Women have higher survival rates than men after transcatheter valve replacement

February 22, 2016

1. Women have higher survival rates than men after transcatheter valve replacement
Abstract: http://www.annals.org/article.aspx?doi=10.7326/M15-0121
Editorial: http://www.annals.org/article.aspx?doi=10.7326/M16-0105
URL goes live when the embargo lifts

Women undergoing transcatheter aortic valve replacement (TAVR) have better survival rates than men at one year, according to a study published in Annals of Internal Medicine. These results are the opposite of those seen in surgical aortic valve replacement (SAVR), for which female sex has been shown to be associated with poorer outcomes.

TAVR has emerged as an alternative for patients with symptomatic aortic stenosis who have been deemed high-risk or inoperable for SAVR due to comorbidities or unfavorable anatomy. Female sex has been shown to be associated with increased risk for adverse events after SAVR, but data examining outcomes after TAVR have been conflicting. Researchers performed a secondary analysis of the Placement of Aortic Transcatheter Valves (PARTNER) Trial to compare postprocedural complications and one-year all-cause mortality among men and women who had TAVR. They found that women undergoing TAVR had a lower mortality rate at one year compared to men and also had a lower rate of rehospitalization. However, the women had a higher 30-day incidence of vascular complications and major bleeding.

Note: For an embargoed PDF, please contact Cara Graeff. To interview the lead author, Dr. Susheel Kodali, please contact Lucky Tran, PhD at lucky.tran@columbia.edu or 212-305-3689.


2. Steroid pill safe and effective first-line treatment for acute gout
Abstract: http://www.annals.org/article.aspx?doi=10.7326/M14-2070
URL goes live when the embargo lifts

An oral steroid had similar effectiveness to an oral non-steroid anti-inflammatory drug (NSAID) for improving pain in patients with acute gout, according to a trial published in Annals of Internal Medicine.

Recent double-blind randomized trials showed that both oral steroids and oral NSAIDs have similar pain-relieving effects in gout, but the trials were small and had other methodological limitations. In a multicenter trial, researchers compared the effectiveness and safety of oral prednisolone versus oral indomethacine in 416 adult patients with acute gout. Patients were randomly assigned to receive either prednisolone or indomethacine, with neither researchers nor patients knowing which medication was administered. Patients in both groups reported similar pain relief with no serious adverse events. The researchers conclude that oral steroids are a safe and effective first-line treatment for patients with acute gout.

Note: For an embargoed PDF, please contact Cara Graeff. The lead author, Dr. Timothy Rainer, can be reached directly at rainerth@cardiff.ac.uk.


3. Experts warn against SPRINTing to more aggressive blood pressure treatment
Abstract: http://www.annals.org/article.aspx?doi=10.7326/M15-3123
URL goes live when the embargo lifts

In an editorial published in Annals of Internal Medicine, experts express concern about the way SPRINT (Systolic Blood Pressure Intervention Trial) findings were presented to the public. The authors say that press releases used to promote the study findings focused solely on the benefits of intensive treatment, while ignoring the harms. This approach could lead patients to expect greater benefits from treatment than physicians can justify with daily use of antihypertensive medications. Unconvinced by SPRINT evidence, the experts caution against medicating large segments of the population to achieve more aggressive blood pressure targets, especially when the adverse events, costs, and burden of such treatment are considered.

Note: For an embargoed PDF, please contact Cara Graeff. The lead author, Dr. Paul James, can be reached directly at paul-james@uiowa.edu.
-end-
Also in this issue:

Is Prostate-Specific Antigen Screening "Proven Ineffective Care"?
Michael J. Barry, MD; Peter C. Albertsen, MD
Ideas and Opinions
Abstract: http://www.annals.org/article.aspx?doi=10.7326/M15-3025

Functional Tricuspid Stenosis in Primary Sclerosing Cholangitis: A Case Report
Rodrigo Mendirichaga, MD; Rhanderson Cardoso, MD; Daniel Garcia, MD; Marian Calfa, MD, Victor Soto, MD
Case Report
Letter: http://www.annals.org/article.aspx?doi=10.7326/L15-0403

Practice Feedback Interventions: 15 Suggestions for Optimizing Effectiveness
Jamie C. Brehaut, PhD; Heather L. Colquhoun, PhD; Kevin W. Eva, PhD; Kelly Carroll, MA; Anne Sales, PhD; Susan Michie, PhD; Noah Ivers, MD, PhD; and Jeremy M. Grimshaw, MD, PhD
Academia and the Profession
Abstract: http://www.annals.org/article.aspx?doi=10.7326/M15-2248

American College of Physicians

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