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ORIGINAL ARTICLE
Year : 2006  |  Volume : 7  |  Issue : 2  |  Page : 65-68

Clinical approach of evidence based therapy For cardiovascular disease


1 Assistant professors, Faculty of Medicine and Health sciences, University of Sana'a, Yemen
2 Cardic Centre , Althawra Teaching Hospital, Sana'a, Yemen

Correspondence Address:
Mohammad A Bajubair
Assistant professors, Faculty of Medicine and Health sciences, University of Sana'a
Yemen
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Source of Support: None, Conflict of Interest: None


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Background: Evidence based drug therapy (EBT) is defined in a way that emphasizes the importance of outcomes and states, that a doctor makes his decisions according to the best available knowledge. EBT narrowly defines "evidence" for effective, ethical therapy as 'results' from double-blind research done with randomly controlled clinical trials (RCTs). Cardiovascular disease (CVD) and drug therapy is a rapidly changing field and one is always open to new evidence or evidence that may have been overlooked in the past. Not all doctors want or need to learn how to practice all five steps of EBT, indeed, most doctors consider themselves users of EBT. Clinical practice requires more stable data in the literature and especially in the teaching and training textbooks. Practicing EBT is an advance in drug therapy and is believed to help relieve contradiction and confusion of the therapy. Objectives : Our aim was to explore the new clinical evidence in the treatment of CVD in clinical practice and the availability of RCTs in the textbooks and commonly used literature. Methods : Cross-sectional interview survey of 20 physicians in the cardiac centre, Althawra teaching hospital, Sanaa, Yemen; to understand the drug use in regard to the EBT (clinically evidenced RCTs) or the mechanism of actions and experiences (non-clinical evidences) especially focusing on ischemic heart disease and heart failure. The five commonly used textbooks were studied for the availability of RCTs. Results : In chronic ischemic heart diseases, ABC regimen (Aspirin, B-blockers, and angiotensin converting enzyme inhibitors, Captopril) as secondary prevention was selected by most of the physicians (70%), while nitrates put as first drug of choice for chronic ischemia more by general physicians (30%). In the treatment of congestive heart failure (CHF), digoxin (10%) was reported to be the first choice more by the newly graduated physicians. All new editions of the textbooks have included the RCTs as the basis for the therapy in clinical practice, especially in Braunwald Heart disease and Davidsons Medicine. Conclusions : Results showed a need for a correlation between basic evidence and clinical evidence (EBT). Including the RCTs in the commonly used textbooks may help in the familiarity for searching new evidence and will help to relieve some of the confusion about clinical practice of therapy.


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