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Efficacy of beta-blockers in patients with heart failure plus atrial fibrillationBeta-blockers are indicated in patients with symptomatic heart failure with reduced ejection fraction; however, the efficacy of these drugs in patients with concomitant atrial fibrillation is uncertain. In order to elucidate this issue, these researchers have performed a meta-analysis of data from ten randomised controlled trials of the comparison of beta-blockers versus placebo in heart failure. The presence of sinus rhythm or atrial fibrillation was ascertained from the baseline electrocardiograph.Over 18,000 patients were assessed. 76% were in sinus rhythm and 17% had atrial fibrillation. Beta-blocker therapy led to a significant reduction in all-cause mortality in patients with sinus rhythm but not in patients with atrial fibrillation.The conclusion reached was that beta-blockers should not be used preferentially over other rate-control medications and not regarded as a standard therapy to improve prognosis in patients with concomitant heart failure and atrial fibrillation.Lancet 2014;384:2235–2243. Cytisine versus nicotine for smoking cessationPlacebo-controlled trials indicate that cytisine, a partial agonist that binds the nicotinic acetylcholine receptor and is used for smoking cessation, almost doubles the chances of quitting at 6 months.This report concerns a non-inferiority trial comparing cytisine with nicotine. Participants were recruited from smokers motivated to quit who had sought advice from the New Zealand national quitline. 1310 adult daily smokers were randomly assigned to receive cytisine for 25 days or nicotine replacement therapy for 8 weeks.The effectiveness of cytisine for continuous abstinence was superior to that of nicotine-replacement therapy at 1 week, 2 months, and 6 months. A downside noted was that there were more self-reported adverse events in the cytisine cohort, primarily nausea and vomiting, and sleep disorders.N Engl J Med 2014;371:2353–2362. Cobalt-chromium everolimus eluting stents or bare metal stent in the management of coronary artery diseaseNetwork meta-analyses have suggested that cobalt-chromium everolimus eluting stents are associated with a reduction in stent thrombosis compared with bare metal stents but the clinical implications of this finding remains unclear. This report concerns a meta-analysis which seeks to clarify the issue.Screening the extensive literature produced 5 randomised controlled trials. They involved 4896 patients. The results obtained demonstrated that cobalt-chromium everolimus eluting stents are associated with improved cardiovascular outcomes including cardiac survival, myocardial infarction, and overall stent thrombosis compared with bare metal stents.BMJ 2014;349:g6427.

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Efficacy of beta-blockers in patients with heart failure plus atrial fibrillationBeta-blockers are indicated in patients with symptomatic heart failure with reduced ejection fraction; however, the efficacy of these drugs in patients with concomitant atrial fibrillation is uncertain. In order to elucidate this issue, these researchers have performed a meta-analysis of data from ten randomised controlled trials of the comparison of beta-blockers versus placebo in heart failure. The presence of sinus rhythm or atrial fibrillation was ascertained from the baseline electrocardiograph.Over 18,000 patients were assessed. 76% were in sinus rhythm and 17% had atrial fibrillation. Beta-blocker therapy led to a significant reduction in all-cause mortality in patients with sinus rhythm but not in patients with atrial fibrillation.The conclusion reached was that beta-blockers should not be used preferentially over other rate-control medications and not regarded as a standard therapy to improve prognosis in patients with concomitant heart failure and atrial fibrillation.Lancet 2014;384:2235–2243. Cytisine versus nicotine for smoking cessationPlacebo-controlled trials indicate that cytisine, a partial agonist that binds the nicotinic acetylcholine receptor and is used for smoking cessation, almost doubles the chances of quitting at 6 months.This report concerns a non-inferiority trial comparing cytisine with nicotine. Participants were recruited from smokers motivated to quit who had sought advice from the New Zealand national quitline. 1310 adult daily smokers were randomly assigned to receive cytisine for 25 days or nicotine replacement therapy for 8 weeks.The effectiveness of cytisine for continuous abstinence was superior to that of nicotine-replacement therapy at 1 week, 2 months, and 6 months. A downside noted was that there were more self-reported adverse events in the cytisine cohort, primarily nausea and vomiting, and sleep disorders.N Engl J Med 2014;371:2353–2362. Cobalt-chromium everolimus eluting stents or bare metal stent in the management of coronary artery diseaseNetwork meta-analyses have suggested that cobalt-chromium everolimus eluting stents are associated with a reduction in stent thrombosis compared with bare metal stents but the clinical implications of this finding remains unclear. This report concerns a meta-analysis which seeks to clarify the issue.Screening the extensive literature produced 5 randomised controlled trials. They involved 4896 patients. The results obtained demonstrated that cobalt-chromium everolimus eluting stents are associated with improved cardiovascular outcomes including cardiac survival, myocardial infarction, and overall stent thrombosis compared with bare metal stents.BMJ 2014;349:g6427.

