• Filter By:
• Specialty
• Source
• Condition
• Cancer
• Infectious Disease
• Drug
• Training
• Management
• Procedure
• Therapy
• Vaccine
• Nutrition
• Country

A Tale of 2 Blood Pressures
In this issue of JAMA Internal Medicine, Drawz et al report data from the Systolic Blood Pressure Intervention Trial (SPRINT) comparing office blood pressure (BP) measured in the trial with office BP obtained during routine clinical practice. SPRINT, which enrolled adults 50 years or older without diabetes or stroke to determine whether a more intensive BP treatment target was beneficial, was stopped early after an interim analysis showed that an office systolic BP (SBP) target of less than 120 mm Hg reduced cardiovascular events and all-cause mortality compared with a standard SBP target of less than 140 mm Hg. As in many...
Source: JAMA Internal Medicine - December 1, 2020 Category: Internal Medicine Source Type: research

Assessment of Shared Decision-making for Stroke Prevention in Patients With Atrial Fibrillation
This randomized clinical trial assesses the use of a shared decision-making tool during clinical encounters and the effects on anticoagulant treatment decisions in patients with atrial fibrillation who are at risk of experiencing stroke.
Source: JAMA Internal Medicine - September 1, 2020 Category: Internal Medicine Source Type: research

All Types of Hemorrhagic Stroke Are Not Created Equally
To the Editor The decision to initiate oral anticoagulation (OAC) posthemorrhagic stroke or traumatic intracerebral hemorrhage (ICH) in those with atrial fibrillation (AF) is a gray area in clinical practice. By showing that the decision to resume OAC may have a favorable risk-benefit ratio, the article by Nielsen et al published in a recent issue ofJAMA Internal Medicine brings us closer to understanding if and when to do this. However, important questions remain, which may be difficult to clarify using such an observational approach.
Source: JAMA Internal Medicine - September 1, 2017 Category: Internal Medicine Source Type: research

All Types of Hemorrhagic Stroke Are Not Created Equally —Reply
In Reply Decision making on the use of oral anticoagulant treatment in patients with atrial fibrillation is often uncomplicated due to the positive risk-benefit ratio, ie, balancing risk of bleeding against benefit from thromboprophylaxis. Observational data on patients with atrial fibrillation sustaining an intracranial hemorrhage are increasing, recognizing the treatment conundrum of resuming oral anticoagulant treatment since the risk-benefit ratio of treatment is shifted substantially.
Source: JAMA Internal Medicine - September 1, 2017 Category: Internal Medicine Source Type: research

Dabigatran Compared With Rivaroxaban vs Warfarin
To the Editor In a recent issue ofJAMA Internal Medicine, Graham et al reported that rivaroxaban use increased risks of major bleeding with nonsignificant reduction in thromboembolic stroke and increased mortality compared with dabigatran in elderly Medicare beneficiaries newly treated with dabigatran or rivaroxaban for nonvalvular atrial fibrillation (November 2011-June 2014). However, dabigatran event rates were lower than reported by Graham et al in a larger group of elderly Medicare beneficiaries newly treated with dabigatran or warfarin for nonvalvular atrial fibrillation with longer follow-up during a partially overl...
Source: JAMA Internal Medicine - May 1, 2017 Category: Internal Medicine Source Type: research

Dabigatran vs Rivaroxaban for Nonvalvular Atrial Fibrillation
This cohort study compares risks of thromboembolic stroke, intracranial hemorrhage, major extracranial bleeding, and mortality in Medicare beneficiaries with nonvalvular atrial fibrillation who initiated dabigatran or rivaroxaban therapy for stroke prevention.
Source: JAMA Internal Medicine - November 1, 2016 Category: Internal Medicine Source Type: research

Comparing Non –Vitamin K Oral Anticoagulants
In 2016, we have a bevy of oral anticoagulants that are approved for stroke prevention in patients with atrial fibrillation. Non –vitamin K oral anticoagulants (NOACs) are increasingly prescribed, and some guidelines recommend their use over vitamin K antagonists. As a consequence, clinicians and patients have more choices and need more data to best balance risks and benefits for each individual.
Source: JAMA Internal Medicine - November 1, 2016 Category: Internal Medicine Source Type: research

