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  • JAMA Internal Medicine March 1, 2018

    Figure: Variation in the Share of Intensification vs Deintensification Recommendations

    Guidelines for cardiovascular disease management included ischemic heart disease, hypertension, hyperlipidemia, heart failure, atrial fibrillation, acute coronary syndrome, myocardial infarction, and cognitive or mental health sequelae. The evidence strength of the recommendations was based on the evidence ratings provided by the guideline developers. Recommendations were drawn from the following guidelines (N = 22 total guidelines). American Diabetes Association (n = 1): Standards of Medical Care in Diabetes—2016 (2016). Eighth Joint National Committee (n = 1): Management of High Blood Pressure in Adults. American Geriatrics Society (n = 1): Improving the Care of Older Adults With Diabetes Mellitus: 2013 Update (2013). Veterans Health Administration (n = 2): Diagnosis and Management of Hypertension in the Primary Care Setting (2014); Management of Dyslipidemia for Cardiovascular Risk Reduction (2014). US Preventive Services Task Force (n = 6): Screening for Coronary Heart Disease With Electrocardiography (2012); Vitamin, Mineral, and Multivitamin Supplements for the Primary Prevention of Cardiovascular Disease and Cancer (2014); Screening for High Blood Pressure in Adults (2015); Screening for Abnormal Blood Glucose and Type 2 Diabetes Mellitus (2015); Aspirin Use to Prevent Cardiovascular Disease and Colorectal Cancer (2015; draft); Statin Use for the Primary Prevention of Cardiovascular Disease in Adults: Preventive Medication (2015; draft). American College of Cardiologists/American Heart Association (n = 9): Secondary Prevention and Risk Reduction Therapy for Patients With Coronary and Other Atherosclerotic Vascular Disease (2011); Effectiveness-Based Guidelines for the Prevention of Cardiovascular Disease in Women (2011); Diagnosis and Management of Patients With Stable Ischemic Heart Disease (2012; jointly issued with the American College of Physicians); Assessment of Cardiovascular Risk (2013); Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults (2013); Management of Heart Failure (2013); Management of Patients With Atrial Fibrillation (2014); Management of Adult Patients With Supraventricular Tachycardia (2015; only for the recommendations related to atrial fibrillation); Duration of Dual Antiplatelet Therapy in Patients With Coronary Artery Disease (2016). American College of Physicians (n = 3): Diagnosis and Management of Patients With Stable Ischemic Heart Disease (2012; jointly issued with the American College of Cardiologists/American Heart Association); Oral Pharmacologic Treatment of Type 2 Diabetes Mellitus (2012); Cardiac Screening With Electrocardiography, Stress Echocardiography, or Myocardial Perfusion Imaging (2015).
  • Noninvasive Cardiac Testing vs Clinical Evaluation Alone in Acute Chest Pain: A Secondary Analysis of the ROMICAT-II Randomized Clinical Trial

    Abstract Full Text
    JAMA Intern Med. 2018; 178(2):212-219. doi: 10.1001/jamainternmed.2017.7360

    This secondary analysis of data from a randomized clinical trial examines differences in outcomes with clinical evaluation and noninvasive testing vs clinical evaluation alone.

  • JAMA Internal Medicine February 1, 2018

    Figure 1: Standardized Differences in Baseline Characteristics Between Patients Receiving Clinical Evaluation and Noninvasive Testing vs Clinical Evaluation Alone

    Standardized differences in baseline characteristics between patients receiving clinical evaluation and noninvasive testing vs clinical evaluation alone before and after inverse probability of treatment weighting (IPTW). CAD/ACS/MI indicates coronary artery disease/acute coronary syndrome/myocardial infarction; COPD, chronic obstructive pulmonary disease; HF, heart failure; PVD, peripheral vascular disease.
  • Eliminating Creatine Kinase–Myocardial Band Testing in Suspected Acute Coronary Syndrome: A Value-Based Quality Improvement

    Abstract Full Text
    JAMA Intern Med. 2017; 177(10):1508-1512. doi: 10.1001/jamainternmed.2017.3597

    This Special Communication discusses the benefits of eliminating creatine kinase–myocardial band testing in suspected acute coronary syndrome.

  • Applicability of the IMPROVE-IT Trial to Current Patients With Acute Coronary Syndrome: An NCDR Research to Practice Project

    Abstract Full Text
    JAMA Intern Med. 2017; 177(6):887-889. doi: 10.1001/jamainternmed.2017.0754

    This study examines the proportion of current patients with acute coronary syndrome in the American College of Cardiology practice innovation and clinical excellence ambulatory cardiology practice registry that would have qualified for the IMPROVE-IT trial, and how their characteristics compared with trial participants.

