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, September 23, 2008)
JAMA NEWS RELEASES
BLACK PATIENTS AT HIGHER RISK FOR COLON POLYPS
STUDY FINDS WIDE VARIABILITY IN SURVIVAL AFTER EMERGENCY TREATMENT FOR CARDIAC ARREST
GUIDELINES FOR TERMINATION-OF-RESUSCITATION OF OUT-OF-HOSPITAL CARDIAC ARREST HELP IDENTIFY PATIENTS WITH LITTLE CHANCE OF SURVIVAL
MEDICATIONS COMMONLY PRESCRIBED FOR COPD ASSOCIATED WITH INCREASED RISK OF CARDIOVASCULAR DEATH, HEART ATTACK OR STROKE
JAMA REPORT (VIDEO SCRIPT)
VIDEO: Windows Media | Quicktime
STUDY FINDS SIGNIFICANT DIFFERENCES IN CARDIAC ARREST INCIDENCE AND SURVIVAL RATES
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TV Note: This week's JAMA Report video is on cardiac arrest survival rates in different regions of North America. The report will be fed Tuesday, September 23, from 9:00 - 9:30 a.m. ET and 2:00 - 2:30 p.m. ET, on Galaxy 28 (C-Band), Transponder 19, downlink frequency: 4080 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, September 23, 2008
Media Advisory: To contact David A. Lieberman, M.D., call Mike McAleer at 503-808-1920. To contact editorial co-author Hemant K. Roy, M.D., call Jim Anthony at 847-570-6132.
BLACK PATIENTS AT HIGHER RISK FOR COLON POLYPS
CHICAGO—Compared with white patients, black patients undergoing screening colonoscopy have a higher prevalence of colon polyps, according to a study in the September 24 issue of JAMA.
Colorectal cancer incidence and death are higher in black patients compared with white patients. Death rates for black men and women are 38 percent to 43 percent higher than for white men and women, and incidence rates are 15.5 percent to 23 percent higher in black individuals, according to background information in the article. Since 1985, as incidence rates have declined in white individuals, rates in black men have increased and remained unchanged in black women. “Colorectal cancer screening might be less effective in black individuals, if there are racial differences in the age-adjusted prevalence and location of cancer precursor lesions,” the authors write.
David A. Lieberman, M.D., of Portland VA Medical Center, Portland, Ore., and colleagues measured the prevalence and location of colon polyps sized more than 9 mm in diameter in black (n = 5,464) and white (n = 80,061) patients who had undergone colonoscopy screening at 67 practice settings across the United States.
The researchers found that a total of 422 black patients (7.7 percent) and 4,964 white patients (6.2 percent) had 1 or more polyps sized more than 9 mm. These differences extended across all age groups in women and men. Compared with white patients, black men had a 16 percent increased odds of having polyps sized more than 9 mm; black women had a 62 percent increased odds.
There was an increased risk associated with age older than 50 years and also a significant increase in risk when patients age 60 to 69 years were compared with those age 50 to 59 years. In a subanalysis of patients older than 60 years, proximal (situated nearest to point of origin) polyps sized more than 9 mm were more likely prevalent in black men and women compared with white men and women.
“In summary, we find that asymptomatic black men and women undergoing colonoscopy screening are more likely to have 1 or more polyps sized more than 9 mm compared with white individuals. The differences were especially striking among women. These findings emphasize the importance of encouraging all black men and women to be screened,” the authors write.
(JAMA. 2008;300[12]:1417-1422. 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: COLORECTAL CANCER RISK—BLACK, WHITE, OR SHADES OF GRAY?
In an accompanying editorial, Hemant K. Roy, M.D., and Laura K. Bianchi, M.D., of Evanston Northwestern Healthcare, Evanston, Ill., comment on the findings of Lieberman and colleagues.
“...it is becoming clear that as physicians and patients enter the era of personalized medicine, colorectal cancer screening will evolve from simply dichotomizing patients into average or increased risk to assigning more precise gradations (‘shades of gray’). Through assessing both genetic and environmental risk factors, clinicians may be able to more rationally tailor screening strategies to maximize cost-effectiveness and risk benefit. While waiting for this field to mature, using the published guidelines with evidence-based judicious modifications (such as more aggressive screening of black patients) would seem to be prudent.”
(JAMA. 2008;300[12]:1459-1461. 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, September 23, 2008
Media Advisory: To contact Graham Nichol, M.D., M.P.H., call Clare Hagerty at 206-685-1323. To contact editorial co-author Arthur B. Sanders, M.D., call George Humphrey at 520-626-7301.
