The prevalent reason offered for increased mortality rates during weekend hours are shortages in staffing and services. The “weekend effect,” elucidated by Pauls et al.¹ in their recent meta-analysis, and the accompanying editorial by Quinn and Bell,² highlight these and other potential causes for this anomaly.

Pauls et al.¹ also cite patient selection bias as a possible explanation for the uptick in deaths during this span (off-hour admissions may be sicker). It is due to the latter that we wish to highlight additional studies published after mid-2013 when the authors concluded their search.

Recent disputes within the UK’s National Health Service³ concerning health system funding spurred timely papers in BMJ⁴ and Lancet⁵ on the uncertainty. They both discovered a stronger signal from patient characteristics admitted during this time rather than on-hand resources and workforce. These new investigations strengthen the support for patient acuity as a determinant in explaining worse outcomes.

We highlight these manuscripts so investigators will continue their attempts to understand the weekend phenomena as suggested by both Pauls et al.¹ and the editorialists.² To allow for the delivery of correct interventions, we must understand its root causes. In this case, it may be the unique features of patients presenting on Saturdays and Sundays and, hence, would require a different set of process changes.

Disclosure: The authors declare no conflict of interest.

The prevalent reason offered for increased mortality rates during weekend hours are shortages in staffing and services. The “weekend effect,” elucidated by Pauls et al.¹ in their recent meta-analysis, and the accompanying editorial by Quinn and Bell,² highlight these and other potential causes for this anomaly.

Pauls et al.¹ also cite patient selection bias as a possible explanation for the uptick in deaths during this span (off-hour admissions may be sicker). It is due to the latter that we wish to highlight additional studies published after mid-2013 when the authors concluded their search.

Recent disputes within the UK’s National Health Service³ concerning health system funding spurred timely papers in BMJ⁴ and Lancet⁵ on the uncertainty. They both discovered a stronger signal from patient characteristics admitted during this time rather than on-hand resources and workforce. These new investigations strengthen the support for patient acuity as a determinant in explaining worse outcomes.

We highlight these manuscripts so investigators will continue their attempts to understand the weekend phenomena as suggested by both Pauls et al.¹ and the editorialists.² To allow for the delivery of correct interventions, we must understand its root causes. In this case, it may be the unique features of patients presenting on Saturdays and Sundays and, hence, would require a different set of process changes.

Disclosure: The authors declare no conflict of interest.

The prevalent reason offered for increased mortality rates during weekend hours are shortages in staffing and services. The “weekend effect,” elucidated by Pauls et al.¹ in their recent meta-analysis, and the accompanying editorial by Quinn and Bell,² highlight these and other potential causes for this anomaly.

Pauls et al.¹ also cite patient selection bias as a possible explanation for the uptick in deaths during this span (off-hour admissions may be sicker). It is due to the latter that we wish to highlight additional studies published after mid-2013 when the authors concluded their search.

Recent disputes within the UK’s National Health Service³ concerning health system funding spurred timely papers in BMJ⁴ and Lancet⁵ on the uncertainty. They both discovered a stronger signal from patient characteristics admitted during this time rather than on-hand resources and workforce. These new investigations strengthen the support for patient acuity as a determinant in explaining worse outcomes.

We highlight these manuscripts so investigators will continue their attempts to understand the weekend phenomena as suggested by both Pauls et al.¹ and the editorialists.² To allow for the delivery of correct interventions, we must understand its root causes. In this case, it may be the unique features of patients presenting on Saturdays and Sundays and, hence, would require a different set of process changes.

Disclosure: The authors declare no conflict of interest.

Treating rheumatoid arthritis patients with lower doses of rituximab for long-term maintenance reduced the risk of serious infections and saved money, based on data from approximately 1,200 patients in a French registry.

