Annals of Internal Medicine is published by the American College of Physicians, an organization of more than 115,000 internal medicine physicians and medical students. These highlights are not intended to substitute for articles as sources of information. For an embargoed fax of an article, call 1-800-523-1546, ext. 2656, or 215-351-2656.
The U.S. Preventive Services Task Force has issued new recommendations for screening asymptomatic (apparently healthy) people for heart disease. The group does not recommend EKG, treadmill tests and CT scans to screen people at low risk for heart disease. It says that evidence is insufficient to recommend for or against using these three tests to screen for heart disease in asymptomatic adults at increased risk for heart disease. The recommendations are available online at www.annals.org as of noon EST, Tuesday, February 17. They will appear in the April 6, 2004, print edition of Annals of Internal Medicine.
Hospice care reduced Medicare expenditures for patients with cancer who were under age 85 but increased Medicare expenditures for patients without cancer and for all patients older than 85 (Improving Patient Care, p. 269). Researchers looked at Medicare expenditures for 245,326 patients over age 68 in the last years of life. Adjusted mean expenditures were 4 percent higher overall among all hospice enrollees than among those who did not have hospice care. Expenditures were 1 percent lower for hospice enrollees with cancer than for patients with cancer who did not use hospice. Savings were highest (7 percent to 17 percent) among hospice users with lung cancer and other very aggressive types of cancer.
Researchers studying 4,006 right-handed individuals age 65 or older with no symptoms of heart disease and no history of transient ischemic attack or stroke found that narrowing of the left carotid artery was associated with cognitive impairment and decline in cognitive function over time compared with those with no left-sided carotid artery disease (Article, p. 237). The authors and an editorial writer caution that the study does not provide evidence that carotid artery surgery should be performed in patients without history of stroke or TIAs to prevent cognitive decline (Editorial, p. 303).