Episode 376: 387. Methods Monday and an Example of Subgroup Analysis
Questioning Medicine17 Maalis 2025

Episode 376: 387. Methods Monday and an Example of Subgroup Analysis

https://www.nejm.org/doi/full/10.1056/NEJMoa2405923?query=clinical-medicine

Mineralocorticoid receptor antagonists have been shown to reduce mortality in patients after myocardial infarction with congestive heart failure. Whether routine use of spironolactone is beneficial after myocardial infarction is uncertain.

Recent attempts to improve outcomes with intensified renin–angiotensin–aldosterone inhibition have not shown improvements in outcomes.7,8 A trial of routine aldosterone antagonism with spironolactone in addition to standard therapy among 1603 patients after myocardial infarction without heart failure showed no improvement in outcomes.9

https://pubmed.ncbi.nlm.nih.gov/27102506/ “ In a non-pre-specified exploratory analysis, the odds of death were reduced in the treatment group (3 [0.5%] vs. 15 [2.4%]; HR: 0.20; 95% CI: 0.06 to 0.70) in the subgroup of ST-segment elevation MI (n = 1,229), but not in non-ST-segment elevation MI (p for interaction = 0.01).”’

However, there was a significant reduction in mortality in the subgroup of 1229 patients with ST-segment elevation myocardial infarction (STEMI), a finding that highlights the need for a large trial.

We conducted the CLEAR trial to evaluate whether routine use of spironolactone is beneficial in patients after myocardial infarction.

Jaksot(385)

Episode 375: 386. Could half dose anticoagulation be the answer?

Episode 375: 386. Could half dose anticoagulation be the answer?

Estimated 5-year incidence of recurrent VTE was similar in the reduced-dose and full-dose groups (2.2% and 1.8%). Estimated 5-year bleeding incidence was significantly lower with reduced-dose than wi...

14 Maalis 20258min

Episode 374: 385. PRACTICE CHANGER! Male-Partner Treatment to Prevent Recurrence of Bacterial Vaginosis

Episode 374: 385. PRACTICE CHANGER! Male-Partner Treatment to Prevent Recurrence of Bacterial Vaginosis

https://www.nejm.org/doi/full/10.1056/NEJMoa2405404NNT of 4! systemic metronid and topical clinda bid for one week

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Episode 373: 384. Chronic Kidney Disease and Empagliflozin Legacy Effect

Episode 373: 384. Chronic Kidney Disease and Empagliflozin Legacy Effect

What Was Studied?The EMPA-KIDNEY trial followed 6,609 CKD patients at risk of disease progression. Participants were randomly assigned to receive empagliflozin (10 mg daily) or a placebo for a median ...

11 Maalis 20259min

Episode 372: 383. What is the GFR at which we stop metforin?

Episode 372: 383. What is the GFR at which we stop metforin?

Metformin while not necessarily first line therapy for diabetes depending on the patients co-morbid conditions it is certainly highly ranked on the list of medications! I know often metformin is stopp...

6 Maalis 202510min

Episode 371: 382. Is it safe to give the flu and covid vaccine at the same time?

Episode 371: 382. Is it safe to give the flu and covid vaccine at the same time?

https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2825813Conclusions and Relevance  In this randomized clinical trial assessing simultaneous vs sequential administration of mRNA COVID-19 an...

4 Maalis 20257min

Episode 370: 381. Relative efficacy of prehabilitation interventions and their components

Episode 370: 381. Relative efficacy of prehabilitation interventions and their components

https://www.bmj.com/content/388/bmj-2024-081164systematic review and meta-analysis on prehabilitation before surgery, published in the BMJ in February 2025.Prehabilitation aims to prepare patients for...

27 Helmi 20257min

Episode 369: 380. REPOST mammo part 2

Episode 369: 380. REPOST mammo part 2

Mammograms

24 Helmi 202520min

Episode 368: 379. REPOST mammogram part 1

Episode 368: 379. REPOST mammogram part 1

379. REPORT mammogram part 1

18 Helmi 202519min

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