  • Eosinophilia in a Man With Suspected Acute Coronary Syndrome

    Abstract Full Text
    JAMA Intern Med. 2016; 176(11):1711-1713. doi: 10.1001/jamainternmed.2016.5781
  • To Cure Sometimes, to Relieve Often, to Comfort Always

    Abstract Full Text
    JAMA Intern Med. 2016; 176(6):731-732. doi: 10.1001/jamainternmed.2016.1220
  • An Elderly Patient With Palpitation and a Negative Nuclear Stress Test Result

    Abstract Full Text
    JAMA Intern Med. 2016; 176(4):542-544. doi: 10.1001/jamainternmed.2016.0023
  • Intra-aortic Balloon Pump Therapy for Acute Myocardial Infarction: A Meta-analysis

    Abstract Full Text
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    JAMA Intern Med. 2015; 175(6):931-939. doi: 10.1001/jamainternmed.2015.0569

    In this meta-analysis, intra-aortic balloon pump therapy was not found to improve mortality among patients with acute myocardial infarction in randomized clinical trials, regardless of whether patients had cardiogenic shock.

  • A Patient With a Biventricular Pacemaker Presenting With Chest Pain

    Abstract Full Text
    JAMA Intern Med. 2015; 175(6):1053-1055. doi: 10.1001/jamainternmed.2015.0515
  • Familial Spontaneous Coronary Artery Dissection: Evidence for Genetic Susceptibility

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    JAMA Intern Med. 2015; 175(5):821-826. doi: 10.1001/jamainternmed.2014.8307

    This case series identifies a familial association in spontaneous coronary artery dissection suggesting a genetic predisposition.

  • Use of Cardiac Biomarker Testing in the Emergency Department

    Abstract Full Text
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    JAMA Intern Med. 2015; 175(1):67-75. doi: 10.1001/jamainternmed.2014.5830

    This retrospective study of ED visits by adults shows that cardiac biomarker testing in the ED is common even among those without symptoms suggestive of acute coronary syndrome.

  • JAMA Internal Medicine November 1, 2014

    Figure: Reporting of Sex and Race/Ethnicity and Percentage of Female Patients and Racial Groups in RCTs and Guidelines

    A, Reporting of patients’ sex and racial groups over time. B, Percentage of female patients in the RCTs of AF, HF and ACS guidelines. C, Percentage of different racial groups in the AF, HF, and ACS guidelines. ACS indicates acute coronary syndromes; AF, atrial fibrillation; HF, heart failure; and RCTs, randomized controlled trials.
  • Underrepresentation of Women, Elderly Patients, and Racial Minorities in the Randomized Trials Used for Cardiovascular Guidelines

    Abstract Full Text
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    JAMA Intern Med. 2014; 174(11):1868-1870. doi: 10.1001/jamainternmed.2014.4758
  • JAMA Internal Medicine October 1, 2014

    Figure: Trends in the Incidence of Acute Coronary Syndrome (ACS), Unstable Angina, and Acute Myocardial Infarction (AMI) Among US Medicare Beneficiaries

    Trends from 1992 to 2009 are shown by age group and for all ages.
  • Incidence of Acute Coronary Syndrome in the General Medicare Population, 1992 to 2009: A Real-World Perspective

    Abstract Full Text
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    JAMA Intern Med. 2014; 174(10):1689-1690. doi: 10.1001/jamainternmed.2014.3446
  • Multifaceted Intervention to Improve Medication Adherence and Secondary Prevention Measures After Acute Coronary Syndrome Hospital Discharge: A Randomized Clinical Trial

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    JAMA Intern Med. 2014; 174(2):186-193. doi: 10.1001/jamainternmed.2013.12944

    Ho and colleagues test a multifaceted intervention to improve cardiac medication regimen adherence and secondary prevention measures. Redberg provides an Editor’s Note.

  • JAMA Internal Medicine February 1, 2014

    Figure: Patient Flowchart

    ACS indicates acute coronary syndrome; VA, Department of Veterans Affairs.
  • An Education Program for Risk Factor Management After an Acute Coronary Syndrome: A Randomized Clinical Trial

    Abstract Full Text
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    JAMA Intern Med. 2014; 174(1):40-48. doi: 10.1001/jamainternmed.2013.11342

    Cohen et al determined whether a nurse-led or dietician-led cardiovascular risk factor education program would improve risk factor reduction over the long term after an acute coronary syndrome. Patients underwent an education program in a House of Education or were treated according to physicians’ standard of care. See the Invited Commentary by Fihn.

  • A 2-Hour Diagnostic Protocol for Possible Cardiac Chest Pain in the Emergency Department: A Randomized Clinical Trial

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    JAMA Intern Med. 2014; 174(1):51-58. doi: 10.1001/jamainternmed.2013.11362

    Than and coauthors compared the effectiveness of a rapid diagnostic pathway with a standard-care diagnostic pathway for the assessment of patients with possible cardiac chest pain in a usual clinical practice setting. See also the Invited Commentary by Rahko.