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Harlan Krumholz, invited contributors, and the CardioExchange community unpack key pieces of clinical research.
Avatar of Harlan M. Krumholz, MD, SM

A DOSE of Reality: The Challenges of Comparing Effectiveness (2 Mar 2011)

Harlan M. Krumholz, MD, SM

An ideal paper for your next journal club — “Diuretic Strategies in Patients with Acute Decompensated Heart Failure” — was just published in NEJM, by the NHLBI Heart Failure Clinical Research Network.  In this study (called DOSE), patients hospitalized with heart failure were randomized to receive different diuretic regimens based on dose and mode of administration. The authors concluded that “there were no significant differences in patients’ global assessment of symptoms or in the change in renal function when diuretic therapy was administered by bolus as compared with continuous infusion… Continue Reading

Avatar of Harlan M. Krumholz, MD, SM

How to Question the Research Question (3 Feb 2011)

Harlan M. Krumholz, MD, SM

Another good paper for a journal club recently appeared in JAMA. What makes this one worth discussing is the research question the investigators posed and how they addressed it. Although this is not focused on cardiac care, the issues are germane to literature in our field and cardiac care certification is also spreading. The article, titled “Association Between Stroke Center Hospitalization for Acute Ischemic Stroke and Mortality,” focuses on the New York State Stroke Center Designation program — a collaboration among the New York State Department of Health, the American Heart… Continue Reading

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Poor Justification for Compulsory Angiography Before Vascular Surgery (24 Jan 2011)

Harlan M. Krumholz, MD, SM

I recently heard a physician quote a paper from JACC to justify pursuing revascularization in an asymptomatic patient who was scheduled for major vascular surgery. This article is worth a close look in your journal club, even though it was published in 2009. In their discussion, the authors summarize their findings as follows: “For patients in preparation for major vascular surgery, the present study shows that a strategy of ‘prophylactic’ coronary artery angiography for all patients at medium-high risk, followed by coronary revascularization as needed, is more effective in curbing… Continue Reading

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Have the COURAGE to Critique a Substudy (10 Jan 2011)

Harlan M. Krumholz, MD, SM

In this journal club, I compare the published data from an original trial with the authors’ conclusions in a substudy from that trial. Often, a substudy provides valuable insights that complement the initial trial findings. Sometimes, however, you need to look closely to identify the additional insight. Case in point: COURAGE. The Original COURAGE Trial As reported in 2007 in the NEJM, 2287 patients with objective evidence of myocardial ischemia and significant epicardial coronary artery disease were randomized to receive either optimal medical therapy (OMT) alone or percutaneous coronary intervention… Continue Reading

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A Rich OASIS for Your Journal Club (19 Sep 2010)

Harlan M. Krumholz, MD, SM

I’m always scouting for papers to discuss in journal club with my students. Earlier this month, I found the perfect pair: two simultaneously published articles from the industry-funded CURRENT–OASIS 7 randomized trial, one in the New England Journal of Medicine and the other in the Lancet. Many of the authors of the two papers were the same. First, a recap: In a 2×2 factorial design, investigators compared higher- with standard-dose aspirin (either 300–325 mg or 75–100 mg daily) and higher- with standard-dose clopidogrel (either 600-mg loading, then 150 mg/day for… Continue Reading