JAMA news releases are made available to the public after 3 pm US Central time on the first 4 Tuesdays of each month. The Archives Journals news releases are made available to the public after 3 pm Central time on Mondays. We also provide a list of previous news releases.
THIS WEEK'S CONTENTS
ARCHIVES OF INTERNAL MEDICINE NEWS RELEASES
Embargoed Until: 3 P.M. (CT), Monday, November 28, 2005
U.S. PATIENTS WITH HEART FAILURE HAVE BETTER SHORT-TERM SURVIVAL RATES THAN CANADIAN PATIENTS; LONG-TERM SURVIVAL RATES SIMILAR IN U.S. AND CANADA
THYROID CONDITION ASSOCIATED WITH INCREASED HEART FAILURE RISK AMONG OLDER ADULTS
INFLAMMATORY MARKERS MAY HELP PREDICT STROKE RISK IN MIDDLE-AGED PEOPLE
HOSPITALIZATION RATES FOR INFECTIOUS DISEASES INCREASE AMONG OLDER ADULTS
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EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, November 28, 2005
Media Advisory: To contact corresponding author Harlan M. Krumholz, M.D., S.M., call Karen Peart at 203-432-1326.
U.S. PATIENTS WITH HEART FAILURE HAVE BETTER SHORT-TERM SURVIVAL RATES THAN CANADIAN PATIENTS; LONG-TERM SURVIVAL RATES SIMILAR IN U.S. AND CANADA
CHICAGO—Elderly patients with heart failure who are hospitalized in the United States have lower death rates at 30 days than patients hospitalized in Canada for the same illness, but one-year death rates are similar in the U.S. and Canada, according to a study in the November 28 issue of the Archives of Internal Medicine, one of the JAMA/Archives journals.
The United States and Canada have different methods of financing and providing health care. The U.S. market-oriented system with limited governmental control is in sharp contrast to Canada's single-payer system, which covers most physician and hospital services and prescription medications. Canadian budgetary restraints have resulted in limited access to specialized care, such as invasive cardiac procedures and physician specialists, according to background information in the article. Health care expenditure per person is significantly higher in the U.S. compared with Canada, but whether there are differences in quality of care of many conditions is unknown.
Dennis T. Ko, M.D., of the University of Toronto, Ontario, and colleagues compared processes of care and 30-day and one-year risk-standardized mortality rates among 28,521 U.S. Medicare beneficiaries and 8,180 similarly aged patients in Ontario, Canada, who were hospitalized with heart failure from 1998 to 2001. Heart failure—a condition in which the ventricles, or lower chambers of the heart, are not able to pump blood effectively—is the most common cause of hospitalization for individuals aged 65 and older in both countries.
"More U.S. patients underwent left ventricular ejection fraction assessment [a test to evaluate the pumping action of the lower chambers of the heart] during hospitalization compared with Canadian patients (61.2 percent vs. 41.7 percent)," the authors write.
The authors also looked at the use of medications commonly prescribed for heart patients. "At discharge, patients in the United States were prescribed beta-blockers more frequently (28.7 percent vs. 25.4 percent), but angiotensin-converting enzyme inhibitors less frequently (54.3 percent vs. 63.4 percent)," they report.
The death rate at 30 days was significantly lower for U.S. patients—8.9 percent compared with 10.7 percent for Canadian patients. But at one year, the death rates for patients in both countries were similar—32.2 percent vs. 32.3 percent.
"In conclusion, we found that HF patients hospitalized in the United States had significantly better short-term mortality but equivalent long-term mortality compared with a sample of HF patients hospitalized in Canada," the authors conclude. "Further studies are needed to explore the reasons underlying this difference in outcomes and to gain additional insights to improve the care and outcomes of HF patients in both countries."
(Arch Intern Med.
