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Source: JAMA
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Total 276 results found since Jan 2013.
Techniques for Treatment of Carotid Stenosis
To the Editor Dr Schermerhorn and colleagues compared transcarotid artery revascularization with transfemoral carotid stenting for treatment of carotid stenosis and found that transcarotid artery revascularization was associated with a lower risk of stroke or death. However, 37% of the patients (n = 1965) were excluded from the transcarotid artery revascularization group and 50% (n = 3354) from the transfemoral carotid stenting group. When such a large percentage of the registry data are excluded, it becomes difficult to make a fair comparison without eliminating selection bias. The authors should have reported th...
Source: JAMA - April 21, 2020 Category: General Medicine Source Type: research
Error in USPSTF Report on Statin Use
The 2016 review for the US Preventive Services Task Force on statins for prevention of cardiovascular disease in adults had errors in the analysis of statins vs placebo and cardiovascular mortality. For the JUPITER trial, we interpreted “MI, stroke or cardiovascular death” as reported in the main trial publication as “myocardial death, stroke death, or cardiovascular death,” when it meant “nonfatal myocardial infarction, nonfatal stroke, or cardiovascular death.” Therefore, the analysis erroneously included nonfatal myo cardial infarction and stroke events (83/8901 vs 157/8901 in the rosuvastatin vs placebo gro...
Source: JAMA - February 18, 2020 Category: General Medicine Source Type: research
Polygenic Risk Scores for Coronary Artery Disease?
A risk-based prevention strategy is the most widely accepted approach to guide clinician-patient decision-making for prevention of coronary artery disease (CAD). According to this approach, the intensity of prevention efforts is matched to the estimated risk of the individual. American College of Cardiology/American Heart Association guidelines currently recommend pooled cohort equations for initial risk assessment, which integrate age, systolic blood pressure, total cholesterol, high-density lipoprotein cholesterol, smoking status, and treatment for hypertension and diabetes to provide race- and sex-specific estimates of ...
Source: JAMA - February 18, 2020 Category: General Medicine Source Type: research
How Effective and Safe Is Factor XI Inhibition in Preventing Venous Thrombosis?
The introduction of the direct oral anticoagulants for stroke prevention in atrial fibrillation and the management of thromboembolism has transformed the care of patients with these disorders. These drugs, which selectively and reversibly inhibit factor Xa or thrombin in the common pathway of the coagulation cascade, have a wide therapeutic window; this allows for simplified dosing regimens without laboratory monitoring of most adult patients as contrasted to vitamin K antagonists. This class of drug is also associated with a lower bleeding risk than vitamin K antagonists, which has been most clearly demonstrated by a 50% ...
Source: JAMA - January 14, 2020 Category: General Medicine Source Type: research
Error in Results Section
The Original Investigation titled “Association of General Anesthesia vs Procedural Sedation With Functional Outcome Among Patients With Acute Ischemic Stroke Undergoing Thrombectomy: A Systematic Review and Meta-analysis” published in the October 1, 2019, issue included errors in the Results regarding the absolute numbers for th e secondary outcome of successful reperfusion. Data in Table 3, text in the Results section, and eTables 12, 14, 15, and 16 in the Supplement have been corrected online (all other information in Table 3, the Results, and the Supplement was correct and remains unchanged).
Source: JAMA - December 21, 2019 Category: General Medicine Source Type: research
Transcarotid Artery Revascularization vs Transfemoral Carotid Artery Stenting for Carotid Artery Stenosis
This study uses registry data to compare stroke and death outcomes for patients with carotid artery stenosis undergoing transcarotid artery revascularization vs transfemoral carotid artery stenting.
Source: JAMA - December 17, 2019 Category: General Medicine Source Type: research
Treatment of Hyperglycemia in Patients With Acute Stroke —Reply
In Reply Dr Long and colleagues point out that the SHINE trial may have shown additional useful results if patients were stratified based on prestroke glycemic control. Although the sample of patients without diabetes was small, eFigure 1 in Supplement 3 in the article showed that there was no significant difference in the primary outcome by treatment group in the subgroups of patients with or without diabetes. We are in the process of conducting secondary analyses to assess hemoglobin A1c levels and outcome.
Source: JAMA - December 10, 2019 Category: General Medicine Source Type: research
Treatment of Hyperglycemia in Patients With Acute Stroke
To the Editor The multicenter Stroke Hyperglycemia Insulin Network Effort (SHINE) randomized clinical trial enrolled 1118 patients with acute ischemic stroke and hyperglycemia (923 with known diabetes) to test the effect of different blood glucose control strategies on neurological outcome. No difference in favorable functional outcome was found with intensive vs standard glucose control. We wish to highlight several issues.
Source: JAMA - December 10, 2019 Category: General Medicine Source Type: research
Incorrect Y-Axis Labels and Minor Data Errors
This article was corrected online.
Source: JAMA - November 5, 2019 Category: General Medicine Source Type: research
General Anesthesia vs Procedural Sedation With Functional Outcome in Patients Undergoing Thrombectomy
This meta-analysis pools individual patient data to estimate the association between receipt of general anesthesia vs procedural sedation and 3-month disability among patients with acute ischemic stroke undergoing mechanical thrombectomy from 3 randomized trials.
Source: JAMA - October 1, 2019 Category: General Medicine Source Type: research
“Smoldering” Brain Lesions Might Signal Severe Multiple Sclerosis
Chronic active lesions in the brain might signal more aggressive and disabling forms of multiple sclerosis (MS), scientists from the National Institute of Neurological Disorders and Stroke (NINDS) recently reported in JAMA Neurology.
Source: JAMA - September 24, 2019 Category: General Medicine Source Type: research
Catheter Ablation Compared With Drug Therapy for Atrial Fibrillation
To the Editor Dr Packer and colleagues for the CABANA Investigators demonstrated no significant difference between catheter ablation and antiarrhythmic drug therapy in patients with paroxysmal and persistent atrial fibrillation on the composite primary end point of death, disabling stroke, serious bleeding, or cardiac arrest. For the composite secondary end point of death or CV hospitalization, patients randomized to catheter ablation had better event-free survival than those randomized to antiarrhythmic drugs.
Source: JAMA - September 17, 2019 Category: General Medicine Source Type: research
Improving Stroke Preparedness Among Blacks and Hispanics
A culturally tailored film on stroke preparedness did not lead to greater recognition of stroke symptoms in black and Hispanic individuals at high risk for stroke, according to a trial in JAMA Neurology.
Source: JAMA - August 27, 2019 Category: General Medicine Source Type: research
Trends in Cardiometabolic Mortality in the United States, 1999-2017
This study evaluates the Centers for Disease Control and Prevention ’s Wide-Ranging Online Data for Epidemiologic Research to compare trends in heart disease, stroke, diabetes, and hypertension mortality rates by race and sex from 1999 to 2017.
Source: JAMA - August 27, 2019 Category: General Medicine Source Type: research
Blood Pressure and Dementia
Alzheimer disease and related dementias affect nearly 10% of US adults older than 65 years. With an aging population, the prevalence of dementia is likely to increase, adding to the enormous burden on affected patients, their caregivers, and the health care system. Besides Alzheimer pathology (eg, amyloid and tau protein deposition) in the brain, there is increasing evidence of the contributions of vascular pathology (eg, stroke, subclinical infarct, and ischemic white matter changes) on dementia occurrence. Furthermore, these 2 common pathologies can coexist in individual patients, with evidence that cerebrovascular insul...
Source: JAMA - August 13, 2019 Category: General Medicine Source Type: research
