Salmonella Strain In King Nut Peanut Butter Found In Connecticut – Genetically Matches The Strain Implicated In The Nationwide Illness Outbreak
Commissioner Jerry Farrell, Jr. announced that genetic testing on the 5-lb unopened tub of King Nut peanut butter found by food inspectors last week at a West Haven distributor has produced the first independently confirmed genetic match for the salmonella strain responsible for the nationwide outbreak. This finding definitively links the peanut butter sample implicated in the recent outbreak back to the manufacturer, Peanut Corporation of America.
“Our work has been instrumental in helping the U.S. Food and Drug Administration track and isolate the source of this tainted product, which has been linked to the death of several people and illness in hundreds,” Farrell said. “Thanks to the fine collaborative efforts between our Food Safety program and the Department of Public Health, this lethal outbreak may soon be contained.”
“Thus far, Connecticut’s King Nut peanut butter sample is the only intact sample that has been found with a PFGE that matches the outbreak strain as determined by clinical sample analysis,” Roberta F. Wagner, Compliance Director with the FDA Center for Food Safety and Applied Nutrition wrote in a communication today to Commissioner Farrell. “It is therefore very important to get this message out,” she concluded.
PFGE refers to Pulsed-Field Gel Electrophoresis, an electrophoresis technique for separation of large DNA for analysis.
Salmonella was found previously in an open five-pound tub of King Nut peanut butter in Minnesota. Connecticut’s finding, in an unopened tub of peanut butter, is the first sample linking the contamination directly back to the manufacturer.
The genetic results were reported out by the Department of Public Health Laboratory on Sunday. Department of Consumer Protection inspectors continue to work with the Public Health laboratory and epidemiologists to prevent the further ingestion of this product by Connecticut consumers.
Peanut Corporation of America sells King Nut peanut butter — through various distributors — only to food service and food processor accounts. It is not sold directly to consumers. King Nut does not supply any of the ingredients for the peanut butter distributed under its label.
“We have obtained distribution information and are conducting recall effectiveness checks,” Farrell said. “While the recalled peanut butter itself is not sold at retail, I strongly reiterate the FDA’s advice that consumers avoid eating cookies, cakes, crackers, ice cream and other products made with peanut butter until the full scope of this outbreak can be determined.”
FDA has posted on its website a searchable list of products and brands associated with the expanded PCA recall at: http://www.accessdata.fda.gov/scripts/peanutbutterrecall/index.cfm . The list is updated as additional sub-recalls occur and as more information is received from the industry. Consumers are encouraged to first visit FDA’s website to learn which commercially-prepared or manufactured peanut butter/peanut paste-containing products are subject to recall. If consumers cannot determine if a certain prepared product contains peanut butter or peanut paste produced by the Peanut Corporation of America, the FDA urges that they not consume those products.
Salmonellosis is an infection with bacteria called Salmonella. Most persons infected with Salmonella develop diarrhea, fever, and abdominal cramps 12 to 72 hours after infection. The illness usually lasts 4 to 7 days, and most persons recover without treatment. However, in some persons, the diarrhea may be so severe that the patient needs to be hospitalized. In these patients, the Salmonella infection may spread from the intestines to the blood stream, and then to other body sites and can cause death unless the person is treated promptly with antibiotics. Older adults, infants, and those with impaired immune systems are more likely to experience severe illness, and should be seen by a physician if they experience these symptoms.
The Connecticut Department of Consumer Protection continues to work with United States Food and Drug Administration (FDA) to assist in the evaluation of recalls of food and other products.
Department of Consumer Protection
165 Capitol Avenue
Hartford
Connecticut 06106
USA
http://www.ct.gov/dcp
Escitalopram May Help Older Adults With Anxiety Disorder
Early results of a randomized controlled clinical trial suggest that the SSRI drug escitalopram (brand names Lexapro, Cipralex) may benefit older
adults with generalized anxiety disorder, although it is likely the trial failed to show clear overall benefits compared with placebo because some trial
patients dropped out. The researchers said the drug needs to be tested further and cautions doctors to explain this to their patients, along with the side
effects which include sleep disturbance and urinary symptoms.