2005;165:2486-2492. Available pre-embargo to the media at www.jamamedia.org)
Editor's Note: Dr. Ko was supported by a research fellowship award from the Heart and Stroke Foundation of Canada, Ottawa, Ontario. Co-author Jack V. Tu, M.D., Ph.D., was a Harkness Associate of the Commonwealth Fund when this study was conducted and is supported by a Canada research chair in health services research. The EFFECT study was funded by operating grants from the Canadian Institutes of Health Research, Ottawa, and the Heart and Stroke Foundation of Canada.
For more information, contact JAMA/Archives media relations at 312/464-JAMA (5262) or e-mail mediarelations{at}jama-archives.org.
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EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, November 28, 2005
Media Advisory: To contact Nicolas Rodondi, M.D., MAS, call Wallace Ravven at 415-476-2557.
To contact editorialist Lawrence M. Crapo, M.D., e-mail profcrapo{at}yahoo.com.
THYROID CONDITION ASSOCIATED WITH INCREASED HEART FAILURE RISK AMONG OLDER ADULTS
CHICAGO—A hormonal condition known as subclinical hypothyroidism is associated with an increased risk of congestive heart failure among older adults, but not with other cardiovascular events and death, according to a study in the November 28 issue of the Archives of Internal Medicine, one of the JAMA/Archives journals.
Subclinical hypothyroidism (SH) refers to patients who have an elevated level of the hormone thyrotropin, also known as thyroid stimulating hormone (TSH), and a normal level of the hormone thyroxine (T4). The prevalence of SH increases with age, and is about ten percent in women over the age of 70, and somewhat lower in men, according to background information in the article. Subclinical hypothyroidism has been associated with higher levels of some cardiovascular risk factors, but data on cardiovascular outcomes and death are limited.
Nicolas Rodondi, M.D., MAS, of the University of California, San Francisco, and colleagues studied 2,730 men and women, aged 70 to 79, to determine whether subclinical hypothyroidism was associated with congestive heart failure (CHF, failure of the heart to pump blood with normal efficiency), coronary heart disease (CHD), stroke, peripheral arterial disease (PAD, partial or total blockage of an artery, usually an artery leading to a leg or arm), death, and cardiovascular-related death. Subclinical hypothyroidism was defined as TSH levels of 4.5-6.9 mIU/L (mild), 7.0-9.9 mIU/L (moderate), and 10 mIU/L or greater (severe).
The authors found that the incidence of CHF during a four-year follow-up period was significantly increased in patients with moderate and severe SH, but not in patients with mild SH, who comprised the highest percentage (68 percent) of all patients with SH in the study.
"In this population-based study of older adults, subclinical hypothyroidism was associated with a higher rate of incident and recurrent CHF among participants with a TSH level of 7.0 mIU/L or greater compared with euthyroid participants [participants with normal thyroid function]," they write. "This association persisted after adjustment for cardiovascular risk factors."
"We found no consistent evidence that subclinical hypothyroidism was associated with CHD events, stroke, PAD, cardiovascular-related mortality, or total mortality," they continue.
"Because no other prospective study has assessed the risk of CHF events in subjects with subclinical hypothyroidism, to our knowledge, our results should be confirmed in other large prospective studies, including those in younger populations," the authors conclude. "Further investigation is also warranted to assess whether subclinical hypothyroidism causes or worsens pre-existing heart failure."
(Arch Intern Med.
2005;165:2460-2466. Available pre-embargo to the media at www.jamamedia.org)
Editor's Note: This study was supported by contracts from the National Institute on Aging, Bethesda, Md., and by a grant from the Swiss National Foundation, Bern, Switzerland, to Dr. Rodondi.
EDITORIAL: SUBCLINICAL HYPOTHYROIDISM AND CARDIOVASCULAR DISEASE
In an accompanying editorial, Lawrence M. Crapo, M.D., of Santa Clara Valley Medical Center, San Jose, Calif., discusses potential treatment for patients, based on findings concerning subclinical hypothyroidism and cardiovascular disease.
"The data in these studies would certainly support the idea that the treatment of severe SH with levothyroxine in patients younger than 80 years may be beneficial, but this remains to be proved in a randomized prospective therapeutic trial," he writes.
