The opposite of heart failure . . . and other stories

BMJ 2016; 354 doi: http://dx.doi.org/10.1136/bmj.i4076 (Published 28 July 2016) Cite this as: BMJ 2016;354:i4076

Heart success

The opposite of heart failure is heart success—meaning the recovery of function in a previously impaired heart. Patients whose left systolic ejection fraction improved with treatment comprised 16.3% of a series of 2166 participants of median age 65 from heart failure clinics at Emory University, Georgia, USA (JAMA Cardiol doi:10.1001/jamacardio.2016.1325). At three years, the age and sex adjusted mortality in this cohort was 4.8% in patients with heart failure with recovered ejection fraction compared with 16.3% in patients with heart failure with reduced ejection fraction and 13.2% in patients with heart failure with preserved ejection fraction.

Multiple sclerosisand birth date in the UK

Multiple sclerosis rates vary across the UK, as do live birth rates by season. But after adjusting for the temporal and regional variations in the live births of the UK population, investigators found that there is a statistically significant season of birth effect in patients with multiple sclerosis, with an increased risk of disease in the peak month (April) compared with the trough month (November) (odds ratio 1.24, 95% confidence interval 1.10 to 1.41) (JAMA Neurol doi:10.1001/jamaneurol.2016.1463).

Maternal flu vaccination and baby flu

Advice about influenza vaccine for pregnant women on NHS Choices states that this also protects babies “for the first few months of their lives.” But in a double blinded, placebo controlled randomised trial of trivalent flu vaccine conducted in South Africa in 2012-13, the protection to infants was only substantial in the first eight weeks of life, as confirmed by polymerase chain reaction tests for influenza (JAMA Pediatr doi:10.1001/jamapediatrics.2016.0921). From eight weeks on there was a steep decline in antibodies.

Midlife fitness and stroke

The time to be fit is in middle life. The message comes through most recently from an analysis of data from 19 815 adult US citizens in the Cooper Center Longitudinal Study, which measured cardiorespiratory fitness using treadmill tests (Stroke doi:10.1161/STROKEAHA.115.011532). Tracking of Medicare data showed that 808 participants had later been admitted with stroke. After adjustment for hypertension, diabetes mellitus, and atrial fibrillation, high midlife cardiorespiratory fitness still emerged as a major protective factor against subsequent stroke (hazard ratio 0.63, 95% confidence interval 0.51 to 0.79; fourth and fifth fifths versus first fifth).

Rheumatoid survival improvement

Good control of rheumatoid arthritis has been shown to normalise life expectancy in individuals. A study based on the UK Health Improvement Network shows how this has translated into a population effect by comparing patients with a first diagnosis between 1999 and 2006 with those having a diagnosis between 2007 and 2014 (Ann Rheum Dis doi:10.1136/annrheumdis-2015-209058). The hazard ratio for death compared with the general population of Britain has declined from 1.56 to 1.29.

Questions to ask about surgery

Older patients and their families often have difficulty in deciding about surgery, yet fully informed consent is especially important when the risks may be high. A qualitative study of shared decision making in this context came up with three domains of questions that need to be addressed: “Should I have surgery?” “What should I expect if everything goes well?” and “What happens if things go wrong?” (JAMA Surg doi:10.1001/jamasurg.2016.1308). The final list included 11 questions within these domains.

Delirium Day

Public delirium was an annual feature in many societies through history. On one or more days of the year, people could abandon themselves to worship Bacchus or become Lords of Misrule or carnival revellers. But Delirium Day, 30 September 2015 in Italy was not like that. It was the appointed date of the first nationwide point prevalence study to assess delirium in adults aged 65 or more admitted to acute and rehabilitation hospital wards (BMC Med doi:10.1186/s12916-016-0649-8). An acute confusional state occurred in more than one out of five patients in these settings: nothing to do with delirious happiness.

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