Cardiothoracic - The Royal Wolverhampton NHS Trust Library Service

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Cardiothoracic - The Royal Wolverhampton NHS Trust Library Service

THE ROYAL

WOLVERHAMPTON

HOSPITALS NHS TRUST

Welcome to the latest

Cardiothoracic Evidence

Newsletter. This will be

produced every 2-3 months

and lists the most recent

literature in the field.

In this issue:

Number & burden of

cardiovascular diseases in

relation to health-related

QoL in a cross-sectional

population-based cohort

study

Effect of sodium

nitroprusside on the

occurrence of atrial

fibrillation after

cardiothoracic surgery

Extended heart failure

clinic follow-up in low-risk

patients

Multisite randomized trial

of a single-session versus

multisession literacysensitive

self-care

intervention for patients

with heart failure

Intraaortic balloon support

for MI with cardiogenic

shock

Prasugrel versus

clopidogrel for acute

coronary syndromes

without revascularization

TAVI: risky and costly

Lung transplantation in

patients with prior

cardiothoracic surgical

procedures

Nutrition intervention in the

critically ill cardiothoracic

patient

Predicting the adverse risk

of statin treatment

Predicting cardiac arrest

on the wards

Is routine chest

radiography indicated

following chest drain

removal after

cardiothoracic surgery?

Further content back page

NICE Guidelines

Cochrane Systematic

Reviews

News in Brief

Current Contents in

Bell Library

Developments

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Cardiothoracic – the

latest evidence

Issue 10 October 2012

Number and Burden of Cardiovascular Diseases in

Relation to Health-Related Quality of Life in a Cross-

Sectional Population-Based Cohort Study

The objective of this cohort study was to clarify whether a greater number of

cardiovascular diseases or a larger burden of disease are associated with poorer healthrelated

quality of life (HRQoL) in an unselected general population.

A population-based cross-sectional postal survey was introduced to take a random sample

of the Swedish general population aged 40–79 years matched for national distributions of

age, gender and region. Out of 6969 eligible individuals, 4910 (70.5%) participated. The

primary outcome was to create a reference database for HRQoL outcomes in the general

population and to assess certain diseases and their relation to HRQoL.

Predefined cardiovascular diseases and HRQoL were assessed from validated

questionnaires (EORTC QLQ-C30). Aspects of HRQoL included in the analyses were

global quality of life, physical function, role function, emotional function, fatigue and

dyspnoea. Individuals were categorised into: ‘good function’ versus ‘poor function’ and ‘no

or minor symptoms’ versus ‘symptomatic’. Multivariable logistic regression calculated OR

with 95% CI for poor HRQoL. The exposures were the number of cardiovascular diseases

and the subjective disease burden.

Out of the 4910 participants, 1358 (28%) reported having a cardiovascular disease and

hypertension was most common. Reporting a greater number of cardiovascular diseases

was associated with an increased risk of poor HRQoL, especially regarding dyspnoea. The

OR for symptomatic dyspnoea was 1.37 (95% CI 1.08 to 1.74) for participants with one

cardiovascular disease, 4.81 (95% CI 3.24 to 7.13) for two diseases and 4.18 (95% CI

2.24 to 7.80) for those with three or more cardiovascular diseases. Among the 271

participants who assessed their cardiovascular disease burden as major, the highest risk

for poor HRQoL was found for physical function (OR 6.18, 95% CI 3.72 to 10.30).

Increased number of cardiovascular diseases and a greater burden of disease are

generally associated with poorer HRQoL in people with cardiovascular disease from an

unselected population. Source: BMJ Evidence Update.

Reference

Djarv T et al (2012) Number and burden of cardiovascular diseases in relation to healthrelated

quality of life in a cross-sectional population-based cohort study. BMJ Open, 2,

e001554. Doi: 10.1136/bmjopen-2012-001554.

Link to full text article, freely available on line.

1


Effect of Sodium Nitroprusside on

the Occurrence of Atrial Fibrillation

after Cardiothoracic Surgery

Postoperative atrial fibrillation (POAF) is a

frequent complication following cardiothoracic

surgery and is associated with an increase in

morbidity, mortality, and cost. One small

prospective study of patients undergoing

isolated coronary artery bypass graft surgery

has demonstrated a decrease in the risk of

POAF with the use of sodium nitroprusside.

