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, June 12, 2007)
JAMA NEWS RELEASES
PRE-OPERATIVE ANEMIA OR VERY HIGH RED BLOOD CELL COUNT ASSOCIATED WITH INCREASED RISK FOR CARDIAC EVENTS OR DEATH IN OLDER PATIENTS UNDERGOING MAJOR SURGERY
BLACK PATIENTS LESS LIKELY TO RECEIVE CERTAIN CORONARY PROCEDURES FOLLOWING HEART ATTACK, AND HAVE HIGHER MORTALITY RATES 1 YEAR LATER
PHYSICIAN-RESEARCHERS OFTEN LESS SUCCESSFUL IN OBTAINING NIH FUNDING
JAMA REPORT (VIDEO SCRIPT)
VIDEO: Windows Media | Quicktime
BLACK PATIENTS APPROXIMATELY 30 PERCENT LESS LIKELY THAN WHITES TO RECEIVE TREATMENT SUCH AS ANGIOPLASTY AFTER HEART ATTACK
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 differences in the use of certain coronary procedures and outcomes for black and white patients following a heart attack. The report will be fed Tuesday, June 12, from 9:00 - 9:30 a.m. ET and 2:00 - 2:30 p.m. ET, on Galaxy 26 (formerly Intelsat America 6) C-Band, Transponder 09, downlink frequency: 3880 vertical, audio 6.2/6.8. For more information, call 312/464-JAMA.
SAVE THE DATE: JAMA will present new research from its theme issue on Chronic Diseases of Children at a media briefing on Tuesday, June 26, from 10 a.m. – 12:15 p.m., at the Millennium Broadway Hotel in New York. Program and registration information will be included in a future email.
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Embargoed for Release: 3:00 p.m. CT, Tuesday, June 12, 2007
Media Advisory: To contact Wen-Chih Wu, M.D., call James Burrows at 401-457-3004. To contact editorial co-author David R. Flum, M.D., M.P.H., call Justin Reedy at 206-685-0382.
PRE-OPERATIVE ANEMIA OR VERY HIGH RED BLOOD CELL COUNT ASSOCIATED WITH INCREASED RISK FOR CARDIAC EVENTS OR DEATH IN OLDER PATIENTS UNDERGOING MAJOR SURGERY
CHICAGO—Older patients with mild degrees of pre-operative anemia (low red blood cell count) or those with a very high red blood cell count have a higher risk of post-operative death or cardiac events following major noncardiac surgery, according to a study in the June 13 issue of JAMA.
Elderly patients are at increased risk for abnormal hematocrit values, according to background information in the article. A hematocrit value is the percentage of a blood sample that consists of red blood cells, measured after the blood has been centrifuged and the cells compacted. Despite nearly universal screening of patients for abnormal pre-operative hematocrit levels, the prognostic implications of pre-operative anemia or polycythemia (an abnormal increase in the red blood cell count) are not well understood, and many reports differ on what hematocrit values could be harmful.
Wen-Chih Wu, M.D., of the Providence Veterans Affairs Medical Center, Providence, R.I., and colleagues evaluated the prevalence of pre-operative anemia and polycythemia and their effects on 30-day post-operative outcomes for 310,311 veterans, age 65 years or older, who underwent major noncardiac surgery between 1997 and 2004 in 132 Veterans’ Affairs medical centers in the U.S. The researchers used data from the VA National Surgical Quality Improvement Program.
Based on pre-operative hematocrit levels, patients were stratified into standard categories of anemia (hematocrit less than 39.0 percent), normal hematocrit (39.0 percent-53.9 percent) and polycythemia (hematocrit 54 percent or greater). The authors estimated increases in 30-day post-operative cardiac events and risk of death in relation to each hematocrit point deviation from the normal category.
The researchers found that 30-day death and cardiac event rates increased incrementally with either positive or negative deviations from normal hematocrit levels. Using these levels, there was a 1.6 percent increase in the adjusted risk of 30-day post-operative death for every percentage point of hematocrit deviation from the normal range. “Thus, a patient with a pre-operative hematocrit value of 30.0 percent has a 14.4 percent increased risk of 30-day post-operative mortality, while a patient with a pre-operative hematocrit of 24.0 percent has a 24.0 percent increase in the risk of 30-day postoperative mortality.”
