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This Week in JAMA
April 26, 2006

This Week in JAMA

JAMA. 2006;295(16):1867. doi:10.1001/jama.295.16.1867
Pacemaker and ICD Reliability and Complications

Reliability and complications of pacemakers and implantable cardioverter-defibrillators (ICDs) are the focus of 3 articles in this issue of JAMA. First, Maisel and colleaguesArticle reviewed manufacturers' reports of device malfunctions to the US Food and Drug Administration for 1990-2002 and found that pacemaker malfunctions declined during these years, but malfunctions of ICDs increased during the latter half of the study period. In the second article, Gould and KrahnArticle surveyed Canadian centers that implant ICDs to assess complications associated with ICD generator replacement when manufacturers' advisories suggest a potential for device malfunction. These authors found that 8.1% of patients having ICD replacement experienced complications, including 2 deaths. In the third article, MaiselArticle reports results of a meta-analysis of device registry data collected from 1983-2004 to assess annual rates of malfunction and trends. He found that pacemaker reliability improved over the period of analysis but reported a transient increase in the ICD malfunction rate from 1998-2002 followed by a substantial decrease through 2004. In an editorial, WilkoffArticle discusses the strengths and weaknesses of these data for informing patient and physician decisions regarding pacemaker or ICD replacement.

Hospital Process Performance and Patient Outcomes

To examine the association between hospital performance and outcomes of patients with acute coronary syndromes, Peterson and colleagues reviewed data from a large hospital quality improvement initiative that emphasized rapid patient risk stratification and early implementation of American College of Cardiology/American Heart Association treatment guidelines. The authors assessed the use of 9 guideline-recommended treatments and found these were followed in 74% of eligible cases. Greater adherence to the guidelines was associated with lower in-hospital mortality.

Financial Conflicts at FDA Drug Advisory Meetings

Financial conflicts of interest held by US Food and Drug Administration (FDA) drug advisory committee members could compromise the integrity of the FDA drug approval process. Lurie and colleagues reviewed agendas and transcripts from FDA Drug Advisory Committee meetings (2001-2004) to characterize financial conflicts and assess any relationship between conflicts and voting behaviors. Among the authors' findings are that conflicts of interest are common, often represent significant monetary value, and rarely result in recusal of a committee member with a conflict. However, in analyses that excluded committee members with financial conflicts, the authors found no evidence that such exclusions would have changed the committee's recommendations.


Many older adults have several long-term health conditions, which add a measure of complexity to their medical care. Durso discusses new evidence-based guidelines for the care of older adults with diabetes that specifically address treatment priorities, concerns, and preferences when patients have comorbid conditions and geriatric syndromes.

A Piece of My Mind

‘What brings you here today?’ I ask. Her shoulders quiver, her fingers stroke her forehead, and tears pool in her eyes, puddle in a wrinkle, then spill over like a miniature waterfall, sliding down her cheeks.” From “Dog Pals.”

Medical News & Perspectives

Scientists are using molecular and genomic techniques to understand the role that a variety of genetic and environmental factors play in Parkinson disease.

Physician-Assisted Suicide

Implications of Gonzales v Oregon for medical practice and professional self-regulation.

Author in the Room Teleconference

Join Donald M. Berwick, MD, MPP, on Wednesday May 17, 2006, from 2 to 3 PM eastern time to discuss the clinical implications of research results. To register, go to http://www.ihi.org/Authorintheroom.

Audio Commentary

Dr DeAngelis summarizes and comments on this week's issue. Go to http://jama.ama-assn.org/misc/audiocommentary.dtl.

JAMA Patient Page

For your patients: Information about implantable cardioverter-defibrillators.