In the Literature
In This Edition
- Cost sharing for prescription medications increases consumption of more costly healthcare services
- Community-acquired pneumonia core measures can lead to unintended consequences
- Prophylactic revascularization has no clear benefit for high-risk patients undergoing vascular surgery
- Aspirin resistance correlates with adverse clinical events
- Low-molecular-weight heparin appears to have greater efficacy as a prophylactic agent against deep-vein thrombosis and pulmonary embolism
- Antipsychotic medications appear to be associated with increased risk of death in demented patients
- Anticoagulation plus antiplatelet therapy fails to show benefit for peripheral arterial disease
- Transient atrial fibrillation following myocardial infarction increases the risk of recurrence and stroke
Intensive Statin Therapy Appears Beneficial, Safe in Older Patients
A randomized controlled trial in the elderly demonstrates 19% relative risk reduction for major cardiovascular events with high-dose statin therapy compared with low-dose statin treatment.
Citation: Wenger NK, Lewis SJ, Herrington DM, et al. Outcomes of using high- or low-dose atorvastatin in patients 65 years of age or older with stable coronary heart disease. Ann Intern Med. 2007 Jul 3;147(1):1-9.
A Third of Top MI Hospitals Fall Outside Highest Performing Quartile
The “America’s Best Hospitals” for treatment of acute myocardial infarction designation awarded by U.S. News & World Report reflects an overall decreased mortality for patients treated at highly ranked hospitals. Up to a third of the ranked hospitals fell outside the best-performing quartile for risk standardized mortality rates.
Citation: Wang O, Wang Y, Lichtman JH, et al. “America’s Best Hospitals” in the treatment of acute myocardial infarction. Arch Intern Med. 2007 Jul 9;167(13):1345-1351.
Quality of Chest Compressions Most Important Factor for Successful Resuscitation after Cardiac Arrest
In animals resuscitated five minutes after induction of a complete left anterior descending artery occlusion, the adequacy of the chest compressions was the most relevant factor in whether animals were successfully resuscitated. Adequacy of compressions was a more important factor than time to cardioversion or whether cardioversion preceded compressions.
Citation: Ristagno G, Tang W, Yun-Te C, et al. The quality of chest compressions during cardiopulmonary resuscitation overrides importance of timing of defibrillation. Chest. 2007 Jun 5;132(2);70-75.
The Next Chapter in Fluoroquinolone Resistance
In addition to resistance to sulfonamides, tetracyclines, and penicillins, a 16-year multisite sentinel surveillance now demonstrates fluoroquinolone resistant strains of Neisseria gonorrhoeae in 70% of cities.
Citation: Wang S, Harvey AB, Conner SM, et al. Antimicrobial resistance for Neisseria gonorrhoeae in the United States, 1998 to 2003: The spread of fluoroquinolone resistance. Ann Intern Med. 2007 Jul 17;147(2):81-88.
Do Beta-Blockers Slow Progression of Coronary Atherosclerosis?
Although a post-hoc, pooled analysis of individual patient data demonstrated that beta-blockers significantly decrease atheroma volume, this study was limited by significant differences between the treatment and the control groups.
Citation: Sipahi I, Tuzcu EM, Wolski KE, et al. B-blockade and progression of coronary atherosclerosis: Pooled analysis of 4 intravascular ultrasonography trials. Ann Intern Med. 2007 Jul 3;147(1):10-18.
Do Incentives to Encourage Use of Certain Medications Affect Care?
Background: Insurers are increasingly using financial mechanisms to affect pharmaceutical usage. These practices may affect medication use and health outcomes in ways that are poorly defined and difficult to detect.
Study design: Literature review
Synopsis: There are numerous structures for drug-cost sharing, and this study evaluated co-payments, tiers/co-insurance, benefit caps, formulary limitations, and reference pricing strategies for their effect on prescription drug usage and healthcare outcomes.
