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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. CARDIOVASCULAR OUTCOMES 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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