Keep evidence in sight when exploring complex algorithms

[摘要] It was highly instructive for me to read the detailed article“Medication management for heart failure with reducedejection fraction” in the December 2021 issue of CanadianFamily Physician.1 If I may be permitted to add some comments, I am familiar with the case of a fit 71-year-oldwoman with no previous cardiac history who was admittedto hospital in late 2016 with community-acquired pneumonia. Quite apart from the pneumonia, she was found to bein atrial fibrillation, was cardioverted, and was placed onrivaroxaban along with other treatments for the pneumonia and cardiac arrhythmia. Her echocardiogram at the timeshowed a left ventricular ejection fraction of 45%.In subsequent follow-up with an internist, she wastold she had heart failure and that it had predated thepneumonia. No evidence for this was offered. She wasrecommended to continue the rivaroxaban, along withdigoxin, ramipril, and metoprolol.

[学科分类] 卫生学