In a study published in Rheumatology, Julien Henry, MD, of Institut pour la Sante et la Recherche Medicale, Paris, and colleagues reviewed data from 1,278 patients; 1,093 (85.5%) received a standard dose of rituximab, and 185 (14.5%) received a reduced dose for maintenance therapy. A standard dose was 1,000 mg per infusion given in two infusions 2 weeks apart), and a reduced dose was 500 mg per infusion given in two infusions 2 weeks apart.

After 5 years, maintenance was 55.5% in the standard group and 53.8% in the reduced group; with no significant difference (hazard ratio, 1.03). However, the cumulative dose for retreatment was 39% less in the reduced group (1.4 g per year vs. 2.3 g per year), “which is greatly cost effective,” the researchers wrote.

In addition, the rate of serious infections was significantly lower in the reduced-dose group, compared with the standard-dose group (2.2 per 100 patient-years vs. 4.1 per 100 patient-years; adjusted hazard ratio = 0.50).

“Of note, factors associated with risk of serious infection, such as baseline low gamma globulin or IgG levels, chronic lung or cardiac disease, and extra-articular involvement, did not differ between groups,” the researchers said.

The study findings were limited by several factors including the observational design and lack of data on certain RA outcome measures such as radiographic progression and function, the researchers noted. However, the results support data from similar studies and suggest that a lower dose of rituximab for retreatment of RA “did not alter the maintenance of the treatment at 5 years and is associated with a significant lower rate of serious infections,” they said.

Dr. Henry had no financial conflicts to disclose. Several coauthors disclosed relationships with multiple drug companies, but the study received no specific funding from any of these companies.

[email protected]

SOURCE: Henry J et al. Rheumatology. 2017 Dec 15. doi: 10.1093/rheumatology/kex446.

Treating rheumatoid arthritis patients with lower doses of rituximab for long-term maintenance reduced the risk of serious infections and saved money, based on data from approximately 1,200 patients in a French registry.

In a study published in Rheumatology, Julien Henry, MD, of Institut pour la Sante et la Recherche Medicale, Paris, and colleagues reviewed data from 1,278 patients; 1,093 (85.5%) received a standard dose of rituximab, and 185 (14.5%) received a reduced dose for maintenance therapy. A standard dose was 1,000 mg per infusion given in two infusions 2 weeks apart), and a reduced dose was 500 mg per infusion given in two infusions 2 weeks apart.

After 5 years, maintenance was 55.5% in the standard group and 53.8% in the reduced group; with no significant difference (hazard ratio, 1.03). However, the cumulative dose for retreatment was 39% less in the reduced group (1.4 g per year vs. 2.3 g per year), “which is greatly cost effective,” the researchers wrote.

In addition, the rate of serious infections was significantly lower in the reduced-dose group, compared with the standard-dose group (2.2 per 100 patient-years vs. 4.1 per 100 patient-years; adjusted hazard ratio = 0.50).

“Of note, factors associated with risk of serious infection, such as baseline low gamma globulin or IgG levels, chronic lung or cardiac disease, and extra-articular involvement, did not differ between groups,” the researchers said.

The study findings were limited by several factors including the observational design and lack of data on certain RA outcome measures such as radiographic progression and function, the researchers noted. However, the results support data from similar studies and suggest that a lower dose of rituximab for retreatment of RA “did not alter the maintenance of the treatment at 5 years and is associated with a significant lower rate of serious infections,” they said.

Dr. Henry had no financial conflicts to disclose. Several coauthors disclosed relationships with multiple drug companies, but the study received no specific funding from any of these companies.

[email protected]

SOURCE: Henry J et al. Rheumatology. 2017 Dec 15. doi: 10.1093/rheumatology/kex446.

Treating rheumatoid arthritis patients with lower doses of rituximab for long-term maintenance reduced the risk of serious infections and saved money, based on data from approximately 1,200 patients in a French registry.

