1. Physical impairment is common in middle age and often progresses to further decline or death
Abstract: http://annals.org/aim/article/doi/10.7326/M17-0496
Editorial: http://annals.org/aim/article/doi/10.7326/M17-2550
FREE Summary for Patients: http://annals.org/aim/article/doi/10.7326/P17-9049
All URLs go live when the embargo lifts
A study of middle-aged adults found that functional impairment, or difficulty performing basic daily activities, was common among the cohort and often progressed to further physical decline or death over 10 years' follow up. These findings challenge the notion that functional impairment is temporary in middle age and suggest a need for early intervention.
The study is published in Annals of Internal Medicine with an accompanying interactive graphic (http://go.annals.org/sunburst-graphic) that allows readers to visualize the data in a way that facilitates a broader understanding of the findings.
The term "functional impairment" is used to describe difficulty performing basic daily activities, such as bathing, dressing, or getting out of bed. Functional impairment is usually associated with geriatric patients, but is also common in middle age and can impede independence, even in younger persons. Despite its prevalence, little is known about the epidemiology or clinical course of functional impairment in middle age, including the extent to which it shares common features with functional impairment in older adults. Gaining understanding is important for developing appropriate strategies to manage the condition.
Researchers from the University of California, San Francisco and the San Francisco Veterans Affairs Medical Center studied longitudinal data from a large, nationally representative sample of nondisabled persons aged 50-56 who were interviewed every 2 years for up to 20 years about changes in their health and wealth. The data showed that more than one in five respondents reported new difficulty in one or more self-care activity by the age of 64. Of those who reported impaired function, nearly two fifths died or had further functional decline over a 10-year follow-up period. Risk factors for functional impairment included low socioeconomic status, health status, and health-related behaviors. The progression of physical impairment was observed to be similar in middle age and late life, suggesting that interventions used to prevent ongoing decline in older patients may also work in younger patients.
Thomas Gill, MD, director of the Yale University Program on Aging, notes that rates of disability in middle age may be much higher than those reported in the study because walking and housework were not among the activities assessed, and because shorter periods of disability may not have been reported if they were resolved between interview intervals. He suggests that future research may benefit from a collection of a more comprehensive array of potential risk factors, shorter assessment intervals, and consideration of intervening illnesses and injuries.
Media contacts: For an embargoed PDF, please contact Cara Graeff. To interview the lead author, Rebecca Brown, MD, MPH, please contact Scott Maier at Scott.Maier@ucsf.edu or 415-476-3595.
2. Dabigatran shown to be a safe and effective alternative to warfarin for reducing stroke risk in atrial fibrillation
Real-world outcomes mirror randomized trial results comparing the two blood thinners
Abstract: http://annals.org/aim/article/doi/10.7326/M16-1157
URLs go live when the embargo lifts
A real-world analysis of dabigatran and warfarin showed that both medications were associated with similar incidence of ischemic stroke and overall bleeding in patients with atrial fibrillation. These findings align well with those seen in clinical trials. The results of a retrospective cohort study are published in Annals of Internal Medicine.
Atrial fibrillation is an irregular heartbeat that increases ischemic stroke risk. To reduce this risk, patients often receive treatment with the blood thinner warfarin, which has been in use since the 1950s, or a newer alternative such as dabigatran, approved by the U.S. Food and Drug Administration (FDA) in 2010. However, since its initial use in clinical practice, reports of major bleeding risk associated with dabigatran have been conflicting.
A team led by investigators from Kaiser Permanente Division of Research used data from the FDA's Sentinel Initiative, a national multi-institutional network to monitor the safety of new medical products after they reach the market, to compare incidence of stroke, bleeding, and myocardial infarction in patients receiving dabigatran versus warfarin in clinical practice. Based on data from more than 55,000 patients treated in clinical practice in the United States, the researchers found that both medications were associated with similar rates of ischemic stroke and overall bleeding. However, people taking dabigatran were less likely to experience bleeding in the brain, which can be dangerous or deadly. The findings were consistent with the results of prior clinical trials that compared the two drugs.
Media contacts: For an embargoed PDF, please contact Cara Graeff. To interview the lead author, Alan Go, MD, please contact Janet Byron at Janet.L.Byron@kp.org.
