Annals of Internal Medicine, tip sheet, August 17, 2004


Compression Stockings Reduce Complications After Deep Vein Thrombosis
(Article, p. 249; Editorial, p. 314.)
A news release will be issued separately; call for an embargoed copy. This study is the subject of a video news release. Call for coordinates.

Resynchronization of Heart can Improve Quality of Life After Heart Failure But Is Not Cost-Effective
A meta-analysis of published clinical trials found that an expensive, relatively new procedure, cardiac resynchronization therapy (CRT), in which a special pacemaker synchronizes the contraction of different parts of the heart, improved the quality of life of people with heart failure and was relatively safe. A cost-effectiveness study found that CRT costs about $90,000 per quality-adjusted life-year saved compared to medical therapy. The authors say this amount is in the general range of other commonly used interventions.

Editorial writers cite limitations of both studies: published research on CRT, (on which the articles are based) is limited; most existing studies have been small and also do not provide good information about CRT's effect on mortality and safety; and the technology, particularly in the area of combined CRT and implantable cardiac defibrillator devices, is rapidly evolving. The editorial writers conclude that CRT improves functional status and quality of life in patients with heart failure and should be considered in patients who have certain clinical findings.

(These articles and editorial will be available online at at 5 p.m. EDT, Monday, August 16. They will appear in the September 7, 2004, print edition of Annals.)

Doctors May Be Performing Too Many Follow-up Colonoscopies
In a survey, 349 gastroenterologists and general surgeons reported that they would perform follow-up colonoscopies after removing non-cancerous polyps much more often than accepted guidelines recommend (Article, p. 264). Guidelines of several professional societies indicate how often to repeat colonoscopy, based on the chances that a particular kind of polyp is likely to recur and become cancerous. Authors say the study findings raise concerns that physicians are not paying sufficient attention to evidence-based clinical guidelines. Moreover, overuse of surveillance colonoscopy reduces scarce resources of money and manpower.

Study: Diabetes Care in VA Health System Bests Managed Care
The health care system of the Department of Veterans Affairs (VA) delivered significantly better diabetes care than commercial managed care organizations, a new study found (Improving Patient Care, p. 272). Researchers used equivalent sampling and measurement methods to study care of 8,205 diabetic patients in five VA medical centers and eight commercial managed care organizations in five matched geographic regions. Compared with patients in commercial managed care, VA patients more often received blood tests, eye and foot examinations, and counseling about aspirin use and had better control of cholesterol. Patients in both systems had poor blood pressure control but reported high satisfaction with care. An editorial discusses the progress the VA has made toward optimal management of chronic diseases and says that the challenge is to translate quality improvement programs from large health care systems, such as the VA, to solo and small-group practices, where most chronic disease care occurs (Editorial, p. 316).

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Last reviewed: By John M. Grohol, Psy.D. on 21 Feb 2009
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