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 CONTENT
JAMA NEWS RELEASES
(Embargoed for Release: 3:00 p.m. CT, Tuesday, November 7, 2006)
JAMA NEWS RELEASES
SYSTOLIC BLOOD PRESSURE LEVEL FOR PATIENTS HOSPITALIZED WITH HEART FAILURE MAY HELP PREDICT RISK OF DEATH
CERTAIN FACTORS RELATED TO HEART FUNCTION AND ASSOCIATED WITH HEART FAILURE MORE COMMON THAN PREVIOUSLY THOUGHT
INDIVIDUALIZED STRATEGIES NEEDED FOR PREVENTION OF MALARIA IN LONG-TERM TRAVELERS
JAMA REPORT (VIDEO SCRIPT)
VIDEO: Windows Media | Quicktime
SYSTOLIC BLOOD PRESSURE IMPORTANT PREDICTOR IN HEART FAILURE PATIENTS AT TIME OF HOSPITAL ADMISSION
INFORMATION CONTAINED IN THESE NEWS RELEASES IS PROTECTED BY COPYRIGHT. JOURNAL ATTRIBUTION IS REQUIRED.
TV Note: This week's JAMA Report video is on the link between systolic blood pressure and outcomes for patients hospitalized with heart failure. The report will be fed Tuesday, November 7, from 9:00 - 9:30 a.m. ET and 2:00 - 2:30 p.m. ET, on Intelsat America 6 (formerly Telstar 6), Transponder 11 (C-Band), Downlink Freq: 3920 MHz Vertical, Audio: 6.20/6.80. For more information, call 312/464-JAMA.
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Embargoed for Release: 3:00 p.m. CT, Tuesday, November 7, 2006
Media Advisory: To contact corresponding author Gregg C. Fonarow, M.D., call Rachel Champeau at 310-794-2270. To contact editorial author Per Hildebrandt, M.D., D.M.Sc., email: rspehi{at}ra.dk.
SYSTOLIC BLOOD PRESSURE LEVEL FOR PATIENTS HOSPITALIZED WITH HEART FAILURE MAY HELP PREDICT RISK OF DEATH
CHICAGO—Patients with heart failure and low systolic blood pressure at hospital admission are more likely to have poor outcomes including higher mortality rates and increased rates of rehospitalization, despite medical treatment, according to a study in the November 8 issue of JAMA.
Acute heart failure is a major public health concern because of its prevalence and associated illness and death. In 2003, 1.1 million patients were discharged from the hospital for heart failure, making this the most common discharge diagnosis among patients older than 65 years, according to background information in the article. Recent studies have indicated that the majority of patients hospitalized for heart failure are admitted with low or normal systolic blood pressure (SBP; the peak pressure in the arteries during the cardiac cycle). Elevated SBP may identify patients with certain clinical characteristics that are unique from those in patients with low SBP.
Mihai Gheorghiade, M.D., of the Feinberg School of Medicine, Northwestern University, Chicago, and colleagues evaluated the relationship between SBP at admission, patient clinical data, and outcomes in patients hospitalized for acute heart failure. The researchers analyzed data from the Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients with Heart Failure (OPTIMIZE-HF) registry and performance-improvement program, which included patients hospitalized with heart failure at 259 U.S. hospitals between March 2003 and December 2004. Patients were divided into quartiles by SBP at hospital admission (<120, 120-139, 140-161, and >161 mm Hg).
In-hospital outcomes were based on 48,612 patients age 18 years or older with heart failure. Of the 41,267 patients who had left ventricular function assessed, 21,149 (51 percent) had preserved left ventricular function. Outcomes following discharge from the hospital were based on a prespecified subgroup (n = 5,791, approximately 10 percent of patients) with follow-up data for between 60 and 90 days.
The researchers found that lower SBP at admission was associated with substantially increased in-hospital risk of death: 7.2 percent (for blood pressure <120 mm Hg), 3.6 percent (120-139 mm Hg), 2.5 percent (140-161 mm Hg), and 1.7 percent (>161 mm Hg). The odds of in-hospital death increased 21 percent for each 10-mm Hg decrease in SBP below 160 mm Hg. In the follow-up group, higher SBP at admission was also associated with lower risk of 60- to 90-day death.
Patients with higher SBP were more likely to be female and black. Fifty percent of the patients had SBP higher than 140 mm Hg at admission.
