News from Nov. 18, 2014 Annals of Internal Medicine

A study being published in Annals of Internal Medicine suggests that people with atrial fibrillation (AF) who take nonsteroidal anti-inflammatory drugs (NSAIDs) may be at risk for serious bleeding or thromboembolisms. Anticoagulants are used to decrease the risk for thromboembolic complications and death in patients with AF but have been found to increase the risk for bleeding. Using NSAIDs with these drugs is assumed to increase that risk, but the magnitude of risk has never been defined. Researchers examined the electronic records of 150,900 Danish patients with a first-time diagnosis of AF to determine the risk for serious bleeding and thromboembolism with ongoing anticoagulant and NSAID therapy. The researchers found that even the use of NSAIDs for a short period of time increased the risk for bleeding and the risk seemed to increase with NSAID dose. An increased risk for blood clots and death following a nonfatal episode of serious bleeding was also observed. The researchers suggest that physicians use caution when prescribing NSAIDs to AF patients who are taking anticoagulants and should offer alternate pain medications, when possible.

Note: The URL for this story will be live at 5:00 p.m. on November 17 and can be used in news stories. For a PDF, please contact Megan Hanks. To interview the lead author, please contact Henrik Spurr at +45 38 67 30 51 or Henrik.Spurr@regionh.dk.

Researchers create 'cascade of care' to identify gaps in addressing diabetes epidemic

Three in 10 adults with diabetes remain undiagnosed, revealing a need for care improvements. A 'cascade of care' model, like that used to address implementation gaps in HIV care, may be similarly useful for visualizing gaps in awareness of diagnosis, engagement, and treatment of diabetes, according to an article being published in Annals of Internal Medicine. The cascade of care concept is a method of showing how many patients are living with a certain condition and how many are receiving the care and treatment that they need to manage that condition. This concept has been used to monitor and address the HIV/AIDS epidemic, and has provided insight into the continuum of care and where gaps in care occur for that disease. Researchers analyzed data from the National Health and Nutrition Examination Survey (NHANES) to create a cascade of care for diabetes. Over the five years studied, an estimated 28.4 million adults, or 11.8 percent of the adult population, in the U.S. ages 18 and older had diabetes and 7.9 million reported being unaware of their condition even though 85 percent of them were liked to a care provider and 67 percent visited care providers at least twice during the preceding year. The authors suggest that increasing awareness of their diagnosis among diabetes patients is important for improving health outcomes. They write that the cascade-of-care concept is powerful in helping visualize gaps and disparities across groups and improving engagement and health care quality.

Note: The URL for this story will be live at 5:00 p.m. on November 17 and can be used in news stories. For a PDF, please contact Megan Hanks. To interview the lead author, please contact Melva Robertson at 404-727-5692 or melva.robertson@emory.edu.

Coronary artery bypass grafting (CABG) proves superior to percutaneous coronary intervention (PCI) for treating multivessel or left main coronary artery disease in diabetic patients, according to a study being published in Annals of Internal Medicine. Diabetes affects up to 400 million persons worldwide, with that number expected to increase significantly over the next two decades. Because patients with diabetes are more than twice as likely to develop cardiovascular disease, the optimal revascularization technique for these patients is an important unsolved question. Researchers conducted a systematic review of published studies comparing long-term outcomes between two revascularization techniques: PCI and CABG. The evidence showed a 33 percent increased risk for death, non-fatal myocardial infarction, and stroke for diabetic patients undergoing PIC. CABG had several superior long-term outcomes including a statistically significant improvement in mortality and avoiding the need for repeated revascularization.

Note: The URL for this story will be live at 5:00 p.m. on November 17 and can be used in news stories. For a PDF, please contact Megan Hanks. To interview the lead author, please contact Julie Robert at 514 934-1934 ext. 71381 or julie.robert@muhc.mcgill.ca.

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