PSNC: Shortage of isosorbide mononitrate tablets 10mg, 20mg and 40mg
Source: PSNC Area: News The Pharmaceutical Services Negotiating Committee (PSNC) has re-iterated advice from the Chief Pharmaceutical Officer on the shortage of isosorbide mononitrate tablets (10mg, 20mg and 40mg).   The PSNC has confirmed the following with the Department of Health: "Contractors will be reimbursed for dispensing an unlicensed medicine against prescriptions for all strengths of isosorbide mononitrate (10mg, 20mg and 40mg) tablets.  However, contractors will need to ensure that these prescriptions have been clearly prescribed as "unlicensed" and then endorsed with the actual price paid minu...
Source: NeLM - Cardiovascular Medicine - March 1, 2013 Category: Cardiology Source Type: news

VTE risk assessment data collection: October to December 2012
Source: Department of Health (DH) Area: News The tenth set of quarterly statistics on Venous Thromboembolism (VTE) Risk Assessment in England, produced by the Department of Health have been published according to the arrangements approved by the UK Statistics Authority. The main points highlighted for this latest release are:   The key results for data collected on the number and proportion of VTE Risk Assessments carried out on adult admissions to NHS funded acute care are as follows:   . Of the 3.4m adult patients admitted to NHS funded acute care between October and December 2012, 94.2% of thes...
Source: NeLM - Cardiovascular Medicine - March 1, 2013 Category: Cardiology Source Type: news

Effect of antioxidant vitamin supplementation on cardiovascular outcomes: A meta-analysis of randomised controlled trials
Source: PLoS One Area: News According to the findings of this systematic review and meta-analysis of pooled data from randomised controlled trials (RCTs), antioxidant vitamin supplementation has no effect on the incidence of major cardiovascular events, myocardial infarction, stroke, total death, and cardiac death.   Data (published and unpublished) for the analysis were sourced through a search of databases such as PubMed, EmBase the Cochrane Central Register of Controlled Trials and conference reports. Studies were included if they were RCTs that reported on the effects of antioxidant vitamins on cardiovascular...
Source: NeLM - Cardiovascular Medicine - February 28, 2013 Category: Cardiology Source Type: news

Viagra (sildenafil) 25mg, 50mg and 100mg tablets - Pfizer Limited - Revised SPC
Source: eMC (electronic Medicines Compendium) Area: Other Library Updates > SPC Changes Section 4.8 Undesirable effects has been updated to include the ADRs haematuria, haematospermia and penile haemorrhage.   Please see link to the SPC for full prescribing information (Source: NeLM - Cardiovascular Medicine)
Source: NeLM - Cardiovascular Medicine - February 28, 2013 Category: Cardiology Source Type: news

NICE issues final guidance supporting the use of apixaban for prevention of stroke and systemic embolism in non-valvular atrial fibrillation (TA 275)
Source: NICE Area: Evidence > Guidelines NICE has issued final guidance (TA 275) supporting the use of apixaban as an option for preventing stroke and systemic embolism within its marketing authorisation, that is, in people with nonvalvular atrial fibrillation with 1 or more risk factors such as:   . prior stroke or transient ischaemic attack . age 75 years or older . hypertension . diabetes mellitus . symptomatic heart failure.   NICE notes that the decision about whether to start treatment with apixaban should be made after an informed discussion between the cli...
Source: NeLM - Cardiovascular Medicine - February 27, 2013 Category: Cardiology Source Type: news

NICE costing statement for its guidance on apixaban for prevention of stroke and systemic embolism in non-valvular atrial fibrillation (TA 275)
Source: NICE Area: News NICE has published a costing statement to accompany its guidance on the use of apixaban for preventing stroke and systemic embolism in nonvalvular atrial fibrillation (TA 275).   The statement notes that "Apixaban provides an alternative treatment option at a comparable cost and therefore it is anticipated that there will not be a significant cost impact as a result of implementing this guidance." (Source: NeLM - Cardiovascular Medicine)
Source: NeLM - Cardiovascular Medicine - February 27, 2013 Category: Cardiology Source Type: news

Supplemental New Drug Application (sNDA) for icosapent capsules (VascepaT) for hypertriglyceridaemia and mixed dyslipidaemia
Source: BioSpace Area: News Amarin Corporation has submitted a Supplemental New Drug Application (sNDA) with the U.S. Food and Drug Administration (FDA) seeking approval for icosapent ethyl capsules (VascepaT) for use as an adjunct to diet in the treatment of adult patients with hypertriglyceridaemia (triglyceride (TG)  =200 mg/dL and <500 mg/dL) with mixed dyslipidaemia.   The FDA has approved the product (an ultrapure capsule containing  96% eicosapentaenoic acid), as an adjunct to diet to reduce TG  levels in adult patients with severe hypertriglyceridaemia (TG ?500mg/dL/ 5.69 mmol/L). ...
Source: NeLM - Cardiovascular Medicine - February 27, 2013 Category: Cardiology Source Type: news

