Sudden death, weight loss and CVD

Running short of time to read the journals? Let Dr Alison Glenesk share the latest findings with you

Research of the week

Mobile phone use in hospitals

BMJ 2006; 333: 767-8

This interesting editorial describes a set of guidelines issued by the MHRA which attempt to rationalise the use of mobile phones in hospitals.

Until now there has been a complete ban, but the authors point out that phones can interfere with only 4 per cent of medical equipment, even at close range, and propose that they should now be banned only in ITU, special-care baby units, and any other area where complex equipment is used.

They do, however, urge caution, because ringtones may mimic alarms on medical machinery.

The DoH suggests that camera phones should be banned owing to fears about patient confidentiality.

Avoiding sudden death in athletes

JAMA 2006; 296: 1,593–601

This is a very timely study, following the death of yet another of our local young men during a football game. The study population is derived from northern Italy, where screening, mainly in the form of a 12-lead ECG, is now mandatory before participation in athletic events.

In this study, carried out between 1982 and 2004, 42,386 athletes between the ages of 12 and 35 were screened and compared with an unscreened population.

During the study, sudden death in athletic events decreased by 89 per cent, with 265 deaths in the unscreened population and only 55 in the screened population. This decrease in sudden deaths was mainly due to detection of hypertrophic cardiomyopathy and night heart failure.

Would this programme be feasible in Britain, or would people see it as another manifestation of the nanny state?

Cardiovascular risk assessment in older women

Heart 2006; 92: 1,396–401

The risk of cardiovascular disease (CVD) tends to be underestimated in women, but in the 60–79-year-old age group it is approaching that of men.

The authors of this study aimed to develop simple criteria which could be used for risk assessment in general practice that is less invasive and expensive than the accepted Framingham criteria. The GP model used age, systolic BP, smoking habit and self-rated health, all of which can be easily obtained in one surgery visit.

In total 3,582 women aged 60–79 years and who were free from CHD were studied.

The results at 4.7 years showed that the most valuable predictive criteria were smoking status (never smoked, ex-smoker, smoking under or over 10 cigarettes a day), age, systolic BP, and self-reported health (excellent, good, fair or poor).

Although this model appears to perform well, it needs to be tested in different populations.

Intervention in weight loss maintenance

N Engl J Med 2006; 355: 1,563–71

Losing weight is difficult, and keeping it off even harder.

In this study, the authors identified 314 dieters with self-reported high-level weight-loss averaging 19.3kg over two years. Participants were then randomised to three groups, to receive either a quarterly newsletter only, face-to-face intervention or internet-based intervention. The intervention programmes emphasised daily self-weighing and self-regulation.

The results showed that the face-to-face intervention group was the most successful, with less weight regain. A self-regulation programme based on daily weighing improved maintenance of weight loss. Food for thought, but could the NHS afford it?

Urge post-MI patients to keep taking tablets

Arch Intern Med 2006; 166: 1,842–7

This study aimed to identify patient and MI treatment factors linked to medication therapy discontinuation and its effects.

In this study, 1,521 post-MI patients discharged with aspirin, beta-blockers and statins were followed. At one month, 184 of them had stopped all medication, 272 had stopped one drug, 56 had stopped two medications, and 1,009 continued talking all three.

Stopping all medication reduced the one-year survival from 97.7 per cent to 88.5 per cent, with comparable results when analysing individual drugs.

Patients with lower educational attainment, and elderly women, were most likely to stop their treatment. Encourage your patients to keep on taking the tablets as it looks like it really works.

Dr Glenesk is a GP in Aberdeen and a member of our team who reviews the journals

The quick study

Cardiovascular screening prevents sudden death in athletes.

Older women’s CVD risk can be accurately predicted with data from a single visit to a GP.

Daily weighing helps dieters maintain weight loss.

Post-MI medication compliance is essential to reduce mortality.

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