"…Rodondi et al found no increased incidence of CHF, CVD, or deaths from CVD over a four-year period in subjects with initial TSH levels in the range of 4.5 to 7.0 mIU/L," he continues. "These data suggest that treatment of subjects with mild SH or high-normal TSH levels would probably not be beneficial in the prevention of CVD."
(Arch Intern Med.
2005;165:2451-2452. Available pre-embargo to the media at www.jamamedia.org)
For more information, contact JAMA/Archives media relations at 312/464-JAMA (5262) or e-mail mediarelations{at}jama-archives.org.
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EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, November 28, 2005
Media Advisory: To contact Christie M. Ballantyne, M.D., call Ross Tomlin at 713-798-4712.
To contact Archives of Internal Medicine Editor Philip Greenland, M.D., call Liz Crown at 312-503-8928.
INFLAMMATORY MARKERS MAY HELP PREDICT STROKE RISK IN MIDDLE-AGED PEOPLE
CHICAGO—In addition to traditional risk factors such as diabetes, high blood pressure, age, and race, a particular enzyme and protein found in the blood may help identify middle-aged men and women at increased risk for ischemic stroke, according to a study in the November 28 issue of the Archives of Internal Medicine, one of the JAMA/Archives journals.
An estimated 700,000 strokes occur each year in the United States, making stroke the third leading cause of death and the leading cause of neurologic disability. Almost a third of strokes occur in people under the age of 65, according to background information in the article. Measurement of inflammatory markers has been reported to identify individuals at increased risk for ischemic stroke, which develops when a blood vessel supplying blood to an area of the brain becomes blocked by a blood clot.
Christie M. Ballantyne, M.D., of Baylor College of Medicine and Methodist DeBakey Heart Center, Houston, Texas, and colleagues examined levels of two inflammatory markers—C-reactive protein (CRP) and the enzyme lipoprotein-associated phospholipase A2 (Lp-PLA2)—to determine if they are associated with increased risk for incident ischemic stroke. The researchers conducted a prospective case-cohort study of 12,762 apparently healthy middle-aged men and women in the Atherosclerosis Risk in Communities (ARIC) study, who were observed for about six years. The final sample size for the analysis was 960, including 194 ischemic stroke cases and 766 non-cases.
The authors report that levels of Lp-PLA2 and CRP were higher in middle-aged Americans who subsequently had an ischemic stroke than in those who did not.
"Mean Lp-PLA2 and CRP levels adjusted for sex, race, and age were higher in the 194 stroke cases than the 766 non-cases, whereas low-density lipoprotein cholesterol (LDL-C) level was not significantly different," the authors write.
"Individuals with high levels of both CRP and Lp-PLA2 were at the highest risk after adjusting for traditional risk factors compared with individuals with low levels of both, whereas others were at intermediate risk," they continue.
"In summary, Lp-PLA2 and CRP levels may be complementary to traditional risk factors to identify middle-aged individuals at increased risk for stroke," the authors conclude. "Future studies should determine whether selective inhibition of Lp-PLA2 or reduction and/or inhibition of CRP reduces ischemic stroke and whether statins and/or fibrates [two types of cholesterol-lowering drugs] are more effective for stroke prevention in patients with elevated levels of Lp-PLA2."
(Arch Intern Med. 2005;165:2479-2484. Available pre-embargo to the media at www.jamamedia.org)
Editor's Note: Dr. Ballantyne has received grant and/or research support from AstraZeneca, diaDexus, Gene Logic, GlaxoSmithKline, Integrated Therapeutics, Kos, Merck, Novartis, Pfizer, Reliant, Sankyo Pharma, and Schering-Plough; he has served as consultant for AstraZeneca, Bayer, Merck, Novartis, Pfizer, Reliant, and Schering-Plough; and he currently serves or has served on the speakers bureau for AstraZeneca, Bristol Myers-Squibb, Kos, Merck, Novartis, Pfizer, Reliant, Sanofi-Synthelabo, and Schering-Plough. The ARIC Study is carried out as a collaborative study supported by contracts from the National Heart, Lung, and Blood Institute, Bethesda, Md. This research was also supported by an unrestricted research grant from GlaxoSmithKline, Research Triangle Park, N.C.