RCT: Effect of spironolactone on diastolic function and exercise capacity in diastolic heart failure (Aldo-DHF)
Source: JAMA Area: News Diastolic heart failure (heart failure with preserved ejection fraction) is a common condition affecting more than half of the total heart failure population but without established therapy. Furthermore, aldosterone stimulation may contribute to its progression.   The Aldo-DHF trial, a multicentre, prospective, randomised, double-blind, placebo-controlled trial, evaluated the effect of long-term spironolactone on diastolic function and exercise capacity in patients with diastolic heart failure.   The study randomised 422 ambulatory patients (mean age, 67 years; 52% female) with ch...
Source: NeLM - Cardiovascular Medicine - February 27, 2013 Category: Cardiology Source Type: news

Exploring beliefs about heart failure treatment in adherent and nonadherent patients: use of the repertory grid technique
This study utilised the repertory grid technique to elicit individuals' beliefs about their heart failure treatment and to investigate whether generated constructs were different between adherent and nonadherent patients. Methods: 92 patients with heart failure were interviewed using a structured questionnaire that applied the repertory grid technique.  Patients were asked to compare and contrast their medicines and self-care activities for their heart failure.  This led to the generation of individual constructs (perceptions towards medicines), and from these, beliefs were elicited about their heart failu...
Source: NeLM - Cardiovascular Medicine - February 27, 2013 Category: Cardiology Source Type: news

Mediterranean diet associated with some reduction in the risk of major cardiovascular events among high-risk persons
Source: NEJM Area: News The New England Journal of Medicine has featured the results of a randomised, controlled trial evaluating the Mediterranean diet for the primary prevention of cardiovascular events.   The multi-centre trial, conducted in Spain, randomised 7447 participants who were at high cardiovascular risk, but with no cardiovascular disease at enrollment, to one of three diets: a Mediterranean diet supplemented with extra-virgin olive oil, a Mediterranean diet supplemented with mixed nuts, or a control diet (advice to reduce dietary fat). Participants received quarterly individual and group educational...
Source: NeLM - Cardiovascular Medicine - February 26, 2013 Category: Cardiology Source Type: news

Review: Postpartum management of hypertension
Source: BMJ Area: News The British Medical Journal has featured a review on the postpartum management of hypertension. The most common cause of postpartum hypertension is gestational hypertension or pre-eclampsia that persists after delivery.   In terms of medical management, the review states that suggested first line antihypertensive drugs that are safe in breastfeeding mothers include labetalol, nifedipine, and enalapril. (Source: NeLM - Cardiovascular Medicine)
Source: NeLM - Cardiovascular Medicine - February 26, 2013 Category: Cardiology Source Type: news

RCT: Metoprolol vs carvedilol, or carvedilol plus N-acetylcysteine on post-operative atrial fibrillation
Source: Eur Heart J Area: News The aim of this study was to evaluate the efficacy of metoprolol, carvedilol, and carvedilol plus NAC on the prevention of post-operative atrial fibrillation (POAF).   Three hundred and eleven patients undergoing cardiac surgery were randomised to metoprolol, carvedilol, or carvedilol plus NAC. The incidence of POAF was statistically lower in the carvedilol plus NAC group compared with the metoprolol group (P < 0.0001) or the carvedilol group (P = 0.03). Duration of hospitalisation was statistically lower in the carvedilol plus NAC group compared to the metoprolol group (P = 0.0...
Source: NeLM - Cardiovascular Medicine - February 22, 2013 Category: Cardiology Source Type: news

In pursuit of certainty: can the systematic review process deliver?
Source: BMC Medical Informatics and Decision Making Area: Evidence > Medicines Management > References Background: There has been increasing emphasis on evidence-based approaches to improve patient outcomes through rigorous, standardised and well-validated approaches.  Clinical guidelines drive this process and are largely developed based on the findings of systematic reviews (SRs).  This paper presents a discussion of the SR process in providing decisive information to shape and guide clinical practice, using a purpose-built review database: the Cochrane reviews; and focussing on a highly prevalent...
Source: NeLM - Cardiovascular Medicine - February 22, 2013 Category: Cardiology Source Type: news

Review: Diagnosis and management of pulmonary embolism
Source: BMJ Area: News There is a wealth of high quality individual studies and meta-analyses to guide the diagnosis and treatment of pulmonary embolism (PE), and in this article, the authors provide an overview and synthesis of that evidence, that addresses the following questions:   . Why is PE important? . Who is at risk? . How does PE present? . How is PE diagnosed? . How is PE treated? (Source: NeLM - Cardiovascular Medicine)
Source: NeLM - Cardiovascular Medicine - February 21, 2013 Category: Cardiology Source Type: news

Expert position paper on use of proton pump inhibitors in patients with cardiovascular disease and antithrombotic therapy
Source: Eur Heart J Area: News The European Society of Cardiology NSTEMI and STEMI guidelines and an ACCF/ACG/AHA consensus document recommend treatment with proton pump inhibitors (PPIs) in patients treated with dual antiplatelet treatment (DAPT) during the initial phase of an acute coronary syndrome (ACS), particularly in patients with a history of GI bleeding or peptic ulcer. Several studies have raised concerns that many PPIs, especially omeprazole, might diminish the antiplatelet effects of clopidogrel, most likely through inhibition of CYP2C19 and, consequently, the conversion of clopidogrel into its active metaboli...
Source: NeLM - Cardiovascular Medicine - February 21, 2013 Category: Cardiology Source Type: news