3. Perioperative aspirin may provide more benefit than harm to patients with prior PCI
Abstract: http://annals.org/aim/article/doi/10.7326/M17-2341
Editorial: http://annals.org/aim/article/doi/10.7326/M17-2954
Low-dose aspirin therapy after noncardiac surgery may provide more benefit than harm to patients with prior percutaneous coronary intervention (PCI). Findings from a subanalysis of the POISE-2 (PeriOperative ISchemic Evaluation-2) trial are published in Annals of Internal Medicine.
Noncardiac surgery is common, with more than 200 million annual procedures worldwide. Despite the benefits of surgery, major perioperative cardiovascular complications can occur, especially among patients who have had prior PCI. In the POISE-2 trial, which influenced perioperative guidelines, investigators randomly assigned 10,010 patients having noncardiac surgery to receive aspirin or placebo. They found that aspirin did not prevent death and nonfatal myocardial infarction, but did increase risk for major bleeding. However, these results were not analyzed for patients with prior PCI.
Researchers from the McMaster University in Hamilton, Ontario did a POISE-2 substudy to evaluate the benefits and harms of perioperative aspirin in 470 patients with prior PCI. The researchers found that compared to placebo, low-dose perioperative aspirin reduced the risk for death and nonfatal myocardial infarction in these patients. This beneficial effect, which differed from the effect found in patients without prior PCI, was driven by a reduction in myocardial infarction. The estimate of composite bleeding risk in patients with prior PCI was uncertain.
Media contacts: For an embargoed PDF, please contact Cara Graeff. To interview the lead author, P.J. Devereaux, MD, PhD, please contact Veronica McGuire at mailto:vmcguir@mcmaster.ca or 905-525-9140 ext. 22169.
4. NIAID Director offers expert advice to President Trump on preparing for infectious disease outbreaks
Abstract: http://annals.org/aim/article/doi/10.7326/M17-2496
Anthony S. Fauci, MD, Director of the NIH's National Institute of Allergy and Infectious Diseases (NIAID), says that the Trump administration should look to the past for guidance on how to respond to unexpected pandemics. An essay detailing Dr. Fauci's advice for President Trump and his cabinet is published in Annals of Internal Medicine.
In January 2017, the outgoing administration of President Barack Obama convened a meeting with most of the cabinet nominees of the incoming administration of President-elect Donald Trump to brief them on the types of emergencies they may face. Dr. Fauci attended that meeting along with other members of the Department of Health and Human Services to discuss the inevitable threat of infectious diseases.
Having served under five U.S. presidents, Dr. Fauci has faced unexpected pandemics ranging from the HIV/AIDS pandemic that began under President Ronald Reagan, to the recent Zika outbreak in the Americas that began under President Barack Obama. In his essay, Dr. Fauci and colleagues review selected infectious disease outbreaks occurring during this time that are especially memorable and have helped to shape and refine the role of the NIAID's research and public health response to such threats. Because current and as-yet unknown infectious diseases will continue to challenge the current administration, these experiences may also serve as lessons that can be applied during the inevitable public health crises to come.
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Media contacts: For an embargoed PDF, please contact Cara Graeff. To interview Anthony Fauci, MD, please contact Anne Oplinger at aoplinger@niaid.nih.gov or on the media line at 301-402-1663.
Also in this issue:
Bringing Data to Life: Interactive Visualizations of Complex Data
Rajesh Talluri, PhD; Jaya K. Rao, MD, MHS; Christine Laine, MD, MPH, Michael Griswold, PhD
Editorial
Abstract: http://annals.org/aim/article/doi/10.7326/M17-2903
Patients Contributing to Their Doctors' Notes: Insights From Expert Interviews
John N. Mafi, MD, MPH; Macda Gerard, BA; Hannah Chimowitz, BA; Melissa Anselmo, MPH; Tom Delbanco, MD; Jan Walker, RN, MBA;
Brief Research Report
Abstract: http://annals.org/aim/article/doi/10.7326/M17-0583
Editorial: http://annals.org/aim/article/doi/10.7326/M17-2802
Journal
Annals of Internal Medicine