In a study published in Rheumatology, Julien Henry, MD, of Institut pour la Sante et la Recherche Medicale, Paris, and colleagues reviewed data from 1,278 patients; 1,093 (85.5%) received a standard dose of rituximab, and 185 (14.5%) received a reduced dose for maintenance therapy. A standard dose was 1,000 mg per infusion given in two infusions 2 weeks apart), and a reduced dose was 500 mg per infusion given in two infusions 2 weeks apart.

After 5 years, maintenance was 55.5% in the standard group and 53.8% in the reduced group; with no significant difference (hazard ratio, 1.03). However, the cumulative dose for retreatment was 39% less in the reduced group (1.4 g per year vs. 2.3 g per year), “which is greatly cost effective,” the researchers wrote.

In addition, the rate of serious infections was significantly lower in the reduced-dose group, compared with the standard-dose group (2.2 per 100 patient-years vs. 4.1 per 100 patient-years; adjusted hazard ratio = 0.50).

“Of note, factors associated with risk of serious infection, such as baseline low gamma globulin or IgG levels, chronic lung or cardiac disease, and extra-articular involvement, did not differ between groups,” the researchers said.

The study findings were limited by several factors including the observational design and lack of data on certain RA outcome measures such as radiographic progression and function, the researchers noted. However, the results support data from similar studies and suggest that a lower dose of rituximab for retreatment of RA “did not alter the maintenance of the treatment at 5 years and is associated with a significant lower rate of serious infections,” they said.

Dr. Henry had no financial conflicts to disclose. Several coauthors disclosed relationships with multiple drug companies, but the study received no specific funding from any of these companies.

[email protected]

SOURCE: Henry J et al. Rheumatology. 2017 Dec 15. doi: 10.1093/rheumatology/kex446.

Synovitis detected by ultrasound in patients with rheumatoid arthritis (RA) in clinical remission has a moderate but significant independent predictive value for the loss of remission, new research shows.

These findings, reported by Swiss investigators at multiple centers and with different sonographers and ultrasound (US) machines, adds to previous research that has shown that patients in clinical remission with US-detected residual synovitis had a tendency to flare more often and have a shorter duration of remission than did patients with sonographic remission.

Bogdanhoda/Thinkstock

The research team observed a loss of remission in 60% of 378 remission phases, with having a 28-joint Disease Activity Score greater than 2.6 deciding the loss of remission status in 66% of cases in both the US+ and the US– groups.

The time from the first US during remission to loss of remission was 2-5 months longer for US– patients than it was for US+ patients.

“After adjusting for potential confounders, [the hazard ratio] of loss of remission for all remission phases using the complete follow-up time was higher for patients with US-detected synovitis at baseline than for those without (combined US score hazard ratio, 1.4; 95% CI, 1.03-2.00 vs. HR, 1.5; 95% CI, 1.1-2.1 for left and right imputation, respectively),” the investigators wrote.

Hazard ratios for the loss of remission also showed a two- to threefold increase when US measurements were taken early in remission (that is, within 3-6 months), a finding that the authors wrote indicated “that the short-term predictive power of US-detected residual synovitis may be more significant than its long-term predictive power.”

The researchers concluded that their study showed that US could be useful in predicting how long patients were likely to remain in remission in “real-life conditions,” but said questions remained over whether it should be used at an individual level.

“According to our results, in particular regarding the moderate HR, a single US done in remission cannot be used as the unique predictor of flare,” they wrote.

Nevertheless, their results may have “some importance in promoting the widespread use of US in real-life conditions for the follow-up of RA, especially when in remission,” they said.

“The next step would be to evaluate whether previous US performed prior to reaching remission and repeated US performed while in remission, particularly after 3-6 months, could provide additional information that is useful to the clinician,” they added.

The Swiss Clinical Quality Management Foundation is supported by the Swiss Society of Rheumatology and nine pharmaceutical companies.

SOURCE: Zufferey P et al. J Rheumatol. 2018 Jan 15. doi: 10.3899/jrheum.161193

Synovitis detected by ultrasound in patients with rheumatoid arthritis (RA) in clinical remission has a moderate but significant independent predictive value for the loss of remission, new research shows.

