The American journal of medicine
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Editorial Comment Review
A review of clinical guidelines with some thoughts about their utility and appropriate use.
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Atrial fibrillation is associated with substantial mortality and morbidity from stroke and thromboembolism. Despite an efficacious oral anticoagulation therapy (warfarin), atrial fibrillation patients at high risk for stroke are often under-treated. This systematic review compares current treatment practices for stroke prevention in atrial fibrillation with published guidelines. ⋯ This systematic review demonstrates the underuse of oral anticoagulation therapy for real-world atrial fibrillation patients with an elevated risk of stroke, highlighting the need for improved therapies for stroke prevention in atrial fibrillation.
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Despite their proven mortality and morbidity outcomes benefits, beta-blockers remain substantially underused in patients with cardiac conditions. Reluctance to prescribe beta-blockers may be owing to concerns about tolerability with the traditional drugs in this class. Beta-blockers with vasodilatory properties, such as carvedilol and nebivolol, may overcome the tolerability and metabolic issues associated with traditional beta-blockers. Because endothelial dysfunction, the pathophysiologic hallmark of hypertension, may be heightened in populations with difficult-to-treat hypertension (e.g., elderly patients, African American patients), a vasodilating beta-blocker may be a particularly appropriate choice for these patient groups.
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Dietary supplements occupy a unique niche within the realm of modern medicine. These products are often used by patients at their own discretion, in an unmonitored setting, and without the input of their physicians. Although laws pertaining to dietary supplement labeling prohibit specific claims for the treatment or prevention of disease, these products are widely used as "alternative" or "complementary" therapy. ⋯ Information on dietary supplements in nonmedical literature is typically unreliable, and even in the medical literature, numerous studies have used products that were not well characterized. Although greater attention has recently focused on dietary supplement quality and integrity, complex issues persist and must be addressed when evaluating literature and advising patients. We seek to clarify many of these issues and make practical suggestions for the clinician.