147 e-Letters

published between 2010 and 2013

  • Reply to comment "Dose-response relationship between caffeine and risk of atrial fibrillation"
    Daniel Caldeira

    We thank Yan Qu and colleagues for their interest in our publication.1 In our systematic review we concluded that caffeine exposure was not associated with increased AF risk. We also have performed a qualitative evaluation of dose-response, which uses the relative proportions of caffeine exposure within each study and the risk of atrial fibrillation (AF). Pooling the relative risk (RR) of low caffeine intake from each st...

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  • Dose-response relationship between caffeine and risk of atrial fibrillation
    Yan Qu

    Dear Editor, We read with great interest the recent meta-analysis showing that low-dose caffeine may have a protective effect on risk of atrial fibrillation, while no favorable effect was found for high dose of caffeine, and a sketch of a J-shape curve was speculated on the association of caffeine with risk of atrial fibrillation.1 Therefore, to clarify the dose-response relationship on caffeine and risk of atrial fibrilla...

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  • Use SMART risk score to correct under- and overtreatment.
    Siep Thomas

    Dorresteijn et al, (Heart 2013;99:866-872), presented a new tool, the SMART risk score, for predicting 10 year risk of recurrence in patients with established cardiovascular disease. This enables clinicians for the first time to differentiate treatment within the hitherto broadly assumed recurrence rate of at least 20% leading to guidelines that, so far, advise maximal drug treatment for elevated risk factors for all patie...

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  • Statistics vs Real Life: a difficult coexistence
    Rui A. Providencia

    Messori et al [1] present a very interesting matter (the difference between inconclusive results and demonstrating non-inferiority) concerning our recently published meta-analysis of dabigatran vs. warfarin in the setting of catheter ablation of atrial fibrillation [2] that merits a practical reflection. First, proving that two treatments are equal in performance is impossible with statistical tools; at most, one can show...

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  • Response to letter by Bin Abdulhak and colleagues about the paper "Safety and efficacy of Dabigatran versus warfarin in patients undergoing catheter ablation of atrial fibrillation: a systematic review and meta-analysis"
    Rui Providencia

    We have read with interest the comments by Bin Abdulhak and colleagues [1] to our recently published article [2]. We share the same opinion concerning the use of dabigatran in this setting. Thus, in our paper we have proposed the same posology in face of the similar findings: despite the lack of conclusive evidence in support of any particular dabigatran dosage or timing for interrupting or restarting drug therapy, like...

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  • Comparing dabigatran vs warfarin in patients with atrial fibrillation undergoing catheter ablation: inconclusiveness of the results concerning thromboembolic complications and major bleedings
    Andrea Messori

    In the interpretation of clinical trials or meta-analyses that show no significant difference between the two comparators, one controversial issue is the need to differentiate between "no proof of difference" (inconclusive result) and "proof of no difference" (or demonstrated non- inferiority). For this purpose, trial-sequential analysis (TSA) is considered to be an appropriate statistical tool (1-4).

    In the met...

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  • Dabigatran in the setting of catheter ablation of atrial fibrillation - The Road Ahead
    Aref A. Bin Abdulhak

    To The Editor:

    We read with interest the study by Providencia et al. which demonstrated that dabigatran had a similar efficacy and safety profile as warfarin in the setting of catheter ablation (CA) of atrial fibrillation (AF) (1). These findings concur with two other meta-analyses on the same topic (including one from our group) which have been recently published (2,3). All the published meta-analyses on this...

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  • Re:Preoperative Beta-blockade: Unanswered Questions
    Sonia Bouri

    Metoprolol Dosing

    We thank Dr Cohn for pointing out that our description[1] of the POISE dosage described only the first dose. The general maintenance dose was 200 mg extended release once a day (equivalent to 50 mg immediate release three times a day). If systolic pressure dropped below 100 mmHg, or heart rate below 50 bpm, beta-blockade was paused and later restarted at 100 mg od.

    Moreover, as Dr C...

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  • Beta-blocakde to prevent perioperative death in non-cardiac surgery: a trial-sequential analysis
    Andrea Messori

    In non-cardiac surgery, the role of beta-blocakde to prevent perioperative death is extremely controversial. While it is now agreed that the results from the DECREASE family of trials cannot be trusted (1), the evidence from the remaining 9 "secure" trials is somewhat difficult to interpret. The recent meta-analysis by Bouri et al. (1) has concluded that, according to these 9 trials, beta-blockade significantly increases...

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  • Five minutes for better cardiac risk stratification
    Giovambattista Scarfone

    Dear Dr. Kotheca,

    after reading with great interest your paper I started to perform the Five-minute heart rate variability test to all patients in my daily cardiology practice. I'm using for spectral analysis of HRV a PC-ECG Workstation manufactured by Contec Medical Systems.

    I'm stimulated from the results of ARM-CAD study to use the Five- minute heart rate variability test as a new clinical tool t...

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