The US and Canadian study was conducted by Dr Eric J Lenze, of Washington University, St. Louis, Missouri, and colleagues, and is published online
on 21 January in the Journal of the American Medical Association, JAMA.
Despite being one of the most common psychiatric disorders among older adults, there is not a lot of information about Generalized Anxiety Disorder
(GAD) to help doctors make safe and effective decisions about treatment.
GAD is characterized by chronic, difficult-to-control worry and anxiety, and associated symptoms, including muscle tension, sleep disturbance and
fatigue. Some 7.3 per cent of older adults in the community have GAD, and this proportion is higher among primary care patients. There is a lack of
effective treatments for older adults with GAD, and the urgency to resolve this grows as more older people join the population.
There is evidence that on balance, SSRIs (selective serotonin reuptake inhibitors) work with younger GAD patients, but we don’t know if the balance
of risks and benefits is the same for older adults.
For the study, Lenze and colleagues recruited 177 participants aged 60 and over from primary care practices and specialty clinics in Pittsburgh,
Pennsylvania. The participants had a principal diagnosis of GAD and were randomized to receive either escitalopram (85 patients) or placebo (92
patients) for a 12 week period from January 2005 to January 2008. The dose was 10 to 20 mg a day for the 12 weeks.
Anxiety, emotional and social function, and other outcomes were assessed using a range of recognized tools, including the Clinical Global
Impressions-Improvement score, the Hamilton Anxiety Rating Scale, the Penn State Worry Questionnaire, and the Late-Life Function and Disability
Instrument activity limitations subscale.
The results showed that the patients on the active drug responded to treatment more and more as the weeks went on (the cumulative incidence of
response to treatment score was higher), when compared to those on placebo (69 versus 51 per cent respectively).
Compared to placebo patients, the escitalopram patients also showed greater improvement in: anxiety symptoms and role functioning; and in activity
limitations and impairments in role and social functioning.
From an analysis that included those that began the trial but then dropped out (the ITT or intention to treat analysis), the researchers found no
difference in response between the active drug and the placebo groups. 16 (18.5 per cent) of the escitalopram patients dropped out before the study
finished at week 12, and 17 (18.4 per cent) of the placebo patients had also dropped out by week 12.
In the escitalopram group, adverse effects included fatigue or sleepiness, sleep disturbance and urinary symptoms.
The authors concluded that:
“Older adults with GAD randomized to escitalopram had a higher cumulative response rate for improvement vs placebo over 12 weeks; however,
response rates were not significantly different using an intention-to-treat analysis. Further study is required to assess efficacy and safety over longer
treatment durations.”
“Given the high human and economic burden of GAD, these data should provide impetus to detect and treat this common disorder,” they
wrote.
The researchers also noted that it was important for doctors to explain to patients that further tests are needed before we can be sure of the drug’s
benefits, and also to make sure they understand the side effects.
“Escitalopram for Older Adults With Generalized Anxiety Disorder: A Randomized Controlled Trial.”
Eric J. Lenze; Bruce L. Rollman; M. Katherine Shear; Mary Amanda Dew; Bruce G. Pollock; Caroline Ciliberti; Michelle Costantino; Sara Snyder;
Peichang Shi; Edward Spitznagel; Carmen Andreescu; Meryl A. Butters; Charles F. Reynolds, III.
JAMA. 2009;301(3):295-303.
Vol. 301 No. 3, published online January 21, 2009.
Click here for Abstract.
Sources: JAMA press release, journal abstract.
Written by: Catharine Paddock, PhD
Copyright: Medical News Today
Not to be reproduced without permission of Medical News Today
UNICEF: In Gaza, Nearly One-third Of Fatalities Are Children; Massive Destruction Of Homes, Schools And Health Facilities
After three weeks of fighting, the Office of the UN’s Humanitarian Coordinator (OCHA) reports that nearly one-third of those killed in the Gaza Strip – some 340 – were children, and that 1600 more children have been moderately to severely injured. Yesterday was the worst day for fatalities, according to OCHA, with 24 children killed.