There was no significant association between

the use of sodium nitroprusside during

cardiothoracic surgery and POAF Source:

OvidMD.

Reference

Bolesta S et al (2012) Effect of sodium

nitroprusside on the occurrence of atrial

fibrillation after cardiothoracic surgery. Annals

of Pharmacotherapy, 46 (6), pp. 785-92.

Full text available via inter library loan, there is

a charge for this service.

Extended Heart Failure Clinic

Follow-Up in Low-Risk Patients

Outpatient follow-up in specialized heart failure

clinics (HFCs) is recommended by current

guidelines and implemented in most European

countries, but the optimal duration of HFC

programmes has not been established. Nor is

it known whether all or only high-risk patients,

e.g. identified by NT-proBNP, might benefit

from an extended HFC follow-up.

This trial concludes, irrespective of the level of

NT-proBNP stable HF patients on optimal

medical therapy do not benefit from long-term

follow-up in a specialized HFC in a publicly

funded universal access healthcare system.

Heart failure patients on optimal medical

therapy with mild or moderate symptoms are

safely managed by their personal GP. Source:

Medline.

Reference

Schou M et al (2012). Extended heart failure

clinic follow-up in low-risk patients: a

2

randomized clinical trial (NorthStar). European

Heart Journal. 2012 Aug 8.

Full text available via inter library loan, there is

a charge for this service.

Multisite Randomized Trial of a

Single-Session Versus Multisession

Literacy-Sensitive Self-Care

Intervention for Patients with Heart

Failure

Self-care training can reduce hospitalization

for heart failure (HF), and more intensive

intervention may benefit more vulnerable

patients, including those with low literacy.

Overall, an intensive multisession intervention

did not change clinical outcomes compared

with a single-session intervention. People with

low literacy appear to benefit more from

multisession interventions than people with

higher literacy. Source: BMJ Evidence

Updates.

Reference

Dewalt DA et al (2012) Multisite randomized

trial of a single-session versus multisession

literacy-sensitive self-care intervention for

patients with heart failure. Circulation, 125

(23), pp. 2854-62. Epub 2012 May 9.

Link to full text article, an Athens password

is required to access this item.

Intraaortic Balloon Support for

Myocardial Infarction with

Cardiogenic Shock

In current international guidelines, intraaortic

balloon counterpulsation is considered to be a

class I treatment for cardiogenic shock

complicating acute myocardial infarction.

However, evidence is based mainly on registry

data, and there is a paucity of randomized

clinical trials.

In conclusion the study reports that the use of

intraaortic balloon counterpulsation did not

significantly reduce 30-day mortality in patients

with cardiogenic shock complicating acute

myocardial infarction for which an early

revascularization strategy was planned.

Source: BMJ Evidence Update.


Reference

Thiele Het al. (2012) Intraaortic Balloon

Support for Myocardial Infarction with

Cardiogenic Shock. New England Journal of

Medicine, 367 (14), pp. 1287-1296. Doi:

10.1056/NEJMoa1208410.

Print copy available in Bell Library for

reference. Three month embargo on online

access.

Prasugrel Versus Clopidogrel for

Acute Coronary Syndromes without

Revascularization

The effect of intensified platelet inhibition for

patients with unstable angina or myocardial

infarction without ST-segment elevation who

do not undergo revascularization has not been

delineated.

Among patients with unstable angina or

myocardial infarction without ST-segment

elevation, prasugrel did not significantly reduce

the frequency of the primary end point, as

compared with clopidogrel, and similar risks of

bleeding were observed. Source: NEJM.

Reference

Roe MT et al (2012) Prasugrel versus

Clopidogrel for Acute Coronary Syndromes

without Revascularization. New England

Journal of Medicine. Published ahead of print

25 th August.

Link to Full text article, no password

required.

