increased risk of death (OR, 2.5). Elevated troponin was found in a median of 43% of those patients.
Am J Cardiol. 2008 May 15;101(10):1437-43 Cohorts
IN cardiovascular death, risk in general population, asymptomatic middle-aged men The Use of
exercise test, stop exercise before reaching 85% of maximal heart rate (HR) and Increased HR at rest, attenuated HR increase or delayed HR recovery
As Prognostic Item
Is useful Than
no comparison
To predict increased risk of sudden death (HR 1.8), cardiac death (HR 1.4) and all-cause mortality (HR 1.3)
Arch Intern Med. 2007 Dec 10;167(22):2490-6 Cohorts
IN cardiovascular death, risk in general population, elderly patients The Use of
addition of: microalbuminuria, and estimated glomerular filtration rate of less than 75 mL/min/1.73 m(2)
As Prognostic Item
Is better Than
classic cardiovascular risk models not including renal function
To predict higher cardiovascular mortality at 8 years
Circulation. 2005 Nov 15;112(20):3088-96 Meta-Analysis
IN cardiovascular death, risk in kidney disease, chronic, end-stage The Use of
troponin T
As Prognostic Item
Is useful Than
no comparison here
To identify patients with higher risk of cardiac death and increased all-cause mortality (relative risk, 2.64)
JAMA. 2013 Sep 4;310(9):918-29 Randomized Controlled Trial, Multicenter Study
IN cardiovascular disease The Use of
polypill, fixed-dose combinations of drugs, 75 mg aspirin, 40 mg simvastatin, 10 mg lisinopril, and 50 mg atenolol
As Prevention, Primary
Is better Than
usual care
To improve medication adherence (86% polypill VS 65% usual) and statistically significant but small improvements in blood pressure and LDL-C
Cochrane Database Syst Rev. 2014;4:CD009868 Systematic Review, Cochrane Review
IN cardiovascular disease, cardiovascular death The Use of
polypill, fixed-dose combinations of drugs
As Treatment, Chronic
Is equal Than
Comparison to be defined
To cardiovascular mortality and cardiovascular events. Reductions in blood pressure and lipid parameters are generally lower than those previously projected.
N Engl J Med. 2006 Jun 8;354(23):2452-62 Randomized Controlled Trial
IN cholera The Use of
azithromycin (single 1-g dose of two 500-mg tablets)
As Treatment, Acute
Is better Than
ciprofloxacin (also a single 1-g dose of two 500-mg tablets)
To produce clinical success (stop watery stools within 48 hours after administration): 73% with azytro VS 27% with cipro. The lack of efficacy of ciprofloxacin may result from its diminished activity against strains in Bangladesh.
Fam Pract. 2009 Aug;26(4):260-8 Systematic Review
IN chronic obstructive pulmonary disease The Use of
clinical items: >45 years, dyspnoea, wheezing, current smoking and extensive smoking (>40 pack years), previous consult for wheezing, self-reported history of COPD, auscultatory wheezing, forced expiratory time, laryngeal height, prolonged expiration
As Diagnostic Tool
Is useful Than
spirometry as gold standard
To diagnose chronic obstructive pulmonary disease
N Engl J Med. 2004 Jun 24;350(26):2645-53 Descriptive
IN chronic obstructive pulmonary disease The Use of
pathology of small airways
As Prognostic Item
Is useful Than
-
To understand the natural history: progression of COPD is associated with the accumulation of inflammatory mucous exudates in the lumen, inflammatory infiltration of the wall and a remodeling process that thickens the walls of small airways
Cochrane Database Syst Rev. 2014;3:CD010844 Systematic Review, Cochrane Review
IN chronic obstructive pulmonary disease The Use of
double inhaled therapy, combining long-acting beta-agonist and inhaled corticosteroids
As Treatment, Chronic
Is better Than
any single inhaled therapy: long-acting anticholinergic, long-acting beta-agonist or inhaled corticosteroids
To increase, at 1 year, FEV1 (+100 mL combined LABA+ICS) and a respiratory clinical score. LAA and LABA were roughly equivalent, ICS were more effective than placebo but less than the other long-term threatments
Cochrane Database Syst Rev. 2014;3():CD010115 Systematic Review, Cochrane Review
IN chronic obstructive pulmonary disease The Use of
inhaled corticosteroids, fluticasone, budesonide
As Treatment, Chronic
Is worse Than
Comparison to be defined
To carry an increased risk of severe pneumonia (causing hospitalization or death) : OR 1.8 for fluticasone, 1.6 with budesonide. The risk of any pneumonia event (i.e. less serious cases) was higher with fluticasone than with budesonide (OR 1.86
Thorax. 2013 Nov;68(11):1029-36 Cohorts
IN chronic obstructive pulmonary disease The Use of
inhaled corticosteroids, specially fluticasone, less budesonide
As Treatment, Chronic
Is worse Than
no inhaled corticosterois
To carry an increased risk of severe pneumonia (causing hospitalization or death) : RR 2.0 for fluticasone, 1.2 with budesonide
Canadian Agency for Drugs and Technologies in Health (CADTH). 2010 May;127:1-131 Systematic Review
IN chronic obstructive pulmonary disease The Use of
triple inhaled therapy combining long-acting anticholinergic, long-acting beta-agonist and inhaled corticosteroids
As Treatment, Chronic
Is better Than
dual combination therapy or monotherapy
To reduce the number of severe exacerbations leading to hospitalization and increase quality of life (compared to monotherapy), with a possible increase in the risk of pneumonia
N Engl J Med. 2003 May 22;348(21):2059-73 Randomized Controlled Trial
IN chronic obstructive pulmonary disease, emphysema The Use of
lung-volume-reduction surgery
As Treatment, Chronic
Is equal Than
medical therapy only
To reduce mortality (overall 11% per year in both treatment groups) and improve exercise capacity (15% in intv. VS 3% in ctrl.). Mortality was reduced in patients with predominantly upper-lobe emphysema and low exercise capacity, but increased in the rest.
Chest. 2005 Nov;128(5):3489-99 Randomized Controlled Trial, Multicenter Study
IN chronic obstructive pulmonary disease, emphysema The Use of
lung-volume-reduction surgery
As Treatment, Chronic
Is worse Than
physical training alone
To perioperative and at 1 year mortality risk: 7/53 patients death in the surgery group VS 1/53 patients in control (p non significant). Health status and FEV1 were improved after surgery at 1 year.
N Engl J Med. 2011 Aug 25;365(8):689-98 Randomized Controlled Trial, Multicenter Study
IN chronic obstructive pulmonary disease, exacerbations The Use of
long-term antibiotics, azithromycin 250 mg daily for 1 year
As Prevention, Secondary
Is better Than
placebo
To reduce (but only marginally) nuber of exacerbations (1.5 par year azytro VS 1.8 per year placebo. Hearing impairment was higher: 25% patients azytro VS 20% placebo
Ann Intern Med. 2001 Apr 3;134(7):600-620 Randomized Controlled Trial
IN chronic obstructive pulmonary disease, exacerbations The Use of
bronchodilators, corticosteroids, antibiotics, and non-invasive positive-pressure ventilation
As Treatment, Acute
Is better Than
placebo or treatment not using it
To reduce death, need for intubation or reduce lenght of hospital stay.
BMJ. 2011 Jun 14;342:d3215. doi: 10.1136/bmj.d3215 Systematic Review
IN chronic obstructive pulmonary disease, exacerbations The Use of
inhaled anticholinergics, long acting, tiotropium, using mist inhaler
As Treatment, Acute
Is worse Than
placebo
To mortality: increased with tiotropium (2.4%) VS placebo (1.7%). NNH = 124
Lancet. 2000 Jun 3;355(9219):1931-1935 Randomized Controlled Trial, Multicenter Study
IN chronic obstructive pulmonary disease, exacerbations The Use of
non-invasive ventilation
As Treatment, Acute
Is better Than
standard treatment without ventilatory support
To reduce need for intubation (15% with ventilation VS 27% without) and reduce mortality (10% with ventilation VS 20% without)
Thorax. 2001 Sep;56(9):708-712 Randomized Controlled Trial, Multicenter Study
IN chronic obstructive pulmonary disease, exacerbations The Use of
non-invasive ventilation
As Treatment, Acute
Is better Than
standard treatment without ventilatory support
To reduce mortality: median length of survival was 17 months in those treated with ventilation VS 13 months without
Thorax. 2008 May;63(5):415-22 Meta-Analysis
IN chronic obstructive pulmonary disease, exacerbations The Use of
short-course antibiotic treatment (5 days or less)
As Treatment, Acute
Is equal Than
longer duration of antibiotic course
To achieve clinical and bacteriological cure (OR 1.0 and 1.05 respectively)
Chest. 2005 Jul;128(1):48-54 Randomized Controlled Trial
IN chronic obstructive pulmonary disease, exacerbations The Use of
smaller doses of short-acting inhaled beta2 agonists (albuterol, 2.5mg/4h)
As Treatment, Acute
Is equal Than
greater doses of the same drug (albuterol, 5mg/4h)
To increase FEV1 and peak expiratory flow rate, increase recovery rate, reduce hospital stay (trend to lower stay with higher doses: 6 vs 9 days, but not significant) or reduce side effects.
Cochrane Database Syst Rev. 2005;(1):CD001288 Systematic Review, Cochrane Review
IN chronic obstructive pulmonary disease, exacerbations The Use of
systemic corticosteroids
As Treatment, Acute
Is better Than
placebo
To reduce, at 1 month, treatment failure (NNT 9) and improve respiratory failure and breathlessness, but increased adverse effects (OR 2.3)
Lancet. 1999 Aug 7;354(9177):456-60 Randomized Controlled Trial
IN chronic obstructive pulmonary disease, exacerbations The Use of
systemic corticosteroids
As Treatment, Acute
Is better Than
placebo
To improve faster FEV1 and reduce lenght of hospital stay
N Engl J Med. 1999 Jun 24;340(25):1941-7 Randomized Controlled Trial, Multicenter Study
IN chronic obstructive pulmonary disease, exacerbations The Use of
systemic corticosteroids
As Treatment, Acute
Is better Than
placebo
To reduce treatment failure (death or mechanical ventilation or need to intensificate treatment): 23% with corticoids VS 33% without. Also, reduce lenght of hospital stay.
