The loop diuretic duels, adverse events during hospital admissions, BP accuracy, and left main revascularization strategies (again) are the topics drjohnm discusses in this week’s podcast.
— a pragmatic RCT of furosemide vs torsemide in patients with HF. The primary endpoint was all-cause mortality, with five secondary outcomes.after the study was presented at the American Heart Association meeting. It’s a big trial and worth a quick re-look now.
After discharge from the hospital no further study-specific follow-ups were scheduled. Patients were followed by phone. So, you might wonder, well, what about hospitalizations for HF ? No, you don’t get to know that. Why? Because the authors measured the correct endpoint — total hospitalizations. HHF are one small component of hospitalizations, and if you are a 75-year-old person, you don’t care what kind of hospital admission is prevented, you just don’t want to be admitted.
Before we conclude that the old stand-by furosemide is where we should start, there were some limitations in this trial, most of which occurred because it was a pragmatic trial. Pragmatic trials, by definition, have limitations. Another limitation was diuretic discontinuation and crossovers. Again, this isn’t one of those trials with strict protocols. Pragmatic trials are designed to simulate what happens in real practice. That’s good because the results generalize well, but it’s bad because there’s a lot of noise that might hide signal.
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