March 18th, 2013
Selections from Richard Lehman’s Literature Review: March 18th
Richard Lehman, BM, BCh, MRCGP
CardioExchange is pleased to reprint selections from Dr. Richard Lehman’s weekly journal review blog at BMJ.com. Selected summaries are relevant to our audience, but we encourage members to engage with the entire blog.
JAMA 13 Mar 2013 Vol 309
Association of Smoking Cessation and Weight Change With CV Disease Among Adults With and Without Diabetes (pg. 1014): It’s a troublesome fact that most people who give up smoking (and come off nicotine replacement) gain weight. Together with the desperately addictive qualities of nicotine, this is a major cause for people to continue smoking. I am sure that you already tell them that the health benefits of giving up far outweigh the health hazards of a few extra pounds in weight; and the Framingham Offspring Study proves you right, with 6 years of follow-up showing a halving of cardiovascular events in the quitters, irrespective of weight gain.
NEJM 14 Mar 2013 Vol 368
Risk of Ischemic Heart Disease in Women after Radiotherapy for Breast Cancer (pg. 987): Last week, I lambasted the NEJM for publishing a truly terrible pharma-funded trial, but this week there are none of these, presumably because the feeding needs of the publishers have been satisfied for the time being. I await next week’s issue with interest. Meanwhile, enjoy this excellent study based on long-term data from all women in Stockholm and Denmark who underwent radiotherapy for breast cancer under the age of 70 between 1958 and 2001 in the case of the Swedes, and under the age of 75 between 1977 and 2000 in the case of the Danes. Their radiation doses were calculated using original records where possible, and they were compared with carefully matched controls for the occurrence of cardiac events. These themselves were carefully validated from hospital records and autopsies. “Exposure of the heart to ionizing radiation during radiotherapy for breast cancer increases the subsequent rate of ischemic heart disease. The increase is proportional to the mean dose to the heart, begins within a few years after exposure, and continues for at least 20 years. Women with preexisting cardiac risk factors have greater absolute increases in risk from radiotherapy than other women.” Observational science at its best.
Long-Term Outcomes in Elderly Survivors of In-Hospital Cardiac Arrest (pg. 1019): If you’re looking for great outcomes research in cardiology, you could find most of it by going to PubMed and searching under the names of Harlan Krumholz, John Spertus, and increasingly Brahmajee Nallamothu. Not too surprising, then, that all three of these names appear on this paper about long-term outcomes in elderly survivors of in-hospital cardiac arrest. The figures are much better than you might surmise: “Among elderly survivors of in-hospital cardiac arrest, nearly 60% were alive at 1 year, and the rate of 3-year survival was similar to that among patients with heart failure. Survival and readmission rates differed according to the demographic characteristics of the patients and neurologic status at discharge.”
Dear dr Lehman concerning the paper in NEJM about Outcomes in Elderly survivors of in-Hospital Cardiac Arrest:
let me add two remarks:
First: Elderly in this study starts a 65! Which seems to me to be relatively young. Fortunately in this range 65-74 the prognosis is better than in the older cohorts (64% survivors vs 50%) Thanks God, if I may say!.
Second: At three years’follow-up the death rate in “elderly survivors…” is the same than patients admitted in cardiac failure and discharged… alive…? sure! ( 43.5% and 45% respectively are survivors) This underlines the very poor prognosis of cardiac failure and the fact that myocardial dysfunction is a real serial killer.
Finally I would be happy to have your opinion concerning “Family Presence in CPR ” in the same issue than the Perspective Topic “Protecting Patient Privacy and Data Security” .
May be in your next review?
And again many thanks for your discussions.
The paper on Long-Term Outcomes in Elderly Survivors of In-Hospital Cardiac Arrest is a nice addition to literature on this subject. The authors acknowledged that a limitation of the study was that they could not provide more detailed information on quality of life measurements in these patients following discharge, which is fair enough in a retrospective study of this nature.
When I talk with families of post-cardiac arrest patients in the ICU they are interested to know the odds for survival and I like this paper since it gives me more information to discuss on this subject. However, most families also really want to know about quality of life should their loved one survive to hospital discharge. Also, I found it somewhat misleading that the authors had no statement in the introduction to the paper about the low rate of acute survival in victims of cardiac arrest. They just glossed over that and focus on the late survival of the small percentage of patients that don’t die acutely as a result of their cardiac arrest.