“Our findings suggest that among older men undergoing elective surgery, the lowest risk of adverse outcomes was in those with pre-operative hematocrit values between 39.0 percent and 50.9 percent. Even minimal deviations from this optimal range were associated with an increased risk of 30-day post-operative mortality and cardiac events. Future studies should determine if treatment of pre-operative anemia and polycythemia improve the post-operative outcomes of this vulnerable population,” they write.
(JAMA. 2007;2481-2488. 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: HEMATOCRIT LEVEL AND POSTSURGICAL OUTCOME—POWERS OF OBSERVATION
In an accompanying editorial, Farhood Farjah, M.D., and David R. Flum, M.D., M.P.H., of the University of Washington, Seattle, (Dr. Flum is also a Contributing Editor, JAMA), comment on the study by Wu and colleagues.
“How should the unexpected results of this study be interpreted? The most likely explanation for the increased risk of advanced and multiple adenomas in the intervention group is that undetected early precursor lesions were present in the mucosa [a type of membrane] of these patients (who are at increased adenoma risk), and that folic acid promoted growth of these lesions. This hypothesis is consistent with experimental studies showing increased colorectal neoplasia when folic acid is administered after lesions are present.”
“Assuming the relationship of hematocrit and outcome is real and generalizes to other cohorts, the central issue to be determined is whether modifying hematocrit improves outcome. The theory linking preoperative anemia and postoperative events is that the stress of an operation combined with the limited compensatory ability of the heart in older individuals with anemia may lead to cardiac ischemia and death. Interventions correcting anemia aimed at preventing cardiac stress might be expected to save lives, but expectation and reality are often at odds.” They add that several studies did not find important differences in clinical outcomes attributable to blood transfusion for hematocrit levels in the moderate anemia range.
“Since no intervention is without risk, clinicians should avoid using these findings reported by Wu et al to justify interventions—use of transfusion, erythropoietic [of or relating to the formation of red blood cells] agents, iron supplementation—outside the research setting. In other clinical arenas involving patients with anemia, such as those with renal failure and cancer, clinicians may have prematurely embraced the aggressive use of erythropoietic agents to boost red blood cell production in the absence of sufficient evidence, only to learn later that despite their best intentions they may have been causing more harm than benefit,” they write.
(JAMA. 2007;297:2525-2526. Available pre-embargo to the media at www.jamamedia.org)
Editor's Note: Please see the article for additional information, including 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, June 12, 2007
Media Advisory: To contact Ioana Popescu, M.D., M.P.H., call Tom Moore at 319-356-3945.
BLACK PATIENTS LESS LIKELY TO RECEIVE CERTAIN CORONARY PROCEDURES FOLLOWING HEART ATTACK, AND HAVE HIGHER MORTALITY RATES 1 YEAR LATER
CHICAGO—A large study has found that black Medicare patients are less likely than white patients to receive blood vessel opening procedures such as angioplasty following a heart attack, whether they are admitted to hospitals that provide or do not provide these procedures, but also experience higher mortality rates at 1 year, according to a study in the June 13 issue of JAMA.
Racial differences in care after acute myocardial infarction (AMI - heart attack) appear most marked for the use of invasive and costly technologies, such as coronary revascularization (restoration of adequate blood supply to the heart, such as with a bypass or angioplasty procedure), although studies have documented similar benefits of post-heart attack coronary revascularization in white and nonwhite patients, according to background information in the article. Few studies have examined patterns of care for heart attack patients admitted to hospitals with and without revascularization services.
Ioana Popescu, M.D., M.P.H., of the VA Medical Center and the University of Iowa Carver College of Medicine, Iowa City, and colleagues assessed racial differences in patterns of care and risk of death for heart attack patients who were admitted to hospitals with and without revascularization services. The study included 1,215,924 black and white Medicare beneficiaries age 68 years and older, admitted for a heart attack between January 2000 and June 2005 to 4,627 U.S. hospitals with and without revascularization services.
The researchers found that black patients admitted to hospitals without revascularization services were less likely to be transferred to a hospital with revascularization services within two days (7.4 percent vs. 11.5 percent) and within 30 days (25.2 percent vs. 31.0 percent) of admission. The likelihood of transfer for black patients admitted to hospitals without revascularization was 22 percent lower compared with that of white patients.
Black patients admitted to hospitals with or without revascularization services were about 30 percent less likely to undergo revascularization than white patients (34.3 percent vs. 50.2 percent and 18.3 percent vs. 25.9 percent). In addition, even among patients who were transferred to hospitals with revascularization services, blacks remained 23 percent less likely to undergo revascularization after adjusting for other clinical factors that may influence the use of revascularization.