These findings, reported by Swiss investigators at multiple centers and with different sonographers and ultrasound (US) machines, adds to previous research that has shown that patients in clinical remission with US-detected residual synovitis had a tendency to flare more often and have a shorter duration of remission than did patients with sonographic remission.

Bogdanhoda/Thinkstock

The research team observed a loss of remission in 60% of 378 remission phases, with having a 28-joint Disease Activity Score greater than 2.6 deciding the loss of remission status in 66% of cases in both the US+ and the US– groups.

The time from the first US during remission to loss of remission was 2-5 months longer for US– patients than it was for US+ patients.

“After adjusting for potential confounders, [the hazard ratio] of loss of remission for all remission phases using the complete follow-up time was higher for patients with US-detected synovitis at baseline than for those without (combined US score hazard ratio, 1.4; 95% CI, 1.03-2.00 vs. HR, 1.5; 95% CI, 1.1-2.1 for left and right imputation, respectively),” the investigators wrote.

Hazard ratios for the loss of remission also showed a two- to threefold increase when US measurements were taken early in remission (that is, within 3-6 months), a finding that the authors wrote indicated “that the short-term predictive power of US-detected residual synovitis may be more significant than its long-term predictive power.”

The researchers concluded that their study showed that US could be useful in predicting how long patients were likely to remain in remission in “real-life conditions,” but said questions remained over whether it should be used at an individual level.

“According to our results, in particular regarding the moderate HR, a single US done in remission cannot be used as the unique predictor of flare,” they wrote.

Nevertheless, their results may have “some importance in promoting the widespread use of US in real-life conditions for the follow-up of RA, especially when in remission,” they said.

“The next step would be to evaluate whether previous US performed prior to reaching remission and repeated US performed while in remission, particularly after 3-6 months, could provide additional information that is useful to the clinician,” they added.

The Swiss Clinical Quality Management Foundation is supported by the Swiss Society of Rheumatology and nine pharmaceutical companies.

SOURCE: Zufferey P et al. J Rheumatol. 2018 Jan 15. doi: 10.3899/jrheum.161193

Synovitis detected by ultrasound in patients with rheumatoid arthritis (RA) in clinical remission has a moderate but significant independent predictive value for the loss of remission, new research shows.

These findings, reported by Swiss investigators at multiple centers and with different sonographers and ultrasound (US) machines, adds to previous research that has shown that patients in clinical remission with US-detected residual synovitis had a tendency to flare more often and have a shorter duration of remission than did patients with sonographic remission.

Bogdanhoda/Thinkstock

The research team observed a loss of remission in 60% of 378 remission phases, with having a 28-joint Disease Activity Score greater than 2.6 deciding the loss of remission status in 66% of cases in both the US+ and the US– groups.

The time from the first US during remission to loss of remission was 2-5 months longer for US– patients than it was for US+ patients.

“After adjusting for potential confounders, [the hazard ratio] of loss of remission for all remission phases using the complete follow-up time was higher for patients with US-detected synovitis at baseline than for those without (combined US score hazard ratio, 1.4; 95% CI, 1.03-2.00 vs. HR, 1.5; 95% CI, 1.1-2.1 for left and right imputation, respectively),” the investigators wrote.

Hazard ratios for the loss of remission also showed a two- to threefold increase when US measurements were taken early in remission (that is, within 3-6 months), a finding that the authors wrote indicated “that the short-term predictive power of US-detected residual synovitis may be more significant than its long-term predictive power.”

The researchers concluded that their study showed that US could be useful in predicting how long patients were likely to remain in remission in “real-life conditions,” but said questions remained over whether it should be used at an individual level.

“According to our results, in particular regarding the moderate HR, a single US done in remission cannot be used as the unique predictor of flare,” they wrote.