Summary

Abstract

Aim

Method

Results

Conclusion

Author Information

Acknowledgements

Correspondence

Correspondence Email

Competing Interests

For the PDF of this article,
contact nzmj@nzma.org.nz

View Article PDF

Efficacy of beta-blockers in patients with heart failure plus atrial fibrillationBeta-blockers are indicated in patients with symptomatic heart failure with reduced ejection fraction; however, the efficacy of these drugs in patients with concomitant atrial fibrillation is uncertain. In order to elucidate this issue, these researchers have performed a meta-analysis of data from ten randomised controlled trials of the comparison of beta-blockers versus placebo in heart failure. The presence of sinus rhythm or atrial fibrillation was ascertained from the baseline electrocardiograph.Over 18,000 patients were assessed. 76% were in sinus rhythm and 17% had atrial fibrillation. Beta-blocker therapy led to a significant reduction in all-cause mortality in patients with sinus rhythm but not in patients with atrial fibrillation.The conclusion reached was that beta-blockers should not be used preferentially over other rate-control medications and not regarded as a standard therapy to improve prognosis in patients with concomitant heart failure and atrial fibrillation.Lancet 2014;384:2235–2243. Cytisine versus nicotine for smoking cessationPlacebo-controlled trials indicate that cytisine, a partial agonist that binds the nicotinic acetylcholine receptor and is used for smoking cessation, almost doubles the chances of quitting at 6 months.This report concerns a non-inferiority trial comparing cytisine with nicotine. Participants were recruited from smokers motivated to quit who had sought advice from the New Zealand national quitline. 1310 adult daily smokers were randomly assigned to receive cytisine for 25 days or nicotine replacement therapy for 8 weeks.The effectiveness of cytisine for continuous abstinence was superior to that of nicotine-replacement therapy at 1 week, 2 months, and 6 months. A downside noted was that there were more self-reported adverse events in the cytisine cohort, primarily nausea and vomiting, and sleep disorders.N Engl J Med 2014;371:2353–2362. Cobalt-chromium everolimus eluting stents or bare metal stent in the management of coronary artery diseaseNetwork meta-analyses have suggested that cobalt-chromium everolimus eluting stents are associated with a reduction in stent thrombosis compared with bare metal stents but the clinical implications of this finding remains unclear. This report concerns a meta-analysis which seeks to clarify the issue.Screening the extensive literature produced 5 randomised controlled trials. They involved 4896 patients. The results obtained demonstrated that cobalt-chromium everolimus eluting stents are associated with improved cardiovascular outcomes including cardiac survival, myocardial infarction, and overall stent thrombosis compared with bare metal stents.BMJ 2014;349:g6427.

Summary

Abstract

Aim

Method

Results

Conclusion

Author Information

Acknowledgements

Correspondence

Correspondence Email

Competing Interests

Contact diana@nzma.org.nz
for the PDF of this article

View Article PDF

Efficacy of beta-blockers in patients with heart failure plus atrial fibrillationBeta-blockers are indicated in patients with symptomatic heart failure with reduced ejection fraction; however, the efficacy of these drugs in patients with concomitant atrial fibrillation is uncertain. In order to elucidate this issue, these researchers have performed a meta-analysis of data from ten randomised controlled trials of the comparison of beta-blockers versus placebo in heart failure. The presence of sinus rhythm or atrial fibrillation was ascertained from the baseline electrocardiograph.Over 18,000 patients were assessed. 76% were in sinus rhythm and 17% had atrial fibrillation. Beta-blocker therapy led to a significant reduction in all-cause mortality in patients with sinus rhythm but not in patients with atrial fibrillation.The conclusion reached was that beta-blockers should not be used preferentially over other rate-control medications and not regarded as a standard therapy to improve prognosis in patients with concomitant heart failure and atrial fibrillation.Lancet 2014;384:2235–2243. Cytisine versus nicotine for smoking cessationPlacebo-controlled trials indicate that cytisine, a partial agonist that binds the nicotinic acetylcholine receptor and is used for smoking cessation, almost doubles the chances of quitting at 6 months.This report concerns a non-inferiority trial comparing cytisine with nicotine. Participants were recruited from smokers motivated to quit who had sought advice from the New Zealand national quitline. 1310 adult daily smokers were randomly assigned to receive cytisine for 25 days or nicotine replacement therapy for 8 weeks.The effectiveness of cytisine for continuous abstinence was superior to that of nicotine-replacement therapy at 1 week, 2 months, and 6 months. A downside noted was that there were more self-reported adverse events in the cytisine cohort, primarily nausea and vomiting, and sleep disorders.N Engl J Med 2014;371:2353–2362. Cobalt-chromium everolimus eluting stents or bare metal stent in the management of coronary artery diseaseNetwork meta-analyses have suggested that cobalt-chromium everolimus eluting stents are associated with a reduction in stent thrombosis compared with bare metal stents but the clinical implications of this finding remains unclear. This report concerns a meta-analysis which seeks to clarify the issue.Screening the extensive literature produced 5 randomised controlled trials. They involved 4896 patients. The results obtained demonstrated that cobalt-chromium everolimus eluting stents are associated with improved cardiovascular outcomes including cardiac survival, myocardial infarction, and overall stent thrombosis compared with bare metal stents.BMJ 2014;349:g6427.

Summary

Abstract

Aim

Method

Results

Conclusion

Author Information

Acknowledgements

Correspondence

Correspondence Email

Competing Interests

Contact diana@nzma.org.nz
for the PDF of this article

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