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 14, 2008)
JAMA NEWS RELEASES
MOST PATIENTS DO NOT UNDERGO RECOMMENDED TEST TO CONFIRM NEED FOR ELECTIVE ANGIOPLASTY
VITAMIN B SUPPLEMENTATION DID NOT SLOW COGNITIVE DECLINE IN PATIENTS WITH ALZHEIMER DISEASE
LESSENING MEDICATION FOR PREVENTION OF ATRIAL FIBRILLATION DOES NOT REDUCE SIDE EFFECTS, APPEARS TO WORSEN OUTCOMES
JAMA REPORT (VIDEO SCRIPT)
VIDEO: Windows Media | Quicktime
STUDY FINDS HIGH-DOSE INTAKE OF THREE B VITAMINS DOES NOT SLOW PROGRESSION OF ALZHEIMER DISEASE
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 effect of B vitamin supplementation on slowing cognitive decline in patients with Alzheimer disease. The report will be fed Tuesday, October 14, 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, October 14, 2008
Media Advisory: To contact corresponding author Rita F. Redberg, M.D., M.Sc., call Lauren Hammit at 415-502-9553. To contact editorial co-author George A. Diamond, M.D., call Simi Singer at 310-423-7798.
MOST PATIENTS DO NOT UNDERGO RECOMMENDED TEST TO CONFIRM NEED FOR ELECTIVE ANGIOPLASTY
CHICAGO—A majority of Medicare patients with stable coronary artery disease who underwent an elective percutaneous coronary intervention (PCI; procedure such as angioplasty or stenting to open narrowed coronary arteries) did not have a recommended stress test performed to confirm the necessity of the procedure, according to a study in the October 15 issue of JAMA.
In the United States, PCI has become a common treatment strategy for patients with stable coronary artery disease (CAD), and its use has increased substantially over the past decade. "However, multiple studies have established that some important outcomes for patients with stable CAD (death and risk of future myocardial infarction [heart attack]) do not differ between patients treated with PCI plus optimal medical therapy and patients treated with optimal medical therapy alone," the authors write. Several professional organizations have jointly published guidelines for PCI, which call for documenting ischemia (inadequate blood supply to an area of the heart) in patients with stable coronary artery disease prior to elective PCI. Previous studies have shown that patients who receive PCI in accordance with these guidelines have better outcomes.
Grace A. Lin, M.D., M.A.S., of the University of California, San Francisco, and colleagues conducted a study of Medicare beneficiaries undergoing elective PCI to determine the frequency with which stress testing (which documents ischemia) was performed prior to PCI. The researchers analyzed claims data from a 20 percent random sample of 2004 Medicare fee-for-service beneficiaries age 65 years or older who had an elective PCI (n = 23,887).
The researchers found that of this study group, 44.5 percent (n = 10,629) of patients underwent stress testing within the 90 days prior to elective PCI. There was significant geographic variation in the rate of stress testing by hospital referral region, with rates ranging from a low of 22.1 percent to a high of 70.6 percent. The rate of stress testing did not correlate with the volume of PCI procedures performed in the hospital referral region. Patients who had a prior cardiac catheterization (the passing of a thin flexible tube into the right or left side of the heart to obtain diagnostic information or to provide treatment) were less likely to undergo stress testing prior to elective PCI.
Female sex, age of 85 years or older, and having co-existing illnesses such as rheumatic disease, chronic obstructive pulmonary disease, congestive heart failure, and CAD were associated with decreased likelihood of stress testing prior to PCI. Conversely, patient characteristics associated with an increased likelihood of a stress test prior to PCI were black race and having a history of chest pain. Patients of physicians who performed a higher volume of PCI procedures had slightly lower rates of stress testing. No hospital characteristics were associated with receipt of stress testing.
"Guidelines for PCI call for documenting ischemia prior to PCI in the vast majority of patients with stable CAD; however, our data suggest that this is not being done consistently. Assessing whether PCI is being performed in appropriately selected patients is crucial to providing high-quality, patient-centered medical care in light of evidence that patients in regions providing high-intensity care do not have better (and sometimes have worse) outcomes than those in regions providing low-intensity care," the authors write.
