Tip sheet Annals of Internal Medicine, Feb. 21, 2006 issue

February 20, 2006

1. Statin and B-Blockers May Reduce Severity of First Heart Event

In this study of more than 4,000 patients who were experiencing coronary heart disease for the first time, patients who were taking statin or b-blocker drugs were more likely to be diagnosed with angina than myocardial infarction or to die from sudden death (Article, p. 229).

Angina is a more stable, more controllable and lower risk form of heart disease. Statins are drugs used to lower high levels of bad cholesterol, and beta-blockers are drugs used to lower high blood pressure.

While statins and b-blockers are already known to improve factors that lead to heart disease (bad cholesterol and high blood pressure), this study shows that the drugs may also influence the severity of coronary heart disease when it first causes symptoms.

NOTES TO EDITORS: This article is the subject of a video news release. Call for coordinates.

2. Neck Artery Disease Found in People with Rheumatoid Arthritis

A study of 98 outpatients with rheumatoid arthritis (RA) but no symptoms of heart disease and 98 patients without RA, matched for age, sex, and ethnicity, found that the patients with RA had a three-fold increase in atherosclerosis in their carotid arteries (Article, p. 249).

Researchers found atherosclerosis (narrowing) of the carotid arteries in 44 percent of patients with RA compared to 15 percent of those without RA.

People with RA are prone to premature death from heart disease even when they have few observable risk factors for heart disease.

The authors suggest that the arthritic inflammation of RA may be linked to arterial plaque, but they acknowledge that their study does not prove that this link exists.

3. Hospital Volume and Experience with Pneumonia Do not Translate Into Better Care

Many studies have shown that hospitals and doctors who provide a high volume of care for some surgical procedures and medical conditions also provide higher quality care.

This relationship may be true for some conditions, but a new study shows that it does not apply to pneumonia. This retrospective cohort study of 3,243 hospitals across the United States and 23, 480 people with pneumonia cared for by 9,741 physicians found no association between caring for large numbers of pneumonia patients and close adherence to selected guidelines for appropriate care of pneumonia (Improving Patient Care, p. 262).

In fact, among both physicians and hospitals, higher pneumonia volume was associated with less adherence to recommendations for vaccinations and speedy administration of antibiotics.

Moreover, high volume providers did not have better patient outcomes.

The authors conclude the quality improvement efforts for pneumonia should be focused on "improving the timeliness of antibiotic administration, especially at high-volume institutions, and on improving hospital-based vaccination rates."

American College of Physicians

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