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Thomas A. Dewland, MD; Eric Vittinghoff, PhD, MPH; Mala C. Mandyam, MD; Susan R. Heckbert, MD, PhD; David S. Siscovick, MD, MPH; Phyllis K. Stein, PhD; Bruce M. Psaty, MD, PhD; Nona Sotoodehnia, MD; John S. Gottdiener, MD; and Gregory M. Marcus, MD, MAS

Atrial fibrillation (AF) prediction models would have enhanced clinical utility if they identified potentially modifiable risks factors. This study found that increases in the hourly number of premature atrial contractions (PACs) were associated with an increased risk for incident AF and overall mortality. Addition of PAC count improved the performance of the Framingham AF risk model.

Topics: atrial fibrillation, atrial premature complexes, atrial arrhythmia
Chen-Hua Liu, MD; Chung-Feng Huang, MD; Chun-Jen Liu, MD, PhD; Chia-Yen Dai, MD, PhD; Cheng-Chao Liang, MD, MS; Jee-Fu Huang, MD, PhD; Peir-Haur Hung, MD; Hung-Bin Tsai, MD; Meng-Kun Tsai, MD; Shih-I Chen, MD; Jou-Wei Lin, MD, PhD; Sheng-Shun Yang, MD, PhD; Tung-Hung Su, MD; Hung-Chih Yang, MD, PhD; Pei-Jer Chen, MD, PhD; Ding-Shinn Chen, MD; Wan-Long Chuang, MD, PhD; Ming-Lung Yu, MD, PhD; and Jia-Horng Kao, MD, PhD

Adding ribavirin to pegylated interferon improves sustained virologic response in hepatitis C virus (HCV) but has been avoided in patients receiving hemodialysis because of safety concerns. In this trial, adding low-dose ribavirin to pegylated interferon in such patients achieved a greater sustained virologic response rate than pegylated interferon monotherapy. Withdrawals due to adverse events were similar in both groups. Patients in the combination therapy group required a higher dosage and longer duration of epoetin-β. Combination therapy for HCV may be appropriate in patients receiving hemodialysis.

Topics: hemodialysis, combined modality therapy, interferons, ribavirin, therapy naive, hepatitis c virus genotype ...
Craig M. Hales, MD, MPH; Rafael Harpaz, MD, MPH; M. Riduan Joesoef, MD, PhD; and Stephanie R. Bialek, MD, MPH

Some speculate whether the increase in herpes zoster in older adults could be due to routine childhood varicella vaccination. Less frequent exposure to varicella could decrease external boosting of varicella-specific immunity. Medicare data showed that the age-specific increase in herpes zoster incidence began before routine childhood varicella vaccination was introduced and does not vary by state vaccination coverage rates in models adjusted for sex, age, and calendar year. Routine childhood vaccination does not seem to explain the age-specific increase in herpes zoster.

Topics: chickenpox vaccine, human herpesvirus 3, medicare
Devan Kansagara, MD, MCR; Edward Dyer, MD; Honora Englander, MD; Rongwei Fu, PhD; Michele Freeman, MPH; and David Kagen, MD

The benefits of treatment of anemia among patients with heart disease are unclear. This review examined the benefits and harms of such treatments. It found low-strength evidence that higher transfusion thresholds do not consistently improve mortality rates. Moderate-strength evidence showed that intravenous iron may help to alleviate symptoms in patients with heart failure and iron deficiency. Moderate- to high-strength evidence found no consistent benefits of erythropoiesis-stimulating agents in patients with mild to moderate anemia and heart disease and that use may be associated with serious harms.

Topics: anemia, iron, heart diseases, congestive heart failure, blood transfusion, transfusion, erythropoiesis-stimulating agents, ...
Caroline K. Kramer, MD, PhD; Bernard Zinman, CM, MD; and Ravi Retnakaran, MD

This review examined the relationship of metabolic status with all-cause mortality and cardiovascular events in normal-weight, overweight, and obese persons. It found that metabolically healthy obese individuals are at increased risk for all-cause mortality and cardiovascular events over the long term and that all phenotypes with unhealthy metabolic status have increased risk. The review suggests no healthy pattern of increased weight.

