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Source: JAMA
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Total 276 results found since Jan 2013.
Management of Patients With a Patent Foramen Ovale With History of Stroke or TIA
This Clinical Guidelines Synopsis summarizes the American Academy of Neurology ’s practice advisory update on management of patients with a patent foramen ovale who have a history of stroke or transient ischemic attack.
Source: JAMA - January 5, 2021 Category: General Medicine Source Type: research
Do Omega-3 Fatty Acids Benefit Health?
An important clinical trial of omega-3 fatty acids in patients at high risk of cardiovascular disease is published in JAMA. In the STRENGTH trial (the Long-Term Outcomes Study to Assess Statin Residual Risk with Epanova in High Cardiovascular Risk Patients with Hypertriglyceridemia), 13 078 patients were randomized to receive 4 g/d of a carboxylic acid formulation of omega-3 fatty acids (a combination of eicosapentaenoic acid [EPA] and docosahexaenoic acid [DHA]) or corn oil as a comparator. After a median follow-up of 42 months, there was no significant difference between the o mega-3 fatty acid group (6539 patients) a...
Source: JAMA - December 8, 2020 Category: General Medicine Source Type: research
Patient Information: Carotid Artery Stenting
This JAMA Patient Page describes the use of the carotid artery stenting procedure to reduce the risk of stroke in patients with carotid artery atherosclerosis.
Source: JAMA - October 27, 2020 Category: General Medicine Source Type: research
Net Adverse Clinical Events With Antiplatelet Therapy in Acute Coronary Syndromes
Clopidogrel, prasugrel, and ticagrelor are oral platelet P2Y12 receptor inhibitors that decrease the risk of platelet-mediated coronary artery thrombosis. Clinical guidelines have recommended ticagrelor or prasugrel over clopidogrel in combination with aspirin as dual antiplatelet therapy (DAPT) for 1 year after acute coronary syndrome (ACS), whether or not percutaneous coronary intervention (PCI) is performed. The ticagrelor recommendation was based on the Study of Platelet Inhibition and Patient Outcomes (PLATO) trial, which enrolled 18 624 patients with ACS and randomized them to receive DAPT with either clopidogrel ...
Source: JAMA - October 27, 2020 Category: General Medicine Source Type: research
Door-to-Needle Time and Long-term Outcomes in Patients With Stroke —Reply
In Reply Although factors other than faster door-to-needle times may have contributed to the associations between door-to-needle times and 1-year mortality and readmission in our study, there are multiple lines of evidence to suggest that door-to-needle times contributed to improved clinical outcomes and were not just an index for generic stroke care quality. The hospitals providing data for our study were participating in Get With The Guidelines (GWTG) –Stroke, a national quality improvement initiative. Prior studies have analyzed conformity of GWTG-Stroke hospitals with standard stroke care measures, including 7 perfor...
Source: JAMA - October 13, 2020 Category: General Medicine Source Type: research
Door-to-Needle Time and Long-term Outcomes in Patients With Stroke
To the Editor We are interested in the relationship between door-to-needle time and 1-year outcomes in patients with acute ischemic stroke in the study by Dr Man and colleagues. We think potential correlation between door-to-needle time and stroke care quality might explain the association between door-to-needle time and outcomes.
Source: JAMA - October 13, 2020 Category: General Medicine Source Type: research
Benefits of Treating Obstructive Sleep Apnea
To the Editor Drs Gottlieb and Punjabi, in their Review on obstructive sleep apnea (OSA), stated that “current evidence suggests that treatment does not reduce the risk of cardiovascular disease, stroke, or metabolic abnormalities in asymptomatic patients.” Even though studies have failed to find a decrease in cardiovascular mortality in patients using continuous positive airway pressure (PAP), they have had significant methodological flaws, such as excluding patients with excessive sleepiness—precisely the patients who need continuous PAP therapy.
