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October 20, 2009JAMA news releases are made available to the public after 3 pm US Central time on the first 4 Tuesdays of each month. The Archives of 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 CONTENTS
JAMA NEWS RELEASES
(Embargoed for Release: 3 p.m. CT Tuesday, October 20, 2009)
JAMA REPORT (VIDEO SCRIPT)
INFORMATION CONTAINED IN THESE NEWS RELEASES IS PROTECTED BY COPYRIGHT. JOURNAL ATTRIBUTION IS REQUIRED. JOURNALISTS CAN NOW ACCESS EMBARGOED JAMA/ARCHIVES STUDIES ON-LINE. Go to www.jamamedia.org for more information and to apply for access. TV Note: This week's JAMA Report video is on the underuse of a recommended treatment for heart failure. The report will be fed Tuesday, October 20, from 9:00 - 9:15 a.m. ET and 2:00 - 2:15 p.m. ET, on Galaxy 28 (C-Band), Transponder 15, downlink frequency: 4000 vertical, audio 6.2/6.8. For more information, call 312/464-JAMA. The JAMA Report video is also now available on Pathfire every Tuesday, in VNF Provider A. Please look for the JAMA Report tab. Please Note: The FOR THE MEDIA website now has a search feature to enable media to find previous JAMA/Archives news releases on specific medical topics. This search feature link is located on the home page at www.jamamedia.org EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), Tuesday, October 20, 2009
Use of Omega-3 With Treatment for Depression in Patients With Heart Disease Does Not Appear to Provide Benefit
CHICAGO—Contrary to the findings of some studies, new research indicates that augmenting antidepressant therapy with an omega-3 fatty acid supplement does not result in improvement in levels of depression in patients with coronary heart disease, according to a study in the October 21 issue of JAMA. "Low dietary intake and low serum or red blood cell levels of omega-3 fatty acids are associated with depression in patients with and without coronary heart disease (CHD) and with an increased risk for cardiac mortality," according to background information in the article. "In depressed psychiatric patients who are otherwise medically well, some studies have indicated that augmentation with omega-3 fatty acids dramatically improves the efficacy of antidepressants." Robert M. Carney, Ph.D., of Washington University School of Medicine, St. Louis, and colleagues conducted a randomized, placebo-controlled trial to examine whether omega-3 improves the efficacy of the antidepression medication sertraline for patients with CHD and major depression. The study included 122 patients, who received 50 mg/day of sertraline and were randomized to receive 2 g/day of omega-3 acid ethyl esters (eicosapentaenoic acid [EPA] and docosahexaenoic acid [DHA]) (n=62) or placebo capsules (n=60) for 10 weeks. Depression was gauged via scores on the Beck Depression Inventory (BDI-II) and the Hamilton Rating Scale for Depression (HAM-D). Adherence to the medication regimen was at least 97 percent in both groups for both medications. The researchers found that there was no difference in improvement between groups on the BDI-II. In both groups, estimated weekly BDI-II scores showed that depressive symptoms improved over time at comparable rates. The placebo and omega-3 groups did not differ at 10 weeks in regard to measurements of depression or anxiety. There was no significant difference in rates of remission or treatment response between the two groups.
"Whether higher doses of EPA, DHA, or sertraline, a longer duration of treatment, or the use of omega-3 as monotherapy can improve depression in patients with stable heart disease remains to be determined," the authors conclude.
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 JAMA/Archives media relations at 312/464-JAMA (5262) or e-mail mediarelations{at}jama-archives.org. EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), Tuesday, October 20, 2009
Recommended Treatment for Heart Failure Often Underused
CHICAGO—Less than one-third of patients hospitalized for heart failure and participating in a quality improvement registry received a guideline-recommended treatment of heart failure, aldosterone antagonist therapy, according to a study in the October 21 issue of JAMA. Clinical trials have established the benefits of aldosterone antagonist therapy (an agent that opposes the action of the adrenal hormone aldosterone) in patients with heart failure (HF), such that they were designated as "useful and recommended," within the American College of Cardiology/American Heart Association (ACC/AHA) Chronic HF Guidelines. Adoption of aldosterone antagonists for treatment of HF has been mixed, according to background information in the article. "The Get With The Guidelines–HF (GWTG-HF) program is a national quality improvement program designed to promote adherence to guideline-based recommendations. It is unknown whether participation in a hospital-based quality program may lead to greater frequency of use of aldosterone antagonist therapy for appropriate indications as well as lower use in situations of increased risk," the authors write. Nancy M. Albert, Ph.D., R.N., of the Cleveland Clinic, Cleveland, and colleagues examined recent aldosterone antagonist use among hospitalized patients with HF, as well as temporal trends and appropriateness of use. The observational analysis included 43,625 patients admitted with HF and discharged home from 241 hospitals participating in the Get With The Guidelines–HF quality improvement registry between 2005-2007. In total, 12,565 patients (28.8 percent) from 201 hospitals met ACC/AHA management guidelines criteria, and 4,087 eligible patients (32.5 percent) received an aldosterone antagonist at hospital discharge. Treatment increased modestly from 28 percent to 34 percent over the study period. There was also wide variation in aldosterone antagonist use among hospitals (0 percent-90.6 percent). "Aldosterone antagonist use in eligible patients was associated with younger age, African American race/ethnicity, lower systolic blood pressure, history of implantable cardioverter-defibrillator use, depression, alcohol use, and pacemaker implantation, and with having no history of renal insufficiency," the authors write. Applying certain appropriateness criteria, inappropriate and potentially inappropriate use of aldosterone antagonist therapy was low and did not change over the 3-year study period.
