Positive inotropic agents, such as dobutamine or milrinone, in patients with acute decompensated heart failure have been associated with an increased risk of death and other cardiovascular events, and there is a need for medications that improve hemodynamics and relieve symptoms without compromising survival. In the clinical trial Survival of Patients With Acute Heart Failure in Need of Intravenous Inotropic Support (SURVIVE), patients were randomly assigned to receive short-term intravenous infusion of either levosimendan or dobutamine. Mebazaa and colleagues report that neither the primary trial outcome, all-cause mortality at 180 days, nor secondary outcomes, including mortality at 31 days and patient-assessed symptom relief at 24 hours, differed among patients receiving levosimendan vs dobutamine.
Using data from the multinational observational cohort study Global Registry of Acute Coronary Events (GRACE), Fox and colleagues assessed whether changes in hospital management of patients with acute coronary syndromes (ACS) between 1999 and 2006 were associated with improvements in clinical outcomes. The authors, writing for the GRACE investigators, report that between 1999 and 2006, the use of interventional therapies increased and changes in pharmacological medications were made consistent with trial evidence and professional guidelines. Rates of new heart failure, mortality, and incidence of stroke and myocardial infarction after discharge declined from 1999 through 2006.
MicroRNAs (miRNAs) are small noncoding RNAs that bind messenger RNA, resulting in degradation or inhibition of the messenger RNA, and aberrant expression of miRNAs has been implicated in carcinogenesis. Bloomston and colleaguesArticle investigated the expression patterns of miRNAs in tissue samples from patients with pancreatic adenocarcinoma, chronic pancreatitis, and normal pancreas. The authors identified distinct miRNA expression patterns that differentiated pancreatic cancer from normal pancreas or chronic pancreatitis and identified several miRNAs that may be associated with long-term (ie, >24 months) vs shorter survival with pancreatic cancer. In an editorial, Waldman and TerzicArticle discuss the need for ongoing investigation and validation of these biomarkers and their potential clinical application for diagnosis, risk stratification, and therapeutic interventions.
Mr M, a 59-year-old man with a history of myocardial infarction, low ejection fraction, and mild congestive heart failure, is considering placement of an implantable cardioverter-defibrillator (ICD). Zimetbaum discusses current indications for ICD placement, the risk of sudden cardiac death, and identifying patients most likely to benefit.
“While she was receiving the best technical care in the world, the individual that she was seemed forgotten, her personhood tossed to the side in lieu of the intricacies of pathophysiology.” From “Rounds.”
Although the hormonal changes of menopause are often assumed to be the cause of sleep problems in midlife, sleep disorders, age-related illnesses, and life stresses may play a larger role.
Ethical concerns related to state mandates that school-aged girls receive the human papillomavirus (HPV) vaccine.
Join Jan L. Brandes, MD, Wednesday May 16, 2007, from 2 to 3 PM eastern time to discuss sumatriptan-naproxen for acute treatment of migraine. To register, go to http://www.ihi.org/AuthorintheRoom.
Dr DeAngelis summarizes and comments on this week's issue. Go to http://jama.ama-assn.org/misc/audiocommentary.dtl.
For your patients: Information about implantable cardioverter-defibrillators.
This Week in JAMA . JAMA. 2007;297(17):1853. doi:10.1001/jama.297.17.1853