While the adjusted risk of death was 9 percent lower for blacks during the first 30 days after admission to hospitals with revascularization and 10 percent lower in hospitals without revascularization, risks were higher thereafter. Between 30 days and 1 year after their initial admission, blacks had a 12 to 26 percent higher adjusted risk of death. These differences were attenuated after further adjustment for whether patients received a revascularization procedure, but nonetheless remained statistically higher.
“… the current study provides evidence that racial differences in the use of revascularization after AMI are of similar magnitude for patients admitted to hospitals with and without full revascularization capability and persist even for patients transferred from hospitals without full invasive cardiac services to hospitals providing these services. These differences could be due to unmeasured clinical or socioeconomic factors, patient preferences, and unmeasured aspects of medical decision making but are unlikely to be related to differences in access to hospitals performing revascularization procedures. Although differences in revascularization may reflect overuse of procedures in white patients, the receipt of revascularization could also explain some of the differences in longer-term mortality in black patients and may represent a broader marker of differences in post-AMI care between black and white patients,” the authors write.
“Thus, as data on the benefits of revascularization in different patient subgroups continue to emerge, efforts to standardize post-AMI treatment with evidence-based protocols and aggressive risk-factor management are essential to eliminating racial differences in care for AMI and other coronary syndromes.”
(JAMA. 2007;2489-2495. 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, June 12, 2007
Media Advisory: To contact corresponding author David Korn, M.D., call Retha Sherrod at 202-828-0975.
PHYSICIAN-RESEARCHERS OFTEN LESS SUCCESSFUL IN OBTAINING NIH FUNDING
CHICAGO—Physician researchers with only an M.D. degree are less likely to receive NIH research grants than researchers with a Ph.D. degree or those with both M.D. and Ph.D. degrees, according to a study in the June 13 issue of JAMA.
“Declines in the number of physician-scientist applicants and recipients of National Institutes of Health (NIH) research and training awards in the 1970s generated concerns that physician clinical investigators would become an ‘endangered species’ if trends continued unaltered,” the authors write. There has been no comprehensive analysis over a long period of the outcomes for first-time investigators with an M.D. applying for research grants.
Howard B. Dickler, M.D., of the Association of American Medical Colleges, Washington, D.C., and colleagues assessed the annual number of first-time applicants with an M.D., a Ph.D., or both, and the likelihood of them applying and receiving an NIH research (R01) grant for clinical and non-clinical research, between 1964 and 2004.
The researchers found that the annual number of first-time physician (M.D. only) applicants was stable during the four decades studied. The average annual percentage of first-time applicants with an M.D. who were awarded grants was 28 percent, while that for applicants with a Ph.D. was 31 percent and for applicants with an M.D. and a Ph.D. was 34 percent. When those first-time applicants who had received funding for a first R01 grant applied for a second R01 grant, a lower percentage of applicants with an M.D. only received funding (average annual percentage of 70 percent) than applicants with a Ph.D. (average annual percentage of 73 percent) and applicants with a M.D. and a Ph.D. (average annual percentage of 78 percent).
An average of 67 percent of individuals with an M.D. who apply annually for a first R01 grant application pursue clinical research. The percentage is much lower for physicians who also have a Ph.D. (43 percent) and for investigators with a Ph.D. only (39 percent). The annual percentage of applications by individuals with an M.D. who are funded for their first R01 grant is on average lower for those who conduct clinical research than those who conduct nonclinical research (23 percent vs. 29 percent). When first-time applicants who had received their first R01 grant applied for a second R01 grant, the difference in obtaining funding between clinical and nonclinical research was again substantial.
“We agree with others that physician-scientists bring unique skills, experience, motivation, and perspective to biomedical research. They play an indispensable role, especially in designing and conducting the translational and clinical research by which scientific advancements are brought into medical practice,” the authors write. “For medical schools and teaching hospitals, the challenge is to create a more attractive and supportive academic culture that not only attracts and trains but also actively nurtures and sustains clinical and translational scientists.”
(JAMA. 2007;2496-2501. 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
BLACK PATIENTS APPROXIMATELY 30 PERCENT LESS LIKELY THAN WHITES TO RECEIVE TREATMENT SUCH AS ANGIOPLASTY AFTER HEART ATTACK
INTRO:
A new study of more than a million Medicare patients shows that for every ten white patients who receive appropriate, specialized treatments after a heart attack, only about seven black patients do. Mavis Prall explains in this week’s JAMA Report.