Transcatheter Aortic Valve

Implantation (TAVI): Risky and

Costly

Around the world, tens of thousands of people

have been treated for a life threatening heart

condition using a minimally invasive technique

that many see as the wave of the future.

Transcatheter aortic valve implantation (TAVI)

offers hope to patients too old or too ill for

conventional aortic valve replacement

operations, and since its introduction 10 years

ago it has spread swiftly—by the end of 2011,

an estimated 40 000 transcatheter

implantations had been done. But serious

unanswered questions remain over the clinical

outcomes and the cost effectiveness of TAVI,

3

as well as the regulatory process that enabled

it to gain such a large market so rapidly,

particularly in Europe. Source: BMJ

Reference

Van Brabamdt. H et al (2012) Transcatheter

Aortic Valve Implantation (TAVI): Risky and

Costly, British Medical Journal, 345 Doi:

10.1136/bmj.e4710.

Link to full text article, an Athens password

is required to access this item.

Lung Transplantation in Patients

with Prior Cardiothoracic Surgical

Procedures

The full spectrum of prior cardiothoracic

procedures in lung transplant candidates and

the impact of prior procedures on outcomes

after lung transplantation (LTx) remain

unknown, though the impact is considered to

be large.

The results of this study suggest that patients

with LTx and prior CTS remain technically

challenging and experience worse outcomes

than patients without prior CTS. A surgical

strategy to minimize cardiopulmonary bypass

time is critical for these challenging LTx

patients. Source: OvidMD

Reference

Shigemura N (2012) Lung transplantation in

patients with prior cardiothoracic surgical

procedures. American Journal of

Transplantation, 12 (5), pp. 1249-55. Doi:

10.1111/j.1600-6143.2011.03946.x.

Full text available via inter library loan, there is

a charge for this service.

Nutrition Intervention in the

Critically Ill Cardiothoracic Patient

Despite acute myocardial infarction and

cardiac surgery accounting for 2 of the most

common reasons patients are admitted to the

intensive care unit, little attention and

investigation have been directed specifically

for these patients. This patient population

therefore deserves special attention as they


are often malnourished but require emergent

interventions, making nutrition intervention

challenging.

This article reviews current medical

interventions implemented in critically ill

cardiothoracic patients and discusses

evidence-based nutrition therapy, including

enteral and parenteral feeding, glycaemic

control, and antioxidant provision. Source:

OvidMD.

Reference

Cresci, G (2012) Nutrition intervention in the

critically ill cardiothoracic patient. Nutrition in

Clinical Practice, 27 (3), pp. 323-34.

Full text available via inter library loan, there is

a charge for this service.

Predicting the Adverse Risk of

Statin Treatment

The purpose of this study was to evaluate the

performance of the QStatin scores for

predicting the 5-year risk of developing acute

renal failure, cataract, liver dysfunction and

myopathy in men and women in England and

Wales receiving statins.

QStatin scores for predicting the 5-year statin

risk of developing acute renal failure, cataract

and myopathy appear to be useful models with

good discriminative and calibration properties.

The model for predicting the 5-year statin risk

of developing liver dysfunction appears to

have limited ability to identify high-risk

individuals and the authors caution against its

use.

Reference

Collins GS (2012) Predicting the adverse risk

of statin treatment: an independent and

external validation of Qstatin risk scores in the

UK. Heart. 98 (14), pp. 1091-7. Epub 2012 Jun

11

Link to full text articles, requires an Athens

password to access the item.

Predicting Cardiac Arrest on the

Wards

Current rapid response team activation criteria

were not statistically derived using ward vital

signs, and the best vital sign predictors of

cardiac arrest (CA) have not been determined.

In addition, it is unknown when vital signs

begin to accurately detect this event prior to

CA.

The MEWS was significantly different between

patients experiencing CA and control patients

by 48 h prior to the event, but includes poor

predictors of CA such as temperature and

omits significant predictors such as diastolic

BP and pulse pressure index. Source: BMJ

Evidence Updates.

Reference

Churpek MM et al (2012) Predicting cardiac

arrest on the wards: a nested case-control

study. Chest. 141 (5), pp. 1170-6. Epub 2011

Nov 3.

Link to full text article, no password required.

