JAMA 3 Nov 2010 Vol 304
1950 Heart failure research in the mid-1990s was to discover that a lot of elderly patients with obvious clinical heart failure had high levels of B-type natriuretic peptide but a normal systolic ejection fraction. British cardiologists said there is no such thing as "diastolic heart failure" and treasonable talk of this kind would stop people having echocardiograms and taking the maximal doses of ACE inhibitors and beta-blockers that real heart failure requires. A provisional understanding of this kind of heart failure is not based solely on events in diastole but also to stiffening of the main capacitance arteries. It is extremely common in people over 75 and we don't know how to treat it, partly because cardiologists and drug companies remain uninterested; as this short commentary on "age disparities in heart failure research" points out.
http://jama.ama-assn.org/cgi/content/extract/304/17/1950
Ann Intern Med 2 Nov 2010 Vol 153
553 With stockings, the longer the better. This is not merely a fetishist preference, but carries the imprimatur of the Medical Research Council of the United Kingdom, the Chief Scientist Office of the Scottish Government, and Chest Heart and Stroke Scotland, the funders of the CLOTS trail collaboration. This clottish acronym is derived from Clots in Legs Or sTockings after Stroke. The subjects were 3114 patients in 112 hospitals (no, they don't have that many in Scotland - the trial covered 9 countries) immobilized by stroke. They were randomised to have below-knee or thigh length compression hose. The latter had fewer clots in their proximal deep veins.
http://www.annals.org/content/153/9/553.abstract
587 Eight Italian meta-analysts go to work on the trials of prophylactic implantable cardioverter-defibrillators. These expensive devices often malfunction with shocking consequences but they probably save a few younger patients from sudden death. But in people of sixty and over - called "elderly" by these authors, perhaps through a limited knowledge of the English language - there is no clear evidence of benefit. Purchasers of care, take note, and do not be duped by interventional cardiologists: biventricular pacing saves lives but putting in an ICD at the same time is usually wrong.
http://www.annals.org/content/153/9/592.abstract
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