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Source: JAMA Internal Medicine
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Total 40 results found since Jan 2013.
Primary Stroke Center Hospitalization for Elderly Patients With Stroke
This cohort study of Medicare beneficiaries with acute stroke examines associations between admission to a primary stroke centers and case fatality, and investigates whether prolonged travel time offsets the association.
Source: JAMA Internal Medicine - July 25, 2016 Category: Internal Medicine Source Type: research
Cerebral Embolic Protection Devices in Transcatheter Aortic Valve Replacement —Effective in Stroke Prevention?
Transcatheter aortic valve replacement (TAVR) has become the mainstay of treatment for severe symptomatic aortic stenosis. Despite advances in device technology and procedural techniques, periprocedural stroke remains a severe complication of TAVR, affecting 2% of patients. The embolization of calcific debris from the degenerated aortic valve and atherosclerotic plaque from the aorta, both of which are manipulated during TAVR, is the likely mechanism of periprocedural stroke. Accordingly, cerebral embolic protection devices (EPDs) have been designed to prevent stroke by sequestering embolic debris during TAVR.
Source: JAMA Internal Medicine - February 24, 2020 Category: Internal Medicine Source Type: research
Admitting the Patient With Acute Stroke to the Right House
The goal of any prehospital sorting function is to allocate patients to the most appropriate destination that will maximize their outcomes as defined by their preferences, goals, needs, and resources. In much the same way, the Sorting Hat at Hogwarts School of Witchcraft and Wizardry in J. K. Rowling ’s world of Harry Potter seeks to place each student in the proper “house.” Just as there are competing schools of wizardry, there are also multiple organizations that seek to certify stroke centers by differing criteria, although The Joint Commission (JC) Primary Stroke Center (PSC) program i s by far the oldest and largest.
Source: JAMA Internal Medicine - July 25, 2016 Category: Internal Medicine Source Type: research
Recurrence and Mortality in Women With Myocardial Infarction or Stroke
This Research Letter reports the long-term mortality and subtype-specific morbidity in young women surviving myocardial infarction or ischemic stroke.
Source: JAMA Internal Medicine - November 23, 2015 Category: Internal Medicine Source Type: research
Resumption of Warfarin Treatment After Hemorrhagic Stroke or ICH
This cohort study uses data from 3 Danish national registries to investigate the prognosis associated with resuming warfarin treatment in patients with atrial firbrillation who sustain a hemorrhagic stroke or traumatic intracranial hemorrhage.
Source: JAMA Internal Medicine - February 20, 2017 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 - July 20, 2020 Category: Internal Medicine Source Type: research
Time to Think About Nutrient Needs in Chronic Disease
There is renewed interest in health benefits of folic acid supplementation since the China Stroke Prevention Primary Prevention Trial (CSPPT) showed the potential benefits of folic acid in preventing stroke in Chinese adults with hypertension. It has long been known that folic acid prevents neural tube defects, which are among the most severe and debilitating congenital birth defects worldwide. The CSPPT was terminated early when 800 µg of folic acid in combination with 10 mg of enalapril significantly reduced primary stroke incidence compared with the enalapril alone treatment arm. This finding was unexpected as other st...
Source: JAMA Internal Medicine - August 22, 2016 Category: Internal Medicine Source Type: research
Screening for Asymptomatic Carotid Artery Stenosis in Adult Patients
Carotid artery stenosis is a risk factor for stroke, but a relatively small proportion of strokes (approximately 11%) can be attributed to atherosclerosis of the internal carotid arteries. There is no evidence that screening for carotid artery stenosis in the asymptomatic adult population (ie, no history or symptoms of stroke or transient ischemic attack) will reduce the risk of stroke, but there are downstream risks from identifying patients with carotid stenosis. Thus, in a recommendation statement and updated evidence report and systematic review, the US Preventive Services Task Force (USPSTF) has reaffirmed its 2014 re...