Is Routine Chest Radiography

Indicated Following Chest Drain

Removal after Cardiothoracic

surgery?

A best evidence topic was written according to

a structured protocol. The question addressed

was whether routine chest radiography is

indicated following chest drain removal in

patients undergoing cardiothoracic surgery.

Whilst the rate of intervention following routine

CXR was as high as 4% in the smallest study,

clinical signs and symptoms suggestive of

pathology were a significant predictor of major

re-intervention (P < 0.01).

Reference

Sepehripour AH et al (2012) Is routine chest

radiography indicated following chest drain

removal after cardiothoracic surgery?

Interactive Cardiovascular & Thoracic Surgery,

14 (6), pp. 834-8.

Link to full text article, no password required.

4


Short- and Long-Term Outcomes

with Drug-Eluting

and Bare-Metal Coronary Stents

Drug-eluting stents (DES) have been in clinical

use for nearly a decade; however, the relative

short- and long-term efficacy and safety of

DES compared with bare-metal stents (BMS)

and among the DES types are less well

defined.

DES are highly efficacious at reducing the risk

of target-vessel revascularization without an

increase in any safety outcomes, including

stent thrombosis. However, among the DES

types, there were considerable differences,

such that EES, SES, and ZES-R were the

most efficacious and EES was the safest stent.

Source: BMJ Evidence Updates.

Reference

Bangalore S et al (2012) Short- and long-term

outcomes with drug-eluting and bare-metal

coronary stents: a mixed-treatment

comparison analysis of 117 762 patient-years

of follow-up from randomized trials.

Circulation, 125 (23), pp. 2873-91.

Link to full text article, a current Athens

password is required to access this item.

Thirty-Day Rehospitalizations after

Acute Myocardial Infarction

Rehospitalization is a quality-of-care indicator,

yet little is known about its occurrence and

predictors after myocardial infarction (MI) in

the community.

Comorbid conditions, longer length of stay,

and complications of angiography and

revascularization or reperfusion are associated

with increased 30-day rehospitalization risk

after MI. Many rehospitalizations seem to be

unrelated to the incident MI. Source: BMJ

Evidence Updates.

Reference

Dunlay SM et al. (2012) Thirty-day

rehospitalizations after acute myocardial

infarction: a cohort study. Annals Internal

Medicine, 157 (1), pp. 11-8.

Link to full text article, no password required.

Basal Insulin and Cardiovascular

and Other

Outcomes in Dysglycemia

The provision of sufficient basal insulin to

normalize fasting plasma glucose levels may

reduce cardiovascular events, but such a

possibility has not been formally tested.

When used to target normal fasting plasma

glucose levels for more than 6 years, insulin

glargine had a neutral effect on cardiovascular

outcomes and cancers. Although it reduced

new-onset diabetes, insulin glargine also

increased hypoglycaemia and modestly

increased weight. Source: BMJ Evidence

Updates.

Reference

The ORIGIN Trial Investigators. Basal Insulin

and Cardiovascular and Other Outcomes in

Dysglycemia. New England Journal of

Medicine. 2012 Jun 11.

Link to full text article, no password required.

Association of Aspirin Use with

Major Bleeding in Patients with and

Without Diabetes

The benefit of aspirin for the primary

prevention of cardiovascular events is

relatively small for individuals with and without

diabetes. This benefit could easily be offset by

the risk of haemorrhage.

In a population-based cohort, aspirin use was

significantly associated with an increased risk

of major gastrointestinal or cerebral bleeding

episodes. Patients with diabetes had a high

rate of bleeding that was not independently

associated with aspirin use. Source: BMJ

Evidence Updates.

Reference

De Berardis G et al (2012) Association of

Aspirin Use with Major Bleeding in Patients

With and Without Diabetes. Aspirin Use and

Major Bleeding in Diabetes. JAMA, 307 (21),

pp. 2286-94.

Link to full text to article, no password

required.

5


GLUTAMICS- A Randomized

Clinical Trial on Glutamate Infusion

in 861 patients Undergoing

Surgery for Acute Coronary

Syndrome

Glutamate has been claimed to protect the

heart from ischemia and to facilitate metabolic

and hemodynamic recovery after ischemia.

