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, October 2, 2007)
JAMA NEWS RELEASES
WOMEN LESS LIKELY THAN MEN TO RECEIVE IMPLANTABLE CARDIOVERTER-DEFIBRILLATORS FOR PREVENTION OF SUDDEN CARDIAC DEATH
USING ADDITIONAL BIOPSY SCORING DATA MAY HELP DETERMINE PROSTATE CANCER PROGNOSIS
ACE INHIBITOR MAY HELP IMPROVE AORTIC STIFFNESS AND DILATION ASSOCIATED WITH CARDIAC COMPLICATIONS FROM MARFAN SYNDROME
JAMA REPORT (VIDEO SCRIPT)
VIDEO: Windows Media | Quicktime
MEN UP TO THREE TIMES MORE LIKELY THAN WOMEN TO RECEIVE LIFE-SAVING IMPLANTABLE DEFIBRILLATORS
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 sex differences in the use of implantable cardioverter-defibrillators for the prevention of sudden cardiac death. The report will be fed Tuesday, October 2, 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 14, downlink frequency: 3880 vertical, audio 6.2/6.8. For more information, call 312/464-JAMA.
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Embargoed for Release: 3:00 p.m. CT, Tuesday, October 2, 2007
Media Advisory: To contact Lesley H. Curtis, Ph.D., or Adrian F. Hernandez, M.D., M.H.S., call Michelle Gailiun at 919-660-1306. To contact editorial author Rita F. Redberg, M.D., M.Sc., call Kristen Bole at 415-476-2743.
WOMEN LESS LIKELY THAN MEN TO RECEIVE IMPLANTABLE CARDIOVERTER-DEFIBRILLATORS FOR PREVENTION OF SUDDEN CARDIAC DEATH
CHICAGO—Among Medicare patients, men are about 2-3 times more likely than women to receive an implantable cardioverter-defibrillator for the prevention of sudden cardiac death, according to a study in the October 3 issue of JAMA.
Sudden cardiac death is a leading cause of death in the United States. Overall, the risk of sudden cardiac death increases with age and is higher in men than in women, although the sex difference narrows and eventually disappears after age 85 years, according to background information in the article. Research has shown the effectiveness of implantable cardioverter-defibrillators (ICDs) in preventing sudden cardiac death, and Medicare coverage of ICDs has expanded, but many eligible patients still do not receive them.
Lesley H. Curtis, Ph.D., of Duke University School of Medicine, Durham, N.C., and colleagues examined the differences between men and women in the receipt of ICDs for the primary and secondary prevention of sudden cardiac death. Data for the study came from a five percent national sample of files from the U.S. Centers for Medicare & Medicaid Services for the period 1991 through 2005. Patients in the study were age 65 years or older with Medicare fee-for-service coverage and diagnosed with a heart attack and either heart failure or cardiomyopathy (a disorder of the heart muscle), the primary prevention cohort: 136,421 patients; n = 65,917 men and 70,504 women; or with cardiac arrest or ventricular tachycardia (a cardiac arrhythmia), the secondary prevention cohort: 99,663 patients; n = 52,252 men and 47,411 women, from 1999 through 2005.
In the 2005 primary prevention group, 32.3 per 1,000 men and 8.6 per 1,000 women received ICD therapy within 1 year of entering the study. Men in this group were about 3.2 times more likely than women to receive an ICD. Among men and women alive at 180 days after group entry, the risk of death in the subsequent year was not significantly lower among those who received ICD therapy.
In the 2005 secondary prevention group, 102.2 per 1,000 men and 38.4 per 1,000 women received ICD therapy. After controlling for various factors, men in this group were about 2.4 times more likely than women to receive ICD therapy. Among men and women alive at 30 days after entry in this group, the risk of death in the subsequent year was 35 percent lower among patients who received ICD therapy.
"In this longitudinal analysis of Medicare beneficiaries at high risk for sudden cardiac death, we found significant sex differences in the use of ICD therapy from 1999 through 2005. Our findings in this cohort of elderly patients differ from an earlier study that suggested a narrowing of the gap between men and women, and they highlight the need for an improved understanding of sex differences in patterns of care," the authors conclude.
(JAMA. 2007;298(13):1517-1524. 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.
MANY ELIGIBLE HEART FAILURE PATIENTS DO NOT RECEIVE ICDS; RATES OF USE LOWER AMONG WOMEN, BLACK PATIENTS
Fewer than 40 percent of potentially eligible patients hospitalized for heart failure receive ICDs, and women and black patients are significantly less likely than white men to receive an ICD, according to a study in this issue of JAMA.