Hypertension, the Swedish Patient Register, and Selection Bias
In Reply We recently reported that high body mass index (BMI) and low aerobic fitness in a large cohort of 18-year-old Swedish men were associated with increased risk of hypertension in adulthood. Hypertension was ascertained using all inpatient diagnoses nationwide throughout the study period (1969-2012) and outpatient diagnoses from all specialty clinics between 2001 and 2012. We indicated that hypertension was therefore underreported because we lacked outpatient data before 2001 or from primary care clinics. Dr Brunström raises the question of whether our findings may be attributable to the known associations between h...
Source: JAMA Internal Medicine - June 1, 2016 Category: Internal Medicine Source Type: research

Misinterpretation of the Safety of Testosterone Dosage Forms
In Reply We appreciate the point of view expressed by Dr Schooling and agree that given widespread use of testosterone products, a thorough investigation of its cardiovascular safety is crucial. Understanding whether testosterone treatment (in any form) contributes to an increased risk of cardiovascular events, stroke, and/or death is of great interest to multiple stakeholders, including patients, physicians, and regulators. Dr Schooling is correct to point out that our recently published study did not attempt to answer those questions. Assessing the safety of testosterone relative to nonuse is methodologically challenging...
Source: JAMA Internal Medicine - November 1, 2015 Category: Internal Medicine Source Type: research

Anticholinergic Use With Incident Dementia
To the Editor The report by Gray et al on the association of anticholinergic use with incident dementia may have overestimated the risk of anticholinergic use due to residual confounding. Participants with the highest level of cumulative exposure had, at baseline, more than double the rate of stroke and triple the rate of fair or poor health by self-report than participants with no exposure. They also had higher rates of hypertension, diabetes mellitus, and obesity; were twice as likely to be women; and 4 times as likely to have high levels of depressive symptoms. Since these independent risks for dementia were present at ...
Source: JAMA Internal Medicine - September 1, 2015 Category: Internal Medicine Source Type: research

Patient Characteristics and Risk of Bleeding With Dabigatran
To the Editor We appreciate the interesting study by Hernandez et al on the risk of bleeding with dabigatran in patients with atrial fibrillation. These are important data to an ongoing controversy. However, we would appreciate an author comment regarding the external validity of the study. To what extent is this sample of Medicare beneficiaries representative of the general population of patients with atrial fibrillation? Comparing the characteristics of patients in the RE-LY Study and the Danish population-based study, it seems that these are not effortlessly comparable. In the study by Hernandez et al, patients are cons...
Source: JAMA Internal Medicine - July 1, 2015 Category: Internal Medicine Source Type: research

New Atrial Fibrillation Guideline
The recent 2014 American Heart Association, American College of Cardiology, and Heart Rhythm Society guideline for the management of patients with atrial fibrillation (AF) recommends using the CHA2DS2-VASc stroke risk score instead of the older CHADS2 score when deciding whether to recommend anticoagulant therapy, in essence lowering the threshold at which oral anticoagulation is recommended. As O’Brien et al2 report, the net effect of using the CHA2DS2-VASc score is to recategorize a large proportion of patients with AF as being at high risk for stroke, thereby making oral anticoagulation recommended for most patients with AF.
Source: JAMA Internal Medicine - May 1, 2015 Category: Internal Medicine Source Type: research

The Case Against Identifying Carotid Stenosis in Asymptomatic Patients
Carotid ultrasonography is performed frequently to identify carotid stenosis in patients with no history of carotid-territory cerebrovascular ischemia. The premises of such testing are that the potential benefit of endarterectomy or stenting exceeds the potential harm in patients with asymptomatic stenosis and that discovery of asymptomatic stenosis may trigger beneficial changes in lifestyle or medical management that otherwise would not have occurred. However, given low contemporary rates of stroke in medically managed patients with asymptomatic carotid stenosis, invasive carotid procedures cannot be justified in this po...
Source: JAMA Internal Medicine - December 1, 2014 Category: Internal Medicine Source Type: research

Further Insight Into the Cardiovascular Risk Calculator The Roles of Statins, Revascularizations, and Underascertainment in the Women’s Health Study
Conclusions and RelevanceStatin use, revascularization procedures, and underascertainment of events do not explain the discrepancy between observed rates of ASCVD in the WHS and those predicted by the ACC/AHA pooled cohort equations. Other explanations include changing patterns of risk within more contemporary populations.
Source: JAMA Internal Medicine - December 1, 2014 Category: Internal Medicine Source Type: research