The GLUTAmate for Metabolic Intervention in

Coronary Surgery trial investigated whether an

intravenous glutamate infusion given in

association with surgery for acute coronary

syndrome could reduce mortality and prevent

or mitigate myocardial injury and postoperative

heart failure. Source: BMJ Evidence Updates.

Reference

Vidlund M et al (2012) GLUTAMICS-a

randomized clinical trial on glutamate infusion

in 861 patients undergoing surgery for acute

coronary syndrome. The Journal of Thoracic

and Cardiovascular Surgery. Published ahead

of print 19 th June 2012.

Link to full text article, an Athens password

is required to access this item.

High-Sensitivity Cardiac Troponin in

the Distinction of Acute Myocardial

Infarction from Acute Cardiac

Noncoronary Artery Disease

The study hypothesized that high-sensitivity

cardiac troponin (hs-cTn) and its early change

are useful in distinguishing acute myocardial

infarction (AMI) from acute cardiac

noncoronary artery disease.

The combined use of hs-cTn at presentation

and its early absolute change excellently

discriminates between patients with AMI and

those with cardiac noncoronary artery disease.

Source: BMJ Evidence Updates.

Reference

Haaf P et al. (2012) High-sensitivity cardiac

troponin in the distinction of acute myocardial

infarction from acute cardiac noncoronary

artery disease. Circulation, 126 (1), pp. 31-40.

Link to full text article, an Athens password

is required to access this item.

6

Costs and Cost-Effectiveness of

Carotid Stenting Versus

Endarterectomy for Patients at

Standard Surgical Risk

The Carotid Revascularization Endarterectomy

versus Stenting Trial (CREST) demonstrated

similar rates of the primary composite end

point between carotid artery stenting (CAS)

and carotid endarterectomy (CEA), although

the risk of stroke was higher with CAS, and the

risk of myocardial infarction was higher with

CEA. Given the large number of patients who

are candidates for these procedures, an

understanding of their relative cost and costeffectiveness

may have important implications

for health care policy and treatment guidelines.

If the CREST results can be replicated in

clinical practice, the findings suggested in this

trial suggest that factors other than costeffectiveness

should be considered when

deciding between treatment options for carotid

artery stenosis in patients at standard risk for

surgical complications. Source: BMJ Evidence

Updates.

Reference

Vilain KR (2012) Costs and cost-effectiveness

of carotid stenting versus endarterectomy for

Patients at Standard Surgical Risk: results

from the arotid revascularization

endarterectomy versus stenting trial (CREST).

Stroke. 43 (9), pp. 2408-2416.

Full text available via inter library loan, there is

a charge for this service.

One-Hour Rule-out and Rule-in of

Acute Myocardial Infarction Using

High-Sensitivity Cardiac Troponin T

High-sensitivity cardiac troponin (hs-cTn)

assays seem to improve the early diagnosis of

acute myocardial infarction (AMI), but it is

unknown how to best use them in clinical

practice. Our objective was to develop and

validate an algorithm for rapid rule-out and

rule-in of AMI.

Using a simple algorithm incorporating hscTnT

baseline values and absolute changes

within the first hour allowed a safe rule-out as

well as an accurate rule-in of AMI within 1 hour

in 77% of unselected patients with acute chest

pain. This novel strategy may obviate the need


for prolonged monitoring and serial blood

sampling in 3 of 4 patients. Source: BMJ

Evidence Updates.

Reference

Reichlin T et al (2012) One-Hour Rule-out and

Rule-in of Acute Myocardial Infarction Using

High-Sensitivity Cardiac Troponin T. Archives

of Internal Medicine. 172 (15), pp. 1-8. Doi:

10.1001/archinternmed.2012.3698.

Full text available via inter library loan, there is

a charge for this service.

Postoperative Respiratory Failure

after Cardiac Surgery: Use of

Noninvasive Ventilation

The objective of this study was to analyse the

use of noninvasive ventilation (NIV) in

respiratory failure after extubation in patients

after cardiac surgery, the factors associated

with respiratory failure, and the need for

reintubation.