"In addition, because Medicare spends $10,000 to $15,000 per PCI and PCI has accounted for at least 10 percent of the increase in Medicare spending since the mid-1990s, it is important to document that patients are receiving PCI for appropriate indications to ensure the optimal use of Medicare resources. Our findings highlight an opportunity for improvement in the care of patients with stable CAD and suggest that current proposals to restructure Medicare payment to reward hospitals and physicians who adhere to guidelines would improve the safety and delivery of health care to Medicare beneficiaries while decreasing Medicare expenditures on costly and inappropriate procedures."
(JAMA. 2008;300[15]:1765-1773. 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: THE DISCONNECT BETWEEN PRACTICE GUIDELINES AND CLINICAL PRACTICE—STRESSED OUT
In an accompanying editorial, George A. Diamond, M.D., and Sanjay Kaul, M.D., of Cedars-Sinai Medical Center and University of California, Los Angeles, write that properly designed economic incentives might balance competing influences regarding the use of PCI.
"The Centers for Medicare & Medicaid Services, for example, might set reimbursement for evidence-based care at a higher level than for non–evidence-based care. Thus, a cardiologist performing PCI for a patient with objective evidence of ischemia despite an appropriate intensity of medical therapy would be paid more than for the same patient without such evidence. Unlike ‘pay-for-performance'these evidence-based reimbursement incentives target individual physician decisions rather than aggregate patient outcomes, are based on empirical data rather than consensus opinion, and are relatively large in size and immediate in effect."
(JAMA. 2008;300[15]:1817-1818. 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 14, 2008
Media Advisory: To contact Paul S. Aisen, M.D., call Debra Kain at 619-543-6163. To contact editorial co-author Robert J. Clarke, M.D., F.R.C.P., email: robert.clarke{at}ctsu.ox.ac.uk.
VITAMIN B SUPPLEMENTATION DID NOT SLOW COGNITIVE DECLINE IN PATIENTS WITH ALZHEIMER DISEASE
CHICAGO—High-dose vitamin B supplementation for patients with mild to moderate Alzheimer disease did not slow the rate of cognitive decline, according to a study in the October 15 issue of JAMA.
Evidence of homocysteine (an amino acid produced by the body) elevation in Alzheimer disease (AD) and the involvement of homocysteine in neuropathological mechanisms suggest that reduction of homocysteine may offer an approach to altering the disease. B vitamins that influence homocysteine metabolism have been considered as a therapeutic option to reduce risk of AD or slow its progression, according to background information in the article. According to the authors, prior studies of B vitamins to reduce homocysteine in AD have not had sufficient size or duration to assess their effect on cognitive decline.
Paul S. Aisen, M.D., of the University of California, San Diego, and colleagues conducted a clinical trial to determine if reduction of homocysteine levels with high-dose supplementation with folic acid and vitamins B6 and B12 for 18 months would slow the rate of cognitive decline in 409 individuals with mild to moderate AD. Participants were randomly assigned to two groups of unequal size to increase enrollment (60 percent treated with high-dose supplements [5 mg/d of folate, 25 mg/d of vitamin B6, 1 mg/d of vitamin B12] and 40 percent treated with identical placebo). A total of 340 participants (202 in active treatment group and 138 in placebo group) completed the trial while taking study medication. Cognitive abilities were measured via testing with the Alzheimer Disease Assessment Scale (ADAS-cog).
The researchers found that even though the vitamin supplement regimen was effective in reducing homocysteine levels, it had no beneficial effect on the primary cognitive measure: the rate of change in ADAS-cog score did not differ significantly between treatment groups. The authors did find that symptoms of depression were more common in the high-dose supplement group.
"Many studies suggest that relative elevation of homocysteine is characteristic of AD, and laboratory research implicates homocysteine in neurodegenerative mechanisms. High-dose B vitamin supplementation in individuals with normal levels of B vitamins was effective in reducing homocysteine levels. However, our study does not support the treatment of individuals with mild to moderate AD and normal vitamin levels with B vitamin supplements," the authors conclude.
