Annals
Established in 1927 by the American College of Physicians

FOR THE PRESS

3 June 2014 Annals of Internal Medicine Tip Sheet

Below is information about articles being published in Annals of Internal Medicine. The information is not intended to substitute for the full article as a source of information. Annals of Internal Medicine attribution is required for all coverage.

1. Evidence does not support guidelines on fatty acid consumption to reduce coronary risk

Current evidence does not support nutritional guidelines that advocate high consumption of polyunsaturated fatty acids and low consumption of total saturated fats, according to an article being published in Annals of Internal Medicine (http://www.annals.org/article.aspx?doi=10.7326/M13-1788). For cardiovascular health, nutritional guidelines generally encourage low consumption of saturated fats, high consumption of ϖ-3 polyunsaturated fatty acids, and avoidance of trans fats. However, uncertainties in available evidence have contributed to the considerable variation in international guidelines about optimum amounts and types of fatty acids people should consume. Further complicating data interpretation, earlier analyses have generally not assessed the consistency between studies that rely on dietary self-report and biomarker measures of fatty acids in relation to coronary disease. Researchers conducted a systematic review and meta-analysis of data from long-term prospective observational studies of a broad range of both dietary and biomarker fatty acid measures in coronary disease. They also examined associations with coronary outcomes in randomized trials of fatty acid supplementation. The researchersí findings did not support cardiovascular guidelines that promote high consumption of long-chain ϖ-3 and ϖ-6 polyunsaturated fatty acids and reduced consumption of total saturated fatty acids. They also found that supplementation did not statistically significantly reduce the risk for coronary outcomes.

2. Patients co-infected with HIV and HCV more likely to suffer liver decompensation

Despite treatment with antiretroviral therapy (ART), patients co-infected with HIV and hepatitis C virus (HCV) have higher rates of liver decompensation than patients with HCV alone, according to an article being published in Annals of Internal Medicine (http://www.annals.org/article.aspx?doi=10.7326/M13-1829). Up to 30 percent of patients with HIV also are often co-infected with HCV and HCV-related liver complications are an important cause of morbidity in co-infected patients. It has been suggested that ART slows HCV-associated liver fibrosis. However, whether rates of hepatic decompensation and other severe liver events in co-infected patients receiving ART are similar to those with HCV only remains unclear. Veterans Affairs researchers compared health records for 4,280 patients co-infected with HIV and HCV who initiated ART with those of 6,079 veterans with HCV only to compare hepatic decompensation rates. Co-infected patients that had HIV RNA levels less than 1,000 copies/ML had a lower rate of hepatic decompensation than those with a lesser degree of HIV suppression. However, the rate was still higher than that of patients with HCV alone. Higher rates of decompensation were seen in co-infected patients receiving ART who had baseline advanced liver fibrosis, severe anemia, diabetes, and were of nonblack race.

3. Pneumonia coding practices may skew hospital performance outcomes

Variations in coding practices related to pneumonia cases may bias efforts to compare quality of care among hospitals, according to an article being published in Annals of Internal Medicine (http://www.annals.org/article.aspx?doi=10.7326/M13-1419). Pneumonia is the most common reason for emergency hospitalization in the United States, making it an appropriate target for quality improvement initiatives and public reporting of hospital quality. Hospital risk-standardized mortality rates for pneumonia are publicly reported but exclude more severe cases of pneumonia, which are coded as sepsis or respiratory failure with pneumonia as a secondary diagnosis. Researchers studied hospital records for 329 U.S. hospitals to examine the effect of the definition of pneumonia on hospital mortality rates. The records showed that the risk-standardized mortality rate tended to increase when sepsis or respiratory failure were included in a broader definition of pneumonia in hospitals that assigned these codes to a greater proportion of patients and to decrease when hospitals applied these codes to a smaller proportion of cases. The researchers conclude that performance measures based on pneumonia coding may misclassify some hospitals and weaken confidence in public reporting.