At a UNICEF press briefing in Geneva today, its Regional Director for the Middle East, Sigrid Kaag, repeated earlier calls for the protection of children caught in the conflict.
Movement within Gaza is still extremely limited and dangerous and it has become increasingly difficult for humanitarian organizations, including UNICEF, to assess needs and distribute aid.
Kaag also expressed concerns about the mental well-being of children in Gaza, noting that its children had very high stress levels even prior to the current outbreak of violence. In addition to emergency assistance, UNICEF and its partners are now prioritizing support to help children regain some sense of normalcy, including an eventual return to school.
Education is a proven coping mechanism for children, and is the subject most often raised by parents in their calls to the UNICEF-sponsored hotlines that continue to operate in Gaza.
In addition to the destruction of homes, schools and health facilities, a UNICEF partner advises that as of 14 January, 59 schools have been damaged in the fighting. The start of the school year has been postponed until February and UNICEF is preparing to re-furnish schools hit by missile strikes.
UNICEF emergency supplies, including large numbers of school kits, are being moved into Gaza although distribution is being hampered by severe congestion at border points which are opened sporadically to humanitarian agencies. No trucks entered Gaza today.
About UNICEF
UNICEF is on the ground in over 150 countries and territories to help children survive and thrive, from early childhood through adolescence. The world’s largest provider of vaccines for developing countries, UNICEF supports child health and nutrition, good water and sanitation, quality basic education for all boys and girls, and the protection of children from violence, exploitation, and AIDS. UNICEF is funded entirely by the voluntary contributions of individuals, businesses, foundations and governments.
UNICEF
RCN Calls For Improvements To Nutritional Care
The Royal College of Nursing (RCN) backed calls to improve nutritional care in all settings. The renewed call echoes the recommendations of a new report – Improving Nutritional Care and Treatment: Perspectives and Recommendations from Population Groups, Patients and Carers.
Responding to the report recommendations, Dr Peter Carter, Chief Executive and General Secretary of the Royal College of Nursing (RCN) said:
“The delivery of quality nutritional care is a fundamental of good healthcare. We call for children and adults in all settings to be screened and monitored for malnutrition as recommended in the report. In order to achieve this, it is crucial that all the appropriate screening tools, equipment and training is provided for all health and social care workers.
“The RCN is committed to improving nutritional care and is currently running the Nutrition Now! campaign to help nurses and other healthcare workers to provide their patients with good nutritional care. A range of resources including information leaflets and a CD to facilitate educational workshops are available.”
Notes
Further information about the RCN’s Nutrition Now campaign can be found at http://www.rcn.org.uk/newsevents/campaigns/nutritionnow
Improving Nutritional Care and Treatment: Perspectives and Recommendations from Population Groups, Patients and Carers was published by BAPEN on 20th January 2009
Royal College of Nursing (RCN) is the voice of nursing across the UK and is the largest professional union of nursing staff in the world. The RCN promotes the interest of nurses and patients on a wide range of issues and helps shape healthcare policy by working closely with the UK Government and other national and international institutions, trade unions, professional bodies and voluntary organisations.
Royal College of Nursing
CMS Announces Course Of Action To Identify Protected Classes Of Prescription Drugs
The Centers for Medicare & Medicaid Services (CMS) announced an interim final rule that makes sure beneficiaries with conditions such as epilepsy, mental illness, and depression will not be discouraged from enrolling in any Part D plan, nor experience any interruptions in their drug therapy. The public comment period for this rule closes on March 17, 2009.
“The steps we are taking today reinforce CMS’ current formulary policy and ensure that Medicare beneficiaries with epilepsy, mental illness, certain cancers, HIV/AIDS, and other conditions will have access, without interruption, to the drugs they need,” said CMS Acting Administrator Kerry Weems.
