Written by Babatunde Carew
Spoon Feed
From sleep meds to systolic goals, this roundup of 2024’s top primary care studies gives great insights into potentially practice changing evidence.
2024 in primary care
- Behavioral intervention for chronic benzodiazepine use
- Design: Canadian RCT of 565 older adults using benzos for ~11 years.
- Finding: Mail-based interventions (Sleepwell & EMPOWER) led to discontinuation in 20-26% vs. 8% usual care.
- Takeaway: 1 in 4 older patients may reduce/stop sleep meds with direct-to-patient education.
- β-blockers after MI with preserved EF
- Design: Two open-label RCTs (REDUCE-AMI, ABYSS).
- Finding: No difference in death/MI at 3.5 years; stopping β-blockers raised hospitalizations for elective procedures.
- Takeaway: In patients with preserved ejection fraction after MI, β-blockers showed no reduction in death or recurrent MI at 3.5 years. Discontinuing them after ~3 years did not affect MACE, but led to more cardiovascular hospitalizations.
- Intensive vs. standard BP control
- Design: ESPRIT & BPROAD RCTs (24,000+ high-risk patients).
- Finding: SBP <120 mm Hg reduced MACEs (NNT=65–75); though increased syncope and renal decline (NNH=333, 84).
- Takeaway: Targeting SBP < 120 mm Hg reduces risk of death and major cardiovascular events in adults with high cardiovascular risk, though death was not reduced in diabetics.
- Vitamin D and fracture prevention
- Design: Meta-analysis of 7 RCTs (71,899 participants, no calcium).
- Finding: No reduction in total or hip fractures; slight increase in hip fractures in women (NNH=334).
- Takeaway: Vitamin D alone does not reduce fractures in healthy elderly.
- Walking to prevent back pain recurrence
- Design: RCT of 701 adults with recurrent low back pain.
- Finding: Walking program delayed recurrence by ~3 months; fewer LBP-related events.
- Takeaway: Walking + education can delay back pain recurrence.
- Testosterone for sexual dysfunction
- Design: Systematic review (10 RCTs, 2223 men).
- Finding: Minimal International Index of Erectile Function (IIEF) score improvement (+2.4, below MCID of 4) and no QoL difference for testosterone therapy vs. placebo in men with low to normal baseline testosterone.
- Takeaway: Testosterone likely has minimal clinical benefit for sexual dysfunction.
- Methotrexate for osteoarthritis
- We actually covered this topic on JF already! Check it out here.
- Edoxaban vs. dual therapy in AF + CAD
- Design: Open-label RCT (1040 patients with stable CAD and AF).
- Finding: At 12 months, no difference between edoxaban monotherapy and edoxaban + single antiplatelet for all-cause mortality or MACEs; fewer major bleeds with monotherapy.
- Takeaway: Edoxaban alone is safer without loss of efficacy at 12 months.
- Colchicine post-MI
- Design: Double-blind RCT (7062 patients).
- Finding: No difference in MACE vs. placebo at 3 years.
- Takeaway: Latest evidence questions colchicine’s benefit post-MI.
- GLP-1s for…well, a lot of things
- Knee osteoarthritis: In patients with knee OA, semaglutide reduced pain scores by 14 points more than placebo on a 100-point scale.
- Obstructive sleep apnea: Tirzepatide reduced apnea-hypopnea events by 20-24/hour in patients with moderate-severe OSA, surpassing the clinical threshold for significance.
- Heart failure with preserved EF: Semaglutide improved symptoms in patients with HFpEF compared to placebo.
- MASH with liver fibrosis: Tirzepatide resolved MASH in 44-62% of patients vs. 10% with placebo (NNT=2–3).
Source
Top studies of 2024 relevant to primary care: From the PEER team. Can Fam Physician. 2025 May;71(5):309-313. doi: 10.46747/cfp.7105309. PMID: 40368626
