Clinical reviews

Only a quarter of patients with symptoms suggestive of heart failure are investigated and referred by GPs in accordance with NICE guidelines, a UK study has shown. Nearly 80% of heart failure patients were diagnosed in hospital. The investigators, from Imperial College, London, extracted data on patients diagnosed with heart failure between 1 January 2010 and 31 March 2013, using the Clinical Practice Research Datalink. This database contains electronic records from 7% of general practices in England.

 Lactobacillus iners-dominated vaginal microbiota was associated with increased susceptibility to Chlamydia trachomatis infection in women, in a Dutch nested case-control study.

Two years of high intensity exercise training, in previously sedentary healthy middle-aged adults, improved maximal oxygen uptake (VO2max) and reduced left ventricular (LV) stiffness, in a study from the United States. The investigators conclude that regular exercise training may protect against the future risk of heart failure with a preserved ejection fraction (HFpEF) by preventing the increase in cardiac stiffness caused by sedentary aging.

Administering a drink of sodium bicarbonate dissolved in water to women with dystocia an hour before oxytocin treatment resulted in better outcomes for both mother and child, compared with standard oxytocin treatment alone, a small trial from Sweden has found.

Canagliflozin was associated with a lower risk of heart failure admissions compared with other classes of diabetes drugs, in a population-based retrospective cohort study from the United States.

The children of women with severe persistent postnatal depression (PND) are at substantially increased risk of preschool behaviour problems, poor academic attainment and adolescent depression, a UK longitudinal cohort study has found.

Rates of cognitive decline were greater in patients with diabetes and prediabetes compared with those who were normoglycaemic, in the English Longitudinal Study of Ageing (ELSA).

The incidence of suicide in adolescent boys is more than twice that among adolescent girls, whereas non-fatal self-harm is much more common in girls than boys, an English retrospective database study has found.

A breathing retraining exercise programme, incorporating a training DVD and accompanying booklet, achieved similar improvements in quality of life scores as conventional face to face training in patients with asthma, in a UK study.

A UK primary care survey has found that many patients are taking benzodiazepines or Z-drugs, recommended for short-term use, for at least a year.

Nulliparous women, undergoing epidural analgesia, who adopted a lying down position were more likely to achieve a spontaneous vaginal delivery than those in an upright position during the second stage of labour, a UK study has found.

The risk of developing age-related visible signs, such as arcus cornea and earlobe crease, was higher in smokers and heavy drinkers in a prospective study from Denmark.

Neither depression nor diabetes distress appear to be related to glycaemic control in newly diagnosed patients with type 2 diabetes, the results of a UK prospective cohort study suggest. However, depressive symptoms at diabetes diagnosis were associated with a higher risk of macrovascular complications, notably myocardial infarction (MI) at two years’ follow-up.

If healthy adults exercise for a minimum of an hour each week, their risk of incident depression can be reduced by 12%, a Norwegian prospective cohort study has found. 

Current guidelines advise treating paroxysmal AF in the same way as sustained AF but the evidence is weak, with only one retrospective analysis comparing the risk of stroke in patients with paroxysmal AF vs chronic AF (analysis of the SPAF trials, performed 15 years ago and limited to patients treated with aspirin). The ACTIVE W trial showed that warfarin is more effective than aspirin plus clopidogrel for the prevention of vascular events (stroke, embolism, MI and vascular death) in patients with AF. A recent substudy of this trial looked at the risk of stroke in 1,202 patients with paroxysmal AF compared with 5,495 with sustained AF, and the effectiveness of thromboprophylaxis in these patients. ' This substudy has shown that the risk of stroke is similar, irrespective of whether AF is paroxysmal or sustained, and that anticoagulation therapy is equally effective in both groups. Other factors, such as age and cardiovascular comorbidity, remain central to the ultimate choice of thromboprophylaxis in these patients.'