"These data confirm that in the context of a hospital-based performance improvement program, aldosterone antagonist therapy can be used according to guidelines with little inappropriate use. Given the substantial morbidity and mortality risk faced by patients hospitalized with HF and the established efficacy of aldosterone antagonist prescription in HF, a stronger uptake of aldosterone antagonist therapy indicated by evidence-based guidelines may be warranted," the researchers conclude.
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 JAMA/Archives media relations at 312/464-JAMA (5262) or e-mail mediarelations{at}jama-archives.org. EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), Tuesday, October 20, 2009
Diagnosis of Cardiovascular Disease Associated With Risk of Subsequent Hip Fracture
CHICAGO—A study that includes twins finds that the risk of hip fracture was significantly increased following a diagnosis of cardiovascular disease (CVD), with analysis also suggesting a genetic predisposition to the development of CVD and fractures, according to a study in the October 21 issue of JAMA. CVD and osteoporosis, which are common in elderly individuals, have been regarded as independent age-related disorders. Research has suggested that there may be common mechanisms that cause these diseases. Stroke is a well-documented risk factor for hip fracture, but it is uncertain whether other CVDs may increase the risk of future hip fracture, according to background information in the article. "It is also unknown whether the risk for hip fracture differs depending on CVD diagnosis and sex, as well as whether the risk reflects lifestyle and individual environmental influences or genetic constitution," the authors write. Ulf Sennerby, M.D., of Uppsala University, Uppsala, Sweden, and colleagues used information from 31,936 twins in the Swedish Twin Registry to investigate the association between cardiovascular events and future hip fracture risk and to examine to what extent the relation was attributable to genes or associated with other lifestyle factors. The researchers note that a study that includes twins provides a framework for an ordinary group analysis while simultaneously examining whether the relation between cardiovascular events and hip fracture is explained by genetic and early environmental factors. The twins, born from 1914-1944, were followed up from the age of 50 years. The National Patient Registry identified twins with CVD and fractures from 1964 through 2005. The researchers found that the crude absolute rate of hip fractures was highest after a diagnosis of heart failure or stroke, compared to after a diagnosis of peripheral atherosclerosis or ischemic heart disease and lowest for those without a CVD diagnosis. In comparison with individuals without CVD, patients with heart failure had about a 4-fold increased rate of hip fracture and individuals with a stroke had 5 times the risk. The elevated hip fracture rate was also present after ischemic stroke, hemorrhagic stroke, peripheral atherosclerosis and ischemic heart disease. "Identical twins without heart failure and stroke also had, after their co-twins had been exposed to these respective diseases, an increased rate of hip fracture," the authors write. These sibling twins who were considered to be "pseudoexposed" (i.e., the twin without CVD was considered to be "pseudoexposed" to having CVD based of their co-twin having a CVD event) for heart failure had a 3.7-fold increased risk for hip fracture; pseudoexposure for stroke had a 2.3 times higher risk of hip fracture. "An increased hip fracture risk for the pseudoexposure in the co-twin analyses, particularly in identical twins, is an indication that genes predispose to the development of CVD and fractures. Most of the overall increased rate of hip fracture after heart failure (and part of the increased risk after stroke) appears to be explained by genes or by early environmental sharing (i.e., not individual lifestyle habits or other individual-specific environmental factors)," the researchers write.