In June 2005, CMS directed that Part D formularies include all or substantially all drugs in the following six drug classes: Antidepressant; Antipsychotic; Anticonvulsant; Immunosuppressant (to prevent rejection of organ transplants); Antiretroviral (for the treatment of infection by retroviruses, primarily human immunodeficiency virus (HIV); and Antineoplastic (only those chemotherapy drugs that are generally are not covered under Medicare Part B).
The interim final rule notifies Part D plans that they must continue to provide coverage of these drugs in 2010, consistent with the policy already in place. As a result, enrollees who are already taking drugs from these six classes will not be discouraged from continuing their current treatment due to drug utilization management techniques, such as step therapy, that is, requiring enrollees to begin with a lower cost drug), quantity limitations, and/or prior authorization.
The rule also codifies in regulation a provision of the Medicare Improvements for Patients and Providers Act (MIPPA) with respect to the identification and coverage of protected drug categories and classes under the Part D program. To identify appropriate drug categories and classes, CMS is beginning an extensive examination of widely used drug treatment guidelines, analyzing Part D data, and planning for a secondary validation review with input from an expert panel of physicians and pharmacists.
Because extensive analysis is needed to identify which protected categories and classes are appropriate, CMS has determined that the timing for Part D formulary submissions for 2010 (which will occur in April 2009) will preclude it from making such identification for the 2010 contract year. Accordingly, as indicated above, the rule states that CMS will continue its existing six classes of protected drugs for 2010 under its existing, pre-MIPPA, administrative authority.
For contract years 2011 and beyond, CMS plans to consider whether any modifications are necessary to the existing six classes currently protected, whether under CMS’s existing administrative authority or under MIPPA. Should CMS decide that modifications are necessary, CMS will propose these modifications through a rulemaking process that provides for meaningful public comment. Similarly, any associated exceptions to those categories and classes will be addressed through rulemaking.
“CMS will conduct a transparent and comprehensive analysis in deciding whether to revise or broaden its list of protected classes of drugs,” said Weems.
Reflecting a MIPPA provision, the interim final rule also requires Part D sponsors to use the same definition for a “medically accepted indication” for anti-cancer drugs as used for Medicare Part B, effective Jan. 1, 2009. As a result, Part D sponsors will use Part B compendia and potentially consider peer reviewed medical literature when necessary and appropriate.
The regulation is on display today at the Federal Register will be available at http://www.archives.gov/federal-register/public-inspection/index.html. Click on View the Regular Filing Documents.
The regulation will be published on Jan. 16, 2009, and may be viewed that day and thereafter at http://www.gpoaccess.gov/fr/browse.html. Click “Go” next to where 2009 appears in the year selection box for “Back Issues (HTML Only).”
Comments on the interim final rule are due by 5:00 p.m. Eastern time on March 17, 2009.
Centers for Medicare & Medicaid Services
CMS Outlines Foundation To Improving Health Care
The Centers for Medicare & Medicaid Services (CMS) today issued Quality Measurement, Resource Use Measurement, and Value-Based Purchasing Roadmaps for the traditional Medicare Fee-For-Service Program.
“These documents are intended to offer a vision for the future and potential options for CMS to pursue to improve the quality and value of health care delivered in the United States and to shift the Medicare FFS program away from paying providers based solely on the volume of services and instead paying them for quality and value of care,” said Kerry Weems, CMS acting Administrator.
Health care today represents one-seventh of the economy with spending totaling more than $2 trillion annually. By 2017, the nation is expected to spend roughly $4 trillion on health care: 21 percent of gross domestic product.
Medicare costs are continuing to skyrocket as well. Last spring, the Medicare Part A Hospital Insurance Trust Fund had been projected to go bankrupt in 2019, 11 years from now. The Medicare chief actuary recently observed that because of the current economic crisis, this date could be moved three years earlier – 2016.
“It is incumbent on us to use the lessons we’ve learned with many of the tools we have implemented to help the nation’s health care leaders as they look to improve the health care system in a time that’s even more critical because the projected rate of growth in health care costs is climbing at an unsustainable rate,” said Weems.