Source: JAMA - September 15, 2020 Category: General Medicine Source Type: research
Association Between New-Onset Atrial Fibrillation After Noncardiac Surgery and Subsequent Stroke and TIA
This retrospective study compared the rate of ischemic stroke or transient ischemic attack among Olmstead County, Minnesota, residents with vs without new-onset postoperative atrial fibrillation after undergoing noncardiac surgery.
Source: JAMA - September 1, 2020 Category: General Medicine Source Type: research
Association of Statin Use With All-Cause and Cardiovascular Mortality in US Veterans 75 and Older
This retrospective cohort study uses Veterans Health Administration data on adults free of atherosclerotic cardiovascular disease (ASCVD) to evaluate the association between new statin use and all-cause and cardiovascular mortality, and a composite of ASCVD events (myocardial infarction, ischemic stroke, and revascularization with CABG surgery or PCI), in veterans 75 years and older.
Source: JAMA - July 7, 2020 Category: General Medicine Source Type: research
Pulse Pressure and Isolated Diastolic Hypertension —Reply
In Reply We agree with Dr Anstadt about the tetrad linking systolic and diastolic blood pressure and that pulse pressure is a critically important consideration in any analysis of the relationship between blood pressure and CVD outcomes. Pulse pressure adds prognostic information to systolic or diastolic blood pressure values because pulse pressure, which is calculated as the absolute difference between systolic and diastolic blood pressure, is related to both stroke volume and the compliance of large arteries (with the latter influencing vascular resistance). Therefore, pulse pressure can be an important surrogate marker ...
Source: JAMA - June 16, 2020 Category: General Medicine Source Type: research
Association Between Thrombolytic Door-to-Needle Times and Ischemic Stroke Outcomes
This cohort study estimates associations between intravenous tissue plasminogen activator (tPA) door-to-needle times of less than 4.5 hours for acute ischemic stroke and 1-year mortality or readmission among Medicare beneficiaries aged 65 years or older.
Source: JAMA - June 2, 2020 Category: General Medicine Source Type: research
Long-term Outcomes After Thrombolytic Therapy for Acute Ischemic Stroke
The role of intravenous thrombolytic therapy in the management of acute ischemic stroke is well established, and faster administration of intravenous tissue plasminogen activator (tPA) has been associated with better short-term outcomes in clinical practice.
Source: JAMA - June 2, 2020 Category: General Medicine Source Type: research
Deprescribing Antihypertensive Medications for Patients Aged 80 or Older
The treatment of hypertension in older adults is a major public health concern. Among the nearly 13 million persons in the United States aged 80 years or older, approximately 80% have high blood pressure (BP). Hypertension is the most potent modifiable risk factor for cardiovascular disease in older adults and has been strongly associated with stroke, myocardial infarction, heart failure, peripheral artery disease, kidney failure, and dementia. Thus, defining optimal strategies for managing elevated BP in older individuals is a high priority.
Source: JAMA - May 26, 2020 Category: General Medicine Source Type: research
Alteplase Inhibits Nerinetide, a Novel Stroke Drug
The investigational neuroprotectant nerinetide did not reduce disability in all patients with ischemic stroke who were treated with endovascular thrombectomy, a trial in The Lancet reported. However, patients who were not concurrently treated with alteplase had a large benefit from nerinetide.
Source: JAMA - April 28, 2020 Category: General Medicine Source Type: research
Techniques for Treatment of Carotid Stenosis —Reply
In Reply In response to Dr Sharma and colleagues, we used propensity score matching methods to account for baseline characteristic differences found between patients undergoing transfemoral carotid artery stenting and transcarotid artery revascularization. Although this led to a 50% exclusion of patients from the transfemoral carotid stenting cohort and a 37% exclusion of patients from the transcarotid artery revascularization cohort, these matching methods are important for controlling intrinsic biases found in observational studies. However, we provided unadjusted complete raw data outcomes in eTable 1 in the supplementa...
Source: JAMA - April 21, 2020 Category: General Medicine Source Type: research
