The PARADIGM-HF trial of LCZ696 — a novel compound that both blocks the renin-angiotensin system with an ARB component and blocks neprilysin’s degradation of natriuretic peptides — increased survival in heart failure by some 20% relative to enalapril. It seems to be a big deal, and the trial’s two principal authors have agreed to talk about their work and its larger meaning.

Running time: 15 minutes

Other links:

The study in the New England Journal of Medicine (free)

NEJM Journal Watch coverage of the study (free)

Running time: 9 minutes

In the light of the New England Journal of Medicine‘s recent publication three papers on sodium intake and its implications for cardiovascular disease, blood pressure, and excess mortality, we thought we’d speak again with Dr. Jan Staessen, who surprised a lot of people 3 years ago with a paper in JAMA warning against population-wide sodium reductions. His research showed that cutting sodium intakes to levels recommended by the U.S. Dept. of Agriculture was associated in his cohort with an increase in cardiovascular risk.

Dr. Staessen kindly agreed to serve as our guide through the new NEJM research.

LINKS:

The 2011 Staessen interview

Physician’s First Watch coverage of the new NEJM studies

Running time: 15 minutes

Dr. Danielle Ofri, author and internist (as well as an aspiring cellist), is writing a book about how patients and clinicians hear each other. Our discussion centers on that, and on her request that you contact her if you can put her in touch with great diagnosticians (and maybe even their patients).

If you have any suggestions about this or other matters, please contact me here: [email protected].

Dr. Ofri may be contacted at her website: http://danielleofri.com

 Here’s a link to our 2009 interview with Ofri.

Running time: 10 minutes

The Institute of Medicine’s report on treatment for post-traumatic stress disorder finds that active military and veterans with PTSD aren’t always getting evidence-based treatments. And when those treatments are used, they’re too often not used according to protocols and the results aren’t measured. The upshot? The agencies with responsibility for treating PTSD don’t know whether they’re doing their patients any good.

Institute of Medicine report on PTSD (free)

Dr. Charlotte Yeh was crossing the street in Washington, D.C., on her way to dinner when a car hit her.

She ended up in a Level I trauma center, and the experience was sobering for its reminder that in our drive to measure quality indicators, the patient may end up ignored or forgotten.

Running Time: 10 minutes

A link to her essay in Health Affairs

 Running time: 11 minutes

The American Heart Association/American College of Cardiology have released four sets of guidelines — all aimed at the lowering of risk for atherosclerotic cardiovascular disease. For perspective, we’ve asked Harlan Krumholz, editor-in-chief of NEJM Journal Watch Cardiology and CardioExchange to chat.

Links:

Risk calculator (free)

CardioExchange (free)

Circulation homepage

New York Times piece by Krumholz on the guidelines (free)

Running time: 10 minutes

The Camden Coalition of Healthcare Providers formed about 10 years ago as a quarterly breakfast club of primary-care providers who were frustrated in their attempts to bring care to comprehensive care to their patients in Camden, N.J.

The Coalition’s found and executive director, Dr. Jeffrey Brenner (himself a family physician) has just been awarded a MacArthur Foundation fellowship, and so we caught up with him for a quick chat.

Link:

The coalition’s website

Running time: 7 min

The recent JAMA article examining the effects of the “polypill” on adherence and clinical benefits in patients with (or at high risk for) cardiovascular disease, is our topic. The polypill in this trial contained fixed doses of four separate drugs: aspirin, a statin, lisinopril and one other blood-pressure-lowering drug — either atenolol or hydrochlorothiazide.

Adherence among patients on the polypill was 20 percentage points higher than among those following regular multi-pill regimens. It was even higher — by some 40 percentage points — among those least adherent to their regimens at the start of the 15-month trial.

Dr. Anthony Rodgers of the University of Sydney — the paper’s senior author — talks with us about the trial.

Links:

Physician’s First Watch coverage of the trial (free)

JAMA article (free)

Running time: 19:45

This week’s guest is Yoanna Skrobik, a Montreal intensivist and author of an intriguing commentary on a Lancet Respiratory Medicine paper on the (non)effect of haloperidol in influencing the incidence or length of delirium/coma in critically ill patients.

Physician’s First Watch coverage of the Lancet articles

Nurse-facilitated family participation

Early physical/occupational therapy in mechanically ventilated patients

Running time: 14 minutes.

A study in Diabetes Care shows that people at higher genetic risk for diabetes and cardiovascular complications had a relatively lower stroke risk when they adhered to a Mediterranean diet. Dr. Jose Ordovas, the study’s senior author, is our guest for this discussion about the interaction between genes and diet — and its implications even for those without risky genetics.

Diabetes Care abstract (free)

Physician’s First Watch summary (free)