STUDY FINDS WIDE VARIABILITY IN SURVIVAL AFTER EMERGENCY TREATMENT FOR CARDIAC ARREST
CHICAGO—An analysis of emergency medical services–treated cardiac arrest outcomes in 10 areas in North America finds a five-fold difference in survival rates, according to a study in the September 24 issue of JAMA.
Approximately 166,000 to 310,000 Americans per year experience an out-of-hospital cardiac arrest (OHCA), although resuscitation is not attempted in many of these cases. “Accurate estimation of the burden of OHCA is essential to evaluate progress toward improving public health by reducing cardiovascular disease,” the authors write. “Knowledge of regional variation in outcomes after cardiac arrest could guide identification of effective interventions that are used in some communities but have not been implemented in others.”
Graham Nichol, M.D., M.P.H., of the University of Washington, Seattle, and colleagues conducted a study to determine whether cardiac arrest incidence and outcome differed across geographic regions. The study included data on all out-of-hospital cardiac arrests in 10 North American sites (8 U.S. and 2 Canadian) from May 2006 to April 30, 2007, followed up to hospital discharge, and including data available as of June 28, 2008. Cases were assessed by organized emergency medical services (EMS) personnel. The ten sites were participants in the Resuscitation Outcomes Consortium, and were located in: Alabama; Dallas; Iowa; Milwaukee; Ottawa, Ontario; Pittsburgh; Portland, Ore.; Seattle; Toronto; and Vancouver, British Columbia.
Among the 10 sites, with a total population of 21.4 million for the areas studied, there were 20,520 cardiac arrests assessed by EMS personnel. Resuscitation was attempted in 11,898 cases (58.0 percent of total); 2,729 (22.9 percent of treated) had initial rhythm of ventricular fibrillation or ventricular tachycardia (unstable, rapid heart rhythm) or rhythms that were shockable by an automated external defibrillator; and 954 (4.6 percent) were discharged alive. The incidence of EMS-treated cardiac arrest per 100,000 population ranged from 40.3 to 86.7; for ventricular fibrillation, the incidence per 100,000 population ranged from 9.3 to 19.0. The EMS-treated cardiac arrest survival across sites ranged from 3.0 percent to 16.3 percent; ventricular fibrillation survival ranged from 7.7 percent to 39.9 percent, with significant differences across sites for incidence and survival.
“These findings have implications for prehospital emergency care. The 5-fold variation in survival after EMS-treated cardiac arrest and 5-fold variation in survival after ventricular fibrillation demonstrate that cardiac arrest is a treatable condition,” the authors write.
“Out-of-hospital cardiac arrest is a common and lethal event. There are significant and important regional variations in the incidence and outcome of cardiac arrest. Additional investigation is necessary to understand the causes of this variation in an effort to better understand implications for allocation of resources to prehospital emergency care clinical practice and translational cardiac arrest research to reduce the magnitude of this variation and improve cardiovascular health.”
(JAMA. 2008;300[12]:1423-1431. 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: SURVIVING CARDIAC ARREST—LOCATION, LOCATION, LOCATION
“...it is time to recognize the importance of EMS systems to the health of a community,” writes Arthur B. Sanders, M.D., and Karl B. Kern, M.D., of the University of Arizona, Tucson, in an accompanying editorial in this week’s JAMA.
“Physicians and the public should demand data on survival from cardiac arrest from every community. Publications and organizations should use these survival data when rating cities for livability and health indices, and businesses and individuals should take these public health data into account when deciding whether to relocate or expand to a new city. It is time to work to overcome barriers in each community, devote appropriate resources, and optimize survival of all patients so that location by city becomes a minor factor in survival of cardiac arrest.”
(JAMA. 2008;300[12]:1462-1463. 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, September 23, 2008
Media Advisory: To contact Comilla Sasson, M.D., M.S., call Kara Gavin at 734-764-2220.
GUIDELINES FOR TERMINATION-OF-RESUSCITATION OF OUT-OF-HOSPITAL CARDIAC ARREST HELP IDENTIFY PATIENTS WITH LITTLE CHANCE OF SURVIVAL
CHICAGO—Researchers have validated criteria that are used to identify patients with out-of-hospital cardiac arrest who have little or no chance of survival after resuscitation, according to a study in the September 24 issue of JAMA.
“During the past 30 years, several research teams have sought to define objective clinical criteria to identify patients who likely will not benefit from rapid transport to the hospital for further resuscitative efforts. Despite this research, many emergency medical services (EMS) systems still urgently transport patients with refractory [not responding to treatment] cardiac arrest to the hospital for continued resuscitative efforts. Rapid transport with lights and siren may pose hazards for EMS personnel and the public and should occur only when the risks of high-speed transport are justified by the potential benefits to the patient,” the authors write.
