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This Week in JAMA
JAMA. 2006;295:131.
Antiarrhythmic Drugs for Patients With an ICD
Implantable cardioverter defibrillator (ICD) shocks are painful. Defining effective antiarrhythmic pharmacotherapy could reduce the number of appropriate and inappropriate shocks delivered. Connolly and colleagues (SEE ARTICLE) report results of the Optimal Pharmacological Therapy in Cardioverter Defibrillator Patients (OPTIC) Trial, which assessed whether 1 year of treatment with amiodarone plus  -blocker (metoprolol, carvedilol, or bisoprolol) or sotalol would be better than -blocker alone for prevention of shocks in patients with a new ICD. The investigators found a reduced incidence of shocks in patients who were randomly assigned to either amiodarone plus -blocker or sotalol compared with patients assigned to -blocker alone. In an editorial, Page (SEE ARTICLE) discusses interactions of antiarrhythmic drug therapy with an ICD and potential benefits and risks of combined therapy.
Algorithm for Managing Pulmonary Embolism
Many strategies to identify patients with suspected pulmonary embolism use relatively complex combinations of clinical decision rules and diagnostic tests. Results of the Christopher Study (SEE ARTICLE), which assessed the validity of a simplified algorithm to rule out pulmonary embolism, are reported. The study algorithm categorized patients as "pulmonary embolism unlikely" or "pulmonary embolism likely" using a validated clinical decision rule and, based on this categorization, directed the use of D-dimer testing and computed tomography in the diagnostic evaluation. Use of the algorithm allowed a management decision in 97.9% of patients and was associated with a low risk of subsequent fatal and nonfatal venous thromboembolism. In an editorial, Hull (SEE ARTICLE) discusses advancements in diagnostic technology and their application, which have improved the management of patients with suspected pulmonary embolism.
International Estimates of CVD Risk and Treatment
There are limited data on the international prevalence, recognition, and treatment of cardiovascular disease (CVD) risk factors in outpatients with atherosclerosis. The Reduction of Atherothrombosis for Continued Health (REACH) Registry is a prospective, observational registry with data from 44 countries. Bhatt and colleagues, writing for the Registry investigators, report data on baseline prevalence of risk factors, medication use, and degree of risk factor control. The investigators found similar risk factor profiles and comparable rates of undertreatment with statins and antiplatelet agents, undertreatment of hypertension, and failures to diagnose hyperglycemia and impaired fasting glucose among patients in the countries studied.
(SEE ARTICLE)
Body Mass Index, Hospitalization, and Mortality
Whether excess weight has an impact on cardiovascular outcomes beyond its effects on established risk factors is controversial. Using data from a prospective cohort study of individuals who were free of cardiovascular disease, diabetes, or major electrocardiographic abnormalities at baseline, Yan and colleagues assessed the relationship of midlife body mass index with morbidity and mortality outcomes in older age. The authors found that compared with persons who were normal weight at midlife, overweight or obese persons with similar cardiovascular risk factors had higher risks of hospitalization and mortality from coronary heart disease, cardiovascular disease, and diabetes when aged 65 or older.
(SEE ARTICLE)
Medical News & Perspectives
Two large-scale efforts to map the genes that are actively expressed in the mouse brain are promising to redefine neuroanatomy and may give researchers new tools for studying brain disorders.
(SEE ARTICLE)
CLINICIAN'S CORNER
Diagnosis of DVT
The Rational Clinical Examination
Clinical assessment of a patient's probability of deep vein thrombosis (DVT) is central to the evaluation of patients with suspected DVT.
(SEE ARTICLE)
Risk Factors for Psoriasis
From the Archives Journals
Data from 3 studies reported in the Archives of Dermatology suggest that patients with psoriasis are more likely to be overweight or obese and to have a history of tobacco use than patients without psoriasis.
(SEE ARTICLE)
Author in the Room
Join Sandra Dial, MD, in a teleconference on January 18, 2006, to discuss new research on the use of gastric acid–suppressive agents and risk of community-acquired Clostridium difficile.
For more information and to register for "Author in the Room," please visit http://www.ihi.org/authorintheroom.
JAMA Patient Page
For your patients: Information about pulmonary embolism.
(SEE ARTICLE)
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