Reintubation was required in half of the NIVtreated

patients and was associated with an

increased hospital mortality rate. Early

respiratory failure after extubation (= 65

years old, and were scheduled for emergency

non-cardiac surgery. The treating anaesthetist

completed a diagnosis and management plan

before and after transthoracic

echocardiography, which was performed by an

independent operator. Clinical examination

rated cardiac disease present in 75%; the

remainder were asymptomatic.

Pre-operative focused transthoracic

echocardiography in patients admitted for

emergency surgery and with known cardiac

disease or suspected to be at risk of cardiac

disease frequently alters diagnosis and

management. Source: Medline.

Reference

Canty DJ (2012) The impact of pre-operative

focused transthoracic echocardiography in

emergency non-cardiac surgery patients with

known or risk of cardiac disease. Anaesthesia,

67 (7), pp. 714-720.

Full text available via inter library loan, there is

a charge for this service.

7


Cochrane Systematic

Reviews

Click on the title to access the full text review.

Lip GYH, Wrigley BJ, Pisters R. Anticoagulation

versus placebo for heart failure in sinus rhythm.

Cochrane Database of Systematic Reviews 2012,

Issue 6. Art. No.: CD003336. DOI: 10.1002/

14651858.CD003336.pub2.

Anti-inflammatory treatment for

carditis in acute rheumatic fever.

June 2012

Author’s Conclusion: There is little evidence

of benefit from using corticosteroids or

intravenous immunoglobulins to reduce the

risk of heart valve lesions in patients with

acute rheumatic fever. The antiquity of most of

the trials restricted adequate statistical

analysis of the data and acceptable

assessment of clinical outcomes by current

standards. Additionally there was substantial

risk of bias, so results should be viewed with

caution. New randomised controlled trials in

patients with acute rheumatic fever to assess

the effects of corticosteroids such as oral

prednisone and intravenous

methylprednisolone, and other new antiinflammatory

agents are warranted. Advances

in echocardiography will allow for more

objective and precise assessments of cardiac

outcomes.

Cilliers A, Manyemba J, Adler AJ, Saloojee H. Antiinflammatory

treatment for carditis in acute

rheumatic fever. Cochrane Database of Systematic

Reviews 2012, Issue 6. Art. No.: CD003176. DOI:

10.1002/14651858.CD003176.pub2.

Anticoagulation versus placebo for

heart failure in sinus rhythm. June

2012

Author’s Conclusion: Based on the two

major randomised trials (HELAS 2006; WASH

2004), there is no convincing evidence that

oral anticoagulant therapy modifies mortality or

vascular events in patients with heart failure

and sinus rhythm. Although oral

anticoagulation is indicated in certain groups of

patients with heart failure (for example atrial

fibrillation), the data available does not support

its routine use in heart failure patients who

remain in sinus rhythm. A large randomised

trial of warfarin in heart failure patients in sinus

rhythm is currently in progress and data from

this trial will be a useful addition to this topic.

8

Blood pressure lowering efficacy of

loop diuretics for primary

hypertension. August 2012

Author’s Conclusion: Based on the limited

number of published RCTs, the

systolic/diastolic blood pressure lowering effect

of loop diuretics is modest (-8/-4 mmHg) and is

likely an overestimate due to the high risk of

bias in the included studies. There are no

clinically meaningful BP lowering differences

between different drugs within the loop diuretic

class. The dose ranging effects of loop

diuretics could not be evaluated. The review

did not provide a good estimate of the

incidence of harms associated with loop

diuretics because of the short duration of the

trials and the lack of reporting of adverse

effects in many of the trials.

Musini VM, Rezapour P, Wright JM, Bassett K,

Jauca CD. Blood pressure lowering efficacy of loop

diuretics for primary hypertension. Cochrane

Database of Systematic Reviews 2012, Issue 8. Art.

No.: CD003825. DOI:

10.1002/14651858.CD003825.pub3.

