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									           Evidence-Based Medicine
  This department uses the best available scientific findings to offer practice guidance on a wide range of
  conditions seen in primary care.The author, Alan Ehrlich, MD, is a deputy editor for DynaMed, Ipswich,
  Mass., and assistant clinical professor in Family Medicine, University of Massachusetts Medical School in
  Worcester. DynaMed (www.ebscohost.com/dynamed/) is a database that provides evidence-based infor-
  mation on more than 3,000 clinical topics and is updated daily through systematic surveillance covering
  more than 500 journals.The most important evidence identified is summarized here.

LENIENT RATE CONTROL                                                              Heart Association functional class. The authors
AND STRICT RATE CONTROL                                                           concluded that lenient rate control was as effec-
FOR ATRIAL FIBRILLATION                                                           tive as strict rate control for the prevention of
APPEAR TO HAVE SIMILAR                                                            major cardiovascular events.
Level 2: Mid-level evidence                                                       MODERATE ALCOHOL
Rate control and rhythm control strategies                                        CONSUMPTION IN WOMEN MAY
have been associated with similar rates of stroke                                 REDUCE RISK OF BECOMING
and death in patients with chronic atrial fibril-                                  OVERWEIGHT OR OBESE
lation (Arch Intern Med. 2005;165:258-262,                                        Level 2: Mid-level evidence
available at archinte.ama-assn.org/cgi/content                                    Moderate alcohol consumption has previously
/full/165/3/258, accessed April 14, 2010). A                                      been associated with decreased cardiovascular risk
target heart rate of 60-80 beats/minute has                                       (BMJ. 2006;332:1244-1248, available at www.
been suggested by the American College of                                         bmj.com/cgi/content/full/332/7552/1244,
Cardiology (Circulation. 2006;114:e257-354,           The desired                 accessed April 14, 2010) and decreased overall
available at circ.ahajournals.org/cgi/content         rate control                mortality (Arch Intern Med. 2006;166:2437-
/full/114/7/e257, accessed April 14, 2010), but                                   2445, available at archinte.ama-assn.org/cgi/
this recommendation is not based on studies
                                                      was achieved                content/full/166/22/2437, accessed April 14,
with clinical outcomes. To address this issue,        through                     2010) in observational studies. A recent study
a randomized trial compared “lenient” rate            the use of                  assessed the effects of alcohol on weight gain in
control (resting heart rate <110 beats/minute)                                    a cohort of 19,220 women (mean age 54 years)
vs. “strict” rate control (resting heart rate <80
                                                      beta blockers,              who had normal BMI (18.5-25) at baseline and
beats/minute and heart rate during moderate           calcium channel             were followed for 13 years (Arch Intern Med.
exercise <110 beats/minute) in patients with          blockers,                   2010;170:453-461). A
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