The papers linked to http://www.cms.hhs.gov/QualityInitiativesGenInfo/ outline the activities that CMS has undertaken to implement value driven health care, including summaries of the various projects to test the policy and concepts designed to provide high quality, affordable health care. The papers provide steps to implement quality and resource use measurement to improve the delivery of care and offer a roadmap to assist in implementing value-based purchasing for Medicare’s FFS payment systems.
These papers are also intended to provide information to policy makers about the demonstrations and pilot programs that are already underway and to articulate the overarching principles guiding further efforts.
The concept behind value-based purchasing is to encourage care delivery patterns that are not only high quality, but also cost-efficient and to move away from the traditional FFS payment systems that pay health care providers to perform services without regard to their quality. In order for a value-based purchasing payment to function, it must be based on standardized quality measures provide information about care that is accurate, reliable, and relevant in a patient-centered way and also based on resource-use measures that can evaluate health care performance in a way that enables comparisons of how efficiently health care is delivered.
Centers for Medicare & Medicaid Services
FDA Alerts Public About Danger Of Skin Numbing Products
The U.S. Food and Drug Administration today issued a Public Health Advisory to alert consumers, patients, health care professionals, and caregivers about potentially serious and life-threatening side effects from the improper use of skin numbing products. The products, also known as topical anesthetics, are available in over-the-counter (OTC) and prescription forms.
Skin numbing products are used to desensitize nerve endings that lie near the surface of the skin, causing a numbness of the skin. These topical anesthetics contain anesthetic drugs such as lidocaine, tetracaine, benzocaine, and prilocaine in a cream, ointment, or gel. When applied to the skin surface, they can be absorbed into the blood stream and, if used improperly, may cause life-threatening side effects, such as irregular heartbeat, seizures, breathing difficulties, coma, or even death. FDA has received reports of adverse events and deaths of two women who used topical anesthetics before laser hair removal. In February 2007, the FDA issued a Public Health Advisory – “Life-Threatening Side Effects with the Use of Skin Products containing Numbing Ingredients for Cosmetic Procedures,” to warn consumers about these products.
Patients for whom an over-the-counter or prescription topical anesthetic is recommended should consider using a topical anesthetic that contains the lowest amount possible of medication that will relieve your pain. Also, health care professionals should determine whether adequate pain relief can be safely achieved with a topical anesthetic, or whether a different treatment would be more appropriate.
The FDA strongly advises consumers not to:
- make heavy application of topical anesthetic products over large areas of skin;
- use formulations that are stronger or more concentrated than necessary;
- apply these products to irritated or broken skin;
- wrap the treated skin with plastic wrap or other dressings; and
- apply heat from a heating pad to skin treated with these products.
When skin temperature increases, the amount of anesthetic reaching the blood stream is unpredictable and the risk of life-threatening side effects increases with greater amounts of lidocaine in the blood.
A recently published study in Radiology looked at women taking acetaminophen and ibuprofen by mouth versus applying lidocaine gel, a topical anesthetic, to the skin to decrease discomfort during mammography. The lidocaine gel was applied to a wide skin surface area and then covered with plastic wrap. There were no serious or life-threatening side effects reported in the study, nor were any reported when FDA discussed the results with the doctor who performed the study. The study results favored the use of lidocaine as there was significantly less discomfort than with the plain gel or oral acetaminophen or ibuprofen. However, given the life-threatening side effects associated with the use of topical anesthetics during laser hair removal, FDA is concerned that similar side effects could occur when topical anesthetics are used during mammography. Further, the study was small and it is possible that a larger study might show different findings.
Patients should talk with their health care professional if they are considering using a topical anesthetic before a mammogram. The following summarizes advice for patients if a topical anesthetic is recommended for their use:
- use a topical anesthetic that contains the lowest strength, and amount, of medication that will relieve the pain;
- apply the topical anesthetic sparingly and only to the area where pain exists or is expected to occur;
- do not apply the topical anesthetic to broken or irritated skin;
- ask their healthcare professional what side effects are possible and how to lower their chance of having life-threatening side effects from anesthetic drugs; and
- be aware that wrapping or covering the skin treated with topical anesthetics with any type of material or dressing can increase the chance of serious side effects, as can applying heat to the treated area while the medication is still present.
