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In This Issue of Archives of Internal Medicine
Arch Intern Med. 2002;162:1666.
Prognosis and Determinants of Survival in Patients Newly Hospitalized
for Heart Failure: A Population-Based Study
In contrast to the well-documented mortality risk of patients with heart
failure enrolled in clinical trials, the prognosis of unselected patients
with heart failure from the community has been less widely studied. Jong et
al reviewed the 1-year outcome of 38 702 consecutive patients from the
community with first-time admissions for heart failure between 1994 and 1997
in Canada. The 30-day and 1-year case-fatality rates were 11.6% and 33.1%,
respectively. Moreover, only young subjects with minimal comorbidity had low
mortality rates typically seen in contemporary trials of heart failure. For
most subjects who were older, women, and with significant comorbidities, their
prognosis remained poor, with 1-year mortality rates reaching over 60%. Despite
recent advances in the treatment of heart failure, the persistent high mortality
observed in this study is a sobering note to the medical community that there
is much more to be done to improve the outcomes of this seriously ill population
than is currently believed.
(SEE ARTICLE)
Should We Screen for Hemochromatosis? An Examination of Evidence of
Downstream Effects on Morbidity and Mortality
Through an analysis of the Third National Health and Nutrition Examination
Survey (1988-1994), and the 1996, 1997, and 1998 National Ambulatory Care
Survey, National Hospital Discharge Survey, and Underlying Cause of Death
Mortality Files, Mainous et al identified the prevalence of hemochromatosis
and the diagnosed morbidity and mortality due to hemochromatosis. While the
prevalence of elevated serum transferrin saturation ranged from 1% to 6%,
the proportion of diagnosed hemochromatosis utilization of total ambulatory
visits, hospitalizations, and deaths was much lower than would be expected
due to the prevalence. When white men were examined separately, the relationships
remained the same as the general population of adults. The results suggest
that recommendations for screening programs may need to be revisited.
(SEE ARTICLE)
A Profile of Military Veterans in the Southwestern United States Who
Use Complementary and Alternative Medicine: Implications for Integrated Care
Although civilian users of complementary and alternative medicine (CAM)
have been well described, little is known about military veteran users of
CAM. In a telephone survey of 508 veterans randomly selected from Southern
Arizona VA Health Care System Primary Care patient lists, 49.6% reported CAM
use. White ethnicity, higher education, and chronic conditions, such as gastrointestinal
problems, insomnia, and asthma, were consistent with civilian CAM users. In
addition to ethnicity and education, higher current daily stress and overseas
military experience were significant predictors of CAM use by these veterans.
Findings also suggest that physicians providing conventional medical care
need to be aware of experiences unique to CAM-using military veterans.
(SEE ARTICLE)
Explaining the Sex Difference in Coronary Heart Disease Mortality Among
Patients With Type 2 Diabetes Mellitus: A Meta-analysis
Most studies suggest that diabetes mellitus is a stronger coronary heart
disease (CHD) risk factor for women than for men, but few have adjusted their
results for classic CHD risk factors. Kanaya et al compared the summary odds
ratio for CHD mortality and the absolute rates for CHD mortality in men and
women with diabetes mellitus. Sixteen studies met all inclusion criteria.
In unadjusted and age-adjusted analyses, odds of CHD death were higher in
women than in men with diabetes. The multivariate-adjusted summary odds ratio
for CHD mortality due to diabetes mellitus was 2.3 (95% confidence interval,
1.9-2.8) for men and 2.9 (95% confidence interval, 2.2-3.8) for women. There
were no significant sex differences in the adjusted risk associated with diabetes
mellitus for CHD mortality, nonfatal myocardial infarction, and cardiovascular
and all-cause mortality. Absolute CHD death rates were higher for diabetic
men than women in every age stratum except the very oldest.
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Summary odds ratios for each sex are presented by adjustment of study
results for white race only. Unadjusted and age-adjusted summary odds ratio
show a trend or significant differences by sex, whereas multiple-adjusted
results (for age, hypertension, total cholesterol level, and smoking) show
no difference by sex. P values are for comparison of odds ratios
between men and women in each category.
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(SEE ARTICLE)
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