Nevertheless, their results may have “some importance in promoting the widespread use of US in real-life conditions for the follow-up of RA, especially when in remission,” they said.

“The next step would be to evaluate whether previous US performed prior to reaching remission and repeated US performed while in remission, particularly after 3-6 months, could provide additional information that is useful to the clinician,” they added.

The Swiss Clinical Quality Management Foundation is supported by the Swiss Society of Rheumatology and nine pharmaceutical companies.

SOURCE: Zufferey P et al. J Rheumatol. 2018 Jan 15. doi: 10.3899/jrheum.161193

Access ACOG/SMFM algorithm for treatment of pregnant women with flu-like illness

Access ACOG/SMFM algorithm for treatment of pregnant women with flu-like illness

Access ACOG/SMFM algorithm for treatment of pregnant women with flu-like illness

ORLANDO – When the Heart Rhythm Society and several collaborating groups published in October 2017 the first revised consensus statement on atrial fibrillation ablation in 5 years, the document included a novel and perhaps unexpected suggestion: Ablation for asymptomatic atrial fibrillation “may be considered.”

This was “the first time” any group of experts suggested an indication potentially existed for ablating asymptomatic atrial fibrillation (AF), Hugh Calkins, MD, said at the annual International AF Symposium.

“You might say ‘are you out of your mind recommending ablation for asymptomatic AF?’ ” conceded Dr. Calkins, professor of medicine and director of the arrhythmia service at Johns Hopkins Medicine in Baltimore. But Dr. Calkins quickly added that this was a “soft” recommendation by being in the “may be considered” category, and he also noted that it received broad support from about 90% of the members of the statement’s 60-member writing group (Heart Rhythm. 2017 Oct;14[10]:e445-e494).

In addition, he personally believed that an amber light for this strategy made a lot of sense.

Mitchel L. Zoler/Frontline Medical News

The ideal candidate for this approach would be a relatively young patient, say someone in their 50s, who is identified as having AF incidentally, such as someone with an irregular pulse that’s found during a routine examination that leads to an ECG and definitive identification of AF despite the patient’s complete denial of having symptoms.

The next step, Dr. Calkins suggested, would be to treat the patient with an antiarrhythmic drug, such as amiodarone or flecainide, and with cardioversion and see whether this stops the AF and makes the patient feel better. If the patient reports improvement, it suggests the AF really is symptomatic and management could then proceed as with any case of symptomatic AF. But if the patient perceives no change and the AF then recurs in a persistent presentation despite drug treatment, the cardiologist could then discuss with the patient the pros and cons of an ablative procedure.

The pros for immediate ablation are that, when left unablated, the patient will face a substantially increased lifetime risk for stroke, dementia, and new onset heart failure, and after 2-3 years of continued persistent AF the left atrium would remodel and become much less likely to respond to ablation with little prospect for the patient ever returning to a normal sinus rhythm. “It’s either a rhythm control strategy now, or we’ll leave you in AF for the rest of your life,” Dr. Calkins explained. “If I were 50 years old and had asymptomatic AF, there’s no way I’d want to have AF for the rest of my life.” The risks from ablation are that the procedure has about a 68% success rate and about a 1% rate of complications.

“A patient with asymptomatic paroxysmal AF doesn’t have much to lose by waiting and seeing whether symptoms develop, but for the patient with persistent AF there is a penalty for allowing continuous AF, because after 2-3 years you won’t be able to successfully ablate it. In the past, we left patients with asymptomatic AF that way for the rest of their life, but now we know that if patients remain in AF over time, they will lose the option to have it ablated, and their risk of stroke, dementia, and heart failure will increase.”Dr. Calkins has been a consultant or adviser to or received honoraria from Abbott, AtriCure, Boehringer Ingelheim, Boston Scientific, iRhythm, Medtronic, Pfizer, St. Jude, and Toray, He has also received research funding from Boston Scientific and Medtronic.

