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NIHR Signal Omega-3 supplements do not prevent heart disease, stroke or death
Omega-3 fatty acid supplements from fish oils or plants have little or no effect on the risk of heart disease, stroke or overall death rates. This finding contradicts a widespread belief that omega-3 supplements are protective. Previous evidence in favour of omega-3 supplements is mainly derived from trials at high risk of bias. The better evidence identified in this review does not demonstrate any health benefit. The review provides robust evidence confirming current guidance that omega-3 supp...
NIHR Signal The blood-thinner apixaban is less likely to cause major bleeding than warfarin
People who take apixaban to prevent blood clots are less likely to suffer major bleeding complications than those taking warfarin. Findings are similar in different groups of people, such as those with irregular heart rhythm (atrial fibrillation) and those who have had joint replacement surgery. Warfarin has long been used as an anticoagulant but needs frequent blood test monitoring. The new class of direct-acting oral anticoagulants does not usually need monitoring and is replacing warfarin. ...
NIHR Signal Two antiplatelet drugs may prevent further strokes but increase major bleeds
People experiencing a minor stroke or a transient ischaemic attack have a lower risk of further stroke within 90 days if given clopidogrel and aspirin, rather than aspirin alone. However, taking both drugs doubles the risk of bleeding over the same period. Current UK guidelines recommend using clopidogrel alone. In this major international trial of nearly 5,000 people, those who took the dual treatment had fewer heart attacks or strokes than those who took aspirin only, particularly in the fir...
NIHR Signal Ethanol locks in catheters for dialysis may prevent sepsis
In patients with tunnelled central venous catheters used for dialysis, ethanol locks may reduce catheter-related bloodstream infections when compared with other locks, mainly saline. There was no increase in the risk of catheter blockage with ethanol locks in this study. Long-term catheters carry a risk of bloodstream infection. ‘Locks’ are the small amount of fluid left inside a long intravenous catheter between uses to reduce the risk of blockage with clotted blood and ideally als...
NIHR Signal Fewer wound hernias occur if mesh is used to reinforce abdominal aortic aneurysm surgery
Mesh reinforcement may result in patients developing fewer hernias at the incision site after aortic aneurysm surgery. This type of hernia is a common complication of midline (vertical) incisions and can cause pain and restrict everyday activities. Although using mesh was linked with fewer incisional hernias, this systematic review could not determine with any certainty whether this led to fewer later operations on the hernia. Reoperation carries extra risk, especially in people who have had an...
NIHR Signal People take prescribed statins more reliably after discussing their advantages and disadvantages
Patients want to know more about how statins work, the reasons for prescribing them and their possible side effects. Statins lower cholesterol and reduce the risk of recurrent stroke or heart attack. They also help prevent cardiovascular disease developing in people at high risk. At a population, level statins reduce the overall incidence of cardiovascular disease for people at moderate risk, but the benefits for an individual are less clear-cut. This review found that people are happy to take...
NIHR Signal Reminders help GPs to find and manage inherited cholesterol disorders
GPs and practice nurses assess more adults with inherited raised cholesterol (familial hypercholesterolaemia) when prompted by reminders. More patients have repeat cholesterol tests and assessments for heart disease, in line with NICE guidelines. This NIHR-funded study used electronic health records from six GP practices to identify patients with total cholesterol greater than 7.5mmol/l. Reminder messages appeared when their records were opened during consultations and prompted GPs to carry out...
NIHR Signal Adrenaline can restart the heart but is no good for the brain
Treating cardiac arrests with adrenaline during resuscitation by paramedics slightly increases survival compared with placebo. Though adrenaline initially helped restore circulation in a third of cases, 3.2% of people survived to 30 days compared to 2.4% of people in the placebo group. Severe brain damage was nearly twice as likely in those who survived after adrenaline injections. Cardiac arrest occurs when the heart no longer pumps blood around the body, usually due to an irregular heart rhyt...
NIHR Signal Endovascular aortic repair (EVAR) surgery more beneficial for ruptured abdominal aortic aneurysms than open repair
EVAR surgery to repair a ruptured abdominal aortic aneurysm had a slightly better survival rate after three years than open repair surgery. The survival benefit in this trial wasn’t apparent 30 days after surgery, but those having EVAR did recover more quickly and went home sooner. This NIHR-funded study also found that EVAR is likely to be more cost-effective. An abdominal aortic aneurysm is a swelling in the main artery that runs from the heart through the abdomen. If it bursts, there i...
NIHR Signal ‘Virtual wards’ reduce readmissions in people after hospitalisation for heart failure
People with heart failure who receive care via virtual wards following discharge from hospital have lower rates of heart failure-related readmission and death than people discharged to other types of care. However, virtual wards did not show similar benefits when offered to people leaving hospital with other high-risk chronic diseases. This systematic review included randomised controlled trials of virtual wards, defined as with four operational criteria to be intensive multidisciplinary team ...
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