Topics: obesity, overweight, body mass index procedure, cardiovascular event
Amir Qaseem, MD, PhD, MHA; Linda L. Humphrey, MD, MPH; Nick Fitterman, MD; Melissa Starkey, PhD; Paul Shekelle, MD, PhD, for the Clinical Guidelines Committee of the American College of Physicians

The American College of Physicians provides clinical recommendations on the treatment of anemia and iron deficiency in adults with heart disease. It recommends using a restrictive red blood cell transfusion strategy (trigger hemoglobin threshold of 7 to 8 g/dL compared with higher levels) in hospitalized patients with coronary heart disease and recommends against the use of erythropoiesis-stimulating agents in patients with mild to moderate anemia and congestive heart failure or coronary heart disease.

Topics: anemia, heart diseases, erythrocyte transfusion, cardiovascular event, exercise tolerance, quality of life, ...
Rima F. Khabbaz, MD

Eleven years ago, a novel coronavirus, branded “SARS” for the severe acute respiratory syndrome, sparked the first major global emerging infectious disease outbreak of the 21st century. This commentary discusses the events and successful global response surrounding the 2003 SARS outbreak, the lessons learned and enhancements made in the past decade, and the significant challenges that remain.

Topics: severe acute respiratory syndrome
Christine A. Sinsky, MD; and John W. Beasley, MD

Texting while driving is associated with a greatly increased risk for crashing and reduces the amount of brain activity devoted to driving. This commentary asks whether typing into electronic health records poses similar risks and discusses ways to reduce “texting while doctoring.”

Topics: patient safety, text messaging
Ryan A. Crowley, BSJ; and Thomas G. Tape, MD

Most individuals and small businesses have begun to shop for and enroll in health insurance coverage through their state's health insurance marketplace, also known as an exchange. The marketplaces serve as a one-stop resource to help the uninsured and the underinsured find comprehensive health coverage that fits their needs and budget and determine whether they qualify for health insurance tax credits provided by the Affordable Care Act. This article discusses the marketplaces and their implications for patients and physicians.

Topics: health policy, health insurance

In this issue, Dewland and colleagues evaluated the ability of baseline hourly PAC count to predict incident AF. The editorialists discuss the study and ask whether we should screen for PACs to predict incident AF or simply screen for prevalent AF in patients who will benefit most from treatment.

Topics: atrial fibrillation
James O. Hill, PhD; and Holly R. Wyatt, MD

In this issue, Kramer and colleagues' meta-analysis provides strong evidence that “healthy obesity” is a myth. The editorialists discuss the meta-analysis and conclude that no level of obesity is healthy. They believe that recognizing this is an important step toward developing and implementing strategies to combat the obesity epidemic.

Topics: obesity, misconceptions
Brian J. Secemsky, MD
Includes: Audio/Video

I cried during a scene from Lars and the Real Girl, a dark comedy about an unconventional man and his relationship with an inflatable sex doll. The tears started pouring as the doll was rushed to the hospital where she “died.” I have encountered countless tragic episodes of death and despair and have never shed a tear. So why now?

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Michael Joel Pottash, MD, MPH
Includes: Audio/Video

“The tragedy of old age,” as Oscar Wilde writes, “is not that one is old, but that one is young.” Though we inevitably age and fall ill, we continue to regard ourselves as young and healthy. When this wisdom is overlooked in medicine, it can become a key barrier to patient care.

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Joseph D. Feuerstein, MD; and Daniel A. Leffler, MD, MS
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Meeta Prasad Kerlin, MD, MSCE; and Jeffrey L. Tokar, MD
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Scott D. Halpern, MD, PhD
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Joel B. Raffel, BMBCh; and Joanne Thompson, BA, MB BChir
Topics: coffee, carbon monoxide
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Jack Coulehan, MD, MPH
Includes: Audio/Video
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Gayatri Patel, MD, MPH; and Tonya L. Fancher, MD, MPH
Includes: CME
Topics: generalized anxiety disorder
Topics: hemodialysis, hepatitis c, ribavirin, peginterferon
Topics: obesity
Topics: anemia, heart diseases, clinical practice guideline
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