Journal Club

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Journal Club
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Clinical ScenarioA 53 year old lady with NYHA I
Heart Failure secondary to Ischemic
Cardiomyopathy and with Hypertension,
Hyperlipidemia and who is overweight presents to
the clinic for extended follow up
visit.History Remarkable for Medication Non
ComplianceNo Symptoms of CHF PE Remarkable for
High BP, No signs of CHFMedications Losartan,
HCTZ, Metaprolol, Simvastatin Aspirin and Plavix
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Clinical Question Is the use of Angiotensin
Receptor Blockers equivalent or superior to
Angiotensin Converting Enzyme Inhibitors in
reducing All Cause Mortality in an overweight 53
year old lady with HTN, Hyperlipidemia and NYHA
Class 1 Heart Failure
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Meta-Analysis Angiotensin-Receptor Blockers in
Chronic Heart Failure and High-risk Acute
Myocardial Infarction. Lee VC et. Al.,Ann Intern
Med. 2004 Nov 2141(9)693-704
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Are the results of the study valid
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What were the results Are they important
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Forest plots for angiotensin-receptor blockers
(ARBs) versus placebo in patients with chronic
heart failure
Lee, V. C. et. al. Ann Intern Med 2004141693-704
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Forest plots for angiotensin-receptor blockers
(ARBs) versus angiotensin-converting enzme (ACE)
inhibitors in patients with chronic heart failure
Lee, V. C. et. al. Ann Intern Med 2004141693-704
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Forest plots for angiotensin-receptor blocker
(ARB) and angiotensin-converting enzyme (ACE)
inhibitor combinations versus ACE inhibitors in
patients with chronic heart failure
Lee, V. C. et. al. Ann Intern Med 2004141693-704
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Cumulative meta-analysis for angiotensin-receptor
blockers versus placebo comparison all-cause
mortality outcome, in patients with chronic heart
failure
Lee, V. C. et. al. Ann Intern Med 2004141693-704
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Will the results help me in caring for my
patients
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Statistical IssuesEquivalenceSuperiority Non
Inferiority
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Intervention vs Placebo
A Equivalence B Indeterminate C
Benefit Clinical benefit unclear D True
Benefit

Benefit Harm
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Intervention 1 vs Intervention 2
A Equivalence B Inferior C Indeterminate D
Non inferior E Superior

Superior Inferior
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Intervention 1 vs Intervention 2 One sided
Hypothesis Testing
C Non inferior D Superior

Superior Inferior
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• Thank You