Just say no

Understanding what actually benefits patients not only leads to better care but also better shepherding of limited resources. Evidence this week underscored several potential opportunities for avoiding technologies or protocols that ultimately don’t improve outcomes.

These are important findings because they help healthcare professionals provide cost-effective care. This is not just a plus for payer and health system’s bottom lines. Physicians and hospitals that apply evidence-based strategies in their decision making free up resources for their sickest patients.    

Let’s start with implantable cardioverter-defibrillators (ICDs). This is a life-saving technology but it carries steep costs and potential complications. Researchers in Australia asked if some STEMI patients who underwent PCI might fare well without device implantation. Their study focused on patients with severely impaired left ventricular ejection fraction but no inducible ventricular tachycardia.

They described the long-term prognosis of patients who did not receive ICDs as favorable with low mortality at three years. Other factors may have contributed to low mortality, as pointed out by an editorial writer.

Another study published this month looked at the use of clopidogrel in addition to aspirin to reduce the risk of recurrence in patients with a recent lacunar stroke. Patients in this post hoc analysis of a randomized, controlled clinical trial were considered “aspirin failures” because they had been taking aspirin at the time of the qualifying event.

The subanalysis found that clopidogrel didn’t offer any protective benefit. The group who received clopidogrel plus aspirin also had higher rates of all-cause mortality and gastrointestinal bleeding, results that mirrored findings in the main trial.

Cardiopulmonary resuscitation (CPR) and blood transfusions also were under the spotlight this month. Mechanical CPR proved to be no more effective than manual CPR, and a blood conservation strategy in patients undergoing aortic valve replacement reduced the need for blood transfusions without increasing mortality or morbidity.

Various study authors suggested their results could sway guideline writers to revise recommendations. This may be a recurring theme in 2014: Just say no when evidence shows existing or novel approaches fail to improve outcomes.    

Candace Stuart

Cardiovascular Business, editor