Consumers and health care professionals may report adverse events to the FDA’s MedWatch program at 800-FDA-1088, by mail at MedWatch, HF-2, FDA, 5600 Fishers Lane, Rockville, Md 20852-9787, or online at http://www.fda.gov/medwatch/report.htm.
To read the FDA’s 2009 Public Health Advisory, go here.
To read the FDA’s 2007 Public Health Advisory, go here.
U.S. Food and Drug Administration
FDA Approves RiaSTAP For Treatment Of Bleeding In Patients With Rare Genetic Defect
The U.S. Food and Drug Administration licensed RiaSTAP, an orphan drug for the treatment of bleeding in patients with a rare genetic defect known as congenital fibrinogen deficiency. Without treatment, these patients are at risk of potentially life-threatening bleeding.
People with congenital fibrinogen deficiency are unable to make sufficient amounts of fibrinogen, which plays an important role in blood coagulation by helping to form blood clots and prevent bleeding. Fibrinogen is manufactured in the liver and circulates in the blood plasma in a normal concentration of 250-400 mg/dL.
“This product offers much-needed treatment for the small number of patients with congenital fibrinogen deficiency,” said Jesse Goodman, M.D., M.P.H., director of the FDA’s Center for Biologics Evaluation and Research. “If bleeding occurs in the brain or other organs and is left untreated, it may lead to blood loss, organ damage and death.”
Fibrinogen deficiency affects only 150 to 300 people in the United States and is usually diagnosed at birth when newborns bleed from their umbilical cord site. Children with the defect need to curtail activities because of risk of bleeding from minor trauma.
RiaSTAP is an intravenous fibrinogen concentrate made from the plasma of healthy human blood donors. The product is indicated for patients who have no fibrinogen or low levels of the substance, an abnormality known as afibrinogenemia, or for those patients whose fibrinogen levels are below 50 mg/dL, an abnormality known as hypofibrinogememia. The product is not indicated for patients with dysfibrinogenemia, who may have normal fibrinogen levels but defective fibrinogen function. Patients such as these are at risk for both bleeding and clotting complications.
The licensing of RiaSTAP was supported by a study of 15 patients with afibrinogenemia who achieved the target level of fibrinogen expected to prevent bleeding after they received 70 mg/kg of the drug. In addition, plasma from 14 of the 15 patients showed increased maximum clot firmness, a surrogate marker likely to predict clinical benefit. Fever and headache were the most common adverse reactions.
Clinical benefit will be further verified in a postmarketing study which will include both afibrinogenemic and hypofibrinogenemic patients.
Orphan drugs are drugs or biologics intended for use in a rare disease or condition. Manufacturers are qualified to receive certain government benefits in exchange for developing such products. RiaSTAP [Fibrinogen Concentrate (Human)] was developed under the FDA’s accelerated approval regulations.
The drug is manufactured by CSL Behring, Marburg, Germany.
U.S. Food and Drug Administration
Terrence Higgins Trust Holds Free Workshops On Sex And Drugs For Gay Men
Terrence Higgins Trust (THT) is holding two free workshops in central London this month aimed at gay men. Both groups allow men to have honest, frank discussions, share experiences, learn a lot and have a laugh.
‘Out of it’, 10am – 5pm, Saturday 24th January
Ever wanted to know more about the drugs you’re taking? ‘Out of it’ focuses on the drugs that are out there and the impact they can have on your work, social life and relationships. It also looks at having sex on drugs and the effect when you mix the two. If you’re worried about your drug use, or just want to know how you can minimise your risk, this workshop is for you.
‘Keeping it hot’, 10am – 5pm, Saturday 31st January
‘Keeping it hot’ focuses on how to have hot sex and stay safe. Learn more about your arse and tackle, HIV, sexually transmitted infections and what makes sex more or less risky.
