As the influenza A(H1N1/2009) pandemic progresses, more data are being accumulated and analyzed to understand the nature and severity of the clinical disease it causes in different populations living in different environments. This study from a Singaporean population living in a tropical environment suggests that the patterns of clinical symptoms caused by this novel virus differ from those of seasonal influenza, with a tendency to infect a younger age group.
With the hypothesis that β-blockers are safe in cocaine-related chest pain, Rangel et al performed a retrospective cohort study of 331 consecutive patients with chest pain and urine toxicologic test results positive for cocaine. Approximately half of the patients received β-blockers in the emergency department. There were no detectable differences in any adverse event recorded, including differences in electrocardiographic changes, troponin levels, length of stay, use of vasopressor agents, intubation, ventricular tachycardia or ventricular fibrillation, or death in those who did and did not receive a β-blocker. An analysis of the national death index revealed no difference in overall mortality in those who received β-blockers over a median 972 days of follow-up.
A secular trend analysis was performed to examine numbers and incidences of fall-related hospitalizations among older Dutch adults between 1981 and 2008. In the study period, fall-related hospital admissions doubled. The annual age-adjusted incidence continued to rise. However, owing to a reduction in the hospital admission duration, the number of fall-related hospital bed–days decreased. Because of aging societies worldwide, an increasing impact on fall-related health care consumption is to be expected.
The clinical course and outcomes of patients with non–ST-segment elevation acute coronary syndrome (NSTE-ACS) and kidney disease (KD) was assessed in a population of 13 141 patients enrolled in 3 multinational ACS registries. Patients with KD composed 32% of the study population and were shown to have a significantly higher risk for in-hospital and 30-day mortality. Coronary angiography was associated with a significantly lower risk of mortality among patients with KD, but this high-risk population still exhibited high residual mortality rates. The findings from this study demonstrate that, in a real-world setting, patients with KD compose approximately one-third of the NSTE-ACS population and the presence of KD is an independent predictor of mortality despite current coronary intervention procedures.
Physicians avoid prescribing β-blockers in patients with chronic obstructive pulmonary disease (COPD) and concurrent cardiovascular disease because of concerns about adverse pulmonary effects. With an observational cohort study of 2230 patients 45 years and older with an incident or prevalent diagnosis of COPD and a mean (SD) follow-up of 7.2 (2.8) years, Rutten et al showed that β-blockers may reduce the risk of exacerbations (adjusted hazard ratio, 0.71 [95% confidence interval, 0.60-0.83]) and improve survival of patients with COPD (adjusted hazard ratio, 0.68 [95% confidence interval, 0.56 to 0.83]), possibly owing to dual cardiopulmonary protective properties. Subgroup analyses in patients with COPD without overt cardiovascular disease revealed similar results.
Cumulative survival of patients with COPD according to β-blocker use.
In This Issue of Archives of Internal Medicine. Arch Intern Med. 2010;170(10):848. doi:10.1001/archinternmed.2010.117