Mayo Clinic proceedings
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Mayo Clinic proceedings · Jan 2016
Prevalence of Preexisting Cardiovascular Disease in Patients With Different Types of Cancer: The Unmet Need for Onco-Cardiology.
Cancer and cardiovascular diseases (CVDs) share many of the same risk factors. Using a cloud-based health care database, we identified patients with malignancies that often require cardiotoxic treatments (leukemia/lymphoma and lung, breast, colon, renal, and head and neck cancers). We report the prevalence of CVDs (coronary artery disease, carotid artery disease, peripheral vascular disease, cerebrovascular disease, and heart failure) in those populations. ⋯ Of those with CVD, only half were referred to cardiologists and received guideline-directed medical therapy. The prevalence of CVDs is unexpectedly high and suboptimally managed in patients with cancer. There seems to be an opportunity for onco-cardiologists to fulfill this unmet need and help improve outcomes in patients with cancer and coexisting heart disease.
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Mayo Clinic proceedings · Jan 2016
Meta AnalysisAngiotensin-Converting Enzyme Inhibitors or Angiotensin Receptor Blockers in Patients Without Heart Failure? Insights From 254,301 Patients From Randomized Trials.
To compare the efficacy and safety of angiotensin-converting enzyme inhibitors (ACEis) and angiotensin receptor blockers (ARBs) in patients without heart failure. ⋯ In patients without heart failure, evidence from placebo-controlled trials (restricted to trials after 2000), active controlled trials, and head-to-head randomized trials all suggest ARBs to be as efficacious and safe as ACEis, with the added advantage of better tolerability.
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Mayo Clinic proceedings · Jan 2016
ReviewDisclosure of Industry Payments to Physicians: An Epidemiologic Analysis of Early Data From the Open Payments Program.
The Centers for Medicare and Medicaid Services' Open Payments program implements Section 6002 of the Affordable Care Act requiring medical product manufacturers to report payments made to physicians or teaching hospitals as well as ownership or investment interests held by physicians in the manufacturer. To determine the characteristics and distribution of these industry payments by specialty, we analyzed physician payments made between August 1, 2013, and December 31, 2013, that were publicly disclosed by Open Payments. We compared payments between specialty types (medical, surgical, and other) and across specialties within each type using the Pearson χ(2) test and the Kruskal-Wallis test. ⋯ Physicians most likely to receive general payments were cardiovascular specialists (78%) and neurosurgeons (77%); those least likely were pathologists (9%). Reports of ownership interest in reporting entities included $310 million in dollar amount invested and $447 million in value of interest held by 2093 physicians. In conclusion, the distribution and characteristics of industry payments to physicians varied widely by specialty during the first half-year of Open Payments reporting.
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The diagnosis and treatment of multiple myeloma has changed dramatically in the past decade. The disease definition has been updated to include highly specific biomarkers in addition to established markers of end-organ damage. ⋯ New drugs introduced in the past few years include carfilzomib, pomalidomide, panobinostat, ixazomib, elotuzumab, and daratumumab. In this review, we outline the current approach to the diagnosis, prognosis, and management of multiple myeloma.