Chest. 2008 Mar;133(3):756-66 Systematic Review
IN chronic obstructive pulmonary disease, exacerbations The Use of
systemic corticosteroids, antibiotics, and noninvasive positive pressure ventilation
As Treatment, Acute
Is better Than
placebo or no use of that treatment
To reduce in-hospital mortality (antibiotics and ventilation) and reduce treatment failure (all, corticosteroids)
BMJ. 2003 Sep 20;327(7416):643 Meta-Analysis
IN chronic obstructive pulmonary disease, exacerbations The Use of
theophylline, methylxanthines
As Treatment, Acute
Is worse Than
placebo
To it did not reduce admissions to hospital, length of stay and relapses at one week. But it caused more adverse effects: vomiting, tremor, arrhythmias
Chest. 2007 Jan;131(1):9-19 Randomized Controlled Trial
IN chronic obstructive pulmonary disease, exacerbations, respiratory infection, lower airways The Use of
procalcitonin, treating with antibiotics according to serum procalcitonin levels
As Diagnostic Tool
Is better Than
systematic treatment with antibiotics
To identify patients with active respiratory infection and guide antibiotic use: it reduced antibiotic use (40% vs 72%) obtaining same clinical outcome at 14 days and rehospitalzation rate (21% vs 24%)
Chest. 2001 Jun;119(6):1840-1849 Descriptive
IN chronic obstructive pulmonary disease, exacerbations, severe, requiring invasive mechanical ventilation The Use of
presence of comorbidities, APACHE, need for ventilation for > 72h or extubation failure
As Prognostic Item
Is useful Than
-
To predict higher in-hospital mortality
Chest. 2010 Sep 30;epub(epub):epub Cohorts
IN chronic obstructive pulmonary disease, in non-smokers The Use of
non-smokers, never smokers patients
As Etiologic risk factor
Is useful Than
no comparison
To though never smokers have much less risk of developing CPOD, they comprise 20-23% of all individuals with COPD. Asthma, age, lower education occupational exposure, childhood respiratory diseases and BMI alterations predicted COPD
Cochrane Database Syst Rev. 2005 Oct 19;(4):CD003566 Systematic Review, Cochrane Review
IN chronic obstructive pulmonary disease, stable The Use of
cardioselective beta-blockers
As Treatment, Chronic
Is equal Than
placebo
To modify respiratory function: no significant difference, at 3 months, in FEV1 or respiratory symptoms
BMJ. 2011 May 10;342:d2549. doi: 10.1136/bmj.d2549 Cohorts
IN chronic obstructive pulmonary disease, stable The Use of
cardioselective beta-blockers, given in addition to inhaled corticosteroid and long acting β agonist, with or without long acting antimuscarinic
As Treatment, Chronic
Is better Than
no beta-blockers use
To reduce all-cause mortality (22% relative reduction) and reduce hospital admissions due to respiratory disease.
Chest. 2007 Mar;131(3):682-9 Meta-Analysis
IN chronic obstructive pulmonary disease, stable The Use of
corticosteroids, inhaled
As Treatment, Chronic
Is better Than
placebo
To increase, at 6 months, FEV1 (mean of 42 mL in men and 29 mL in women compared with placebo) and keep this difference afterwards
N Engl J Med. 2000 Dec 28;343(26):1902-1909 Randomized Controlled Trial, Multicenter Study
IN chronic obstructive pulmonary disease, stable The Use of
corticosteroids, inhaled
As Treatment, Chronic
Is equal Than
placebo
To reduce the rate of decline of post-bronchodilator FEV1 at 3 years. It reduced the visits to a physician because of a respiratory illness (1.2% /year in intv. VS 2.1% /year in ctrl.) and reduced symptoms.
BMJ. 2000 13 May;320(7245):1297-1303 Randomized Controlled Trial
IN chronic obstructive pulmonary disease, stable The Use of
corticosteroids, inhaled
As Treatment, Chronic
Is better Than
placebo
To reduce excerbation rate (0,99/year in intv. VS 1,32/year in ctrl.) and produce a small increase in FEV1. But it did not affect the rate of decline in FEV1
Thorax. 2003 Nov;58(11):937-41 Meta-Analysis
IN chronic obstructive pulmonary disease, stable The Use of
corticosteroids, inhaled
As Treatment, Chronic
Is better Than
placebo
To reduce the rate of FEV1 decline (mean reduction 7.7 ml/year, and with high dose regimens 9.9 ml/year)
Lancet. 1999 May 29;353(9167):1819-23 Randomized Controlled Trial
IN chronic obstructive pulmonary disease, stable The Use of
corticosteroids, inhaled
As Treatment, Chronic
Is equal Than
placebo
To reduce the rate of decline in FEV1, reduce exacerbations or improve symptoms at 3 years.
Lancet. 1998 Mar 14;351(9105):773-80 Randomized Controlled Trial
IN chronic obstructive pulmonary disease, stable The Use of
corticosteroids, inhaled
As Treatment, Chronic
Is better Than
placebo
To reduce excerbation rate at 6 months (32% in intv. VS 37% in ctrl.) and increase FEV1, symptoms and 6 min walking distance
JAMA. 2008 Nov 26;300(20):2407-16 Meta-Analysis
IN chronic obstructive pulmonary disease, stable The Use of
corticosteroids, inhaled
As Treatment, Chronic
Is equal Than
placebo
To reduce overall mortality at 1 year (RR 0.86). Inhaled corticoids increased pneumonia rate (RR 1.34).
Cochrane Database Syst Rev. 2007;(2):CD002991 Systematic Review, Cochrane Review
IN chronic obstructive pulmonary disease, stable The Use of
corticosteroids, inhaled
As Treatment, Chronic
Is better Than
placebo
To temporarily (first 6 months) reduce the decline of FEV1 and reduce at long term rate of exacerbations (-0.26 /patient/year)
N Engl J Med. 1999 Jun 24;340(25):1948-53 Randomized Controlled Trial, Multicenter Study
IN chronic obstructive pulmonary disease, stable The Use of
corticosteroids, inhaled
As Treatment, Chronic
Is better Than
placebo
To reduce the rate of decline of post-bronchodilator FEV1 in the first 6 monts of treatment but but does not appreciably affect the long-term progressive decline.
Chest. 2010 Feb;137(2):318-25 Meta-Analysis
IN chronic obstructive pulmonary disease, stable The Use of
corticosteroids, inhaled
As Treatment, Chronic
Is better Than
placebo
To modestly reduce exacerbations rate (RR 0.82) across all levels of severity.
Am J Respir Crit Care Med. 2009 Oct 15;180(8):741-50 Randomized Controlled Trial, Multicenter Study
IN chronic obstructive pulmonary disease, stable The Use of
corticosteroids, inhaled (budesonide), combined with inhaled long-acting beta2 agonists (formoterol), added to inhaled long-acting anticholinergics (tiotropium)
As Treatment, Chronic
Is better Than
placebo plus tiotropium
To improve, at 3 months, VEMS (1.14 cortics/beta2 VS 1.08 placebo), improve respiratory symptoms and reduce exacerbations (8% cortics/beta2 VS 18% placebo)
N Engl J Med. 2007 Feb 22;356(8):775-89 Randomized Controlled Trial, Multicenter Study
IN chronic obstructive pulmonary disease, stable The Use of
corticosteroids, inhaled (fluticasone), alone or combined with inhaled long-acting beta2 agonists
As Treatment, Chronic
Is equal Than
placebo
To modify survival 3 years. There was a trend to better survival with combined inhaled corticosteroids plus lon-acting beta2 agonists but it did not reach sisnificance
J Gen Intern Med. 2006 Oct;21(10):1011-9 Meta-Analysis
IN chronic obstructive pulmonary disease, stable The Use of
inhaled anticholinergics
As Treatment, Chronic
Is better Than
long acting beta2-agonists
To reduced severe exacerbations (RR 0.67, compared to placebo) and respiratory deaths (RR 0.27, compared to placebo) while beta2-agonists associated increased risk for respiratory deaths
Cochrane Database Syst Rev. 2006 Jul 19;3:CD006101 Systematic Review, Cochrane Review
IN chronic obstructive pulmonary disease, stable The Use of
inhaled anticholinergics, ipratropium bromide
As Treatment, Chronic
Is equal Than
long acting beta2-agonists
To to improve COPD symptoms and exercise tolerance, although beta2-agonists improved better morning PEF and FEV1. combination therapy was a little better than beta-2 agonists alone for symptoms.
Thorax. 2006 Oct;61(10):854-62. Epub 2006 Jul 14 Meta-Analysis
IN chronic obstructive pulmonary disease, stable The Use of
inhaled anticholinergics, long acting, tiotropium
As Treatment, Chronic
Is better Than
placebo, ipratropium bromide, or long acting beta2-agonists
To reduce exacerbations (OR 0.73) and related hospitalisation (OR 0.68), but not to reduce mortality, all-cause or specific
Ann Intern Med. 2007 Nov 6;147(9):639-53 Systematic Review
IN chronic obstructive pulmonary disease, stable The Use of
long-acting beta2 agonists plus corticosteroids, inhaled and oxygen ; pulmonary rehabilitation
As Treatment, Chronic
Is better Than
placebo or inhaled corticosteroids alone and no oxygen
To reduce mortality (8.6% long-acting beta2 plus cortics VS 11% controls) (oxygen in resting hypoxemic patients RR 0.61). All lon-acting bronchodilators (B2 or tiatropium) reduced exacerbations and rehabilitation improved health status.
Lancet. 2008 Jun 14;371(9629):2013-8 Randomized Controlled Trial, Multicenter Study
IN chronic obstructive pulmonary disease, stable The Use of
mucolytics, carbocisteine
As Treatment, Chronic
Is better Than
placebo
To reduce exacerbation rate: 1.01 per patient per year with carbocisteine VS 1.35 placebo.
Lancet. 2005 Apr 30;365(9470):1552-60 Randomized Controlled Trial, Multicenter Study
IN chronic obstructive pulmonary disease, stable The Use of
mucolytics, N-acetylcysteine
As Treatment, Chronic
Is equal Than
placebo
To reduce yearly reduction in pulmonary function (FEV1 reduction 54ml VS 47ml/y) and the number of exacerbations per year (1.5 VS 1.29)
Chest. 2001 Jun;119(6):1661-70 Randomized Controlled Trial
IN chronic obstructive pulmonary disease, stable The Use of
theophylline, added to inhaled beta2-agonists
As Treatment, Chronic
Is better Than
inhaled beta2-agonists alone
To reduce - at 3 months - symptoms and dyspnea (53% in Theo+B2 VS 40% in B2 alone) and improve FEV1. Number of exacerbations was not significantly different and theophylline increased adverse effects.
N Engl J Med. 2017 Sep 07;377(10):923-935 Randomized Controlled Trial, Multicenter Study
IN chronic obstructive pulmonary disease, stable, early stage The Use of
inhaled anticholinergics, long acting, tiotropium
As Treatment, Chronic
Is better Than
placebo
To slightly improve at 2 years the FEV1 (mean difference 71 to 133 ml after bronchodilator use) and slightly reduce the decline of FEV1 after bronchodilator use (29 ml/year tiotrop VS 51 ml/year placebo)
N Engl J Med. 2011 Mar 24;364(12):1093-103 Randomized Controlled Trial, Multicenter Study
IN chronic obstructive pulmonary disease, stable, moderate to severe The Use of
inhaled anticholinergics, long acting, tiotropium
As Treatment, Chronic
Is better Than
long acting beta2-agonists, salmeterol
To reduce number of moderate or seve exarcerbations at 1 year: 0.64 tiotropium VS 0.72 salmeterol. the incidence of serious adverse events was similar.
Ann Intern Med. 2012 Dec 18;157(12):878-88 Systematic Review
IN clostridium difficile Infecion, diarrhea, acute, infectious, antibiotic-associated The Use of
probiotics, mainly different types of lactobacillus
As Prevention, Primary
Is better Than
placebo
To to reduce the incidence of Clostridium difficile-associated diarrhea in patients taking antibiotics: RR 0.34
N Engl J Med. 2011 Feb 3;364(5):422-31 Randomized Controlled Trial, Multicenter Study
IN clostridium difficile infecion, diarrhea, acute, infectious, antibiotic-associated The Use of
fidaxomicin, 200 mg twice daily for 10 days, new class of narrow spectrum non-absorbable macrocyclic antibiotic
As Treatment, Acute
Is better Than
oral vancomycin, 125 mg four times daily for 10 days
To reduce recurrence rates at 4 weeks (13% fidaxo VS 24% vanco) with non-inferior rates of initial clinical response (88% fidaxo VS 86% vanco)
AHRQ Comparative Effectiveness Reviews. 2016 Mar. Report No.: 16-EHC012-EF Systematic Review
IN clostridium difficile infecion, diarrhea, acute, infectious, antibiotic-associated The Use of
high strenght: various preventive intervantions, oral vancomycine, fidaxomicin. Low strenght: probiotics, fecal transplantation
As Treatment, Acute
Is better Than
comparison
To other comparative intervantions in preventing and treating acute symptomatic c. difficile infection
CADTH Technology Report. 2011 Jan 26; No. 136, publication 2775 Systematic Review
IN clostridium difficile Infecion, diarrhea, acute, infectious, antibiotic-associated The Use of
vancomycin, oral
As Treatment, Acute
Is better Than
metronidazole, oral
To increase cure rate of initial or recurrent episodes of severe C. difficile (relative reduction 27%), while having equal effectiveness in moderate episodes.
