Preclinical models and early clinical studies suggest glucagon-like peptide-1 (GLP-1) agonists have cardioprotective effects in heart failure. Margulies and colleagues assessed whether treatment with the GLP-1 agonist liraglutide—initiated within 2 weeks of hospitalization for acute heart failure and continued for 180 days—would improve clinical stability in a randomized study involving 300 patients with established heart failure and reduced left ventricular ejection fraction. The authors report that, compared with placebo, use of liraglutide did not lead to greater clinical stability after hospitalization for heart failure.
CME
To improve kidney function and prevent kidney failure among patients with septic shock, early vasopressin use has been proposed as an alternative to norepinephrine. In a multicenter randomized trial that enrolled 409 patients with septic shock requiring vasopressors, Gordon and colleagues found that early use of vasopressin compared with norepinephrine did not improve the number of kidney failure–free days during the 28-day period after treatment randomization.
During traditional on-site cardiac monitoring of non–critically ill patients, telemetry alarms are often without clinical relevance and may lead to alarm fatigue. Cantillon and colleagues evaluated patient outcomes among 99 948 non–critically ill patients at 4 hospitals who had continuous cardiac rhythm monitoring provided by an off-site central monitoring unit. The authors found that use of standardized cardiac telemetry with an off-site central monitoring unit was associated with timely detection and response team notification of cardiac rhythm and rate changes and found a reduction in the census of monitored patients—without an increase in cardiopulmonary arrests.
CME
Clinical Review & Education
This article by US President Barack Obama reviews the factors that influenced his decision to pursue US health care reform—culminating in the 2010 Affordable Care Act (ACA)—and summarizes findings from an analysis of publicly available data, government agency data, and data from published research to assess the effects of the ACA on health insurance coverage and trends in health care costs and quality. President Obama concludes with recommended actions that could further improve the US health care system and identifies general lessons for US public policy that derive from the experience of legislating and implementing the ACA. Four Editorials provide scholarly commentary on the ACA and US health care policy.
Editorial 1, 2, 3, and 4
CME
This JAMA Guide to Statistics and Methods article by Tolles and Meuer discusses the use of logistic regression, a common statistical method for quantifying the relationship between patient characteristics and clinical outcomes. The authors focus on the use of logistic regression to create models for predicting patient outcomes. They discuss strengths and limitations of the method and offer caveats to consider when assessing the results of a logistic regression analysis.
This JAMA Diagnostic Test Interpretation article by Hannah-Shmouni and colleagues considers the case of a 32-year-old woman with hypothyroidism who presented for evaluation of fatigue and a 9-kg weight loss. The patient’s body mass index was 20. Her vital signs were normal. Examination revealed darkening of the palmar creases and buccal mucosa. Morning laboratory tests were performed. Among the findings were a low serum cortisol level and an elevated adrenocorticotropic hormone level. What would you do next?