Clinical service organisation for

heart failure. September 2012

Author’s Conclusion: Amongst CHF patients

who have previously been admitted to hospital

for this condition there is now good evidence

that case management type interventions led

by a heart failure specialist nurse reduces CHF

related readmissions after 12 months follow

up, all cause readmissions and all cause

mortality. It is not possible to say what the

optimal components of these case

management type interventions are, however

telephone follow up by the nurse specialist

was a common component. Multidisciplinary

interventions may be effective in reducing both

CHF and all cause readmissions. There is

currently limited evidence to support

interventions whose major component is follow

up in a CHF clinic.

Takeda A, Taylor SJC, Taylor RS, Khan F, Krum H,

Underwood M. Clinical service organisation for


heart failure. Cochrane Database of Systematic

Reviews 2012, Issue 9. Art. No.: CD002752. DOI:

10.1002/14651858.CD002752.pub3.

Pharmacotherapy for mild

hypertension. August 2012

Author’s Conclusion: Antihypertensive drugs

used in the treatment of adults (primary

prevention) with mild hypertension (systolic BP

140-159 mmHg and/or diastolic BP 90-99

mmHg) have not been shown to reduce

mortality or morbidity in RCTs. Treatment

caused 9% of patients to discontinue treatment

due to adverse effects. More RCTs are

needed in this prevalent population to know

whether the benefits of treatment exceed the

harms.

Diao D, Wright JM, Cundiff DK, Gueyffier F.

Pharmacotherapy for mild hypertension. Cochrane

Database of Systematic Reviews 2012, Issue 8. Art.

No.: CD006742. DOI: 10.1002/1465

1858.CD006742.pub2

Preoperative bathing or showering

with skin antiseptics to prevent

surgical site infection. September 2012

Author’s Conclusion: This review provides

no clear evidence of benefit for preoperative

showering or bathing with chlorhexidine over

other wash products, to reduce surgical site

infection. Efforts to reduce the incidence of

nosocomial surgical site infection should focus

on interventions where effect has been

demonstrated.

Webster J, Osborne S. Preoperative bathing or

showering with skin antiseptics to prevent surgical

site infection. Cochrane Database of Systematic

Reviews 2012, Issue 9. Art. No.: CD004985. DOI:

10.1002/14651858.CD004985.pub4.

studies included mainly patients undergoing

myocardial revascularizations the results

cannot be extrapolated to patients undergoing

other cardiac procedures such as heart valve

or aortic surgery.

Liakopoulos OJ, Kuhn EW, Slottosch I,

Wassmer G, Wahlers T. Preoperative statin

therapy for patients undergoing cardiac

surgery. Cochrane Database of Systematic

Reviews 2012, Issue 4. Art. No.: CD008493.

DOI: 10.1002/14651858.CD008493.pub2

Unfractionated heparin versus low

molecular weight heparin for

avoiding heparin-induced

thrombocytopenia in postoperative

patients. September 2012

Author’s Conclusion: There was a lower

incidence of HIT and HIT complicated by VTE

in postoperative patients undergoing

thromboprophylaxis with LMWH compared

with UFH. This is consistent with the current

clinical use of LMWH over UFH as front-line

heparin therapy. However, conclusions are

limited by a scarcity of high quality evidence.

We did not expect the paucity of RCTs

including HIT as an outcome as heparin is one

of the most commonly used drugs worldwide

and HIT is a life-threatening adverse drug

reaction. To address the scarcity of clinicallyrelevant

information on the topic of HIT as a

whole, HIT should be included as an outcome

in future RCTs of heparin, and HIT as an

adverse drug reaction should be considered in

clinical recommendations regarding monitoring

of the platelet count for HIT.

Junqueira DRG, Perini E, Penholati RRM, Carvalho

MG. Unfractionated heparin versus low molecular

weight heparin for avoiding heparin-induced

thrombocytopenia in postoperative patients.

Cochrane Database of Systematic Reviews 2012,

Issue 9. Art. No.: CD007557. DOI: 10.1002/

14651858.CD007557.pub2.