Half of all deaths from heart failure are sudden events thought to be attributable primarily to lethal arrhythmias, according to background information in the article. Studies have shown that ICDs reduce the risk of death for certain heart failure patients. The influence of sex and race on ICD use among eligible patients is unknown.
Adrian F. Hernandez, M.D., M.H.S., of Duke University School of Medicine, Durham, N.C., and colleagues examined the overall use of ICD therapy in patients with heart failure who were at risk for sudden cardiac death. The analysis included 13,034 patients admitted with heart failure and left ventricular ejection fraction of 30 percent or less (a measure of how well the left ventricle of the heart pumps with each contraction). Patients were treated between January 2005 and June 2007 at 217 hospitals participating in a quality improvement program.
Among patients eligible for ICD therapy, 4,615 (35.4 percent) had ICD therapy at discharge. ICDs were used in 375 of 1,329 eligible black women (28.2 percent), 754 of 2,531 white women (29.8 percent), 660 of 1,977 black men (33.4 percent), and 2,356 of 5,403 white men (43.6 percent). After adjustment for patient characteristics and hospital factors, compared with white men, the odds of ICD use were: 27 percent lower for black men; 38 percent lower for white women; and 44 percent lower for black women.
"There are several potential factors that may explain the disparities observed in this study. System inequities may exist in the identification of eligible patients and delivery of ICD therapy. Physicians may consider certain subgroups more prominently due to a large number of white men in clinical trials. Patients may also differ in preferences for ICD therapy across sex and race subgroups …" the authors write.
"Further research is needed to understand the reasons for the disparities at the patient, physician, and hospital levels. Programs for awareness and promotion of evidence-based use of medical devices in heart failure are needed overall and for the important subgroups studied here. Publicly reported measures regarding ICD therapy should be considered."
(JAMA. 2007;298(13):1525-1532. 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: DISPARITIES IN USE OF IMPLANTABLE CARDIOVERTER-DEFIBRILLATORS
In an accompanying editorial, Rita F. Redberg, M.D., M.Sc., of the University of California-San Francisco Division of Cardiology, comments on studies regarding the use of ICDs.
"...the multibillion-dollar question is: Are too few ICDs for primary prevention being implanted in women (and minorities) or are too many ICDs being implanted in (white) men? The important clinical and policy question may be not why women and black Medicare beneficiaries are less likely to get an ICD, but which Medicare beneficiaries will benefit from ICD at all? To answer this question, studies must look beyond reporting only process measures, such as implantation rates, and must include clinical outcomes, such as survival and quality of life after ICD implantation for primary and secondary prevention. By reporting the first outcomes data for ICD in the Medicare population, the study by Curtis et al should stimulate national dialogue on this crucial question."
"Thus, in addition to their findings regarding disparities in ICD use, the studies by Curtis et al and Hernandez et al raise, perhaps inadvertently, a more serious concern. Their reports are important, but only first steps in understanding how to optimize delivery of cardiovascular health care in the United States. Their work highlights the importance of outcomes data for new therapies such as ICDs, reported according to sex and race/ethnicity subgroups, to determine if all patients are benefiting from health care advances."
(JAMA. 2007;298(13):1564-1566. 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, October 2, 2007
Media Advisory: To contact Abhijit A. Patel, M.D., Ph.D., call Lori Shanks at 617-534-1604.
USING ADDITIONAL BIOPSY SCORING DATA MAY HELP DETERMINE PROSTATE CANCER PROGNOSIS
CHICAGO—Men with certain scores and patterns based on prostate cancer biopsy were found to be at higher risk of PSA-failure, suggesting that this measurement could help predict the risk of prostate cancer recurrence, according to preliminary research published in the October 3 issue of JAMA.
One of the tools used for the diagnosis and treatment of prostate cancer is the Gleason scoring system, which grades adenocarcinomas (malignant tumors) of the prostate based on the patterns of prostatic glands. Many studies have confirmed the prognostic significance of the Gleason score with respect to time to recurrence and death following therapy, according to background information in the article. The Gleason scoring system assigns a grade of 1 to 5 (higher grade being less differentiated) to the predominant pattern and to the second most prevalent pattern in the prostate specimen. The two grades are summed to arrive at a final score between 2 and 10. Although the Gleason scoring system does not incorporate a third pattern, the presence of more than two Gleason patterns in an individual tumor is widely recognized to occur and many pathologists use a tertiary (third) pattern.