“… this analysis demonstrates that SBP at hospital admission, a readily accessible vital sign, is an important and independent predictor of morbidity and mortality in patients with heart failure, including patients with reduced or relatively preserved systolic function. Systolic blood pressure at hospital admission can effectively identify groups of patients that differ with respect to clinical characteristics, prognosis, and perhaps underlying pathophysiology. Accordingly, the therapeutic approach may vary among patients with high, normal, or low SBP,” the authors write.
(JAMA. 2006;2217-2226. Available pre-embargo to the media at www.jamamedia.org)
Editor's Note: Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
EDITORIAL: SYSTOLIC AND NONSYSTOLIC HEART FAILURE - EQUALLY SERIOUS THREATS
In an accompanying editorial, Per Hildebrandt, M.D., D.M.Sc., of Roskilde University Hospital, Roskilde, Denmark, comments on the two studies on heart failure in this week’s issue of JAMA.
“The findings … that approximately half of patients with heart failure, whether observed in the community or in the hospital, have preserved systolic function and that mortality in these patients is similar to that for patients with heart failure and reduced systolic function have important implications. Just as heart failure with reduced LVEF [left ventricular ejection fraction] has long been recognized as a common and serious disease and has been the subject of a number large-scale clinical trials, the entities of heart failure with preserved LVEF and diastolic dysfunction equally deserve attention. Deciphering the mechanisms and developing evidence-based treatments for these major public threats deserve the highest priority.”
(JAMA. 2006;296:2259-2260. Available pre-embargo to the media at www.jamamedia.org)
Editor's Note: Financial disclosures: Dr. Hildebrandt reported receiving honoraria from AstraZeneca, Bristol-Myers Squibb, GlaxoSmithKline, Merck, Novartis, Pfizer, Sanofi-Aventis, Servier, and Takeda.
For More Information: Contact the JAMA/Archives Media Relations Department at 312/464-JAMA (5262) or email: mediarelations{at}jama-archives.org.
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Embargoed for Release: 3:00 p.m. CT, Tuesday, November 7, 2006
Media Advisory: To contact the corresponding author Veronique L. Roger, M.D., M.P.H., call Traci Klein at 507-284-5005.
CERTAIN FACTORS RELATED TO HEART FUNCTION AND ASSOCIATED WITH HEART FAILURE MORE COMMON THAN PREVIOUSLY THOUGHT
CHICAGO—Several factors related to heart function and that play a role in heart failure are more prevalent than previously thought, according to a study in the November 8 issue of JAMA.
Heart failure (HF) is a highly prevalent illness with various causes, which may be associated with reduced or preserved ejection fraction (EF; the fraction [volume] of blood pumped out of the ventricle of the heart with each heart beat). Reduced EF is less than 50 percent; preserved EF, 50 percent or greater. There is disagreement on the prevalence, characteristics and outcomes of heart failure and preserved EF, and the prevalence of diastolic dysfunction (or diastolic heart failure; when the heart contracts normally but the ventricles do not relax properly and less blood enters the heart during normal filling).
Francesca Bursi, M.D., M.Sc., formerly of Mayo Clinic and Foundation, Rochester, Minn., and colleagues examined the prevalence of preserved and reduced EF and that of diastolic dysfunction among all residents treated for heart failure in Olmsted County, Minn. The study, conducted from September 2003 to October 2005, included 556 participants who underwent assessment of EF and diastolic function by echocardiography and measurement of brain natriuretic peptide (BNP; a substance secreted from the heart in response to changes that occur when heart failure develops or worsens). Blood levels of BNP increase when heart failure worsens and decrease when the heart failure condition is stable.
The researchers found that of the 556 patients with heart failure, 55 percent had preserved EF. Compared with their counterparts with reduced EF, patients with preserved EF were older, more likely to be women and less likely to be smokers or have a history of heart attack. Diastolic dysfunction was present in 80 percent of patients, combined systolic and diastolic dysfunction was present in 37 percent, and isolated diastolic dysfunction was present in 44 percent.
Patients with reduced EF were more likely to have moderate or severe diastolic dysfunction than their counterparts with preserved EF. Both low EF and diastolic dysfunction were independently related to higher levels of BNP. At 6 months, the number of deaths was 16 percent for both preserved and reduced EF (compared with an expected rate of death of 4 percent and 3 percent, respectively).
