Harlan Krumholz Profile picture
Apr 2 8 tweets 4 min read
Should we put patients w/chronic heart failure on low sodium diets. This international trial indicates it doesn’t decrease risk of CV events or all-cause death. Little reason to promote the approach.
Nice study @JustinEzekowitz and colleagues. #ACC22 thelancet.com/journals/lance…
@JustinEzekowitz The #SODIUMHF study had an interesting finding…secondary endpoints of health status modestly improved w/low salt diet. People can try it if they want & see if they feel better. If not, they can stop w/o fear they're increasing their risk. We docs should not push it on them.
@JustinEzekowitz Another interesting feature of the study is that while people reported modest improvement in health status w/low salt diet, they did not walk farther in 6 minute walk test. So a split in what you might expect.
@JustinEzekowitz I did see a low salt enthusiastic tweet this trial as if it were positive, extolling the health status finding… but the for the experiment they ran, it did not show the benefit they expected. We can explore the data though, but it should be done w/caution.
@JustinEzekowitz Another issue is salt was self-reported…makes sense, as expensive to measure it in everyone, but adds uncertainty as to what people actually did. Also, at baseline people did not have a high salt diet (groups started ~2100 mg/d). Might be different for someone on high salt diet.
@JustinEzekowitz And then it took 6 years at 26 sites in 6 countries to enroll people with chronic heart failure into a simple diet study… maybe people didn’t want to try a low salt diet. That is a very selected sample.
@JustinEzekowitz Digging into data… what to make of separation of curves at 6 mos. And the 11% lower risk would be meaningful for benign intervention, but the study was powered for 30% reduction. But 11% is not nothing for these people…need a bigger study though. And late separation… not sure.
@JustinEzekowitz Anyway, kudos to those who do trials and to these investigators… 6 years in the trenches to provide evidence from the largest trial of a low salt diet for chronic heart failure. Easy to raise the unanswered questions, hard to do the trials. Thanks to them for this evidence.

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More from @hmkyale

Apr 3
Hey #ACC22 presenters, especially late breaking studies of consequence. If you don't have simultaneous peer-reviewed pub, consider #preprint what you presented so it's archived & accessible. Let’s make it normative. @medrxivpreprint @yaleHFdoc #LBCT @EricTopol @CMichaelGibson Image
@medrxivpreprint @yaleHFdoc @EricTopol @CMichaelGibson For all #ACC22 presenters, preprinting is easy; we accept scientific studies, screen rapidly, post quickly. Non-profit. It is of the community-available throughout the world, understood as pre-peer reviewed, and citable. Almost all reputable journals are fine with it, incl @NEJM.
@medrxivpreprint @yaleHFdoc @EricTopol @CMichaelGibson @NEJM In the pandemic @medrxivpreprint stimulated discussions about research in progress, & many examples of advancing research. Cardiology has not yet fully embraced it, yet is this work any less important? All fields should accelerate public scientific communication & #openscience.
Read 6 tweets
Apr 3
Great piece @FrancesSSellers ...'How #LongCovid is accelerating a revolution in medical research...Patients, who have typically been only subjects in the research process, are becoming partners in it.’ @washingtonpost @limitlessliza @dianaberrent @VirusesImmunity @YaleMed @PCORI Image
@FrancesSSellers @washingtonpost @limitlessliza @dianaberrent @VirusesImmunity @YaleMed @PCORI “The people who had the wisdom [about #LongCovid were the people experiencing it.” And that Krumholz, said “opened a lot of people’s eyes to a different way of doing research.” [and this approach should become normative…not more subjects in studies, just authentic partners] Image
@FrancesSSellers @washingtonpost @limitlessliza @dianaberrent @VirusesImmunity @YaleMed @PCORI People participating in research as partners, and w/agency over their data, & w/an approach of 'nothing about me, without me’ has great promise, yet threatens a status quo… but about time. Will enable better, faster, more efficient, more relevant, and less burdensome research.
Read 7 tweets
Apr 2
Perhaps the most important and most actionable trial #ACC22 is Chronic Hypertension and Pregnancy (CHAP) Trial. Blood pressure control matters in pregnancy. This needs to be put into action. Next in line of great recent BP trials. nejm.org/doi/pdf/10.105… @ACCinTouch @NEJM
@ACCinTouch @NEJM In this study @atitapatterns and colleagues randomized 2408 women w/chronic htn to target <140/90 or usual care (unless BP ≥160/105). Outcomes improved substantially with strategy of targeting <140/90. 18% reduction in risk for primary outcome. @nih_nhlbi @NICHD_NIH
@ACCinTouch @NEJM @atitapatterns @nih_nhlbi @NICHD_NIH Here is the blood pressure in the trial…at baseline SBP was ~134 mm Hg. About 56% diagnosed and receiving medication. SBP randomization to delivery lower in active-Rx group (129.5 vs 132.6 and 81.5 vs 81.5). That’s not much, but yet, yielded benefit.
Read 7 tweets
Jan 25
Our new piece: #Racism as a Leading Cause of Death in the US. "To address racism, understand its impact on health, & identify remedies, a national set of metrics is needed to galvanise action & promote accountability." bmj.com/content/376/bm… @bmj_latest #HealthEquity @YaleMed Image
@bmj_latest @YaleMed "Black people in the US are more likely to die young—not because there is some intrinsic biological risk, but because of racism… For many racial & ethnic minority groups, particularly for descendants of enslaved Africans, equality in health and longevity remain beyond reach."
@bmj_latest @YaleMed "The excess deaths associated with race can be understood as a toll that is in large part a result of racism in the United States. There is no biological reason, independent of social context, that Black people should die younger than White people."
Read 6 tweets
Jan 22
Your data, packaged and sold by @IBM. 'Business analysts said the data dump instantly makes Francisco Partners a significant player in the multibillion-dollar business of buying and selling sensitive information about the care of patients.’ @statnews @caseymross
@IBM @statnews @caseymross How did IBM get all your sensitive health data to sell? They bought other companies that acquired your sensitive health data. And how did they get it? Mostly from 3rd parties who obtained it from health systems, insurers, & others you trust with your data. #privacy #digitalhealth
@IBM @statnews @caseymross And what is being done w/your sensitive data as billion dollar companies buy and sell it? [well, something that makes it valuable to people who want to buy it] And can you reclaim it or get access to it? [no] And is there consequences to orgs that share your sensitive data [no]
Read 9 tweets
Jan 21
Was watching #Dopesick, and I started reflecting on when I first learned IMS (now IQVIA) tracked every prescription by every doc &sold it to pharma so the doctors could be targeted for drug sales… and how inappropriate that seemed to me. And yet I didn’t do anything.
I was on a plane and a drug representative was sitting beside me going through the prescriptions written by doctors he covered - and there was so much detail. Data-drive marketing…& we docs had no idea the companies were tracking us in this way… & IMS was making billions on it.
It felt like an invasion of privacy… & I was puzzled that it could be legal…we were saying at the time that pharma should not be giving gifts…but we didn’t talk about tracking of individual MD's prescribing patterns by the sales teams - and how they acted on that information.
Read 21 tweets

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