Preoperative statin therapy for

patients undergoing cardiac

surgery. April 2012

Author’s Conclusion: Preoperative statin

therapy reduces the odds of post-operative AF

and shortens the stay on the ICU and in the

hospital. Statin pretreatment had no influence

on perioperative mortality, stroke, myocardial

infarction or renal failure. Since analysed

9


News in Brief

To view the full text of each news item, click on

the link below. NHS Choices news is freely

available, no password required. You may

need to register for Medscape to access full

text.

Can fish oil prevent heart attack disease?

NHS Choices

Childhood obesity may impact on heart

health in later life. NHS Choices

Diet rich in antioxidants can cut heart attack

risk. NHS Choices

First operation of implant for heat failure

due. NHS Choices

Having desk job “doubles risk” of heart

attack. NHS Choices

High Cholesterol genes discovered. NHS

Choices

Horrible bosses: do they cause heart attacks.

NHS Choices

HRT can cut heart attack deaths. NHS Choices

Playing football is “the best way” for men to

tackle high blood pressure. NHS Choices

Statins may help healthy adults. NHS

Choices

Tai chi heart benefits examined. NHS

Choices

Cardiology in the Young

Circulation

European Heart Journal

Future Cardiology

Heart

Interactive Cardiovascular and Thoracic

Surgery

International Journal of Cardiology

Journal of Cardiothoracic and Vascular

Anesthesia

Journal of Cardiothoracic Surgery

Journal of Cardiovascular Nursing

Journal of Thoracic and Cardiovascular

Surgery

Seminars in Cardiothoracic and Vascular

Anesthesia

The Open Cardiovascular Medicine Journal

Bell Library Developments

New Books Added to Bell Library

Working yourself to death – overtime link

to heart disease. NHS Choices

Current Contents In ….

To view the content of the current issue, click

on the link below. Full text should be available

via and Athens Username and password.

Mackay, JH et al

(2012) Core

topics in cardiac

anesthesia. 2 nd

ed.

American Journal of Cardiology

BMC Cardiovascular Disorders

British Journal of Cardiology

Cardiology

10


New Library Blog and Web Site

Bell Library now have a blog and externally

accessible web site to help with your information

needs.

The blog is accessible at

http://rwhtrbelllibrary.wordpress.com/

The Evidence Newsletters will be posted on the

blog, plus other items identified in the press of

interest , any library developments and training

events, You may subscribed to RSS feeds from the

site and add your own comments.

The WEB address is available at

https://sites.google.com/site/wolvesbelllibrary/home

This will provide access to resources currently

available via the internal KITE site, NICE guidance,

and new books.

Revised Opening Times

The Bell Library is now open from 8.30am each

morning. The new hours are as follows.

Mon-Thurs 8.30am to 5.00pm

Fri 8.30am to 4.30pm

We hope you find this newsletter useful.

Suggestions or comments? E-mail The Editor

Alternatively, to remove your name from our

mailing list, please click here.

Contents Continued

Short- and long- term

outcomes with drug-eluting

and bare-metal coronary

stents

Thirty-day

rehospitalisation’s after

acute MI

Basal insulin and

cardiovascular and other

outcomes in dysglycemia

Association of aspirin use

with major bleeding in

patients with and without

diabetes

GLUTAMICS – a

randomized control clinical

trial on glutamate infusion

in 861 patients undergoing

surgery for acute coronary

syndrome

High-sensitivity cardiac

troponin in the distinction of

acute myocardial infarction

for acute cardiac non

coronary artery disease

Cost and cost-effectiveness

of carotid stenting versus

endarterectomise for

patients at standard

surgical risk

One-hour rule-out and rulein

of acute MI using highsensitivity

cardiac troponinT

Postoperative respiratory

failure after cardiac surgery:

use of non-invasive

ventilation

Magic bullets in cardiac

anesthesia and intensive

care

The impact of pre-operative

focused transthoracic

echocardiography in

emergency non-cardiac

surgery patients with known

or risks of cardiac disease

5

5

5

5

6

6

6

6

7

7

7

This newsletter is produced by:

Bell Library, Wolverhampton Medical Institute

New Cross Hospital, Wolverhampton, WV10 0QP

Tel: 01902 695322

E-mail: rwh-tr.belllibrary@nhs.net

11

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