Abhijit A. Patel, M.D., Ph.D., of Brigham and Women’s Hospital and the Dana Farber Cancer Institute, Boston, and colleagues conducted a study to compare the prognostic significance of Gleason score 7 with tertiary grade 5 vs. other Gleason scores with respect to time to prostate-specific antigen (PSA) failure (an increase in the blood level of PSA after prostate cancer treatment with surgery or radiation). From 1989 to 2005, 2,370 men with various tumor grades and prostate cancer that had not spread to nearby lymph nodes or elsewhere in the body, underwent therapy with surgery or radiation therapy with or without hormonal therapy. Gleason scores were assigned to the prostate needle biopsy specimens.
The researchers found that men with Gleason score 7 and tertiary grade 5 disease had a significantly shorter time to PSA failure than men with 7 without tertiary grade 5 (median [midpoint] time, 5.0 vs. 6.7 years, respectively); or score of 6 or less (median time, 15.4 years). However, a significant difference was not observed when these men were compared with men with Gleason score 8 to10 disease (median time, 5.1 years).
"If these findings are validated by additional studies in other populations, they may affect the management of care for men with Gleason score 7 prostate cancer for which the currently practiced management standards include dose-escalated radiation therapy including prostate brachytherapy [radiation therapy where the radioactive source is placed inside the prostate] with or without supplemental radiation therapy, radiation therapy and short course androgen suppression therapy (AST) or radical prostatectomy. Specifically, given the time to recurrence, management options for men with Gleason score 7 who also have tertiary grade 5 disease could include treatments that are the current standards of care for men with Gleason 8 to 10 prostate cancer," the authors write.
"These standards of care based on the results of randomized trials include radiation therapy and short- or extended-course AST or radical prostatectomy with the expectation that further therapy may be needed postoperatively depending on the final pathology findings of the radical prostatectomy and postoperative PSA level."
(JAMA. 2007;298(13):1533-1538. 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, October 2, 2007
Media Advisory: To contact corresponding author Bronwyn A. Kingwell, Ph.D., email: bronwyn.kingwell{at}baker.edu.au.
ACE INHIBITOR MAY HELP IMPROVE AORTIC STIFFNESS AND DILATION ASSOCIATED WITH CARDIAC COMPLICATIONS FROM MARFAN SYNDROME
CHICAGO—Preliminary research suggests that use of the ACE inhibitor perindopril, along with a beta-blocker, may help reduce cardiac measures such as aortic stiffness and dilation that are associated with the cardiac complications of Marfan syndrome, according to an article in the October 3 issue of JAMA.
Marfan syndrome (MFS) is a hereditary disorder principally affecting the connective tissues of the body, often characterized by excessive bone elongation and joint flexibility and abnormalities of the eye and cardiovascular system. Progressive aortic dilation and rupture are the most serious complications and the most common cause of premature death. Beta-blockers are currently the standard treatment for MFS, but may not be as effective as other therapies in treating aortic wall degeneration, according to background information in the article. Angiotensin-converting enzyme (ACE) inhibitors have been shown to reduce arterial stiffness.
Anna A. Ahimastos, Ph.D., of the Baker Heart Research Institute, Melbourne, Australia, and colleagues conducted a study to examine the effectiveness of the ACE inhibitor perindopril to reduce arterial stiffness and aortic dilation relative to placebo in 17 adult patients with MFS taking standard beta-blocker therapy. The randomized trial began in January 2004 and was completed in September 2006. Patients were administered 8 mg/day of perindopril (n = 10) or placebo (n = 7) for 24 weeks.
"The major novel finding of our study was that perindopril therapy for 24 weeks reduced aortic diameters relative to placebo in both systole [the contraction of the chambers of the heart] and diastole [the expanding of the chambers of the heart] in patients with MFS taking standard beta-blocker therapy. In systole, perindopril reduced the progression of aortic dilatation observed in the placebo group. However, in diastole, perindopril actually reduced aortic diameters below baseline levels by an average of between 1.2 and 3.0 mm/m2," the authors write.
"In conclusion, therapy with perindopril reduced both aortic stiffness and aortic root diameter in patients with MFS taking standard beta-blocker therapy. These findings warrant further investigation in a larger, longer-term clinical trial."
(JAMA. 2007;298(13):1539-1547. 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
MEN UP TO THREE TIMES MORE LIKELY THAN WOMEN TO RECEIVE LIFE-SAVING IMPLANTABLE DEFIBRILLATORS
INTRO:
It’s hard to believe that gender is still an issue in today’s society, but a new study says that men are far more likely than women to receive a particular life-saving medical device. Mavis Prall explains in this week’s JAMA Report.