EDITORIAL: WHEN IS A NEW PREDICTION MARKER USEFUL?
In an accompanying editorial, Archives of Internal Medicine Editor Philip Greenland, M.D., and Patrick G. O'Malley, M.D., Walter Reed Army Medical Center, write that epidemiologic studies, such as that by Ballantyne and colleagues, are most useful for identifying potential new risk predictors or new potential approaches to treatment requiring further confirmatory observational studies or future clinical trials.
"From the Ballantyne et al study, it is unclear how useful CRP or Lp-PLA2 level will be for improving risk prediction vs. traditional risk factors alone," they write. "Simply showing statistical independence, as recently discussed in an Archives review article, is not adequate for demonstrating clinical utility for risk prediction."
(Arch Intern Med.
2005;165:2454-2456. Available pre-embargo to the media at www.jamamedia.org)
For more information, contact JAMA/Archives media relations at 312/464-JAMA (5262) or e-mail mediarelations{at}jama-archives.org.
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EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, November 28, 2005
Media Advisory: To contact To contact Aaron T. Curns, M.P.H., call Jennifer Morcone at 404-639-1690.
HOSPITALIZATION RATES FOR INFECTIOUS DISEASES INCREASE AMONG OLDER ADULTS
CHICAGO—Due in part to a growing population of older adults, there was a 13 percent increase in the infectious disease hospitalization rate between 1990 through 1992 and 2000 through 2002, according to a study in the November 28 issue of the Archives of Internal Medicine, one of the JAMA/Archives journals.
"Adults 65 years or older (older adults) account for a disproportionate share of patients with infectious disease (ID)–related hospitalizations and all-cause hospitalizations in the United States," according to background information in the article. From 1980 through 1994, rates of infectious disease hospitalizations increased among older adults, while rates for those younger than 65 years decreased. The number of older adults is expected to increase from 35 million in 2000 to 69 million by 2030, accounting for approximately one fifth of the total U.S. population.
Aaron T. Curns, M.P.H., of the Centers for Disease Control and Prevention, Atlanta, and colleagues, examined the National Hospital Discharge Survey (NHDS) to estimate older adult hospitalization rates from 1990 through 2002. The NHDS is a national probability survey that collects data annually from a sample of about 270,000 inpatient records from approximately 500 hospitals.
From 1990 through 2002, there were approximately 21.4 million ID hospitalizations among older adults, 48 percent of which had an ID as the primary diagnosis. Between 1990 through1992 and 2000 through 2002, there was a 13 percent increase in the ID hospitalization rate, from 449.4 to 507.9 hospitalizations per 10,000 older adults. Nearly half of ID hospitalizations (46 percent) and ID-related hospitalization deaths (48 percent) were associated with lower respiratory tract infections from 2000 through 2002. The hospitalization rates for lower respiratory tract infections and kidney, urinary tract, and bladder infections did not change significantly. The rate for septicemia (infection of the bloodstream), however, increased 22 percent from 50.4 to 61.7 hospitalizations per 10,000 older adults from 1990 through 1992 to 2000 through 2002. Rates for infections of the heart, infections and inflammatory reactions to prosthetic devices, and postoperative infections had the most dramatic growths, with increases of approximately 240 percent, 130 percent and 80 percent, respectively.
"The hospitalization rate for IDs increased slightly among the older adult U.S. population during the 13-year study and was associated with the aging of the older adult population," the authors write. "The reduction of ID hospitalization rates among older adults could help attenuate the anticipated increase in the number of hospitalizations among older adults and should be a high priority given the projected population growth among older adults in the United States."
(Arch Intern Med.
2005;165:2514-2520. Available pre-embargo to the media at www.jamamedia.org)
For more information, contact JAMA/Archives media relations at 312/464-JAMA (5262) or e-mail mediarelations{at}jama-archives.org.
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