Health Technol Assess. 2013 Dec;17(57):1-140 Randomized Controlled Trial, Multicenter Study
IN clostridium difficile infecion, diarrhea, acute, infectious, antibiotic-associated, older people The Use of
probiotics, high-dose preparation of lactobacilli and bifidobacteria
As Treatment, Acute
Is equal Than
placebo
To modify incidence of antibiotic-associated diarrhea (10% both groups), including C. difficile infections (probiotic 0.8%, placebo 1.2%, p 0.35)
Aliment Pharmacol Ther. 2006 Jul 1;24(1):47-54 Meta-Analysis
IN coeliac disease The Use of
human recombinant tissue transglutaminase antibody
As Diagnostic Tool
Is better Than
endomysial antibody
To sreen asymptomatic people and for excluding coeliac disease in symptomatic individuals with a low pretest probability (i.e. <25%), if pretest probability >25%, biopsy should be preferred. Sensitivity 93%, specificity 98%.
Aliment Pharmacol Ther. 2008 Jun 1;27(11):1044-52 Systematic Review
IN coeliac disease The Use of
intake of a little amount of gluten (<10 mg/day)
As Etiologic risk factor
Is better Than
higher intake of gluten
To avoid cause significant histological abnormalities
Cochrane Database Syst Rev. 2011;1:CD006220 Systematic Review, Cochrane Review
IN cognitive impairment, age related, mild cognitive impairment The Use of
cognitive training
As Prevention, Primary
Is better Than
no intervention at all
To improve immediate and delayed verbal recall, but the improvements of specific training improvements observed did not exceed the improvement in active control conditions.
Neurobiol Aging. 2014 Aug;35(8):1873-82 Descriptive
IN cognitive impairment, age related, older people without cognitive impairment The Use of
higher lifestyle cognitive activity and higher current physical activity
As Etiologic risk factor
Is better Than
lower lifestyle cognitive and physical activities
To be associated with lower volume of white matter lesion, higher neural integrity and higher global cognitive functioning
Cochrane Database Syst Rev. 2015;4:CD005381 Systematic Review, Cochrane Review
IN cognitive impairment, age related, older people without cognitive impairment The Use of
physical exercise, exercicse training
As Treatment, Acute
Is equal Than
no exercise training
To improve cognitive function
Cochrane Database Syst Rev. 2006 Oct 18;(4):CD003575 Systematic Review, Cochrane Review
IN collagenous colitis, diarrhea, chronic The Use of
budesonide, oral, enteral liberation formulation, 9 mg daily (entocort (r))
As Treatment, Chronic
Is better Than
placebo, or other therapeutics tested
To improve diarrhea and symptoms: NNT 2
Neurology. 2006 Jul 25;67(2):203-10 Systematic Review
IN coma, post-cardiac arrest, post-resuscitation care The Use of
several predictors: pupillary light response, corneal reflexes, motor responses to pain, myoclonus status epilepticus, serum neuron-specific enolase, and somatosensory evoked potential studies
As Diagnostic Tool
Is better Than
others clinical, biological and radiological findings
To accurately predict poor outcome in comatose patients after cardiopulmonary resuscitation
Cochrane Database Syst Rev. 2011 Mar 16;3:CD005967 Study type to be defined
IN Condition to be defined The Use of
artesunate, intravenous or intramuscular
As Treatment, Acute
Is better Than
quinine, intravenous
To reduce death (RR 0.61) in adults and children and in different parts of the world
Cochrane Database Syst Rev. 2007;(4):CD006829 Systematic Review, Cochrane Review
IN Condition to be defined The Use of
combined long-acting beta2 agonists plus corticosteroids, inhaled
As Treatment, Chronic
Is better Than
long-acting beta-agonists alone
To reduce exacerbation rate (Rate Ratio 0.82) and improve quality of life. No difference in mortality or hospitalisations. Pneumonia more frequent with combined Tt (OR 1.62)
Chest. 2016 Mar;149(3):756-66 Systematic Review
IN Condition to be defined The Use of
various pharmacologic treatments, including pirfenidone and nintedanib
As Treatment, Chronic
Is equal Than
placebo
To modify respiratory-specific or all-cause mortality
Am J Med. 2009 Feb;122(2):152-61 Study type to be defined
IN Condition to be defined The Use of
Intervention to be defined
As Undefined
Is undefined Than
Comparison to be defined
To Results to be defined
N Engl J Med. 2009 Mar 26;360(13):1320-8 Study type to be defined
IN Condition to be defined The Use of
Intervention to be defined
As Undefined
Is undefined Than
Comparison to be defined
To Results to be defined
BMJ. 2010;341(341):c3584 Study type to be defined
IN Condition to be defined The Use of
Intervention to be defined
As Undefined
Is undefined Than
Comparison to be defined
To Results to be defined
Cochrane Database Syst Rev. 2012;3(N):CD007176 Study type to be defined
IN Condition to be defined The Use of
Intervention to be defined
As Undefined
Is undefined Than
Comparison to be defined
To Results to be defined
JAMA. 2006 Jul 26;296(4):403-11 Diagnostic
IN coronary disease The Use of
coronary multidetector computed tomography
As Diagnostic Tool
Is worse Than
coronary angiography
To diagnose coronary stenosis of more than 50%: in patient-based analysis, 98% sensitivity for detecting at least 1 stenosis, 54% specificity, 50% positive predictive value, 99% negative predictive value. So, too much false positives.
Eur Heart J. 2011 Mar;32(5):637-45 Diagnostic
IN coronary disease The Use of
coronary multidetector computed tomography
As Diagnostic Tool
Is worse Than
coronary angiography
To detect significant coronary stenosis: sensib 100%, spec 85%, positive predict value 81%, negative predict value 100%. It detected all patients with atherosclerosis but misclassified some as severe stenosis
Eur Heart J. 2007 Oct;28(20):2485-90 Diagnostic
IN coronary disease The Use of
coronary multidetector computed tomography
As Diagnostic Tool
Is better Than
exercise electrocardiography, with coronary angiography as gold standard
To diagnose significant coronary disease: 91% sensitivity and 83% specificity of scan VS 73% sensitivity and 31% specificity of exercise ECG.
Ann Intern Med. 2000 Jun 6;132(11):862-70. Cohorts
IN coronary disease The Use of
stress test, treadmill exercise testing, in elderly persons
As Diagnostic Tool
Is equal Than
treadmill exercise testing, in younger persons
To predict overall survival and cardiac event-free survival. Workload achieved was the main exercise testing variable that was predictive of death.
J Am Coll Cardiol. 2010 Mar 9;55(10):1017-28 Cohorts
IN coronary disease The Use of
cardiac computed tomography angiography , and also, in addition, left ventricle ejection fraction
As Prognostic Item
Is useful Than
no comparison here
To predict increased risk of all-cause mortality or nonfatal myocardial infarction at 1.5 years: HR 3 when sever coronary disease detected.
Circulation. 2012 Jun 12;125(23):2873-91. Epub 2012 May 14 Meta-Analysis
IN coronary disease The Use of
drug-eluting stents, specially using everolimus, sirolimus and zotarolimus, but not those using paclitaxel
As Treatment, Acute
Is better Than
bare-metal stents
To reduce long-term need for revascularization and reduce myocardial infarction (RR 0.50), with no increase in the risk of any long-term safety outcomes, including stent thrombosis
Am J Med. 2009 Apr;122(4):356-65 Meta-Analysis
IN coronary disease The Use of
calcium channel blockers
As Treatment, Chronic
Is better Than
placebo, or mixed comparison placebo plus others treatments
To reduce angina and stroke, but not to reduce mortality (either all-cause or cardiovascular) nor to reduce myocardial infarction
Eur Heart J. 2005 Oct;26(20):2148-53. Epub 2005 Jun 23 Randomized Controlled Trial
IN coronary disease The Use of
coronary artery bypass surgery
As Treatment, Chronic
Is equal Than
percutaneous coronary angioplasty
To improve long-term survival: overall mortality was similar after 13 years. Time to first re-intervention was significantly shorter in angioplasty, but frequency of re-intervention was comparable (about 70%) and also symptomatic angina or dyspnoea.
Ann Intern Med. 2007 Nov 20;147(10):703-16 Systematic Review
IN coronary disease The Use of
coronary artery bypass surgery
As Treatment, Chronic
Is equal Than
percutaneous coronary intervention (angioplasty with/out stent)
To modify mortality at 10 years. Strokes were more common after CABG(1.2% CABG vs. 0.6% PCI) and repeated revascularization was more common after PCI (at 5 years 46.1% balloon angioplasty, 40.1% PCI with stents, and 9.8% CABG).
N Engl J Med. 2007 Mar 8;356(10):1030-9 Meta-Analysis
IN coronary disease The Use of
drug-eluting stents, sirolimus
As Treatment, Chronic
Is equal Than
bare-metal stents
To reduce the overall risk of death, myocardial infarction and stent thrombosis.
Lancet. 2007 Sep 15;370(9591):937-48 Meta-Analysis
IN coronary disease The Use of
drug-eluting stents, sirolimus, paclitaxel
As Treatment, Chronic
Is equal Than
bare-metal stents
To reduce the risk of death and myocardial infarction
N Engl J Med. 2007 Mar 8;356(10):998-1008 Meta-Analysis
IN coronary disease The Use of
drug-eluting stents, sirolimus, paclitaxel
As Treatment, Chronic
Is worse Than
bare-metal stents
To reduce stent thrombosis at 4 years (1.2 to 1.3% drug-eluting VS 0.6 to 0.9% bare-metal) Rates of death or myocardial infarction did not differ.
JAMA. 1999 Dec 1;282(21):2058-67 Meta-Analysis
IN coronary disease The Use of
vitamin K antagonists, added to aspirin, but not alone
As Treatment, Chronic
Is better Than
aspirin alone
To prevent myocardial infarction or stroke (risk reduction not given), but based in few studies (3 studies, 480 patients) and increasing bleeding risk by about 2 fold.
Am Heart J. 1999;137(6):1137-1144 Diagnostic
IN coronary disease, acute coronary syndrome The Use of
troponin T
As Diagnostic Tool
Is better Than
creatine kinase-MB (CK-MB)
To equally diagnosing acute myocardial infeartion in the first 24 h, but much better predicting death or major cardiac complications
Circulation. 2003 Feb 25;107(7):966-72 Randomized Controlled Trial
IN coronary disease, acute coronary syndrome The Use of
P2Y12 inhibitors, clopidogrel, added to aspirin, combined anti-platelet therapy
As Treatment, Acute
Is better Than
aspirin alone
To reduce ischemic events (cardiovascular death, myocardial infarction, or stroke) at 30 days (4.3% in intv. VS 5.4% in ctrl.) and at 12 months (5.2% in intv. VS 6.3% in ctrl.) No significant excess in life-threatening bleeds (but yes for total bleeds)
N Engl J Med. 2007 Nov 15;vol(issue):pag [Epub ahead of print Nov 4] Randomized Controlled Trial, Multicenter Study
IN coronary disease, acute coronary syndrome The Use of
P2Y12 inhibitors, prasugrel, added to aspirin, combined anti-platelet drugs
As Treatment, Acute
Is better Than
clopidogrel, added to aspirin, combined anti-platelet therapy
To reduce recurrence of myocardial infarction (7.4% for prasugrel VS 9.7% for clopidogrel) and a derived combined end-point of cardiovascular death and major events.
