Primary Care
Research Brief

RANDOMISED TRIAL · HIGH-STRENGTH EVIDENCE

Statins work for primary prevention after age 70

Clinical question. Does starting a statin benefit otherwise healthy adults aged 70 or older without cardiovascular disease, diabetes or dementia?

Result. In the double-blind STAREE trial, 9,971 adults received atorvastatin 40 mg or placebo. Over a median 5.9 years, major cardiovascular events occurred at 10.9 versus 15.5 per 1,000 person-years (HR 0.70, 95% CI 0.61–0.82). This was an absolute reduction of about 2.3%, or approximately 43 people treated for six years to prevent one event. Statins did not significantly improve survival free from dementia or persistent disability. Serious adverse events were similar, although muscle-, liver- and diabetes-related events were somewhat more frequent with atorvastatin.

Limitations. The population was Australian, predominantly White, relatively healthy and independent. The trial tested atorvastatin 40 mg, not every statin regimen, and functional survival did not improve.

GP implication. Age alone should not be used to withhold primary-prevention statins. Discuss absolute cardiovascular benefit alongside frailty, life expectancy, polypharmacy and patient preference.

Practice verdict: Change discussions now, but do not prescribe automatically to every person over 70. Continue to follow local risk-based guidance until it is formally updated.

Read the STAREE trial in NEJM →

RANDOMISED TRIAL · PROMISING, LIMITED BY FEW EVENTS

Anticoagulation for “intermediate-risk” atrial fibrillation

Clinical question. Should patients with clinical atrial fibrillation and a CHA₂DS₂-VASc score of 1 in men or 2 in women receive a direct oral anticoagulant?

Result. SINGLE-AF randomised 1,803 patients to apixaban or rivaroxaban versus no anticoagulation. At two years, stroke, systemic embolism, major bleeding or cardiovascular death occurred in 0.5% versus 1.5% (HR 0.31, 95% CI 0.10–0.94). Ischaemic stroke occurred in 0.1% versus 1.1%; major bleeding in 0.3% versus 0.5%.

Limitations. There were only 13 primary events, with a wide confidence interval. The trial was open-label, conducted in Korea, excluded chronic kidney disease and had substantial antiplatelet use in controls. The large relative reduction rests on a small absolute event difference.

GP implication. For clinical AF with one non-sex stroke-risk factor, anticoagulation deserves an explicit shared decision. Consider bleeding risk, renal function, AF burden and patient preference.

Practice verdict: Watch closely and discuss now. Evidence is not yet strong enough to make DOAC treatment automatic before local guidance changes.

Read SINGLE-AF in NEJM →

AUTHORITATIVE GUIDELINE

New ESC heart-failure guideline broadens treatment

Key changes. The 2026 ESC guideline now classifies an ejection fraction below 50% as reduced-EF heart failure, removing the separate 41–49% category. It gives mineralocorticoid-receptor antagonists a Class I recommendation across the EF spectrum and recommends considering semaglutide or tirzepatide in patients with HFpEF and obesity. Prevention, rapid initiation of foundational treatment, education and self-care receive greater emphasis.

Limitations. ESC recommendations are not automatically adopted by NICE, Irish or South African formularies. MRAs require careful potassium and renal monitoring; access to GLP-1/GIP treatment varies considerably.

GP implication. Review heart-failure registers for undertreatment, obesity and avoidable therapeutic delay. Do not independently add an MRA without checking eGFR, potassium, interacting medicines and the local heart-failure pathway.

Practice verdict: Prepare to change practice, but implement medication changes through local guidance and specialist or shared-care arrangements.

Read the 2026 ESC heart-failure guideline →

AUTHORITATIVE GUIDELINE

Test cardiac patients for kidney disease using both eGFR and urine ACR

Recommendation. The first ESC cardiovascular disease–CKD guideline recommends screening everyone with cardiovascular disease at diagnosis using both serum-creatinine-derived eGFR and urine albumin-to-creatinine ratio. Testing eGFR alone misses clinically important albuminuric CKD.

Limitations. Much of the underlying evidence is not new, and national thresholds, formularies and referral pathways still govern treatment.

GP implication. Audit patients with coronary disease, stroke, peripheral arterial disease or heart failure. If urine ACR has never been checked, the cardiovascular assessment is incomplete.

Practice verdict: Change now. This is inexpensive, feasible and clinically useful in South Africa, the UK and Ireland.

Read the ESC cardiovascular disease–CKD guideline →

CLUSTER-RANDOMISED TRIAL · PRACTICE-RELEVANT

Nurse-coordinated heart-failure care is especially relevant to South Africa

Clinical question. Can nurse-led, digitally supported coordination improve outcomes for people with HFrEF in a resource-constrained health system?

Result. The Indian TIME-HF cluster-randomised trial found that nurse-coordinated care supported by mobile technology improved time alive and outside hospital and reduced two-year mortality by approximately 22% compared with usual care.

Limitations. This was an open-label, system-level intervention in Indian heart-failure centres. Effectiveness depends on staff training, medication availability and reliable follow-up.

GP implication. A simple heart-failure register, designated nurse, post-discharge call, medication checklist, weight and symptom monitoring, and rapid escalation pathway may deliver more benefit than another isolated consultation.

Practice verdict: Change care processes now where feasible.

Read TIME-HF in Circulation →