(JAMA. 2008;300[15]:1774-1783. 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: B VITAMINS FOR PREVENTION OF COGNITIVE DECLINE - INSUFFICIENT EVIDENCE TO JUSTIFY TREATMENT
In an accompanying editorial, Robert J. Clarke, M.D., F.R.C.P., and Derrick A. Bennett, Ph.D., of the University of Oxford, England, comment on the findings regarding B vitamin supplementation.
"The precise reasons the [study by Aisen and colleagues] failed to detect any beneficial effect of B vitamins on the rate of cognitive decline remain unclear," they write. "However, until and unless new data suggest otherwise, there is insufficient evidence to justify routine use of homocysteine-lowering vitamin supplements for the prevention of Alzheimer disease and cognitive decline among individuals with normal vitamin status."
(JAMA. 2008;300[15]:1819-1821. 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 14, 2008
Media Advisory: To contact corresponding author Isabelle C. Van Gelder, M.D., Ph.D., email: I.C.van.Gelder{at}thorax.umcg.nl.
LESSENING MEDICATION FOR PREVENTION OF ATRIAL FIBRILLATION DOES NOT REDUCE SIDE EFFECTS, APPEARS TO WORSEN OUTCOMES
CHICAGO—Reducing how often a patient receives amiodarone, a medication used for suppressing atrial fibrillation (irregular heart beat) but which causes side effects, did not decrease the overall amount of amiodarone-related and heart disease related side effects, but did increase the rate of atrial fibrillation recurrence and the risk of death from all causes and cardiovascular hospitalizations, according to a study in the October 15 issue of JAMA.
The adverse events caused by amiodarone are mostly associated with high daily dosages and long-term therapy, according to background information in the article.
Sheba Ahmed, M.D., of the University of Groningen, Netherlands, and colleagues conducted a study to compare the effects of episodic vs. continuous amiodarone treatment on major events related to amiodarone use and to determine if episodic treatment could effectively suppress atrial fibrillation. The trial included 209 patients with recurrent atrial fibrillation who were randomly assigned to receive either episodic or continuous amiodarone treatment. Episodic amiodarone treatment was discontinued after a month of sinus rhythm (the normal regular rhythm of the heart) and reinitiated if atrial fibrillation relapsed. In the continuous treatment group amiodarone was maintained throughout.
After a median (midpoint) follow-up of 2.1 years, 51 (48 percent) of the patients in the episodic vs. 64 (62 percent) in the continuous treatment group had sinus rhythm. The researchers found that in the episodic group, more atrial fibrillation recurrences occurred (80 percent) than in the continuous treatment group (54 percent). The incidence of the primary outcome for the study—any amiodarone or underlying heart disease–related major event—was 35 percent in the episodic vs. 33 percent in the continuous treatment group. There were differences in the incidence of amiodarone major events (19 percent, episodic vs. 24 percent, continuous) and underlying heart disease–related major events (16 percent, episodic vs. 9 percent, continuous), although these differences did not reach statistical significance. All-cause deaths and cardiovascular hospitalizations were higher among those receiving episodic treatment (53 percent vs. 34 percent).
"Considering the above, episodic amiodarone treatment cannot be advocated for most patients with persistent atrial fibrillation," the authors write. "This study shows that episodic amiodarone treatment—in contrast to our expectations—has no clinical advantage over continuous treatment because it did not lower morbidity in patients with persistent atrial fibrillation over 2 years of follow-up."
(JAMA. 2008;300[15]:1784-1792. 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 HIGH-DOSE INTAKE OF THREE B VITAMINS DOES NOT SLOW PROGRESSION OF ALZHEIMER DISEASE
INTRO:
Alzheimer disease is a devastating condition affecting millions of Americans and their loved ones – and the search for a cure has been elusive. We now have results of a recent study which explored whether taking high doses of three vitamins could help slow disease progression. Alissa Krinsky explains in this week’s JAMA Report.