"Clinicians should be aware of the considerably increased rate of hip fracture in both sexes, especially after a recent hospitalization for CVD. Genetic predisposition is probably a major determinant of the excess fracture rate," the authors conclude.
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 JAMA/Archives media relations at 312/464-JAMA (5262) or e-mail mediarelations{at}jama-archives.org. EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), Tuesday, October 20, 2009
Comparison Finds Considerable Differences on Estimates of Future Physician Workforce Supply
CHICAGO—Compared with a source of data often used regarding physician workforce supply and projected changes, data from the U.S. Census Bureau suggests that the future physician workforce may be younger but fewer in number than previously projected, according to a study in the October 21 issue of JAMA. Recent projections have indicated that the supply of physicians may soon decrease below recommended requirements, with some projecting a shortfall as high as 200,000 by 2020. "Although debate over potential shortages has focused largely on the number and type of physicians needed in the future, concerns have also been raised about data used in physician supply estimates and projections," the authors write. The American Medical Association Physician Masterfile (Masterfile) data, although frequently used by workforce analysts, are believed to overestimate the number of active physicians at older ages, attributed to delays in updating the Masterfile data when a physician retires or experiences a change in status, according to background information in the article. Douglas O. Staiger, Ph.D., of Dartmouth College, Hanover, N.H., and colleagues conducted an analysis of employment trends of physicians using the Masterfile data and the U.S. Census Bureau Current Population Survey (CPS), a data source used extensively by the U.S. Department of Labor to estimate current trends in employment. The researchers used data from between 1979 and 2008. Physician supply through 2040 was also projected using both data sources. The researchers found that in an average year, the CPS estimated 67,000 (10 percent ) fewer active physicians than did the Masterfile during the sample period. Estimates from the Masterfile and CPS data were similar for physicians between the ages of 35 and 54 years, but differed markedly at both younger and older ages. Older physicians accounted almost entirely for the lower estimates of active physicians in the CPS. During the sample period, on average, the CPS estimated 22,000 (20 percent) fewer active physicians per year ages 55 to 64 years than did the Masterfile, and estimated 35,000 (51 percent) fewer active physicians per year 65 years or older than the Masterfile. The CPS estimated more young physicians (ages 25-34 years) than did the Masterfile, with the difference increasing to an average of 17,000 (12 percent) during the final 15 years. "The CPS estimates of more young physicians were consistent with historical growth observed in the number of first-year residents, and the CPS estimates of fewer older physicians were consistent with lower Medicare billing by older physicians," the authors write. Regarding projections for the future physician workforce supply, both the CPS and the Masterfile data indicate that the number of active physicians will increase by approximately 20 percent between 2005 and 2020. However, projections for 2020 using CPS data estimate nearly 100,000 (9 percent) fewer active physicians than projections using the Masterfile data (957,000 vs. 1,050,000), and estimate that a smaller proportion of active physicians will be 65 years or older. "The CPS-based projection indicates that 71 percent of active physicians will be younger than 55 years and only 9 percent will be older than 65 years, whereas the Masterfile-based projection indicates that 61 percent of active physicians will be younger than 55 years and 18 percent will be older than 65 years," the researchers note.
"Although this analysis was restricted to physician supply, projections of physician requirements also rely on estimates of the current number of physicians as a starting point for projections. Thus, without more accurate estimates of the size and age distribution of the current workforce, projections of physician supply, requirements, and potential shortages may mislead policymakers as they try to anticipate and prepare for the health care needs of the population," the authors conclude.
Editor's Note: Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc. Editorial: How Many Physicians? How Much Does It Matter?
In an accompanying editorial, Thomas C. Ricketts, Ph.D., M.P.H., of the University of North Carolina, Cecil G. Sheps Center for Health Services Research, Chapel Hill, N.C., writes on the importance of having accurate projections regarding the physician workforce.
"The physician workforce is one of the most critical factors that must be considered in current health care reform efforts and discussions. Having accurate estimates for determining not only the number of physicians, but also current and future physician workforce requirements and capabilities for delivering primary and specialty care, will be essential for achieving and sustaining effective health care reform."
Editor's Note: Please see the article for additional information, including financial disclosures, funding and support, etc. For more information, contact JAMA/Archives media relations at 312/464-JAMA (5262) or e-mail mediarelations{at}jama-archives.org.
JAMA REPORTS
VIDEO: Windows Media | Quicktime
STUDY FINDS RECOMMENDED HEART FAILURE MEDICATION PRESCRIBED FOR ONLY ONE-THIRD OF ELIGIBLE PATIENTS
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