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This Week in JAMA
September 22/29, 2010

This Week in JAMA

JAMA. 2010;304(12):1295. doi:10.1001/jama.2010.1375

The value of self-management programs for patients with heart failure is unclear. In the Heart Failure Adherence and Retention Trial, a single-center behavioral efficacy trial involving 902 patients with mild to moderate heart failure, Powell and colleagues Article found similar rates of death or heart failure hospitalization among patients who were randomly assigned to receive group-based self-management counseling and heart failure patient educational materials as patients who received the heart failure education materials alone. In an editorial, Cleland and Ekman Article discuss the importance and critical components of self-management of chronic conditions and the inescapable role of electronic media.

Unfractionated heparin is recommended as adjunctive therapy during percutaneous coronary intervention (PCI) among patients with acute coronary syndromes (ACS) initially treated with fondaparinux—a synthetic factor Xa inhibitor—but the optimal heparin regimen is uncertain. In the prospective, randomized FUTURA/OASIS-8 trial, which enrolled high-risk patients with ACS initially treated with fondaparinux, the investigators compared low-dose with standard-dose unfractionated heparin during PCI and found that the low-dose regimen was not associated with lower risks of major periprocedural bleeding or vascular access-site complications.

Bhatt and colleagues analyzed data from the Reduction of Atherothrombosis for Continued Health Registry, which enrolled outpatients with coronary artery disease, cerebrovascular disease, peripheral arterial disease, or multiple risk factors to identify clinical characteristics associated with a high risk of future ischemic events. Among the investigators' findings were that patients with atherothrombosis and a history of ischemic events at baseline had the highest rate of subsequent cardiovascular death, myocardial infarction, and stroke and that patients with risk factors but without established atherothrombosis were at lowest risk of future cardiovascular events.

Short telomere length is associated with cell senescence and chromosomal instability in tissue culture and animal models. In a cohort of patients with severe aplastic anemia, Scheinberg and colleagues assessed the relationship between pretreatment leukocyte telomere length and treatment response, relapse, clonal evolution (eg, the appearance of a new marrow cytogenetic abnormality), and survival. The authors report that telomere length was unrelated to treatment response, but shorter telomere length was associated higher rates of relapse, clonal evolution, and mortality.

Whether patients with subclinical hypothyroidism have an increased risk of adverse cardiovascular outcomes is not clear. In an analysis of individual-level data from 55 287 participants in 11 prospective cohort studies, Rodondi and colleagues found that subclinical hypothyroidism (defined as a thyroid-stimulating hormone [TSH] level ≥4.5 to ≤19.9 mIU/L) was associated with an increased risk of coronary heart disease events and coronary heart disease mortality, particularly among persons with a TSH level of 10 mIU/L or higher.

“Our medical training had taught us to diagnose and treat disease, but my wife and I knew nothing about how to deal with illness.” From “Healing Hearts.”

A US government investigation has found that direct-to-consumer genetic tests may provide misleading results and that the companies who offer them often make inappropriate claims about the tests' implications.

Rethinking rapid response teams

Role of state attorneys general in health policy

Putting the secure examination to the test

An Asian American and Pacific Islander health agenda

Join Ralph Gonzales, MD, MSPH, Wednesday, October 20, 2010, from 2 to 3 PM eastern time to discuss whether adolescent or adult coughing may be a symptom of pertussis. To register, go to http://www.ihi.org/AuthorintheRoom.

For your patients: Information about subclinical hypothyroidism.

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