Gordon Mundie, Groupwork co-ordinator at THT said “These groups are always really relaxed and everyone has a laugh. There will be activities throughout the day to keep things interesting, we’ll be talking about personal experiences and you can ask any questions you have whether they’re serious or strange. Bring some mates or come alone, either way you’ll be made really welcome.”
For further information on the venue for these workshops or to sign up call 020 7812 1773 or email groupworklondon@tht.org.uk. You can also book a place online at http://www.gmfa.org.uk/gwk
Terrence Higgins Trust
Less Severe First MI Might Explain Fewer Cardiac Deaths In US
A new US study of patients hospitalized with acute myocardial infarction (MI or heart attack), found that the severity of heart attacks has dropped,
and this, along with other factors, may have contributed to the drop in heart attack deaths observed during 1987 to 2002.
The study was the work of first author, Dr Merle Myerson, who was a medical director at the National Heart, Lung, and Blood Institute, National
Institutes of Health, Bethesda, Maryland, at the time, and colleagues, and is published online before print on 19 January in the journal
Circulation. Myerson is now Director, Cardiovascular Disease Prevention Program, at St. Luke’s-Roosevelt Hospital of Columbia.
In their background information the authors wrote that there appeared to be no clear reason for the fall in death rates from heart disease observed in the
US in the last 20 years or so. They had the idea that it could be due to reduced severity of heart attacks and decided to investigate, using data from
patients hospitalized in the Atherosclerosis Risk in Communities (ARIC) Study.
For the study, the researchers used 1987 to 2002 records from ARIC’s community surveillance section, which tracked patients aged 35 to 74 years old
from 4 diverse communities who had hospitalized MI or fatal coronary heart disease.
The researchers used records of discharged patients who had had incident, hospitalized MI, and classified MI severity according to chest pain,
electrocardiogram (ECG, an electrical record of heart activity) evidence, and cardiac biomarkers. They also used data from hospital charts to validate
definite or probable MIs.
The results showed that with few exceptions, MI severity appeared to decline during 1987 to 2002, according to both ECG and biomarker criteria.
The proportion of MI cases with major ECG abnormalities went down, as evidenced by declines in three types of ECG pattern: a 1.9 per cent per year
decline in initial ST-segment elevation, a 3.9 per cent per year decline in those with subsequent Q-waves, and a 4.5 per cent per year decline in those
with any major Q wave.
The evidence from cardiac biomarkers showed that maximum creatine kinase and creatine kinase-MB values went down 5.2 and 7.6 per cent per year
respectively, although in the later years, the value of another marker, troponin I, remained stable.
The percentage of incident, hospitalized MI patients with shock also went down by 5.7 per cent per year, although the percentage with congestive heart
failure did not change.
The researchers also found that overall severity, based on the PREDICT combined severity score (short for Predicting Risk of Death in Cardiac
Disease Tool) went down by 0.2 per cent per year.
The results for black and female patients were similar to those of the whole group.
The authors concluded that:
“Evidence from ARIC community surveillance suggests that the severity of acute MI has declined among community residents hospitalized for
incident MI.”
“This reduction in severity may have contributed, along with other factors, to the decline in death rates for coronary heart disease,” they
wrote.
Speculating on what lies behind the decline, the authors suggest part of the reason could be better primary prevention and improved acute care. Also,
we know a lot more about preventive drugs, such as using aspirin, beta-blockers and statins, they said, so perhaps with more people using these, it
means they present with less severe MI when it happens.
“Declining Severity of Myocardial Infarction From 1987 to 2002. The Atherosclerosis Risk in Communities (ARIC) Study.”
Merle Myerson, Sean Coady, Herman Taylor, Wayne D. Rosamond, David C. Goff, Jr, and for the ARIC Investigators.
Circulation Published online before print January 19, 2009.
doi:10.1161/CIRCULATIONAHA.107.693879
Click here for
Abstract.
Sources: Journal abstract.
Written by: Catharine Paddock, PhD
Copyright: Medical News Today
Not to be reproduced without permission of Medical News Today
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