Trials Flashcards
What is the Save trial Intervention In who Outcomes
Treat MI with ACE inhibitor. Mostly asymptomatic Reduced mi.
What is stitch hypothesis 1 Who Intervention Outcomr
Omt vs Cabg in Ef <35. No stastical difference but in pt without angina. Lots of crossover. No survival difference with viability.
Survival differences in heart mate 2 trial
60% in hm2 vs 24% with xve at 2 yrs
Cumulative effect of ace inhibitors? + beta blockers + aldo blockers
28% 34% 15%
Solvd trial When Who Outcomes
1991 Ef < 35. Two trials one with sx/one no sx Enalapril 10 bid Lowered all cause mortality and death/HF hospitalizations
Save trial Who What happened
Post mi Ef <40, no overt HF Placebo vs captopril Reduced cv death 21%
What are the 4 bb trials RRR, inlusion
Us carvedilol 65 rrr, mild/mod HF Ef <3 cibis 35 mod/severe merit 35 mild/mod hf improve Ef by 30% Copernicus 35 severe Capricorn post mi
Comet trial
Carvedilol va metop Much less dm
Who should get beta blockers when to start When to titrate dose?
Symptomatic and asymptomatic Ef <40 Initiate once euvolemic/Discontinue inotropes prior to sc Change dose every 2 week
Elite 2 trial outcomes
Losartan had no benefit over captopril
Val heft Intervention Outcomes
Valsartan added to ace. Reduced HF hospitalizations.
Charm alt/added
Charm alt had benefit Added did not
Optimaal Intervention Outcome
Losartan vs captopril post mi. No difference
Valiant Intervention Outcome
Post mi Valsartan v captopril No differences
Who should get arb
Class 1: ace intolerant, those on Arbs already, Don’t use post mi, don’t use if on spirinolactone.
Consensus trial Intervention Outcome
Enalapril in stage d. Nnt 7
Optime CHF
No benefit of milrinone .5 But seemed to work better in non ischemic
Corona-Gissi HF
No benefit of statins
Rales Population Outcome Weaknesses
Class iv. Nnt 9 Weakness low use bb
Emphasis Population Intervention Nnt/rrr
Class ii/3 Ef<30 spirinolactone Nnt 19 rrr 15%
Ephasus Population Nnt
MI, Ef<35, sx of HF Nnt 44
How often should you measure k in pt on aldostorone
At week one and four and every 3 mos Don’t give k unless less than 4
Enrollment in emphasis Primary outcome Findings rrr nnt
Nyha 2, ef<30 or 35 with wide qrs Cv death or hf hospitalization, Rrr 30, nnt 19
Aheft What is endpoint?
Composite death, HF, qol 4 % arr Recommended for aa, with moderate to severe symptoms reasonable in ace intolerant
Goal digoxin level
Less than 1.
Should patients with non ischemic cm get aspirin
No
HEAAL
NYHA 2-4, Ef< 40 Ace intolerant, randomized to 150 vs 50 of losartan. Higher doses reduced hospitalizations.
Shift trial
Class. 2-4 Decreased HF death, hospitalizations if hr > 77
Why use swan
Low bp Fluid status Renal failure Vasoactive agents Advanced therapies
What’s a cross sectional study
Data collected at a single point in time.
Why is randomization important
Eliminates bias from treatment assignment Tries to remove type 1 error.
What is most important thing about clinical trial endpoints
If doesn’t hit primary end point must ignore secondary endpoint.
Utility of secondary endpoints
Only useful if statistically significant primary endpoint.
Best primary outcomes
Clinical outcomes Symptoms Surrogates (may not always work).