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6 December 2005 Annals of Internal Medicine Tip Sheet

Annals of Internal Medicine is published by the American College of Physicians. These highlights are not intended to substitute for articles as sources of information. For an embargoed copy of an article, call 1-800-523-1546, ext. 2656, or 215-351-2656. Leave fax or e-mail and article topics.

Heart Attack Patients Have High Risk for Subsequent Stroke, Study Finds

A study of 2,160 people who had heart attacks found a high risk for stroke in the first month after the heart attacks (Article, p. 785). Approximately 22.6 per 1,000 people had a stroke within 30 days of a myocardial infarction. Further, heart attack patients who had a stroke were almost three times more likely to die than those who did not have a stroke. Additional risk factors for stroke after heart attack were older age, a previous stroke, and having diabetes. The researchers say that “use of oral anticoagulation after acute MI remains controversial,” but should be revisited. “The strong association between stroke and death further underscores the need to aggressively pursue preventive approaches,” they say.

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Botulinum Toxin Relieves Pain of Tennis Elbow in Small Study

Sixty people who had tennis elbow (lateral epicondylitis) for at least three months received a single injection of botulinum toxin or inactive saline solution (Article, p. 793). The group receiving the botulinum toxin had less pain at one and three months. Botulinum toxin made no difference in hand grip strength and in a few cases appeared to cause arm weakness and loss of finger function. The botulinum toxin used in this study was Dysport®. An editorial writer says that since physicians do not know exactly how BT works, they should reserve BT for traditional uses, such as treating involuntary movements, ticks and disorders in which “muscle spasms and abnormal postures are prominent” (Editorial, p. 838).

Hospital Care at Home Is Feasible and Cost-Effective, Study Finds

Sixty percent of patients who required hospitalization for one of four conditions chose to receive hospital-quality care at home (Article, p. 798). Patients who agreed to treatment at home received similar quality of care, had fewer and shorter treatments, and generated lower costs than those who were hospitalized. An editorial writer says the study affirms that “hospital-at-home care offers worthy net benefits” but does not provide objective evidence to judge the health or economic benefits of this type of care (Editorial, p. 840).

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