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This Week in JAMA
JAMA. 2002;288:3077.
Dual-Chamber vs Ventricular Backup Pacing for ICDs
Most currently implanted implantable cardioverter defibrillator (ICD) devices are coupled with dual-chamber pacemaker devices. The Dual Chamber and VVI Implantable Defibrillator (DAVID) trial (SEE ARTICLE) compared the efficacy of dual-chamber pacing with that of ventricular backup pacing in patients with left ventricular dysfunction and indications for ICD implantation for the treatment of ventricular tachyarrhythmias but without an indication for antibradycardia pacing. At 1 year, the rate of the composite end point of death or first hospitalization for new or worsened congestive heart failure was significantly higher in patients who received dual-chamber rate-responsive pacing at 70/min than among those who received ventricular backup pacing at 40/min. In an editorial, Kass (SEE ARTICLE) discusses the adverse effect of discoordinated ventricular activity from single-site ventricular stimulation.
Outcomes of Early Invasive Treatment of ACS in Women
Women who present with acute coronary syndromes (ACSs) have different clinical and angiographic characteristics than men. Glaser and colleagues (SEE ARTICLE) analyzed data from the TACTICS-TIMI 18 (Treat angina with Aggrastat and determine Cost of Therapy with an Invasive or Conservative Strategy—Thrombolysis In Myocardial Infarction 18) trial, a randomized trial comparing an early invasive treatment strategy with conservative treatment for patients with unstable angina and non–ST-segment elevation ACS, to evaluate sex differences in baseline characteristics and clinical outcomes. Despite significant sex differences in baseline clinical comorbidities and angiographic characteristics, the reduction in the rate of the primary composite end point of death, myocardial infarction, or rehospitalization for ACS at 6 months in the early invasive strategy group was not significantly different in women and men. In an editorial, Hochman and Tamis-Holland (SEE ARTICLE) consider why the results of this study might differ from those of 2 other recently published trials in which outcomes of invasive strategies for non–ST-segment elevation ACS were better in men than in women.
Fish Consumption and Stroke Risk in Men
Some studies suggest that consumption of fish, perhaps via intake of long-chain omega-3 polyunsaturated fatty acids, which inhibit platelet aggregation and are almost exclusively derived from marine sources, might reduce the risk of ischemic stroke and increase risk of hemorrhagic stroke. In this analysis of data from the Health Professional Follow-up Study, a prospective cohort study of men aged 40 to 75 years with 12 years of follow-up, He and colleagues found that the risk of ischemic stroke in men who consumed fish once per month or more was significantly lower than in men who ate fish less often. No significant associations were found between fish intake or long-chain omega-3 polyunsaturated fatty acid intake and risk of hemorrhagic stroke.
(SEE ARTICLE)
Trends in Disability and Functioning in Older Americans
Freedman and colleagues (SEE ARTICLE) conducted a systematic review of articles published from 1990 through May 2002 to assess recent trends in disability and functioning in US adults generally aged 65 or 70 years or older. Their analysis of data sets from 8 surveys published in 16 articles indicates that the prevalence of any disability and of instrumental activities of daily living disability declined consistently during the 1990s. In an editorial, Fries (SEE ARTICLE) discusses how future reductions in age-related disability might best be achieved through reductions in lifestyle risk factors and implementation of health promotion programs for older adults.
A Piece of My Mind
"A healthy sense of responsibility can facilitate healing. An exaggerated sense of responsibility—or guilt—can oppose healing." From "Not Guilty."
(SEE ARTICLE)
Medical News & Perspectives
Some researchers are working to develop antibiotics from a newly discovered microorganism, Streptomyces munumbi, found in the Australian snakevine, while others seek to legitimize antiaddiction treatment with ibogaine, from the African plant Tabernanthe iboga.
(SEE ARTICLE)
Accommodating Faculty With Disabilities
A discussion of accommodating active medical school faculty members who have disabilities based on the experience of a University of Pennsylvania School of Medicine faculty committee that explored concerns of faculty with physical and sensory disabilities.
(SEE ARTICLE)
CLINICIAN'S CORNER
Contempo Updates
Controversies in vaccine safety.
(SEE ARTICLE)
Authorship for Research Groups
Guidelines for determining and designating authorship for studies by research groups published in JAMA.
(SEE ARTICLE)
JAMA Patient Page
For your patients: Information about heart disease and women.
(SEE ARTICLE)
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