“The prevalence of moderate and severe diastolic dysfunction among patients with HF and preserved EF was strikingly higher than that observed in elderly patients with cardiovascular disease but without HF in the same community, supporting the hypothesis that diastolic dysfunction is present in a large segment of patients presenting with HF and preserved EF. Similarly, the high prevalence of moderate and severe diastolic dysfunction in patients with HF and reduced EF supports the importance of diastolic dysfunction in both forms of HF. The importance of characterizing the pathophysiology of HF with preserved EF is underscored by the high mortality rate of these patients, which is comparable to that of patients with reduced EF,” the authors conclude.
(JAMA. 2006;296:2209-2216. Available pre-embargo to the media at www.jamamedia.org)
Editor's Note: Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
For More Information: Contact the JAMA/Archives Media Relations Department at 312/464-JAMA (5262) or email: mediarelations{at}jama-archives.org.
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Embargoed for Release: 3:00 p.m. CT, Tuesday, November 7, 2006
Media Advisory: To contact Lin H. Chen, M.D., call Kelly Kass at 617-254-9500.
INDIVIDUALIZED STRATEGIES NEEDED FOR PREVENTION OF MALARIA IN LONG-TERM TRAVELERS
CHICAGO—Prevention of malaria for persons who travel for more than 6 months is complex and should be individualized, with advice from travel medicine specialists, according to a review article in the November 8 issue of JAMA.
There were more than 800 million trips by travelers worldwide in 2005, according to background information in the article. For long-term travelers visiting malaria-endemic countries, recommendations for prevention have been difficult to standardize due to the diversity of long-term travelers and their itineraries, the variation in the quality of and access to medical care, the limited data on malaria incidence in travelers overseas, and the lack of controlled studies on long-term safety and effectiveness of antimalarial agents. Further complicating the recommendations is the growth in the intensity of transmission and resistance patterns of the malaria parasites, the seasonality of transmission, and the wide range of international guidelines and travelers’ beliefs and expectations.
Lin H. Chen, M.D., of Mount Auburn Hospital, Cambridge, Mass., and colleagues conducted a review of relevant studies and articles, published through July 2006, to examine the risk of malaria in long-term travelers, recent developments in personal protective measures, and the safety and tolerability of malaria treatments during long-term use and to consider prevention strategies.
The studies indicated that long-term travelers (more than 6 months) have a higher risk of malaria than short-term travelers. “Long-term travelers underuse personal protective measures and adhere poorly to continuous chemoprophylaxis regimens. A number of strategies are used during long-term stays: discontinuation of chemoprophylaxis after the initial period, sequential regimens with different medications for chemoprophylaxis, stand-by emergency self-treatment, and seasonal chemoprophylaxis targeting high-incidence periods or locations. All strategies have advantages and drawbacks,” the researchers write.
The authors add that vivax malaria (a form of malaria marked by convulsions that occur every 48 hours and caused by the parasite Plasmodium vivax) causes significant illness in travelers, but relapses of vivax malaria are not prevented with the current first-line chemoprophylaxis regimens.
“Long-term travelers to malaria-endemic areas face risk of death, morbidity, and reduced productivity because of malaria. General guidelines are desirable, but recommendations for malaria prevention in long-term travelers must be individualized and should be provided by travel medicine specialists. Personal protective measures are paramount. Identification of reliable medical facilities at destination is crucial for long-term travelers regardless of their malaria prevention strategies, and a number of resources are available to aid in this process. Data on safety of chemoprophylaxis drugs show reasonable clinical support for long-term use, particularly for mefloquine.”
“All travelers should be advised to carry or arrange adequate supplies of antimalarial agents, because counterfeit drugs are rampant in developing countries. Long-term travelers should also consider evacuation insurance for medical emergencies,” they write. “Presumptive antirelapse therapy should be considered for long-term travelers who have been intensively exposed to P vivax. Because inconsistent recommendations undermine the adherence to any preventive strategy, national and international experts should strive toward consensus on guidelines for malaria prevention in long-term travelers.”
(JAMA. 2006;296:2234-2244. Available pre-embargo to the media at www.jamamedia.org)
Editor's Note: Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
For More Information: Contact the JAMA/Archives Media Relations Department at 312/464-JAMA (5262) or email: mediarelations{at}jama-archives.org.