N Engl J Med. 2009 Sep 10;361(11):1045-57 Randomized Controlled Trial, Multicenter Study
IN coronary disease, acute coronary syndrome The Use of
P2Y12 inhibitors, ticagrelor, added to aspirin, combined anti-platelet therapy
As Treatment, Acute
Is better Than
clopidogrel, added to aspirin, combined anti-platelet drugs
To reduce at 12 months cardiovascular events (death from vascular causes, myocardial infarction, or stroke): 10% ticagrelor VS 12% clopidogrel. Ticagrelor increased minor bleedings but not major haemorrhages.
N Engl J Med. 2011 Aug 25;365(8):699-708. [Epub 2011 Jul 24] Randomized Controlled Trial, Multicenter Study
IN coronary disease, acute coronary syndrome The Use of
anticoagulants, oral factor Xa inhibitors, apixaban, 5 mg twice daily
As Treatment, Chronic
Is worse Than
placebo
To improve results at 8 months: it increase in major bleeding events (1.3% apixaban VS 0.5% placebo) and did not reduced cardiovascular events (7.5% apixaban VS 7.9% placebo)
N Engl J Med. 2012 Jan 5;366(1):9-19. Epub 2011 Nov 13 Randomized Controlled Trial, Multicenter Study
IN coronary disease, acute coronary syndrome The Use of
anticoagulants, oral factor Xa inhibitors, rivaroxaban, 2.5 or 5 mg twice daily, in addition to double antiplatelet treatment
As Treatment, Chronic
Is better Than
placebo
To reduce at 13 months cardiovascular events (cardiovascular death, myocardial infartion , stroke): 8.9% rivaroxaban VS 10.7% placebo. However, it increases major bleedings: 2.1% rivaroxaban VS 0.6% placebo
J Am Coll Cardiol. 2018 May 01;71(17):1869-1877 Randomized Controlled Trial, Multicenter Study
IN coronary disease, acute coronary syndrome The Use of
selecting the PY212 antiplatelet (clopidogrel, prasugrel, or ticagrelor) on the basis of a patient,s genetics, genotyping of ABCB1, CYP2C19*2, and CYP2C19*17
As Treatment, Chronic
Is better Than
selecting P2Y12 antiplatelet on clinical characteristics alone
To reduce at 1 year a composite endpoint of cardiovascular death and the first occurrence of nonfatal myocardial infarction, nonfatal stroke, and major bleeding: 16% pharmacogenomic VS 26% usual care
N Engl J Med. 2014 Dec 4;371(23):2155-66 Randomized Controlled Trial, Multicenter Study
IN coronary disease, acute coronary syndrome, after percutaneous coronary intervention, drug eluting stents The Use of
dual antiplatelet therapy (aspirin + P2Y12 inhibitor (clopidogrel or prasugrel)) for 30 months
As Treatment, Chronic
Is worse Than
dual antiplatelet therapy (aspirin + thienopyridine) for 12 months only
To improve all-cause mortality (2.0% 30 months VS 1.5% 12 months), even if it reduced cardiovascular events (4.3% 30 months VS 5.9% 12 months). Extended treatment increased major bleedings (2.5% vs 1.6%) but that did not explain the mortality difference
N Engl J Med. 2015 May 07;372(19):1791-800 Randomized Controlled Trial, Multicenter Study
IN coronary disease, acute coronary syndrome, after percutaneous coronary intervention, drug eluting stents The Use of
mantaining dual antiplatelet after 1 year with ticagrelor (90 mg twice daily or 60 mg twice daily) plus low-dose aspirin
As Treatment, Chronic
Is better Than
placebo plus low-dose aspirin
To reduce cardiovascular events (8% both doses ticagrelor VS 9% aspirin alone) but increasing major bleeding (2.5% ticagrelor VS 1% aspirin alone)
J Am Coll Cardiol. 2015 Mar 24;65(11):1092-102 Meta-Analysis
IN coronary disease, acute coronary syndrome, after percutaneous coronary intervention, drug eluting stents The Use of
short- (≤6 months) dual antiplatelet therapy
As Treatment, Chronic
Is better Than
long-term (1 year) dual antiplatelet therapy
To reduce bleeding (HR 0.66) while achieving similar rates of cardiac events (cardiac death, myocardial infarction, or definite/probable stent thrombosis: HR 1.11)
BMJ. 2015 Apr 16;350:h1618 Meta-Analysis
IN coronary disease, acute coronary syndrome, after percutaneous coronary intervention, drug eluting stents The Use of
short term course of dual antiplatelet therapy
As Treatment, Chronic
Is better Than
12 month dual antiplatelet therapy
To reduce major bleeding (OR 0.58) with no significant differences in ischaemic or thrombotic outcomes. Extended VS 12 month Tt yielded a reduction of ischemic events (OR 0.33 to 0.53) but more major bleeding (OR 1.66) and more all-cause deaths (OR 1.30)
N Engl J Med. 2017 Oct 19;377(16):1513-1524 Randomized Controlled Trial, Multicenter Study
IN coronary disease, acute coronary syndrome, after percutaneous coronary intervention, drug eluting stents, atrial fibrillation The Use of
dual treatment with dabigatran 110 mg twice daily plus an a P2Y12inhibitor (clopidogrel or ticagrelor) antiplatelet
As Treatment, Chronic
Is better Than
triple therapy with dose-adjusted vitamin K antagonist plus dual antiplatelet
To reduce at 14 months major or clinically relevant bleeding events (15% dabigatran 110mg VS 27% triple therapy) with no increase of cardiovascular events (13.7% dual-therapy VS 13.4% triple-therapy)
Lancet. 2013 Mar 30;381(9872):1107-15 Randomized Controlled Trial, Multicenter Study
IN coronary disease, acute coronary syndrome, after percutaneous coronary intervention, drug eluting stents, atrial fibrillation The Use of
dual treatment with INR adjusted warfarin plus clopidogrel
As Treatment, Chronic
Is better Than
triple therapy with dose-adjusted vitamin K antagonist plus dual antiplatelet (aspirin + clopidogrel)
To reduce at 1 year any bleeding event (19% dual Tt VS 44% triple Tt) with no increase in the rate of thrombotic events
N Engl J Med. 2016 Dec 22;375(25):2423-2434 Randomized Controlled Trial, Multicenter Study
IN coronary disease, acute coronary syndrome, after percutaneous coronary intervention, drug eluting stents, atrial fibrillation The Use of
low-dose rivaroxaban (15 mg /d) plus an P2Y12 inhibitor antiplatelet for 12 months OR very-low-dose rivaroxaban (2.5 mg twice daily) plus dual antiplatelet for 1, 6, or 12 months
As Treatment, Chronic
Is better Than
dose-adjusted vitamin K antagonist plus dual antiplatelet for 1, 6, or 12 months
To reduce clinically significant bleeding (17% rivaroxaban 15 + 1 antiplatelet, 18% rivaroxaban 2.5 + 2 antiplatelets, and 26.7% antivitamin K + 2 antiplatelets) while having similar rates of cardiovascular events (6.5%, 5.6% and 6% respectively)
N Engl J Med. 2004 Apr 8;350(15):1495-504 Randomized Controlled Trial, Multicenter Study
IN coronary disease, acute coronary syndrome, high or normal cholesterol The Use of
high dose statins, atorvastatin 80 mg/d
As Treatment, Chronic
Is better Than
standard dose statins, standard lipid lowering, pravastatin 40 mg/d
To reduce cardiovascular events (composite of death from any cause, myocardial infarction, hospitalization for unstable angina, revascularization and stroke): 22,4% at 2 years in intv. VS 26,3% in ctrl.
J Am Coll Cardiol. 2010 May 11;55(19):2096-106 Cohorts
IN coronary disease, acute coronary syndrome, myocardial infarction The Use of
copeptin, added to troponin
As Diagnostic Tool
Is better Than
troponin
To more accurately diagnose an acute coronary syndrome (c-statistics 0.93 copeptin + troponin VS 0.84 troponin alone) and to rule out coronary syndrome in the first 3 hours: 92% negative predictive value with copeptin + troponin
Cochrane Database Syst Rev. 2011;1:CD007038 Systematic Review, Cochrane Review
IN coronary disease, acute coronary syndrome, myocardial infarction The Use of
pentasacharide analogues, fondaparinux
As Treatment, Acute
Is better Than
low molecular weight heparins (LMWH), enoxaparin
To reduce the risk of all-cause mortality at 90 to 180 days (RR 0.89) while reducing minor bleeding
Ann Intern Med. 2005 Aug 16;143(4):241-50 Meta-Analysis
IN coronary disease, acute coronary syndrome, myocardial infarction The Use of
vitamin K antagonists, warfarin, added to aspirin
As Treatment, Chronic
Is better Than
aspirin alone, NOT compared to aspirin plus clopidrogel
To decrease the annual rate of myocardial infarction (0.022 vs. 0.041) and ischemic stroke (0.004 vs. 0.008) but not to reduce mortality. Major bleeding increased (0.015 vs. 0.006)
Eur Heart J. 2011 Jun;32(11):1379-89 Diagnostic
IN coronary disease, acute coronary syndrome, myocardial infarction, older patients The Use of
high-sensitive cardiac troponin assays
As Diagnostic Tool
Is better Than
standard cardiac troponin assay
To diagnose acute myocardial infarction: AUC 0.95 sensitive troponine VS 0.90 standard troponine. Best cut-offs in elderly patients differed clearly from younguer patients. Mild elevations are commont in non-infarctus elderly (20% patients)
Eur Heart J. 2013 Sep 11. [Epub ahead of print] Meta-Analysis
IN coronary disease, acute coronary syndrome, myocardial infarction, ST-segment elevation The Use of
intracoronary bone marrow cell therapy
As Treatment, Acute
Is better Than
placebo or no cell therapy
To improve (at a time not well defined) left ventricle ejection fraction (LVEF) : 2.5% mean increase, 5.3% when LVEF was < 40%
N Engl J Med. 1998 Nov 5;339(19):1349-57 Randomized Controlled Trial
IN coronary disease, acute coronary syndrome, myocardial infarction, unstable angina, normal cholesterol The Use of
statins, pravastatin 40 mg/d
As Prevention, Secondary
Is better Than
placebo
To reduce - at 6 years - overall mortality (11.0% in pravastatin vs 14.1% in placebo) and cardiovascular mortality (7.3% in pravastatin vs 9.6% in placebo)
JAMA. 2006 Apr 5;295(13):1519-30. Epub 2006 Mar 14 Randomized Controlled Trial, Multicenter Study
IN coronary disease, acute coronary syndrome, ST-segment elevation The Use of
pentasacharide analogues, fondaparinux (2.5 mg/d) for 8 days
As Treatment, Acute
Is better Than
unfractionated heparin for 2 days, or placebo
To reduce at 30 days bad outcome (death or reinfarction): 9.7% fondaparinux VS 11.2% controls. No difference in bleeding.