VIDEO:
B-ROLL
Ambulance at emergency room entrance
Cardiac surgery
Angioplasty
AUDIO:
RIGHT AFTER A HEART ATTACK, PATIENTS OFTEN NEED REVASCULARIZATION – THAT MEANS THEY NEED DOCTORS TO OPEN THEIR BLOCKED ARTERIES, EITHER THROUGH OPEN HEART SURGERY OR THROUGH A PROCEDURE CALLED ANGIOPLASTY. BUT NOT EVERY HEART ATTACK PATIENT IS RECEIVING THIS IMPORTANT, SPECIALIZED TREATMENT.
VIDEO:
SOT/FULL
@ :15
Super: Ioana Popescu, M.D., M.P.H.
University of Iowa
Runs :12
AUDIO:
“Black patients were consistently less likely to receive specialized heart treatments as compared to white patients, even after transfer to hospitals providing these treatments.”
VIDEO:
B-ROLL
Dr. Popescu and colleagues discussing data
GFX/JAMA COVER
AUDIO:
DR. IOANA (yo-AH-na) POPESCU (poe-PESS-coo) OF THE UNIVERSITY OF IOWA AND HER COLLEAGUES REVIEWED MEDICARE RECORDS OF MORE THAN A MILLION HEART ATTACK PATIENTS TREATED ACROSS THE U.S. BETWEEN 2000 AND 2005. THEIR FINDINGS APPEAR IN JAMA, JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION.
VIDEO:
SOT/FULL
Ioana Popescu, M.D., M.P.H.
University of Iowa
Runs :07
AUDIO:
“We were able to document significant and persistent differences in treatment for heart attack for black and white patients.”
VIDEO:
FULL SCREEN GRAPHIC Over shot of older black man/cardiac patient in hospital bed
Title: Treatment After Heart Attack
Blacks about 20% less likely to transferred to hospitals with specialized services
Blacks about 30% less like to get specialized services
B-roll
Nurse tending to older black man/cardiac patient in hospital bed
AUDIO:
COMPARED TO WHITE PATIENTS, BLACK PATIENTS WERE ABOUT TWENTY-PERCENT LESS LIKELY TO BE TRANSFERRED TO HOSPITALS THAT PROVIDE SPECIALIZED SERVICES, AND OVERALL THEY WERE ABOUT THIRTY-PERCENT LESS LIKELY TO GET THOSE SERVICES. THE RISK OF DEATH FOR BLACK PATIENTS WAS LOWER THAN FOR WHITE PATIENTS DURING THE FIRST THIRTY DAYS AFTER HOSPITAL ADMISSION, BUT WAS UP TO SEVENTEEN PERCENT HIGHER AT ONE YEAR.
VIDEO:
SOT/FULL
Ioana Popescu, M.D., M.P.H.
University of Iowa
Runs :04
AUDIO:
“We are truly uncertain of what causes these differences.”
VIDEO:
SOT/FULL
@ 1:11
Super: Kim Allen Williams, M.D.
University of Chicago Cardiologist
Runs :05
AUDIO:
“One concern is that the patients are being viewed differently by the physicians.”
VIDEO:
B-ROLL
Dr. Williams talking with another African American doctor
AUDIO:
DR. KIM ALLEN WILLIAMS IS A CHICAGO CARDIOLOGIST. HE SAYS DOCTOR BIAS IS A CONCERN, BUT SO ARE BLACK PEOPLE’S ATTITUDES THAT MAY KEEP THEM FROM ACCEPTING APPROPRIATE HEALTHCARE.
VIDEO:
SOT/FULL
Kim Allen Williams, M.D.
University of Chicago Cardiologist
Runs :11
AUDIO:
“Because there’s a distrust of the system, going back historically with good reason, and not realizing that things are different now and that these people are not out to hurt you.”
VIDEO:
B-ROLL
Dr. Popescu with patient in exam room through “both”
Nurse tending to older black man/cardiac patient in hospital bed
AUDIO:
DR. POPESCU SAYS HOPEFULLY THOSE ATTITUDES CAN CHANGE IF BOTH DOCTORS AND PATIENTS FOCUS ON QUALITY, AND THAT SHOULD HELP EQUALIZE CARE. THIS IS MAVIS PRALL WITH THE JAMA REPORT.
TAG:
Dr. Popescu says that all patients, regardless of race, should be as informed as possible about their treatment options and advocate for their own quality care. For more information, visit www.jama.com.