VIDEO:
B-ROLL
Close up of hand holding defibrillator (no brand showing)
Close-up of chest/skin
Bulge in bare chest where defibrillator is implanted
Elderly white man being examined by Dr. Hernandez
AUDIO:
THIS IS AN IMPLANTABLE CARDIOVERTER-DEFIBRILLATOR, OR ICD. DOCTORS IMPLANT IT UNDER THE SKIN IN PEOPLE WHO HAVE A HISTORY OF HEART PROBLEMS. IT SENDS ELECTRIC SHOCKS TO THE HEART IF IT STARTS BEATING IRREGULARLY, AND CAN PREVENT SUDDEN DEATH. BUT LISTEN TO THIS:
VIDEO:
SOT/FULL
@ :16
Super: Lesley Curtis, Ph.D.
Duke University School of Medicine
Runs :12
AUDIO:
“What we found was that men were two to three times more likely than women to receive an ICD. That’s not a small, subtle difference, that’s a large effect, and that was surprising.”
VIDEO:
B-ROLL
Dr. Curtis and Dr. Hernandez walking down hospital hallway
AUDIO:
DR. LESLEY CURTIS AND COLLEAGUES AT DUKE UNIVERSITY SCHOOL OF MEDICINE REVIEWED ABOUT SEVEN YEARS OF DATA ON MORE THAN TWO-HUNDRED THOUSAND MEDICARE PATIENTS.
VIDEO:
SOT/FULL
Lesley Curtis, Ph.D.
Duke University School of Medicine
Runs :08
AUDIO:
“One group was at risk because they had had a prior cardiac arrest and survived. The other group was at risk because they’d had a prior heart attack and survived.”
VIDEO:
B-ROLL
Elderly white man having ICD checked
Cuts to black female doctor at “black women”
More exam of white man
GFX/JAMA COVER
AUDIO:
THEY FOUND THAT WHITE MEN WERE MOST LIKELY TO RECEIVE ICDS, AND BLACK WOMEN WERE LEAST LIKELY, EVEN WHEN BOTH HAD THE SAME RISK FACTORS FOR SUDDEN CARDIAC DEATH. THEIR FINDINGS APPEAR IN JAMA, JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION.
VIDEO:
SOT/FULL
Lesley Curtis, Ph.D.
Duke University School of Medicine
Runs :09
AUDIO:
“Clearly we need to do a lot more work to understand why this gap exists and then do even more work to close the gap.”
VIDEO:
B-ROLL
Dr. Hernandez talking with white male patient
Older white woman having blood pressure checked
AUDIO:
STUDY CO-AUTHOR AND CARDIOLOGIST DR. ADRIAN HERNANDEZ SAYS THE GAP COULD BE BECAUSE DOCTORS FOCUS ON MEN WHEN IT COMES TO HEART PROBLEMS. HE SAYS WOMEN NEED TO ADVOCATE FOR THEIR OWN HEALTH.
VIDEO:
SOT/FULL
@ 1:15
Super: Adrian Hernandez, M.D., M.H.S.
Duke University School of Medicine
Runs :15
AUDIO:
“We need to do a better job to make sure that women understand heart disease does occur in women, it’s important and that specifically sudden cardiac death is important, and defibrillators are therapy for preventing sudden cardiac death.”
VIDEO:
B-ROLL
Dr. Hernandez examining/talking with Mary Lee
AUDIO:
MARY LEE FARLEY HAS AN ICD. SHE JUST LEARNED OF THE STUDY FINDINGS.
VIDEO:
SOT/FULL
@ 1:33
Super: Mary Lee Farley
Has ICD
Runs :05
AUDIO:
“It shouldn’t be like that. Women go through the same thing men go through.”
VIDEO:
B-ROLL
More Dr. Hernandez examining Mary Lee
AUDIO:
SHE SAYS THE FINDINGS MAKE HER FEEL LUCKY TO HAVE HER ICD.
VIDEO:
SOT/FULL
Mary Lee Farley
Has ICD
Runs :08
AUDIO:
“I am lucky, very lucky. If a black woman’s at the end and white men is at the top, ya, I’m lucky.”
VIDEO:
B-ROLL
More Dr. Hernandez examining Mary Lee
AUDIO:
BE SHE SHOULDN’T HAVE TO BE LUCKY TO GET LIFE-SAVING THERAPY. THIS IS MAVIS PRALL WITH THE JAMA REPORT.
TAG:
The study authors say the findings are particularly surprising because Medicare recently expanded eligibility criteria for receiving an ICD, which means it should be easier for more people, including women, of course, to receive this important therapy. For more information, visit www.jama.com.