Lancet. 2000 Jul 1;356(9223):9-16 Randomized Controlled Trial, Multicenter Study
IN coronary disease, acute coronary syndrome, unstable angina The Use of
routine invasive strategy (angiography and revascularization), first 10 days
As Treatment, Acute
Is better Than
non invasive startegy
To reduce, 1 year later, death (2.2% invasive VS 3.2% conservative) and reinfarction (9% invasive VS 12% conservative)
N Engl J Med. 2001 Aug 16;345(7):494-502 Randomized Controlled Trial, Multicenter Study
IN coronary disease, acute coronary syndrome, without ST elevation The Use of
adenosine diphosphate (ADP) receptor inhibitors, clopidogrel, added to aspirin, combined anti-platelet therapy
As Treatment, Acute
Is better Than
aspirin alone
To reduce, at 1 year, ischemic events (cardiovascular death, myocardial infarction or stroke): 9.3% in intv VS 11.4% in ctrl. Increase major bleeds (3.7% in intv. VS 2.7% in ctrl.)
J Am Coll Cardiol. 2010 Mar 2;55(9):858-64 Randomized Controlled Trial, Multicenter Study
IN coronary disease, acute coronary syndrome, without ST elevation The Use of
early invasive strategy of coronary angiography and revascularization when feasible
As Treatment, Acute
Is equal Than
conservative strategy: coronary angiography and revascularization only if recurrent ischemia or on provocative testing
To modify at 5 years cumulative death or MI rates (22.3% early VS 18.1% conservative), or mortality.
JAMA. 2001 Nov 21; 286 (19):2405-12 Randomized Controlled Trial, Multicenter Study
IN coronary disease, acute coronary syndrome, without ST elevation The Use of
early invasive strategy of coronary angiography between 4 and 48 hours and revascularization when feasible
As Treatment, Acute
Is better Than
Conservative strategy: coronary angiography and revascularization only if recurrent ischemia at rest or on provocative testing
To reduce composite end point of death, MI, or rehospitalization for acute coronary syndrome at 6 months: 15.3% in intv. VS 25% in ctrl.
N Engl J Med. 2005 Sep 15;353(11):1095-104 Randomized Controlled Trial, Multicenter Study
IN coronary disease, acute coronary syndrome, without ST elevation The Use of
early invasive strategy of coronary angiography revascularization when feasible
As Treatment, Acute
Is equal Than
conservative strategy: coronary angiography and revascularization only if recurrent ischemia or on provocative testing
To reduce at 1 year a composite enpoint of death, nonfatal myocardial infarction, or rehospitalization for anginal symptoms: 22.7% in early invasive VS 21.2% with conservative strategy. Early invasive strategy associated more AMI but less rehospitalisations
Lancet. 2002 Jan 19;359(9302):189-98 Meta-Analysis
IN coronary disease, acute coronary syndrome, without ST elevation The Use of
glycoprotein IIb/IIIa inhibitors, anti-platelet
As Treatment, Acute
Is better Than
placebo
To reduce at 30 days death or myocardial infarction (10.8% in intv. VS 11.8% in ctrl.). Increase major bleeds (2,4% in intv. VS 1,4% in ctrl)
N Engl J Med. 2006 Apr 6;354(14):1464-76. Epub 2006 Mar 14 Randomized Controlled Trial, Multicenter Study
IN coronary disease, acute coronary syndrome, without ST elevation The Use of
pentasacharide analogues, fondaparinux (2.5 mg/d SC) for 6 days
As Treatment, Acute
Is equal Than
low molecular weight heparin (LMWH), enoxaparin 1 mg/Kg/12h
To reduce at 30 days bad outcome (death, reinfarction, or refractory ischemia): 8.0% fondaparinux VS 8.6% enoxaparin. Fondaparinux had fewer major haemorrhages: 3.1% VS 5.0% enoxaparin
JAMA. 2008 Jul 2;300(1):71-80 Meta-Analysis
IN coronary disease, acute coronary syndrome, without ST elevation, biomarkers positive The Use of
early invasive strategy of coronary angiography revascularization when feasible
As Treatment, Acute
Is better Than
conservative strategy
To reduce death, myocardial infarction or readmission: 21% early invasive strategy VS 25.5% conservative.
Lancet. 2006 Sep 16;368(9540):998-1004 Randomized Controlled Trial, Multicenter Study
IN coronary disease, acute coronary syndrome, without ST-segment elevation The Use of
early invasive strategy with coronary angiography and, if appropriate, revascularisation within 7 days
As Treatment, Acute
Is better Than
conservative strategy: non-invasive primarily medical strategy
To reduce at 5 years death or myocardial infarction: 19.9% invasive strategy VS 24.5% conservative strategy.
Ann Intern Med. 2008 Feb 5;148(3):186-96 Systematic Review
IN coronary disease, acute coronary syndrome, without ST-segment elevation The Use of
routine invasive strategy (angiography and revascularization)
As Treatment, Acute
Is equal Than
conservative strategy (ischaemia- or symptom-driven angiography)
To reduce mortality (RR 0.90, 0.80 to 1.14) or re-infarction (RR 0.86, 0.68 to 1.08)
Eur Heart J. 2012 Jan;33(1):51-60 Randomized Controlled Trial
IN coronary disease, acute coronary syndrome, without ST-segment elevation, women The Use of
routine invasive strategy (angiography and revascularization)
As Treatment, Acute
Is worse Than
conservative strategy (ischaemia- or symptom-driven angiography)
To routine invasive strategy increased death at 1 year in women (8.8% VS 1.1% in the RCT and OR 1.51 in the meta-analysis) and did NOT modify MI and stroke rates. Results in men are not always extapolable to women
JAMA. 2007 Jul 18;298(3):299-308 Cohorts
IN coronary disease, atherosclerosis The Use of
nonfasting triglycerides
As Etiologic risk factor
Is useful Than
no comparison here
To predict risk of developping coronary disease, myocardial infarction and death.
Ann Intern Med. 2010 May 18;152(10):630-9 Cohorts
IN coronary disease, chest pain The Use of
coronary multidetector computed tomography, computed tomography coronary angiography
As Diagnostic Tool
Is better Than
stress testing
To screen for coronary disease, specially in patients at intermediate pre-test probability (+ results indicated 93% need for coronary angiography and negative results indicated no need for further testing (1% + cases).
N Engl J Med. 1997 Dec 4;337(23):1648-53 Cohorts
IN coronary disease, chest pain, acute coronary syndrome The Use of
troponin I, troponin T
As Diagnostic Tool
Is better Than
CPK and ECG alone
To identify early patients at risk to develop myocardial infartion or death from cardiac causes: For the 34 total events (20 deaths, 14 infarctions), troponin I was positive in 32 and negative in 2. Troponin T was positive in 27 and negative in 7.
Lancet. 2012 Feb 4;379(9814):453-60 Diagnostic
IN coronary disease, chest pain, high risk patients The Use of
magnetic resonance imaging (MRI) of the heart, with adenosine stress
As Diagnostic Tool
Is better Than
single-photon emission computed tomography (SPECT), with adenosine stress, perfusion scintigraphy
To diagnose significant coronary disease (gold standard : coronary angiography) : IRM sensitivity 86%, specificity 83% ; SPECT sensitivity 66%, specificity 82%
Heart. 2010 Dec;96(24):1973-9 Diagnostic
IN coronary disease, chest pain, low to intermediate risk patients The Use of
coronary multidetector computed tomography, 64-slice CT coronary angiography
As Diagnostic Tool
Is better Than
exercise ECG testing (invasive coronariography as reference test)
To accurately diagnose significant coronary disease: sensitivity 100%, specificity 98.7%, positive and negative predictive values 92.9% and 100%, at the patient level (as opposed to analysis by coronary segment)
Health Technol Assess. 2008 May;12(17):iii-iv, ix-143 Systematic Review
IN coronary disease, clinically suspected The Use of
coronary multidetector computed tomography, 64-slice or higher
As Diagnostic Tool
Is worse Than
invasive coronary angiography
To diagnose suspected coronary disease: high negative predictive value 95 - 100%, less good positive predictive value, less detailed info. Useful to avoid unnecessary invasive angiography.
J Am Coll Cardiol. 2008 Jan 1;51(1):37-45 Meta-Analysis
IN coronary disease, elderly patients The Use of
statins
As Prevention, Secondary
Is better Than
placebo
To reduce overall mortlity (15.6% statins VS 18.7% placebo, NNT 28), cardiac mortality, myocardial infarction and stroke
Eur Heart J. 2006 May;27(10):1230-7. Epub 2006 Apr 18 Cohorts
IN coronary disease, heart failure, stroke, cardiovascular death, risk in general population The Use of
brain natriuretic peptide (BNP), plasma N-terminal pro-A-type and pro-B-type natriuretic peptides (BNP)
As Prognostic Item
Is useful Than
no comparison here
To predict risk of death from cardiovascular causes: adjusted risk was 1.35-fold for each SD increment in multivariate analysis
J Am Coll Cardiol. 2007 Oct 9;50(15):1469-75 Diagnostic
IN coronary disease, intermediate and low risk symptomatic patients The Use of
coronary multidetector computed tomography
As Diagnostic Tool
Is useful Than
coronary angiography as gold standard
To diagnose significant coronary disease: see below pre and post-test probabilities of coronary disease for each strata of high, intermediate and low risk.
Eur Heart J. 2007 Dec;28(24):3034-41 Diagnostic
IN coronary disease, intermediate pre-test probability patients The Use of
16 and 64-slice coronary multidetector computed tomography
As Diagnostic Tool
Is worse Than
coronary angiography as gold standard
To diagnose significant coronary disease: sensitivity 99%, specificity 75%, NPV 99%, PPV ?
N Engl J Med. 2011 May 5;364(18):1718-27. Epub 2011 Apr 4 Randomized Controlled Trial, Multicenter Study
IN coronary disease, left main coronary artery stenosis The Use of
coronary artery bypass surgery
As Treatment, Acute
Is equal Than
percutaneous stent implantation, sirolimus-eluting
To modify major cardiovascular events (death, infarction or stroke) at 2 years: 4.4% stent VS 4.7% surgery. Ischemia-driven target-vessel revascularization was more frequent in stent patients, however (9% VS 4%)
N Engl J Med. 2011 Apr 28;364(17):1607-16. Epub 2011 Apr 4 Randomized Controlled Trial, Multicenter Study
IN coronary disease, left ventricular dysfunction The Use of
coronary artery bypass surgery
As Treatment, Acute
Is equal Than
medical treatment alone
To modify mortality from any cause: 36% bypass VS 41% medical Tt (P=0.12). Bypass surgery reduced death from adjudicated cardiovascular cause and hospitalizations
N Engl J Med. 2011 Apr 28;364(17):1617-25. Epub 2011 Apr 4. Randomized Controlled Trial, Multicenter Study
IN coronary disease, left ventricular dysfunction, ischemic but viable myocardium The Use of
coronary artery bypass surgery
As Treatment, Acute
Is equal Than
medical treatment alone
To modify mortality (no frequency figures given in abstract)
N Engl J Med. 1999 Aug 26;341(9):650-8 Cohorts
IN coronary disease, lifestyle and habits The Use of
exercise regular, enfermedad coronaria
As Prevention, ejercicio físico
Is Than
To
Lancet. 2009 Apr 4;373(9670):1190-7 Meta-Analysis
IN coronary disease, multivessel disease The Use of
coronary artery bypass surgery
As Treatment, Acute
Is equal Than
percutaneous coronary intervention (angioplasty with/out stent)
To reduce long-term (6 years) mortality (15% bypass VS 16% PCI). Bypass may reduce mortality in patients with diabetes or aged > 65 years
N Engl J Med. 2005 May 26;352(21):2174-83 Cohorts
IN coronary disease, multivessel disease (2 or 3 vessels) The Use of
coronary artery bypass surgery
As Treatment, Chronic
Is better Than
percutaneous stent implantation
To reduce death and revascularization at 3 years: rates?