VIDEO:
B-ROLL
Pauns looking at photos
Close-up of wedding photo
AUDIO:
GARY AND MARY PAUN HAVE BEEN MARRIED FOR 31 YEARS. THEIR LIVES CHANGED FOREVER WHEN MARY BEGAN EXPERIENCING SYMPTOMS OF ALZHEIMER DISEASE THREE YEARS AGO.
VIDEO:
SOT/FULL
Super @ :12
Mary Paun
Has Alzheimer Disease
Runs:03
AUDIO:
"I’m doing the best I can do."
VIDEO:
SOT/FULL
Super @ :16
Gary Paun
Wife Has Alzheimer Disease
Runs:17
AUDIO:
"It just disrupts mostly what we thought was normal life. But it’s also brought us a lot closer together. So it’s really drove us – instead of apart, or making life seem like it’s terrible, making it seem like, hey, life’s pretty short, enjoy it while you can..."
VIDEO:
B-ROLL
Doctor Walking Down Hallway
Vitamins
AUDIO:
DR. PAUL AISEN (ACE’-IN) IS WITH THE UNIVERSITY OF CALIFORNIA-SAN DIEGO SCHOOL OF MEDICINE. HE AND HIS COLLEAGUES STUDIED 340 PEOPLE WITH MILD TO MODERATE ALZHEIMER DISEASE. AT ISSUE: WHETHER LARGE DOSES OF THREE VITAMINS – B6, B12, AND FOLIC ACID – WOULD SLOW DISEASE PROGRESSION, INCLUDING COGNITIVE DECLINE.
VIDEO:
SOT/FULL
Super @ :54
Paul Aisen, M.D.
UC-San Diego School of Medicine
Runs:06
AUDIO:
"And in Alzheimer’s disease, the aspect of cognition that is most obviously affected is memory."
VIDEO:
B-ROLL
GXF/JAMA COVER
Dissolve to doctor reviewing study, tight shot of study pages
AUDIO:
THE STUDY APPEARS THIS WEEK IN JAMA, JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION. IT FOCUSED ON REDUCING PATIENTS'LEVELS OF AN AMINO ACID, HOMOCYSTEINE (HO-MO-SIST’-EEN) – WHICH HAS BEEN LINKED TO ALZHEIMER DISEASE.
VIDEO:
SOT/FULL
Paul Aisen, M.D.
UC-San Diego School of Medicine
Runs: 06
AUDIO:
"Homocysteine levels tend to be higher in people with Alzheimer's disease compared to other people."
VIDEO:
B-ROLL
Pan up from study binder to Doctor typing
Close-up of computer screen
AUDIO:
THE STUDY SHOWED THAT HOMOCYSTEINE LEVELS WERE LOWERED BY THE HIGH-DOSE VITAMIN INTAKE, BUT WITH NO EFFECT ON SLOWING DISEASE PROGRESSION.
VIDEO:
SOT/FULL
Paul Aisen, M.D.
UC-San Diego School of Medicine
Runs :10
AUDIO:
"And, unfortunately the results were disappointing in the sense that this intervention – the high-dose vitamins - did not have a favorable effect on the disease."
VIDEO:
B-ROLL
Pauns walking toward camera
AUDIO:
BUT WITH EVERY BIT OF RESEARCH COMES HOPE FOR PROGRESS.
VIDEO:
SOT/FULL
Super @ :
Gary Paun
Wife Has Alzheimer Disease
Runs :08
AUDIO:
"I'm frustrated in only the fact that they haven't found a cure yet. But I think the cure is close, I really do."
VIDEO:
B-ROLL
Pauns walking away from camera
AUDIO:
AND THAT WOULD TRULY BE A LIFE-CHANGING DISCOVERY. ALISSA KRINSKY, THE JAMA REPORT.
TAG:
The four-year study showed that not only do the high-doses of vitamins fail to halt the progression of cognitive decline, they may actually result in increased depression in some Alzheimer patients. For more information about this study you can log on to www.jama.com.
