DynaMed Weekly Update

April 21, 2009

Volume 4 Issue 16

DynaMed Systematic Literature Surveillance

For the week ending April 17, 2009

This week, 694 articles were considered for inclusion in DynaMed and 239 met criteria for inclusion.

Based on the criteria of selecting “articles most likely to change clinical practice,” one article of significant interest is included in this weekly update.

Aspirin Increases Heart Failure Hospitalization and Non-Fatal Stroke Compared to Warfarin in Patients with Heart Failure

Use of aspirin for patients with heart failure is controversial. Previously, the Warfarin/Aspirin Study in Heart Failure (WASH) trial found increased hospitalization for heart failure in patients taking aspirin compared to patients taking either warfarin or placebo. The newly published Warfarin and Antiplatelet Therapy in Chronic Heart Failure (WATCH) trial compared the relative efficacy of warfarin, clopidogrel and aspirin in 1,587 patients with heart failure followed for mean 1.9 years. Warfarin was administered open-label, but clopidogrel and aspirin groups were double-blinded. While there was no difference in the primary composite outcome of death from all causes, non-fatal myocardial infarction, and non-fatal stroke, the trial did support the WASH trial findings regarding the increase in hospitalization for heart failure with the use of aspirin (level 2 [mid-level] evidence). Hospitalization for heart failure was significantly higher for the aspirin group compared to warfarin (22.2% vs. 16.5%, p = 0.02, NNH 17). Incidence of non-fatal stroke was lower for warfarin (0.2%) than both aspirin (1.7%, p = 0.0095 vs. warfarin, NNH 66) and clopidogrel (2.1%, p = 0.0031 vs. warfarin, NNH 52). Mortality was about 18% overall with no differences between groups. There were no differences in bleeding outcomes between warfarin and aspirin (Circulation 2009 Mar 31;119(12):1616). For more information, see the Heart Failure and Aspirin use in patients with heart failure topics in DynaMed.

DYNAMED EXTRA – New ACC/AHA Guidelines on Heart Failure in Adults

The American College of Cardiology/American Heart Association (ACC/AHA) Guidelines for the Diagnosis and Management of Heart Failure in Adults have recently been updated and now include information on hospitalized patients (Circulation 2009 Apr 14;119(14):1977 PDF). The guidelines have been fully summarized in the new DynaMed topic American College of Cardiology/American Heart Association (ACC/AHA) guidelines on heart failure in adults, and have been used as a general reference to update the Heart failure, Acute heart failure and Diastolic heart failure topics as well as to create a new topic to address Heart failure prevention. For more information, see these topics in DynaMed.

DynaMed and Zynx Health Expand Evidence-Based Clinical Decision Support

EBSCO Publishing and Zynx Health recently announced a partnership to imbed DynaMed’s evidence-based, clinically-organized summaries into Zynx evidence-based order sets for mutual customers. Combining order set creation, maintenance, and order set use at the point of care with the best available evidence-based clinical reference content allows for more consistent decision making and improved quality of care. DynaMed is used in thousands of hospitals worldwide and the Zynx partnership will further enable mutual customers to provide the content to clinicians where and when they need it most. See DynaMed and Zynx Health Expand Evidence-Based Clinical Decision Support for more information.

DynaMed Topic Activity

New summaries added to DynaMed this week:

· American College of Cardiology/American Heart Association (ACC/AHA) guidelines on heart failure in adults

· Antibiotics for streptococcal pharyngitis

· Carotenemia

· Coronary artery disease major risk factors

· Heart failure prevention

· Masked hypertension

DynaMed Peer Review

We are currently seeking reviewers for:

· Carotenemia

· Coronary artery disease major risk factors

· Masked hypertension

For more information, see Editorial Policies for Authors & Reviewers and DynaMed Peer Review.

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DynaMed Weekly Update is a compilation of 1 to 5 articles that are of significant interest to clinicians. Articles are selected from DynaMed's Systematic Literature Surveillance as articles most likely to change clinical practice. Updates are prepared by the DynaMed Editorial Team which includes 28 clinicians from multiple disciplines. Send comments to DynaMedEditor@epnet.com. To learn more about DynaMed, go to www.dynamicmedical.com.

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Copyright © 2009 EBSCO Publishing. All rights reserved.
DynaMed® is a registered trademark of and published by DynaMed LLC. Original date of on-line publication December 15, 1995 with continuous daily updating. ISSN: 1554-1177. Subscriptions and queries can be addressed to DynaMed LLC, EBSCO Publishing, 10 Estes St., Ipswich, Massachusetts, USA 01938-0602, telephone (978) 356-6500, facsimile (978) 356-6565, e-mail Editor@DynamicMedical.com. The opinions expressed herein are solely those of the authors and editors and may or may not represent the official position of cooperating or endorsing Medical Societies. Development of DynaMed was supported in part by the National Science Foundation through a Small Business Innovative Research grant. (All other support comes from subscriptions. No advertisements are accepted.)