Circulation. 2010 Sep 7;122(10):949-57 Randomized Controlled Trial
IN coronary disease, multivessel disease, stable angina The Use of
coronary artery bypass surgery
As Treatment, Chronic
Is better Than
percutaneous coronary intervention or medical treatment alone or
To reduce at 10 years: myocardial infarction (10% CABG VS 13% PCI VS 21% medical) and need for further revascularization, but there wer no significant difference in overall mortality (75% CABG or PCI, 69% medical Tt, p NS)
Heart. 2009 Mar;95(3):198-202 Systematic Review
IN coronary disease, myocardial infarction The Use of
rutine oxygen
As Treatment, Acute
Is worse Than
room air
To improve mortality or clinical outcomes: the only one study found that high-flow O2 had non-sifnificant increased risk of death and higher enzyme levels
Eur Heart J. 2007 Dec;28(24):3012-9 Meta-Analysis
IN coronary disease, myocardial infarction The Use of
further reduction of resting heart rate using beta blockers (or calcium channel blockers)
As Treatment, Chronic
Is better Than
less important reduction of resting herat rate
To reduce cardiac mortality: each 10 b.p.m. reduction estimated to reduce the relative risk of cardiac death by 30%
J Am Coll Cardiol. 2014 Nov 18-25;64(20):2071-82 Randomized Controlled Trial, Multicenter Study
IN coronary disease, myocardial infarction The Use of
polypill, fixed-dose combinations of drugs
As Treatment, Chronic
Is better Than
same drugs given separately
To improve medication adherence : 51% polypill VS 41% drugs separately
Ann Intern Med. 1998 Nov 1;129(9):681-9 Randomized Controlled Trial
IN coronary disease, myocardial infarction The Use of
statins
As Treatment, Chronic
Is Than
To
N Engl J Med. 2002 Sep 26;347(13):969-74 Randomized Controlled Trial, Multicenter Study
IN coronary disease, myocardial infarction The Use of
vitamin K antagonists, warfarin, added to aspirin or alone
As Treatment, Chronic
Is better Than
aspirin alone
To reduce cardiovascular events (death, MI or ischemic stroke), rates per year: 3.5% warfarin plus aspirin VS 4.2% warfarin VS 5% aspirin.
JAMA. 2006 Jun 7;295(21):2511-5 Randomized Controlled Trial, Multicenter Study
IN coronary disease, myocardial infarction, cardiogenic shock The Use of
early invasive strategy, early revascularization, angioplasty or surgical
As Treatment, Acute
Is better Than
conservative strategy: initial medical stabilization and selective late revascularization
To to improve patient long term survival: at 6 years, overall survival rates were 32.8% in early revasc and 19.6% in initial medical Tt
N Engl J Med. 1999 Aug 26;341(9):625-34 Randomized Controlled Trial
IN coronary disease, myocardial infarction, cardiogenic shock The Use of
early invasive strategy, early revascularization, angioplasty or surgical
As Treatment, Acute
Is better Than
conservative strategy: initial medical stabilization and selective late revascularization
To reduce mortality at 6 months: 50% with urgent revascularization vs. 63% conttrols
N Engl J Med. 2003 Nov 13;349(20):1893-906 Randomized Controlled Trial, Multicenter Study
IN coronary disease, myocardial infarction, heart failure, chronic, systolic The Use of
angiotensin II receptor blockers, valsartan, alone or combined with ACE inhibitors
As Treatment, Chronic
Is equal Than
angiotensin converting enzyme (ACE) inhibitors, captopril
To modify overall mortality (about 9.97% per year in valsartan, 9.75% per year in captopril and 9.63% per year with combined treatment) Combining valsartan + captopril did not increased survival but it did adverse events
PLoS Med. 2009 Apr 21;6(4):e1000057 Cohorts
IN coronary disease, myocardial infarction, non-Q, unrecognized The Use of
delayed-enhancement cardiac magnetic resonance
As Diagnostic Tool
Is better Than
ECG and cardiac enzymes
To diagnose recent non-Q myocardial infarction: 27% of patients suspected of ischemic heart disease. Unrecognized non-Q infarction carries a hight mortality: 26% at 2.2 years.
N Engl J Med. 2005 Mar 24;352(12):1179-89 Randomized Controlled Trial, Multicenter Study
IN coronary disease, myocardial infarction, ST-segment elevation The Use of
antiplatelet drugs, adenosine diphosphate (ADP) receptor inhibitors, clopidogrel (300-mg loading dose, 75 mg/d after) added to fibrinolysis plus aspirin plus heparin
As Treatment, Acute
Is better Than
standard antithrombotic Tt with fibrinolysis + aspirin + heparin alone (+ placebo)
To reduce at 30 days vascular events (cardiovascular death, recurrent infarction, revascularization because recurrent ischemia): 11,6% with clopidogrel VS 14,6% standard Tt, Major bleeding and intracranial hemorrhage similar in the two groups.
Lancet. 2005 Nov 5;366(9497):1607-21 Randomized Controlled Trial, Multicenter Study
IN coronary disease, myocardial infarction, ST-segment elevation The Use of
antiplatelet drugs, adenosine diphosphate (ADP) receptor inhibitors, clopidogrel (75 mg/d) added to standard Tt (aspirin 100%, fibrinolysis 50%, anticoagulant 75%)
As Treatment, Acute
Is better Than
aspirin alone and standard antithrombotic Tt
To To reduce at 30 days vascular events (death, recurrent infarction, stroke): 9,2% with clopidogrel VS 10,1% aspirin alone.
Lancet. 2005 Nov 5;366(9497):1622-32 Randomized Controlled Trial, Multicenter Study
IN coronary disease, myocardial infarction, ST-segment elevation The Use of
early intravenous beta-blockers (metoprolol, up to 15 mg IV then 200 mg oral daily
As Treatment, Acute
Is equal Than
placebo
To reduce at 30 days death (7.7% VS 7.8%) or death, reinfarction, or cardiac arrest combined (9.4% with metoprolol VS 9.9% with placebo).
Circulation. 2010 Apr 6;121(13):1484-91 Randomized Controlled Trial, Multicenter Study
IN coronary disease, myocardial infarction, ST-segment elevation The Use of
early treatment with primary percutaneous coronary intervention, angioplasty
As Treatment, Acute
Is better Than
early primary fibrinolysis
To reduce at 8 years reinfarction (13% angioplasty VS 18.5% fibrinolysis ) and mortality (27% angioplasty VS 33% fibrinolysis )
JAMA. 2007 Nov 28;298(20):2399-405 Randomized Controlled Trial, Multicenter Study
IN coronary disease, myocardial infarction, ST-segment elevation The Use of
glucose-insulin-potassium infusion
As Treatment, Acute
Is equal Than
no this treatment
To improve death or heart failure: 6.2% in the GIK group VS 5.5% in the control group, p non significant.
Am J Cardiol. 2005 Oct 15;96(8):1053-8. Epub 2005 Aug 24 Randomized Controlled Trial
IN coronary disease, myocardial infarction, ST-segment elevation The Use of
glucose-insulin-potassium infusion
As Treatment, Acute
Is better Than
usual care (thrombolysis with streptokinase) alone
To reduce at 1 month major adverse cardiac events (death, reinfarction, serious arrhythmias and severe heart failure): 10% with gluc-insulin-K vs 32.5% without.
JAMA. 2005 Jan 26;293(4):437-46 Randomized Controlled Trial, Multicenter Study
IN coronary disease, myocardial infarction, ST-segment elevation The Use of
glucose-insulin-potassium infusion
As Treatment, Acute
Is equal Than
usual care alone
To reduce mortality, cardiogenic shock or reinfarction at 30 days
Eur Heart J. 2004 Dec;25(24):2187-94 Randomized Controlled Trial
IN coronary disease, myocardial infarction, ST-segment elevation The Use of
late (2 - 15 days after MI) routine percutaneous revascularization
As Treatment, Acute
Is equal Than
medical treatment alone, if patient stable
To reduce cardivascular events (composite of cardiac death, non-fatal MI, or ventricular tachyarrhythmia) at 3 years: 7.3% revascularization VS 8.7% controls
N Engl J Med. 2006 Apr 6;354(14):1477-88. Epub 2006 Mar 14 Randomized Controlled Trial, Multicenter Study
IN coronary disease, myocardial infarction, ST-segment elevation The Use of
low molecular weight heparins (LMWH), enoxaparin, for at least 2 days
As Treatment, Acute
Is better Than
unfractionated heparin (UFH), for the same time
To reduce, at 30 days, death or recurrent infarction: 9.9% enoxaparin VS 12% unfractionated heparin. Major bleeding were a little more frequent with enoxaparin (2.1%) than with UFH (1.4%)
Circulation. 2005 Dec 20;112(25):3855-67. Epub 2005 Dec 12 Meta-Analysis
IN coronary disease, myocardial infarction, ST-segment elevation The Use of
low molecular weight heparins (LMWH), for 4 to 8 days
As Treatment, Acute
Is better Than
placebo or unfractionated heparin (UFH)
To reduce, at 7 days, the risk of reinfarction (1.6% LMWH VS 2.2% placebo, NNT 167) and reduce death (7.8% LMWH VS 8.7% placebo, NNT 111)
Circulation. 2005 Dec 20;112(25):3846-54. Epub 2005 Nov 15 Randomized Controlled Trial, Multicenter Study
IN coronary disease, myocardial infarction, ST-segment elevation The Use of
low molecular weight heparins (LMWH), for 4 to 8 days
As Treatment, Acute
Is better Than
unfractionated heparin (UFH)
To reduce, at 30 days, cardiovascular death or recurrent myocardial infarction (6.9% with LMWH versus 11.5% with UFH)
JAMA. 2005 Jan 26;293(4):427-35 Randomized Controlled Trial, Multicenter Study
IN coronary disease, myocardial infarction, ST-segment elevation The Use of
low molecular weight heparins (LMWH), reviparin, for 7 days
As Treatment, Acute
Is better Than
placebo, added to usual medical care
To reduce cardivascular events (composite of death, reinfarction or stroke) at 30 days: 11,8% LMWH VS 13,6% controls; with reductions of 1,5% in mortality and 0,3% in reinfartion, non significant for stroke, 0,1% increase of severe bleeding.
Eur Heart J. 2011 Jan;32(1):51-60 Randomized Controlled Trial
IN coronary disease, myocardial infarction, ST-segment elevation, elder patients The Use of
primary percutaneous coronary intervention
As Treatment, Acute
Is equal Than
fibrinolysis
To significantly reduce cardiovascular events (all-cause mortality, re-infarction, or disabling stroke) at 30 days: 19% pPCI VS. 25% fibrinolysis. A pooled analysis with other 2 trials showed, however, a significant reduction of cardiovascular events
N Engl J Med. 2005 Dec 29;353(26):2758-68 Randomized Controlled Trial, Multicenter Study
IN coronary disease, myocardial infarction, ST-segment elevation, failed thrombolysis The Use of
rescue emergency angioplasty after failed thrombolytic therapy
As Treatment, Acute
Is better Than
repeated thrombolysis or conservative treatment
To reduce, at 6 months, cardiovascular events (composite of death, reinfarction, stroke, or severe heart failure): 15.4% with rescue angioplasty VS 31.3% with repeated thrombolysis and 29.1% with conservative treatment
J Am Coll Cardiol. 2007 Jan 30;49(4):422-30 Meta-Analysis
IN coronary disease, myocardial infarction, ST-segment elevation, failed thrombolysis The Use of
rescue emergency angioplasty after failed thrombolytic therapy
As Treatment, Acute
Is better Than
repeated thrombolysis or conservative treatment
To reduce heart failure (RR 0.73) and reinfarction (RR 0.58), but associated with increased risk of stroke (RR 4.98)
N Engl J Med. 2006 Dec 7;355(23):2395-407 Randomized Controlled Trial, Multicenter Study
IN coronary disease, myocardial infarction, total occlusion of the infarct-related artery The Use of
routine (3 to 28 days) invasive strategy, percutaneous coronary stenting
As Treatment, Acute
Is equal Than
optimal medical therapy and percutaneous intervention only if needed
To reduce, at 4 year, death or myocardial reinfarction: 17.2% invasive group VS 15.6% medical therapy
Lancet. 2005 Sep 10;366(9489):914-20 Randomized Controlled Trial, Multicenter Study
IN coronary disease, myocardial infarction, without ST-segment elevation The Use of
routine invasive strategy (angiography and revascularization)
As Treatment, Acute
Is better Than
conservative strategy (ischaemia- or symptom-driven angiography)
To reduce at 5 years: death or non-fatal myocardial infarction (16.6% in invasive VS 20% in conservative strategy). A trend to reduce death but not significant.
