RESEARCH ROUND-UP

New COPD strategy An anti-inflammatory drug called roflumilast could become a new therapeutic strategy for patients with chronic obstructive pulmonary disease, according to the results of a randomised trial published in The Lancet.

The researchers tested whether roflumilast, a phosphodiesterase-4 inhibitor, had an effect on lung function and healthrelated quality of life in patients with moderate to severe COPD. The investigators recruited 1,157 patients from centres in 11 countries.

Patients were randomly assigned to 250mg of roflumilast, 500mg of roflumilast or a placebo. Roflumilast was found to improve lung function and reduce worsening of respiratory symptoms when compared with placebo.

Patients also had greater improvements in health-related quality of life than those assigned the placebo, although long-term studies are needed to fully assess this.

The Lancet; 366: 563571. www. thelancet. com Heart failure Multidisciplinary interventions for patients with heart failure significantly reduce both hospital admission and all-cause mortality, according to a systematic review of randomised controlled trials in hospital and community settings.

Post-discharge interventions delivering patient education and symptom selfmanagement reduced the risk of all-cause admission by around 13 per cent and heart failure admission by 30 per cent.

Mortality was reduced by as much as 20 per cent, similar to that achieved by ACE inhibitors in heart failure.

The study also investigated whether the effectiveness varied according to where the interventions were carried out. It found the most effective interventions were delivered at least partly in the home through visits, telephone calls, or more advanced tele-video techniques.

Heart 2005; 91:849850. www. heart.

bmjjounals. com NICE underestimates The National Institute for Clinical Excellence has 'grossly' underestimated the need for drug-eluting stents (DES) for heart patients in 'real-world practice', researchers have concluded.

The study, at a tertiary referral centre, involved a retrospective analysis of the records of 1,673 patients undergoing percutaneous coronary intervention over a seven-month period.

It found that threequarters of patients, not the one third estimated by NICE, were eligible for at least one DES using NICE criteria.

The NICE technology appraisal on the use of coronary artery stents recommended that the decision to use a DES rather than a bare-metal stent (BMS) should be based solely on the anatomy of the target vessel being stented.

A third of patients at the centre received a BMS inappropriately, despite fulfilling NICE criteria for a DES.

Br J Cardiol (Acute Interv Cardiol) 2005: 12: AIC 45-AIC 48.

www. bjcardio. co. uk