The American journal of medicine
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Previous studies have described an "obesity paradox" with heart failure, whereby higher body mass index (BMI) is associated with lower mortality. However, little is known about the impact of obesity on survival after acute myocardial infarction. ⋯ There appears to be an "obesity paradox" among patients after acute myocardial infarction such that higher BMI is associated with lower mortality, an effect that was not modified by patient characteristics and was comparable across age, sex, and diabetes subgroups.
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Randomized Controlled Trial Multicenter Study
Placebo adherence and mortality in the Heart and Estrogen/Progestin Replacement Study.
Analyses from double-blind randomized trials have reported lower mortality among participants who were more adherent to placebo compared with those who were less adherent. We explored this phenomenon by analyzing data from the placebo arm of the Heart and Estrogen/Progestin Replacement Study (HERS), a randomized, double-blind, placebo-controlled trial of estrogen plus progestin for secondary prevention of coronary heart disease in postmenopausal women. Our primary aim was to measure and explain the association between adherence to placebo and total mortality among the placebo-allocated participants in the HERS. Secondary aims included assessment of the association between placebo adherence and cause-specific morbidity and mortality. ⋯ Analyses of the HERS data support a strong association between adherence to placebo study medication and mortality. Although probably not due to simple confounding by healthy lifestyle factors, the underlying mechanism for the association remains unclear. Further analyses of this association are necessary to explain this observation.
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In the United States, emergency physicians and hospitalists are increasingly responsible for managing hospitalized patients. These specialists share a common practice space and similar shift work schedules. Together they govern decisions about use of the most expensive care setting in medicine-the hospital. ⋯ Hospital care is increasingly driven by emergency physicians and hospitalists. We envision a vital role for ongoing collaboration between them in achieving the goals of patient care, education, and quality and safety outcomes.