Comilla Sasson, M.D., M.S., of the University of Michigan, Ann Arbor, and colleagues conducted a study to validate two out-of-hospital termination-of-resuscitation rules developed by the Ontario Prehospital Life Support (OPALS) study group, one rule for use by responders providing basic life support (BLS) and the other rule for those providing advanced life support (ALS). The researchers analyzed surveillance data submitted by emergency medical systems and hospitals in 8 U.S. cities that were part of the Cardiac Arrest Registry to Enhance Survival (CARES). The study included 5,505 adults with out-of-hospital cardiac arrest.
The BLS rules include: event not witnessed by emergency medical services personnel; no automated external defibrillator used or manual shock applied in out-of-hospital setting; and no return of spontaneous circulation in out-of-hospital setting. The ALS rules include the BLS rules plus: arrest not witnessed by bystander; and no bystander-administered cardio-pulmonary resuscitation.
The researchers found that the overall rate of survival to hospital discharge was 7.1 percent (n = 392). Of 2,592 patients (47.1 percent) who met BLS criteria for termination of resuscitation efforts, only 5 (0.2 percent) patients survived to hospital discharge. Of 1,192 patients (21.7 percent) who met ALS criteria, none survived to hospital discharge. The BLS rule had a positive predictive value of 0.998 for predicting lack of survival; the ALS rule had a positive predictive value of 1.000 for predicting lack of survival.
“Widespread implementation of either rule could materially reduce the risk posed to EMS personnel during high-speed transports, decrease pressure on overburdened EMS systems, allow emergency department staff to focus on patients who have greater odds of survival, and decrease admissions to the intensive care unit of patients with out-of-hospital cardiac arrest who have little or no chance of surviving to discharge,” the authors write.
(JAMA. 2008;300[12]:1432-1438. 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, September 23, 2008
Media Advisory: To contact Sonal Singh, M.D., M.P.H., call Jessica Guenzel at 336-716-3487.
MEDICATIONS COMMONLY PRESCRIBED FOR COPD ASSOCIATED WITH INCREASED RISK OF CARDIOVASCULAR DEATH, HEART ATTACK OR STROKE
CHICAGO—The use of inhaled anticholinergic agents (medications that help reduce bronchospasm) by patients with chronic obstructive pulmonary disease (COPD) is associated with a significantly increased risk of heart attack, stroke of cardiovascular death, according to a meta-analysis of randomized trials published in the September 24 issue of JAMA.
COPD is the fourth leading cause of chronic illness and death in the United States, and is projected to rank fifth in 2020 in burden of disease worldwide. Inhaled anticholinergic agents (including ipratropium bromide or tiotropium bromide) are widely used in patients with COPD, but their effect on the risk of cardiovascular outcomes is unknown, according to background information in the article. Inhaled tiotropium is the most widely prescribed medication for COPD, with more than 8 million patients worldwide having used it since its approval in 2002.
Sonal Singh, M.D., M.P.H., of Wake Forest University School of Medicine, Winston-Salem, N.C., and colleagues conducted a meta-analysis to determine cardiovascular risks (myocardial infarction [MI; heart attack], stroke, and cardiovascular death) associated with the long-term use of inhaled anticholinergics. After identifying and a detailed screening of 103 articles, 17 randomized trials enrolling 14,783 patients were analyzed. Follow-up duration ranged from 6 weeks to 5 years.
The analysis indicated that inhaled anticholinergics significantly increased the risk, by 58 percent, of cardiovascular death, heart attack, or stroke (1.8 percent vs. 1.2 percent for controls). Among individual components of the primary outcome, inhaled anticholinergics significantly increased the risk of heart attack by 53 percent (1.2 percent vs. 0.8 percent for controls) and also significantly increased (by 80 percent) the risk of cardiovascular death (0.9 percent vs. 0.5 percent for controls).
All-cause death was reported in 149 of the patients treated with inhaled anticholinergics (2.0 percent) and 115 of the control patients (1.6 percent). A sensitivity analysis restricted to 5 long-term trials (greater than 6 months) confirmed the significantly increased risk (73 percent) of cardiovascular death, heart attack, or stroke (2.9 percent of patients treated with anticholinergics vs. 1.8 percent of the control patients).
“Chronic obstructive pulmonary disease is an independent risk factor for cardiovascular hospitalization and cardiovascular death. Cardiovascular death is a more frequent cause of death in patients with COPD than respiratory causes, with the proportion of cardiovascular deaths increasing with the severity of the disease,” the authors write.
