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This Week in JAMA
November 8, 2006

This Week in JAMA

JAMA. 2006;296(18):2175. doi:10.1001/jama.296.18.2175
Patient Factors and Outcomes in Heart Failure

Two articles examine clinical characteristics of patients with heart failure. In the first article, Bursi and colleaguesArticle report results of a prospective community-based study that assessed ejection fraction, diastolic function, and brain natriuretic peptide levels in patients with heart failure. The authors found that 55% of the patients had preserved ejection fraction (≥50%), 80% had diastolic dysfunction, and 44% had isolated diastolic dysfunction and found that mortality rates were similar for patients with preserved and reduced ejection fraction. Severity of systolic and diastolic dysfunction was independently related to higher levels of brain natriuretic peptide. In the second article, Gheorghiade and colleaguesArticle report results of an analysis of data from 48 612 patients hospitalized with heart failure. They assessed the relationship between admission systolic blood pressure and hospital outcomes. The authors found that admission systolic blood pressure is an important independent predictor of morbidity and mortality among patients with reduced and relatively preserved systolic function. Patients with an admission systolic blood pressure less than 120 mm Hg had a particularly poor prognosis. In an editorial, HildebrandtArticle discusses the contribution of these 2 studies toward a better understanding of heart failure prevalence and prognosis.

Dilatation and Surgical Myotomy for Achalasia

Pneumatic dilatation and surgical myotomy are principal methods to reduce symptoms of achalasia, but there have been no community-based studies comparing treatment outcomes after the 2 procedures. Lopushinsky and Urbach reviewed Ontario, Canada, administrative data from mid-1991 through 2002 to assess subsequent interventions among patients who had either pneumatic dilatation or surgical myotomy as their first procedure for achalasia. The authors found that the risk of subsequent interventions was common for patients in both treatment groups, although the risk was lower among patients whose initial treatment was surgical myotomy.

Malaria Prevention in Long-term Travelers

Current guidelines for malaria prevention largely address strategies for short-term travelers to malaria-endemic regions. Chen and colleagues conducted a literature review to assess the risk of malaria among persons traveling for 6 or more months, recent developments in personal protective measures, and the safety and tolerability of malaria chemoprophylaxis during long-term use and to consider sequential regimens with different medications, emergency self-treatment, strategies to prevent relapse, and other concerns. The authors discuss key findings from their review, including the importance of individualized prevention strategies, the advantages and drawbacks of various approaches to prevention, and concerns about overseas purchase of antimalarial drugs with unproven safety and efficacy.

Clinician's corner

Mrs K is an 89-year-old woman with multiple medical problems and declining physical function. Dr T, who has cared for her since 1985, discusses the challenges in recognizing frailty in older adults, common problems and symptoms experienced by frail elderly persons, and approaches to management.

A Piece of My Mind

“I attend medical school in San Francisco, which my family views as a highly suspicious place, full of sin and odd ways of living. Medical school with its rarefied education and esoteric jargon is one more way to distance myself from my past.” From “Family Medicine.”

Medical News & Perspectives

The 2006 Nobel prizes in chemistry and in physiology or medicine honor 3 scientists who made fundamental discoveries about RNA, a molecule that plays crucial roles in human health and disease.

UK Health Information

England's national health information system will connect physicians, hospitals, community, and mental health organizations and allow patient access to personal health information from home computers.

Violence and Human Rights

Authors are invited to submit manuscripts for an upcoming JAMA theme issue.

Author in the Room Teleconference

Join Dariush Mozaffarian, MD, DrPH, Wednesday, November 15, 2006, from 2 to 3 PM eastern time to discuss the risks and benefits of eating fish. 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 frailty in older adults.