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29 Jan 2013

Selections from Richard Lehman’s Literature Review: January 28th

CardioExchange is pleased to reprint selections from Dr. Richard Lehman’s weekly journal review blog at BMJ.com. Selected summaries are relevant to our audience, but we encourage members to engage with the entire blog.

JAMA  23-30 Jan 2013  Vol 309

Hospital Readmission as a Quality Marker? (pg. 381): Readmission is now being looked at routinely as a quality marker for providers in the USA: but does this make any sense? Do we know of any effective means to reduce it? This study of a quality improvement initiative for care transitions by healthcare and social services personnel and Medicare Quality Improvement Organization staff in defined geographic areas was essentially negative. A Viewpoint piece looks at the logic of using 30 day readmission as a quality marker for heart failure care and decides there isn’t any. “Each quality metric should be data driven and patient focused. The 30 day readmission measure does not appear to meet either of these criteria. The important remaining question is whether patients will benefit from this measure. Thus far, it appears that this metric has the potential to result in more harm than benefit for patients with heart failure.”

NEJM  24 Jan 2013  Vol 368

Cardiovascular Safety of Peginesatide in Patients with Anemia Undergoing Hemodialysis (pg. 307): Hmm. Why then did we have the withdrawal of Vioxx and Avandia; why do we still not know if Tamiflu has any useful effect; and why was it so long before there were safety concerns over epoetin? It’s partly because of hidden data, and partly because of inadequate surrogate endpoints. Epoetin is very good at raising haemoglobin levels in renal dialysis patients: the only problem is that those with a “normal” Hb die sooner. Now there is a new kid on the block, called peginesatide, which works as well as epoetin but only needs to be injected monthly. Here is a study (EMERALD 1) which shows that the stuff not only raises Hb but is as safe as epoetin using a composite end-point of all-cause death, myocardial infarction, stroke, or serious cardiac events in dialysis patients.

Cardiovascular Safety of Peginesatide for Anemia in Patients with CKD Not Receiving Dialysis (pg. 320): However, when you compare peginesatide with darbepoetin in patients with advanced renal failure who are not on dialysis, the picture is less favourable. Cardiovascular end-points are commoner with the new agent. That’s a high price to pay for greater convenience of use, and I’m not convinced we yet know enough about this new agent to license it for general use.