In a randomized clinical trial that enrolled 450 adults with uncontrolled blood pressure (BP) who were recruited from 16 primary care clinics in an integrated health system, Margolis and colleagues compared the effect of home BP telemonitoring with clinic-based pharmacist case management vs usual care for BP control. The authors report that home BP telemonitoring and pharmacist case management achieved better BP control than usual care during the 12-month intervention and in the 6 months after the intervention. In an editorial, Magid and Green discuss benefits of home BP monitoring and barriers to wide-scale adoption.
Author Video Interview
Evidence is lacking to support prescription of a home-based walking program for patients with lower extremity peripheral artery disease (PAD). McDermott and colleagues randomly assigned 194 patients with PAD to either a 6-month home-based walking program that incorporated group support and self-regulatory skills or an attention control (health education) group. The authors found that the home-based walking program significantly improved walking performance and physical activity in patients with PAD with and without classic claudication symptoms.
In a randomized trial that enrolled 1374 patients with cardiovascular risk factors, Ledwidge and colleagues assessed whether brain-type natriuretic peptide (BNP)–based screening and referral of patients with elevated levels (>50 pg/mL) to collaborative care involving a specialist cardiovascular service would reduce the prevalence of asymptomatic left ventricular dysfunction with or without incident heart failure. The authors report that compared with primary care physician management alone, BNP-based screening and collaborative care reduced the combined rates of left ventricular systolic and diastolic dysfunction and heart failure. In an editorial, Hernandez discusses challenges in the prevention of heart failure.
Sandin and colleagues examined the association between birth after in vitro fertilization (IVF) and neurodevelopmental outcomes in a population-based prospective cohort study involving more than 2.5 million Swedish children born between 1982 and 2007. The authors report that compared with spontaneous conception, IVF treatment was not associated with autism but was associated with a small increased risk of mental retardation in the offspring. In an editorial, Cedars discusses the need for continued study of the relationship between IVF procedures and neurodevelopmental outcomes.
Prevention is deeply embedded in US culture, yet—paradoxically—disease prevention in clinical medicine and public health is difficult to accomplish. Fineberg discusses a number of reasons that prevention is resisted, including the invisibility of success, the long delay before rewards are evident, and the changing or inconsistent preventive advice. He suggests strategies for overcoming obstacles to prevention, highlights the role of employers and policy makers to support prevention, and urges the use of multiple media channels to educate and elicit positive change.
Author Audio Interview,
Continuing Medical Education
US guidelines on smoking cessation do not endorse gradual reduction in smoking as an effective cessation strategy. Lindson-Hawley and colleagues summarize the results of a 2012 Cochrane review that analyzed data from 10 randomized trials (3760 patients) that assessed rates of smoking abstinence among individuals randomly assigned to gradual smoking cessation or abrupt quitting. The authors conclude that compared with abrupt cessation, gradual reduction may result in clinically comparable rates of smoking cessation rates at 6 months’ follow-up.
Highlights. JAMA. 2013;310(1):7–9. doi:10.1001/jama.2013.5183