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JAMA REPORTS
VIDEO: Windows Media | Quicktime
SYSTOLIC BLOOD PRESSURE IMPORTANT PREDICTOR IN HEART FAILURE PATIENTS AT TIME OF HOSPITAL ADMISSION
VIDEO:
NAT SOT UP FULL FOR :03
Blood pressure cuff being pumped – close up
AUDIO:
“Blood pressure cuff being pumped”
VIDEO:
B-ROLL
Wide shot of Dr. Gheorghiade taking Michael Thompson’s blood pressure in hospital room
GFX/JAMA COVER
More Dr. Gheorghiade taking Michael’s blood pressure
AUDIO:
LOW BLOOD PRESSURE IS HEALTHIER THAN HIGH. BUT A NEW STUDY IN JAMA, THE JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, SHOWS THERE IS ONE, BRIEF PERIOD OF TIME WHEN IT’S BETTER FOR HEART FAILURE PATIENTS TO HAVE HIGH BLOOD PRESSURE… AT THE TIME OF THEIR ADMISSION TO THE HOSPITAL.
VIDEO:
SOT/FULL
@ :16
Super: Mihai Gheorghiade, M.D.
Northwestern University
Runs :17
AUDIO:
“During stress, or at the time of admission, it appears that when you have high blood pressure for a limited amount of time, let’s say hours, that may indicate that your heart is stronger.”
VIDEO:
B-ROLL
Dr. Gheorghiade and nurse looking at data on computer
Michael in hospital bed talking to Dr. Gheorghiade
More blood pressure video
Cutaways to arm with pressure cuff, needle moving on gauge to show measurement, etc.
AUDIO:
DR. MIHAI (ME-hi) GHEORGHIADE (george-ee-AH-day) OF NORTHWESTERN UNIVERSITY’S FEINBERG SCHOOL OF MEDICINE IS ONE OF THE STUDY AUTHORS. THEY FOUND THAT IF A PERSON COMING TO THE HOSPITAL WITH HEART FAILURE HAS A HEART THAT’S STILL PUMPING STRONG ENOUGH TO MAKE THE BLOOD PRESSURE HIGH AT THE TIME OF ADMISSION, THAT PATIENT HAS A MUCH LOWER RISK OF DYING DURING THAT HOSPITAL STAY THAN SOMEONE COMING IN WITH LOW BLOOD PRESSURE.
VIDEO:
SOT/FULL
Mihai Gheorghiade, M.D.
Northwestern University
Runs :07
AUDIO:
“So it’s not that the blood, that the high blood pressure is good, but it’s a measure of the strength of the heart.”
VIDEO:
B-ROLL
Close up of blood pressure measurement
Woman having her blood pressure taken in medical office setting
Dr. Cotts and nurse at computer
AUDIO:
IN FACT, THE FIRST THING PHYSICIANS SHOULD DO IS TRY TO LOWER THAT BLOOD PRESSURE. BUT KNOWING WHETHER THE PATIENT CAME IN WITH HIGH PRESSURE OR LOW TELLS THE DOCTORS HOW TO TREAT THE PATIENT. THAT’S A LOT OF VALUABLE INFORMATION GLEANED FROM SUCH A SIMPLE TOOL, ACCORDING TO THIS CARDIOLOGIST.
VIDEO:
SOT/FULL
@ 1:15
Super: William Cotts, M.D.
Northwestern Memorial Hospital
Runs :11
AUDIO:
“I think going back to the basics and really looking at things like blood pressure, it shows that it’s still important to look at the basics of the physical exam.”
VIDEO:
B-ROLL
Dr. Gheorghiade with Michael in hospital room measuring blood pressure
Cutaway to needle moving on gauge to measure blood pressure
AUDIO:
DR. GHEORGHIADE SAYS PATIENTS SHOULD ALSO KNOW WHAT THEIR BLOOD PRESSURE IS AT ADMISSION, AND REMIND THEIR DOCTORS HOW IMPORTANT IT IS. THIS HEART PATIENT SAYS HE’D DEFINITELY DO THAT.
VIDEO:
SOT/FULL
@ 1:35
Super: Michael Thompson
Heart patient
Runs :04
AUDIO:
“If I know it’s going to make my care better, I’d be glad to do it.”
VIDEO:
B-ROLL
Different man having blood pressure checked in medical office setting
AUDIO:
BUT REMEMBER, YOU STILL WANT TO KEEP YOUR BLOOD PRESSURE LOW IN YOUR DAILY LIFE. THAT’S ONE WAY TO PREVENT HEART FAILURE IN THE FIRST PLACE. THIS IS MAVIS PRALL WITH THE JAMA REPORT.
