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28 January 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. Pandemic concerns prompt experts to seek better understanding of Middle East Respiratory Syndrome (MERS)

Health officials have expressed concern that the Middle East Respiratory Syndrome Coronavirus (MERS-CoV) could become a major public health threat, according to an article being published in Annals of Internal Medicine. Since September 2012, 163 infections have been reported to the World Health Organization (WHO), including 71 deaths. The severity of symptoms, high fatality rate, and ease of transmission resemble the infection caused by severe acute respiratory syndrome coronavirus (SARS-CoV) but data on MERS-CoV-infected critically ill patients are limited. Researchers studied 12 patients with confirmed or probable MERS-CoV in three intensive care units at two tertiary hospitals in Saudi Arabia. They found that all of the critically ill patients had underlying comorbidities, developed acute respiratory failure characterized by severe hypoxemia, had high severity of illness, and had high incidence of extra-pulmonary manifestations, and a high mortality rate. The researchers noted that all of the MERS-CoV patients had underlying chronic comorbidities, which strongly suggests that patients with such comorbidities are susceptible hosts for MERS-CoV. While transmission to health care workers appeared to be low, human-to-human transmission can occur with unprotected exposure. The authors suggest an urgent collaborative study to examine therapeutic options to treat MERS-CoV, as the disease has the potential to become a worldwide public health threat. The authors of an accompanying editorial cite lessons learned from SARS-CoV and agree that scientific transparency and collaboration is needed to effectively protect populations from MERS-CoV.

2. Amidst controversy, four new articles help physicians make sense of new cholesterol treatment guidelines

On November 12, 2013, the American College of Cardiology and the American Heart Association issued clinical guidelines on cardiovascular disease risk assessment and cholesterol treatment. The new guidelines quickly became the source of debate among stakeholders and the controversy was widely covered in the news media. Four new articles published in Annals of Internal Medicine seek to help physicians make sense of the new guidelines amidst the controversy. In a synopsis of the recommendations, guideline panel members summarize the key features of the guidelines and how the recommendations will work in practice to reduce the risk for atherosclerotic cardiovascular disease, a leading cause of death, lost quality of life, and increased health care costs. In an accompanying commentary, authors praise the doctor-patient collaboration recommended in the guidelines but advise health care providers to seek a middle ground when making treatment decisions A second commentary applauds the panel for basing statin treatment on risk factors rather than LDL-C targets because this approach greatly simplifies treatment for clinicians and patients. Finally, an editorial explores why guidelines seem to generate controversy and urges physicians to listen to the evidence, not the noise created by the disagreement over the new recommendations.

3. Task Force evidence reviews suggests that one-time screening for abdominal aortic aneurysms could benefit older men

A one-time screening for abdominal aortic aneurysm in men 65 years or older is associated with decreased AAA rupture and AAA-related mortality rates, according to a new review being published in Annals of Internal Medicine. AAA is a weakening in the wall of the infrarenal aorta resulting in localized dilation, or ballooning, of the abdominal aorta. A large proportion of AAAs are asymptomatic until a rupture develops, which is generally acute and often fatal (up to 83 percent of patients die before hospitalization). Risk factors for AAA include advanced age, male sex, smoking, and a family history, with smoking being the most important modifiable risk factor. The United States Preventive Services Task Force (USPSTF) reviewed published evidence to update its previous recommendation on screening for AAA. The reviewers found convincing evidence that screening men aged 65 and older decreased AAA-related mortality rates by approximately 50 percent over 13 to 15 years. Determining the most effective and efficient approaches to population-based AAA screening was an important goal of the review. Critics of the 2005 recommendation for selectively screening men aged 65 to 75 who had ever smoked argued that the guidelines missed opportunities to prevent AAA rupture in women, younger nonsmoking males, and those with a family history. The reviewers maintain that targeting older male smokers is warranted because no single risk factor other than age, sex, or smoking history is as strong a predictor of AAA. A draft recommendation will be posted on January 27 at 5:00 p.m.