“Clinicians need to closely monitor patients with COPD who are taking long-term anticholinergics for the development of cardiovascular events. Clinicians and patients should carefully consider these potential long-term cardiovascular risks of inhaled anticholinergics in the treatment of COPD, and decide whether these risks are an acceptable trade-off in return for their symptomatic benefits.”
(JAMA. 2008;300[12]:1439-1450. 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
STUDY FINDS SIGNIFICANT DIFFERENCES IN CARDIAC ARREST INCIDENCE AND SURVIVAL RATES
INTRO:
Cardiovascular disease is a leading cause of death in the United States. A recent study finds when it comes to cardiac arrest incidence and survival rates vary greatly. Depending on where you live, you may be less likely to survive. Jennifer Mitchell explains in this week's JAMA Report.
VIDEO:
B-ROLL
Ambulance on street
Flashing lights
Opening door to ambulance
AUDIO:
CARDIAC ARREST OCCURS SUDDENLY AND OFTEN THERE ARE NO WARNING SIGNS. NOW A NEW STUDY FINDS DEPENDING ON WHERE YOU LIVE YOU MAY BE LESS LIKELY TO SURVIVE.
VIDEO:
SOT/FULL
Graham Nichol, M.D., M.P.H.
University of Washington
Runs: 05
AUDIO:
“Cardiac arrest is the loss of mechanical activity of the heart.”
VIDEO:
B-ROLL
Doctor at work
Map of US and Canada:
Highlight following areas in RED:
Alabama, Dallas, TX, Iowa Milwaukee, WI
Ottawa,Ontario,Canada
Pittsburgh, Pennsylvania
Portland, OR
Seattle, Washington
Toronto, Ontario, Canada
Vancouver, British Columbia, Canada
Video of ambulances
AUDIO:
DOCTOR GRAHAM NICHOL IS A PROFESSOR OF MEDICINE AT THE UNIVERSITY OF WASHINGTON. HE AND HIS COLLEAGUES ANALYZED DATA FROM MORE THAN TWENTY THOUSAND CASES OF OUT-OF-HOSPITAL CARDIAC ARREST ACROSS THESE TEN REGIONAL AREAS IN NORTH AMERICA. THEY FOUND JUST MORE THAN HALF OF PATIENTS HAD RESUSCITATION ATTEMPTED AND LESS THAN ONE THOUSAND WERE DISCHARGED ALIVE. SURVIVAL RATES VARIED DEPENDING ON WHERE A PATIENT LIVED.
VIDEO:
SOT/FULL
Super @ :44
Graham Nichol, M.D., M.P.H.
University of Washington
Runs: 11
AUDIO:
“Someone in one community is two hundred percent more likely to have cardiac arrest and five hundred percent more likely to die when they have cardiac arrest.”
VIDEO:
B-ROLL
Tight ambulance/lights
People walking in city
Paramedics
AUDIO:
SUCH LARGE DISCREPANCIES APPEAR TO BE ASSOCIATED WITH DIFFERENCES NOT ONLY IN A PATIENT’S OWN RISK FOR CARDIAC ARREST BUT ALSO DIFFERENCES IN THE LOCAL APPROACH TO EMERGENCY RESPONSE.
VIDEO:
SOT/FULL
Graham Nichol, M.D., M.P.H.
University of Washington
Runs: 12
AUDIO:
“Some communities may need to train more of the public to recognize and respond to medical emergencies other communities may need to focus on improving their local organized emergency response.”
VIDEO:
B-ROLL
GXF/JAMA COVER
AUDIO:
THE STUDY APPEARS THIS WEEK IN JAMA, JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION.
VIDEO:
SOT/FULL
Graham Nichol, M.D., M.P.H.
University of Washington
Runs: 09
AUDIO:
“We think it is important that cardiac arrest be reported to public health groups so that every community knows how often cardiac arrest occurs and what the local rate of success is.”
VIDEO:
B-ROLL
People on street
Ambulance pulls into hospital
Paramedics at work
AUDIO:
RESEARCHERS FOUND THAT ONLY ABOUT A QUARTER OF PATIENTS IN THE STUDY RECEIVED C-P-R FROM A BYSTANDER. THEY SAY PART OF THE REASON IS BECAUSE CARDIAC ARREST OFTEN OCCURS IN THE HOME WITH NOBODY AROUND BUT ALSO BECAUSE SOME PEOPLE ARE STILL NOT TRAINED IN C-P-R. JENNIFER MITCHELL THE JAMA REPORT.
TAG:
Researchers say in order to improve public health additional funding for research related to emergency cardiovascular care is needed. They believe if survival rates after out-of-hospital cardiac arrest could be improved, thousands of premature deaths could be prevented each year. For more information about this study you can log on to www.jama.com.
