0
We're unable to sign you in at this time. Please try again in a few minutes.
Retry
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
Retry
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Editor's Correspondence |

Siesta, All-Cause Mortality, and Cardiovascular Mortality: Is there a “Siesta” at Adjudicating Cardiovascular Mortality?

Sripal Bangalore, MD, MHA; Sabrina Sawhney, MD; Franz H. Messerli, MD
Arch Intern Med. 2007;167(19):2143. doi:10.1001/archinte.167.19.2143-a.
Text Size: A A A
Published online

Extract

In the interesting article by Naska et al,1 siesta in healthy individuals was associated with reduced coronary mortality and the association was more pronounced in working men. The authors used the end point of coronary mortality as opposed to all-cause mortality and argue that coronary mortality is an outcome likely to be related to a stress factor. While this may be true, the very adjudication of coronary mortality is fraught with subjectivity. The cause of death usually is determined using death certificates (as was also done in this study), and we know that the information is biased and often inaccurate. Death is usually a complex process (in most cases), and to clearly identify a cardiac cause in patients with multiple comorbidities may not be easy. Although cardiac disease may be severe, it still is not always the primary cause of death. In a study of 384 death certificates in a university hospital, the death certificates were filled incorrectly in 59% of cases,2 presumably because practicing physicians confused the “cause of death” with the “mechanism of death.” Cardiac arrest is the most common mechanism of death in all cases (other than brain death). Studies have shown that the diagnosis of death is proved wrong in about 29% to 42% of cases after necropsy.3,4 This inaccuracy rate will be much higher given the low necropsy rates in general practice. We therefore agree with the observation by Lauer et al5 that using an end point of coronary death may introduce some “softness” to the “hard” end point of all-cause mortality.

Sign in

Create a free personal account to sign up for alerts, share articles, and more.

Purchase Options

• Buy this article
• Subscribe to the journal

First Page Preview

View Large
First page PDF preview

First Page Preview

View Large
First page PDF preview

Figures

Tables

References

Correspondence

CME
Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.
Submit a Comment

Multimedia

Some tools below are only available to our subscribers or users with an online account.

Sign in

Create a free personal account to sign up for alerts, share articles, and more.

Purchase Options

• Buy this article
• Subscribe to the journal

Related Content

Customize your page view by dragging & repositioning the boxes below.

Articles Related By Topic
Related Collections
Jobs
brightcove.createExperiences();