EBM Journal Club Tai Chi & Heart Failure R2

Transcription

1 EBM Journal Club Tai Chi & Heart Failure R2 1

2 Outline Heart failure reviews EBM concepts Clinical Scenarios Asking Acquiring Appraisal Apply 2

3 Outline Heart failure reviews EBM concepts Clinical Scenarios Asking Acquiring Appraisal Apply 3

4 Heart Failure Definition Clinical syndrome Structural or functional abnormalities Metabolic demand impairment Progressively, High M & M Heart Failure, Cardiomyopathy, and Valvular Heart Disease. The Washington Manual of Medical Therapeutics, 33rd Ed. 4

5 Classifications 5 Hunt SA et al. Circulation. 2001;104: Farrell MH et al. JAMA. 2002;287:

6 Treatment Medications ACEi/ARB Diuretics β-blocker Aldosterone antagonists Nitrates & Hydralazine Digoxin Inotropic agents Heart Failure, Cardiomyopathy, and Valvular Heart Disease. The Washington Manual of Medical Therapeutics, 33rd Ed. 6

7 Treatment Non-medications Coronary revascularization Cardiac resynchronization therapy or biventricular pacing ICDs IABPs Ventricular assist devices Cardiac transplantation Heart Failure, Cardiomyopathy, and Valvular Heart Disease. The Washington Manual of Medical Therapeutics, 33rd Ed. 7

8 Treatment Other treatment Lifestyle modifications Minimization of medications Oxygen supplement Sleep apnea treatment Heart Failure, Cardiomyopathy, and Valvular Heart Disease. The Washington Manual of Medical Therapeutics, 33rd Ed. 8

9 Outline Heart failure reviews EBM concepts Clinical Scenarios Asking Acquiring Appraisal Apply 9

10 Five Steps to Practice EBM Asking an answerable question Tracking down the best evidence Critical appraisal Integrating the appraisal Evaluation 10

11 Asking Four components Patients Intervention Comparison Outcome 11

12 From Dr. Joseph F Smith Medical Library Searching 12

13 From Searching 13

14 Critical Appraisal Validity Chance, Bias Impact NNT, NNH Practice applicability 14

15 Outline Heart failure reviews EBM concepts Clinical Scenarios Asking Acquiring Appraisal Apply 15

16 Clinical Scenarios 16

17 Scenarios 17

18 Outline Heart failure reviews EBM concepts Clinical Scenarios Asking Acquiring Appraisal Apply 18

19 Asking Patients Patient with Heart failure Interventions Tai chi Comparison Conventional treatments Outcome Prognosis 19

20 Outline Heart failure reviews EBM concepts Clinical Scenarios Asking Acquiring Appraisal Apply 20

21 Acquiring Database EBM - All Pubmed Clinical queries 21

22 Keywords Heart failure [text] Tai chi [text] AND 22

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29 Journal Citation Report : Science Edition 29

30 Outline Heart failure reviews EBM concepts Clinical Scenarios Asking Acquiring Appraisal Apply 30

31 Validity Clinical Appraisal Tool (CAT) CEBM - University of Oxford 31

32 32 Critical Appraisal Sheets from CEBM, University of Oxford

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50 Evaluation Primary outcome Exercise capacity 6 mins walk test Disease specified QoL Minnesota Living With Heart Failure Questionnaire(MLHF) Secondary outcome NT-proBNP Blood pressure Peak oxygen uptake (peak V02) 50

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52 Primary outcome 52

53 Exercise Capacity 53

54 Quality of Life 54

55 Secondary outcome 55

56 NT pro-bnp 56

57 Systolic BP 57

58 Diastolic BP 58

59 Peak Oxygen uptake 59

60 Discussion Improved in QoL The reason of non-significance Cause of heterogeneity Low cost and no adverse effect 60

61 Limitations Other objective measurement LV function, muscle strength, Survival Other exercise performance walking, conventional treadmill, bicycle ergometer exercise Small sample size Better study design needed 61

62 Conclusion Tai chi may improve quality of life, but does not appear to increase exercise capacity in patient with heart failure. (Level I[high-level] evidence) 62

63 Outline Heart failure reviews EBM concepts Clinical Scenarios Asking Acquiring Appraisal Apply 63

64 Return to Clinical Scenario 64

65 References Pan L, Yan J, Guo Y, Yan J. Effects of Tai chi training on exercise capacity and quality of life in patients with chronic heart failure: a meta-analysis. Eur J Heart Fail Oct 25. [Epub ahead of print] Barrow DE, Bedford A, Ives G, O Toole L, Channer KS. An evaluation of the effects of tai chi chuan and chi kung training in patients with symptomatic heart failure: a randomised controlled pilot study. Postgrad Med J 2007;83: Caminiti G, Volterrani M, Marazzi G, Cerrito A, Massaro R, Arisi A, Franchini A,Sposato B, Rosano G. Tai chi enhances the effects of endurance training in the rehabilitation of elderly patients with chronic heart failure. Rehabil Res Pract2011;2011: Yeh GY, Wood MJ, Lorell BH, Stevenson LW, Eisenberg DM, Wayne PM, Goldberger AL, Davis RB, Phillips RS. Effects of tai chi mind body movement therapy on functional status and exercise capacity in patients with chronic heart failure: a randomized controlled trial. Am J Med 2004;117: Yeh GY, McCarthy EP, Wayne PM, Stevenson LW, Wood MJ, Forman D, Davis RB, Phillips RS. Tai chi exercise in patients with chronic heart failure: a randomizedclinical trial. Arch Intern Med 2011;171: Brian R. Lindman, Stacy A. Mandras, Benico Barzilai, Susan M. Joseph, and Gregory A. Ewald: Heart Failure, Cardiomyopathy, and Valvular Heart disease. The Washington Manual of Medical Therapeutics, 33rd Ed. P Critical Appraisal Sheets from CEBM, University of Oxford 65

66 Thanks for your attention! 66