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In This Issue of Archives of Internal Medicine
July 23, 2012

In This Issue of Archives of Internal Medicine

Arch Intern Med. 2012;172(14):1052. doi:10.1001/archinternmed.2011.967

In the global REduction of Atherothrombosis for Continued Health (REACH) Registry of 44 573 outpatients 45 years or older and at risk of, or with, atherothrombosis, Udell et al found that living alone was independently associated with increased all-cause and cardiovascular mortality among middle-aged participants.

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This systematic review by Mueller et al included controlled intervention studies on medication reconciliation in the hospital setting. Seventeen controlled studies were identified and reported on pharmacist-related (n = 10), information technology-related (n = 4), and other (n = 3) interventions. Studies consistently demonstrated a reduction in medication discrepancies (12/12 studies), potential adverse drug events (5/5 studies), and adverse drug events (1/1 study), but showed inconsistent reduction in postdischarge healthcare utilization (significant improvement in 2/5 studies). The comparison group for all studies was usual care, with no direct comparisons of different types of interventions. The authors concluded that there is a paucity of rigorously designed studies comparing different modalities of inpatient medication reconciliation practices and their effect on clinical outcomes. Available evidence supports medication reconciliation interventions that heavily use pharmacy staff and focus on a high-risk group. Higher-quality studies are needed to determine the most effective approaches to inpatient medication reconciliation.

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In this 6-year longitudinal cohort study, Perissinotto et al investigated the relationship between self-reported loneliness and time to death as well as functional decline in 1602 adults older than 60 years, selected from the Health and Retirement Study. The results show significant relationships between baseline measures of loneliness and functional decline at the 6-year follow-up in activities of daily living performance and different measures of physical function. Loneliness also predicted time to death. These relationships remained strong after multivariate analysis, which took into account sociodemographic, economic, health, and behavioral factors.

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In light of the recent trend toward earlier dialysis initiation and its association with mortality among patients with end-stage renal disease, Bao et al hypothesized that frailty is associated with higher estimated glomerular filtration rate at dialysis start and may confound the relation between earlier dialysis initiation and mortality. The authors examined frailty among participants of the Comprehensive Dialysis Study. Among 1576 incident dialysis participants included, the prevalence of frailty was 73%. In multivariable analysis, higher eGFR at dialysis initiation was associated with a 44% higher odds of frailty. Frailty was independently associated with mortality (hazard ratio [HR], 1.57 [95% CI, 1.25 to 1.97]; P < .001) and time to first hospitalization (HR, 1.26 [95% CI, 1.09-1.45]; P < .001). While higher eGFR at dialysis initiation was associated with mortality (HR, 1.12 [95% CI, 1.02-1.23] per 5 mL/min/1.73m2; P = .02), the association was no longer statistically significant after frailty was accounted for (HR, 1.08 [95% CI, 0.98-1.19] per 5 mL/min/1.73m2; P = .11). The study findings suggest that the decision of early dialysis initiation should be considered carefully, since the results do not prove any benefits of early start regardless of baseline frailty status.

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In a cohort of 556 patients with stable coronary heart disease followed up for 8 years, shorter distance on the 6-minute walk test was associated with greater rates of myocardial infarction, heart failure, and death. These associations persisted after adjustment for traditional risk factors and markers of cardiac disease severity. Improvement in risk prediction with six-minute walk test was similar to improvement with treadmill exercise capacity. These results suggest that this simple test can serve as a prognostic tool in patients with coronary heart disease.

Cardiovascular events by quartile of 6-minute walk test distance.

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