Source: JAMA Internal Medicine - February 2, 2021 Category: Internal Medicine Source Type: research
Implications of the 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 - March 2, 2015 Category: Internal Medicine Source Type: research
Anticoagulant Prescription in Patients With AF
In patients with atrial fibrillation (AF) who are at risk for thromboembolism, anticoagulation therapy with warfarin or the newer novel anticoagulants reduces morbidity and mortality. Because oral anticoagulant use carries a risk of bleeding, the drugs are not recommended in patients with AF who are at a particularly low risk for stroke. Specifically, previous AF guidelines recommend against the use of oral anticoagulation in patients younger than 60 years without heart disease or other known risk factors for thromboembolism, and more recently updated guidelines do not recommend the use of oral anticoagulation in patients ...
Source: JAMA Internal Medicine - April 13, 2015 Category: Internal Medicine Source Type: research
Differential Diagnosis of New Giant T-Wave Inversions
To the Editor The electrocardiogram (ECG) presented by Dr Cai and colleagues is indeed a great challenge. Two days after a fall, an older patient was admitted to the hospital with a hip fracture that was treated by external fixation and skin traction. On hospital day 2, the patient suddenly lost consciousness. An ECG immediately performed showed giant negative T waves (>20 mm) in the precordial leads and a QTc prolongation of 535 milliseconds. Cardiac troponin was elevated. Findings of computed tomography and magnetic resonance imaging (performed because of neurologic deficits) showed bilateral multifocal subacute ische...
Source: JAMA Internal Medicine - July 10, 2023 Category: Internal Medicine Source Type: research
Unintended Influence When Our Words Mean More Than We Think
A family friend recently shared the experience of her 83-year-old mother, a relatively healthy woman who lives independently at home. She has 3 daughters who check in on her and support her. The only notable medical history was a stroke about a year and a half prior that resulted in challenges with decision making, but she has made considerable recovery.
Source: JAMA Internal Medicine - December 1, 2014 Category: Internal Medicine Source Type: research
Presentation on US Hospital Websites of Risks and Benefits of Transcatheter Aortic Valve Replacement Procedures
Adequate presentation of risks and benefits of medical therapies is essential to informed decision making by patients. Transcatheter aortic valve replacement (TAVR) has been recently approved by the US Food and Drug Administration for the treatment of severe aortic stenosis among carefully selected patients; recent randomized clinical trials have identified important positive and negative outcomes of TAVR in these populations, including twice the risk of stroke for patients undergoing TAVR vs those undergoing open aortic valve replacement. Since 78% of all adults in the United States seek out health information online, we ...
Source: JAMA Internal Medicine - January 12, 2015 Category: Internal Medicine Source Type: research
Effect of the 2014 Atrial Fibrillation Guideline Revisions on the Proportion of Patients Recommended for Oral Anticoagulation
In 2014, the American Heart Association, American College of Cardiology, and Heart Rhythm Society published a revised guideline for atrial fibrillation (AF) treatment recommending use of a refined stroke risk score and revised threshold for oral anticoagulation (OAC) initiation. We assessed the potential effect of this new guideline by comparing the proportion of patients with AF recommended for OAC under the 2011 and 2014 guidelines.
Source: JAMA Internal Medicine - March 2, 2015 Category: Internal Medicine Source Type: research
Dialysis
More than 400 000 persons in the United States are currently receiving maintenance dialysis as life-sustaining treatment for end-stage renal disease (ESRD), with more than 90% receiving in-center hemodialysis. Mortality rates in the ESRD population in the United States remain extremely high (18%-20% per year) despite a slight downward trend during the past 2 to 3 years. Most deaths among patients with ESRD are due to cardiovascular disease, with exceptionally high rates, particularly on an age-adjusted basis, of heart failure, stroke, and sudden death. In fact, sudden death accounts for roughly 1 in 4 deaths among patien...
Source: JAMA Internal Medicine - April 27, 2015 Category: Internal Medicine Source Type: research