Am J Med. 2005 May;118(5):465-74 Meta-Analysis
IN coronary disease, myocardial infarction, without ST-segment elevation, unstable angina The Use of
routine invasive strategy
As Treatment, Acute
Is better Than
conservative strategy
To reduce rates of fatal or nonfatal re-infarction and hospital readmission, but not all-cause mortality.
N Engl J Med. 2017 10 05;377(14):1319-1330 Randomized Controlled Trial, Multicenter Study
IN coronary disease, stable The Use of
anticoagulants, oral factor Xa inhibitors, rivaroxaban (2.5 mg twice daily) plus aspirin (100 mg once daily)
As Treatment, Chronic
Is better Than
rivaroxaban (5 mg twice daily) alone, or aspirin (100 mg once daily) alone
To reduce cardiovascular events (death, stroke or MI): 4.1% riva+aspirine VS 5.4% aspirine. But increased major bleeding: 3.1% VS 1.9%. Riva 5 mg/d alone did not better than aspirin and had more bleeding.
N Engl J Med. 2011 Dec 1;365(22):2078-87. Epub 2011 Nov 15 Clinical Trial (non-controlled, non-randomized)
IN coronary disease, stable The Use of
high dose statins, atorvastatin 80 mg daily, or rosuvastatin 40 mg daily
As Treatment, Chronic
Is useful Than
no comparison done
To induced regression of atherome plaques (decrease percent atheroma volume (by about 1%) and total atheroma volume) measured by serial intravascular ultrasonography at 4.5 years
N Engl J Med. 1999 Jul 8;341(2):70-6 Randomized Controlled Trial
IN coronary disease, stable The Use of
high dose statins, atorvastatin 80 mg/d
As Treatment, Chronic
Is better Than
routine angioplasty, without statins
To reduce cardiovascular events (composite of coronary fatal and nonfatal events and stroke) at 18 months: 13.4% statin VS 20.9% angioplasty (mostly worsening angor)
N Engl J Med. 2007 Apr 12;356(15):1503-16. Epub 2007 Mar 26 Randomized Controlled Trial, Multicenter Study
IN coronary disease, stable The Use of
routine invasive strategy (angiography and revascularization)
As Treatment, Chronic
Is equal Than
optimal medical therapy alone
To reduce all-cause mortality or myocardial infarction, at 4.6 years: 19% routine PCI vs. 18.5% medical Tt alone. No difference in stroke or hospitalizations neither.
Lancet. 1992 Dec 12;340(8833):1421-5 Randomized Controlled Trial, Multicenter Study
IN coronary disease, stable angina The Use of
aspirin, low dose (75 mg/d)
As Treatment, Chronic
Is better Than
placebo
To reduce major cardiovascular events (34% relative reduction)
JAMA. 1999 May 26;281(20):1927-36 Meta-Analysis
IN coronary disease, stable angina The Use of
beta blockers
As Treatment, Chronic
Is better Than
calcium channel blockers
To reduce number of angina episodes (OR 0.31). But no significant differences in rates of death or myocardial infarction.
JAMA. 2003 Mar 5;289(9):1117-23 Randomized Controlled Trial, Multicenter Study
IN coronary disease, stable angina, elderly patients The Use of
routine invasive strategy (angiography and revascularization)
As Treatment, Chronic
Is equal Than
optimal medical therapy alone
To modify 1-year mortality (11% invasive VS 8% medical, p NS) or modify death + nonfatal infarction (17% invasive VS 20% medical). Invasive approach had increased events early months, and medical management had more cardiac events after 6 months.
Circulation. 2007 Mar 6;115(9):1082-9 Randomized Controlled Trial, Multicenter Study
IN coronary disease, stable angina, multvessel disease The Use of
coronary artery bypass graft (CABG)
As Treatment, Chronic
Is better Than
naked percutaneous coronary intervention (PCI), or medical therapy alone
To reduce, at 5 years, myocardial infarction, or refractory angina requiring revascularization (21% CABG VS 33% PCI VS 36% medical). No differences in overall mortality between the 3 goups
N Engl J Med. 2005 Apr 7;352(14):1425-35 Randomized Controlled Trial
IN coronary disease, stable, normal cholesterol The Use of
high dose statins, atorvastatin 80 mg/d
As Treatment, Chronic
Is better Than
standard dose statins, atorvastatin 10 mg/d
To reduce cardiovascular events (cardiac death or arrest, AMI or stroke) at 5 years: 8,7% with 80mg/d VS 10,9% with 10mg/d, an ARR of 0,44% year
Circulation. 2014 Apr 15;129(15):1577-85 Cohorts
IN coronary disease, stable, atrial fibrillation The Use of
anticoagulation alone, vitamin K antagonists
As Treatment, Chronic
Is equal Than
bi-therapy combining anticoagulant (vitamin K antagonist) + an antiplatelet
To modify at 3 years the risk of myocardial infarction, cardiac death or thromboembolism, while the risk of bleeding was higher with bi-therapy (HR 1.5)
N Engl J Med. 2009 Jun 11;360(24):2503-15. Epub 2009 Jun 7 Randomized Controlled Trial, Multicenter Study
IN coronary disease, stable, diabetes mellitus, type 2 The Use of
systematic prompt revascularization, either by percutaneous coronary intervention (PCI) or coronary-artery bypass grafting (CABG)
As Treatment, Chronic
Is equal Than
intensified medical therapy alone
To reduce at 5 years major cardiovascular events (77.2% revascularization VS 75.9% medical Tt). A reduction in cardiovascular events was observed with CABG in tri-troncular patients (22% revascularization VS 30% medical Tt)
Lancet. 2003 Sep 6;362(9386):782-8 Randomized Controlled Trial, Multicenter Study
IN coronary disease, stable, normal left ventricular function, most patients previous myocardial infarction and revascularization The Use of
angiotensin converting enzyme (ACE) inhibitors, perindopril 8 mg/d, added to standard treatment
As Treatment, Chronic
Is better Than
placebo
To reduce cardiac events (cardiovascular death, myocardial infarction, or cardiac arrest): 8% perindopril VS 10% placebo
N Engl J Med. 2004 Nov 11;351(20):2058-68 Randomized Controlled Trial, Multicenter Study
IN coronary disease, stable, normal left ventricular function, most patients previous revascularization The Use of
angiotensin converting enzyme (ACE) inhibitors, trandolapril (4 mg/d), added to standard treatment
As Treatment, Chronic
Is equal Than
placebo
To reduce cardiac events (death from cardiovascular causes, myocardial infarction, or coronary revascularization): 21.9% in trandolapil VS 22.5% in placebo - at 5 years (so, aprox. 4.4% per year event rate)
Lancet. 2008 Sep 6;372(9641):807-16 Randomized Controlled Trial, Multicenter Study
IN coronary disease, stable, reduced left ventricular function The Use of
ivabradine, added to beta-blockers
As Treatment, Chronic
Is equal Than
placebo
To reduce a composite outcome (cardiovascular deah, myocardial infarction or worsening heart failure) at 20 months. It improved a secondary endpoint (myocardial infarction) but not main endpoint, in one subgroup analysis (patients with heart rate > 70 bpm)
N Engl J Med. 2009 Mar 5;360(10):961-72 Randomized Controlled Trial, Multicenter Study
IN coronary disease, three-vessel disease, or left main coronary artery disease The Use of
coronary artery bypass surgery
As Treatment, Acute
Is better Than
percutaneous coronary intervention
To reduce at 12 months major cardiovascular events (12.4% surgery VS 17.8% percutaneous), mainly reducing the need for rvascularization (5.9% surgery VS 13.5% percutaneous). But more strokes with surgery: 2.2% VS 0.6% percutaneous.
N Engl J Med. 2011 Mar 17;364(11):1016-26 Randomized Controlled Trial, Multicenter Study
IN coronary disease, three-vessel or left main coronary artery disease The Use of
coronary artery bypass surgery
As Treatment, Acute
Is better Than
percutaneous coronary intervention with drug-eluting stents
To modestly improve symptoms of angina (difference in score: 1.7 points) and increase number of patients free from angina at 12 months: 76% surgery VS 71% PCI
N Engl J Med. 2000 Oct 19;343(16):1139-47 Cohorts
IN coronary disease, unstable angina The Use of
troponin, C reactive protein (CRP)
As Prognostic Item
Is Than
To
N Engl J Med. 1997 Aug 14;337(7):447-52 Clinical Trial, Randomized Controlled Trial
IN coronary disease, unstable angina The Use of
heparin, low molecular weight, unfractionated
As Treatment, Acute
Is Than
To
Lancet. 2000 Jun 3;355(9219):1936-42 Meta-Analysis
IN coronary disease, unstable angina The Use of
heparin, low molecular weight, unfractionated
As Treatment, Acute
Is Than
To
J Am Coll Cardiol. 1995 Aug;26(2):313-8 Clinical Trial, Randomized Controlled Trial.
IN coronary disease, unstable angina The Use of
low molecular weight heparin (LMWH), added to aspirin
As Treatment, Acute
Is better Than
aspirin alone, or aspirin plus unfractionated heparin
To reduce recurrent angina and myocardial infarction, but not death
N Engl J Med. 1999 Dec 16;341(25):1882-90 Randomized Controlled Trial
IN coronary disease, ventricular arrhythmia, sudden death The Use of
implantable cardioverter defibrillator
As Treatment, Chronic
Is better Than
antiarrhythmic drugs or no treatment
To reduce the risk of sudden death.
Arch Intern Med. 2008 May 26;168(10):1034-46 Review (Narrative)
IN corticosteroids, systemic, for infections The Use of
systemic corticosteroids
As Treatment, Acute
Is better Than
placebo
To improve outcomes or accelerate symptom resolution in a variety of bacterial, tuberculous and viral infections
N Engl J Med. 2009 Mar 26;360(13):1283-97 Randomized Controlled Trial, Multicenter Study
IN critically ill patients The Use of
tight glucose control (target < 6 mmol/L), intensive insulin therapy
As Treatment, Acute
Is worse Than
conventional glycemic control (target < 10 mmol/L)
To modify overall mortality at 3 months: 27.5% intensive VS 24.9% conventional
JAMA. 2008 Aug 27;300(8):933-44 Meta-Analysis
IN critically ill patients The Use of
tight glucose control, intensive insulin therapy
As Treatment, Acute
Is worse Than
usual glycemic control
To to reduce hospital mortality (21.6% tight control VS 23.3% usual care) but increased hypoclycemia (13.7% tight control VS 2.5% usual care)
N Engl J Med. 2008 Jul 3;359(1):7-20. Epub 2008 May 20 Randomized Controlled Trial, Multicenter Study
IN critically ill patients, acute kidney injury The Use of
intensive renal-replacement therapy: intermittent hemodialysis 6 days/week if hemodynamically stables, 35 ml/Kg continuous venovenous hemodiafiltration if hemodynamically unstable
As Treatment, Acute
Is worse Than
less-intensive renal-replacement therapy: intermittent hemodialysis 3 days/week if hemodynamically stables, 20 ml/Kg continuous venovenous hemodiafiltration if hemodynamically unstable
To reduce death (53.6% intensive VS 51.5% less-intensive), reduce the duration of renal-replacement therapy or increase the rate of recovery of kidney function or nonrenal organ failure.
