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Is the new professionalism and ACP's new ethics really just about following guidelines?

The Charter ( Medical Professionalism in the New Millennium.A Physician's Charter) did not deal with just the important relationship of ...

Friday, May 11, 2018

Is ablation better than drugs for A FIb? What did CABANA trial show?

The results of the Cabana trial were presented at the Heart Rhythm Society meeting in May 2018. The full results will be published later. Here is Larry Husten's reporting in Forbes.

The intention-to-treat (ITT) analyses indicated there was no statistically significant difference between ablation and drug treatment in regard to the primary outcome which was the total of death,disabling stroke, serious bleeding and cardiac arrest.

On the other hand the per-protocol analysis (PPA) gave different results indicating  an advantage to the ablation group.

It got down to a battle of the Packers. Dr Doug Packer,who presented the data,said that the per protocol analysis should trump the ITT, while Dr. Milton Packer seemed to think that venerable epidemiologic principles would be violated if one did not follow the ITT analysis.

There is already talk of the need for a sham trial  and EP cardiologists talking about sub-group analysis (ablation maybe better in those under 65 years of age and in those with heart failure) and touting the quality of life benefits of ablation .

One obvious problem (many more will likely be talked about) was the drug treatment group was not homogenous-it  included both rate and various rhythm  control strategies.  

Since there seems to be a battle between the ITT folks and the PPA supporters ,for those who might want to drive deeper into the issue , here is a place to start.

Thursday, May 03, 2018

Argument for aerobic exercise in patients with Parkinson's disease.

There ae no randomized clinical trials that demonstrate the benefit of regular aerobic exercise in delaying the progression of Parkinson's disease  (PD) nor in the decrease in the risk of development of dementia.However the Mayo Clinic has published an excellent review of the literature regarding  the beneficial effect of exercise on various brain areas and functions. See here.

Quoting the authors : "This aggregate literature provides a compelling argument for regular aerobic exercise and cardiovascular fitness attenuating PD progression."

h/t to Dr. Robert Donnell at his blog "Notes from Dr. RW" .