N Engl J Med. 2006 Feb 2;354(5):449-61 Randomized Controlled Trial, Multicenter Study
IN critically ill patients, multiple-organ failure, non-surgical patients The Use of
intensive insulin therapy, insulin infusion to get glycaemia 4.4 to 6 mmol/L
As Treatment, Acute
Is equal Than
conventional treatment, insulin only if very high glycaemia (>12 mmol/L)
To affect mortality: 37.3% in conventional insuline VS 40% with intensive insuline.
N Engl J Med. 2001 Nov 8;345(19):1359-67 Randomized Controlled Trial
IN critically ill patients, multiple-organ failure, septic shock The Use of
intensive insulin therapy
As Treatment, Acute
Is better Than
conventional treatment, insulin only if very high glycaemia (>12 mmol/L)
To reduce mortality at 1 year: 4.6% with intensive VS 8% with conventional
J Am Geriatr Soc. 2003 Feb;51(2):155-60 Randomized Controlled Trial
IN dehydration, geriatric patients The Use of
subcutaneous rehydration
As Treatment, Acute
Is equal Than
intravenous rehydration
To efectiveness for low volumes (750 - 1,000 mL/day). Also equal for local and general adverse effects.
J Neurol Neurosurg Psychiatry. 2011 May;82(5):500-4 Cohorts
IN delirium, dementia, hospitalized older patients The Use of
any error in identifying the year, month, day of the month or day of the week; and an error of >1 h in identifying the time of day
As Diagnostic Tool
Is useful Than
full cognitive assesment as reference
To diagnose dementia or delirium: error identifying the year sensitivity 86% and specificity 94%; error in either year or month sensitivity 95% and specificity 86%
Age Ageing. 2011 Jan;40(1):23-9 Systematic Review
IN delirium, elder patients The Use of
opioids, benzodiazepines, dihydropyridines calcium channel blockers, antihistamines and possibly (uncertain) H(2) antagonists, tricyclic antidepressants, antiparkinson medications, steroids, non-steroidal anti-inflammatory drugs and antimuscarinics
As Etiologic risk factor
Is worse Than
not taking those drugs
To increase risk of delirium: opioids OR 2.5, benzodiazepines OR 3.0, dihydropyridines OR 2.4, antihistamines OR 1.8.
JAMA. 2010 Aug 18;304(7):779-86 Systematic Review
IN delirium, hospitalized older patients The Use of
several bedsides tools, specially the Confusion Assessment Method (CAM)
As Diagnostic Tool
Is good Than
DSM-MD diagnoses definition as gold standard
To diagnose delirium. For CAM test: 2 to 5 minutes to be done, positive LR 9.6, negative LR 0.16.
Age Ageing. 2012 May 15. [Epub ahead of print] Randomized Controlled Trial
IN delirium, hospitalized older patients The Use of
non-pharmacological intervention: providing a clock and calendar, avoiding sensory deprivation (glasses, denture, hearing aids), familiar objects in the room, reorientation by family members, extended visitation times (5 h)
As Treatment, Acute
Is better Than
standard management
To reduce occurrence of delirium at any time during the hospitalisation: 6% intervention VS 13% controls
J Am Geriatr Soc. 2005 Oct;53(10):1658-66 Randomized Controlled Trial
IN delirium, hospitalized older patients, postoperative The Use of
antipsychotic drugs, neuroleptics, conventional, haloperidol
As Prevention, Primary
Is better Than
placebo
To reduce duration of delirium (5.4days with haloperidol VS 12 days placebo) but not to reduce frequence of developpment (15% with haloperidol VS 16.5% placebo)
N Engl J Med. 2003 Jun 19;348(25):2508-16 Cohorts
IN dementia The Use of
actividad intelectual recreativa
As Prevention
Is Than
To
JAMA. 2000 July 5;284(1):47-52 Cohorts
IN dementia The Use of
cuando avanzada, tras complicación aguda
As Prognostic Item
Is Than
To
Ann Intern Med. 2010 Aug 3;153(3):182-93 Systematic Review
IN dementia, age related cognitive impairment The Use of
cognitive training, physical exercise
As Etiologic risk factor
Is better Than
no training, no exercise
To help to maintain cognitive function over age
Arch Intern Med. 2007 Jan 8;167(1):21-30 Systematic Review
IN dementia, age related cognitive impairment The Use of
folic acid supplementation, alone or combined with vitamin B6, B12
As Treatment, Chronic
Is equal Than
placebo
To reduce age related cognitive impairment: only 1 of 3 trials found a benefit but in patients with low baseline serum folate levels. In 1 trial of folic combined vith B vitamins, placebo group did better
Lancet. 2007 Jan 20;369(9557):208-16 Randomized Controlled Trial, Multicenter Study
IN dementia, age related cognitive impairment, adults with raised homocysteine The Use of
folic acid supplementation, 800 mug daily, long term
As Treatment, Chronic
Is better Than
placebo
To reduce age related cognitive impairment, at 3 years: memory, sensorimotor speed and information processing speed improved slighty in treated patients while decreased slightly in controls
Curr Med Res Opin. 2005 Aug;21(8):1317-27 Randomized Controlled Trial
IN dementia, alzheimer The Use of
cholinesterase inhibitors, rivastigmine
As Treatment, Chronic
Is equal Than
cholinesterase inhibitors, donepezil
To modify the measures of cognition and behaviour (main endpoint: Severe Impairment Battery, not significant different). Rivastigmine showed significant results in some secondary and subgroup analysis
Arch Neurol. 1998 Nov;55(11):1409-15 Meta-Analysis
IN dementia, alzheimer The Use of
ginkgo biloba
As Treatment, Chronic
Is better Than
placebo
To improve, marginally (3% in ADAS-cog scale), cognitive function
JAMA. 1997 Oct 22-29;278(16):1327-32 Randomized Controlled Trial
IN dementia, alzheimer The Use of
ginkgo biloba
As Treatment, Chronic
Is better Than
placebo
To improve at 6 to 12 months ADAS-Cog score (1.4 points better than placebo)
Eur Heart J. 2013 Jun 4. [Epub ahead of print] Cohorts
IN dementia, alzheimer, coronary disease, acute coronary syndrome, myocardial infarction, older patients The Use of
cholinesterase inhibitors
As Treatment, Chronic
Is better Than
no cholinesterase inhibitors
To reduce the risk of myocardial infarction (HR 0.62) and death (HR 0.64). Patients taking the highest doses recommended had the lowest risk of MI or death
J Neurol Neurosurg Psychiatry. 2011 Mar;82(3):240-6 Diagnostic
IN dementia, alzheimer, cortical dementias, frontotemporal dementia, semantic dementia The Use of
cerebrospinal fluid biomarkers, beta-amyloid 1-42 (Aβ 42), total tau protein and phosphorylated tau protein
As Diagnostic Tool
Is useful Than
no comparison done
To distinguish Alzheimer from frontotemporal or semantic dementia: the best marker was Phosphorylated-Tau/Aβ(42) ratio, with sensitivity 92-98% and specificity 84-92%.
Nat Med. 2014 Mar 9. doi: 10.1038/nm.3466. [Epub ahead of print] Controlled Trial (non-randomized)
IN dementia, alzheimer, early-stage The Use of
a set of 10 specific plasma phospholipids, reflecting cell membrane integrity
As Diagnostic Tool
Is useful Than
no comparison done
To predict clinical development of either amnestic mild cognitive impairment or Alzheimer,s disease in a 2-3 year
Arch Neurol. 2004 Dec;61(12):1852-6 Randomized Controlled Trial, Multicenter Study
IN dementia, alzheimer, early-stage The Use of
cholinesterase inhibitors, donepezil
As Treatment, Chronic
Is better Than
placebo
To improve different cognitive scores, at 6 months: ADAS (by 2.3 points), MMS (by 1.4 points) and Computerized Memory Battery Test, having few adverse events
JAMA. 2009 Jul 22;302(4):385-93 Diagnostic
IN dementia, alzheimer, early-stage, mild cognitive impairment The Use of
cerebrospinal fluid biomarkers: beta-amyloid(1-42) (Abeta42), total tau protein (T-tau), and tau phosphorylated-threonine 181 (P-tau)
As Diagnostic Tool
Is useful Than
final diagnostic after 4 year follow-up as standard
To help diagnose Alzheimer's: sensitivity 83%, specificity 72%, predictive positive value 62%, negative value 88% (for the 3 markers combined)
Arch Neurol. 2010 Aug;67(8):949-56 Diagnostic
IN dementia, alzheimer, early-stage, mild cognitive impairment The Use of
cerebrospinal fluid biomarkers: beta-amyloid(1-42) (Abeta42), total tau protein (T-tau), and tau phosphorylated-threonine 181 (P-tau)
As Diagnostic Tool
Is useful Than
final diagnostic after follow-up or autopsy as standards
To help diagnosign Alzheimer's disease: typical biomarker signature found in 90%, 72%, and 36% of Alzh, mild cognitive impairment, and cognitively normal groups, respectively. Very high sesitivity (lower spec.) to predict evol to Alzh in MCI patients
J Am Geriatr Soc. 2011 Sep;59(9):1705-10 Diagnostic
IN dementia, alzheimer, mild cognitive impairment The Use of
neuropsychological tests and structural magnetic resonance imaging (MRI)
As Diagnostic Tool
Is better Than
measurement of amyloid-beta and tau in cerebrospinal fluid (CSF) or [18F]fluorodeoxyglucose positron emission tomography (FDG-PET)
To diagnose alzheimer,s disease: neuropsychological tests and MRI were the most informative techniques, with 84% and 82% correct classifications. FDG-PET and CSF assessments had 76% and 73% correct classifications
N Engl J Med. 2012 Mar 8;366(10):893-903 Randomized Controlled Trial
IN dementia, alzheimer, moderate to severe The Use of
maintaining cholinesterase inhibitors, donepezil
As Treatment, Chronic
Is better Than
stopping donepezil or changing for memantine
To improve cognitive measures at 1 year: SMMSE score higher by 1.9 points and BADLS score lower (indicating less impairment) by 3.0 points, than stopping donezepil
N Engl J Med. 2005 Dec 1;353(22):2335-41 Cohorts
IN dementia, associated agitation or delirium The Use of
antipsychotic drugs, neuroleptics, conventional
As Treatment, Acute
Is worse Than
antipsychotic drugs, neuroleptics, atypical
To mortality: relative risk 1.37 using conventional VS atypical antipsychotics. This increased risk existed in all subgroups.
Am J Psychiatry. 2007 Oct;164(10):1568-76; quiz 1623 Cohorts
IN dementia, associated agitation or delirium The Use of
antipsychotic drugs, neuroleptics, conventional, atypicals
As Treatment, Acute
Is worse Than
psychiatric nonantipsychotic drugs
To increased mortality: 22.6%-29.1% with antipsychotics VS 14.6% with nonantipsychotics
JAMA. 2015 Sep 22-