[email protected]

This article was updated 2/9/18.

ORLANDO – When the Heart Rhythm Society and several collaborating groups published in October 2017 the first revised consensus statement on atrial fibrillation ablation in 5 years, the document included a novel and perhaps unexpected suggestion: Ablation for asymptomatic atrial fibrillation “may be considered.”

This was “the first time” any group of experts suggested an indication potentially existed for ablating asymptomatic atrial fibrillation (AF), Hugh Calkins, MD, said at the annual International AF Symposium.

“You might say ‘are you out of your mind recommending ablation for asymptomatic AF?’ ” conceded Dr. Calkins, professor of medicine and director of the arrhythmia service at Johns Hopkins Medicine in Baltimore. But Dr. Calkins quickly added that this was a “soft” recommendation by being in the “may be considered” category, and he also noted that it received broad support from about 90% of the members of the statement’s 60-member writing group (Heart Rhythm. 2017 Oct;14[10]:e445-e494).

In addition, he personally believed that an amber light for this strategy made a lot of sense.

Mitchel L. Zoler/Frontline Medical News

The ideal candidate for this approach would be a relatively young patient, say someone in their 50s, who is identified as having AF incidentally, such as someone with an irregular pulse that’s found during a routine examination that leads to an ECG and definitive identification of AF despite the patient’s complete denial of having symptoms.

The next step, Dr. Calkins suggested, would be to treat the patient with an antiarrhythmic drug, such as amiodarone or flecainide, and with cardioversion and see whether this stops the AF and makes the patient feel better. If the patient reports improvement, it suggests the AF really is symptomatic and management could then proceed as with any case of symptomatic AF. But if the patient perceives no change and the AF then recurs in a persistent presentation despite drug treatment, the cardiologist could then discuss with the patient the pros and cons of an ablative procedure.

The pros for immediate ablation are that, when left unablated, the patient will face a substantially increased lifetime risk for stroke, dementia, and new onset heart failure, and after 2-3 years of continued persistent AF the left atrium would remodel and become much less likely to respond to ablation with little prospect for the patient ever returning to a normal sinus rhythm. “It’s either a rhythm control strategy now, or we’ll leave you in AF for the rest of your life,” Dr. Calkins explained. “If I were 50 years old and had asymptomatic AF, there’s no way I’d want to have AF for the rest of my life.” The risks from ablation are that the procedure has about a 68% success rate and about a 1% rate of complications.

“A patient with asymptomatic paroxysmal AF doesn’t have much to lose by waiting and seeing whether symptoms develop, but for the patient with persistent AF there is a penalty for allowing continuous AF, because after 2-3 years you won’t be able to successfully ablate it. In the past, we left patients with asymptomatic AF that way for the rest of their life, but now we know that if patients remain in AF over time, they will lose the option to have it ablated, and their risk of stroke, dementia, and heart failure will increase.”Dr. Calkins has been a consultant or adviser to or received honoraria from Abbott, AtriCure, Boehringer Ingelheim, Boston Scientific, iRhythm, Medtronic, Pfizer, St. Jude, and Toray, He has also received research funding from Boston Scientific and Medtronic.

[email protected]

This article was updated 2/9/18.

ORLANDO – When the Heart Rhythm Society and several collaborating groups published in October 2017 the first revised consensus statement on atrial fibrillation ablation in 5 years, the document included a novel and perhaps unexpected suggestion: Ablation for asymptomatic atrial fibrillation “may be considered.”

This was “the first time” any group of experts suggested an indication potentially existed for ablating asymptomatic atrial fibrillation (AF), Hugh Calkins, MD, said at the annual International AF Symposium.

“You might say ‘are you out of your mind recommending ablation for asymptomatic AF?’ ” conceded Dr. Calkins, professor of medicine and director of the arrhythmia service at Johns Hopkins Medicine in Baltimore. But Dr. Calkins quickly added that this was a “soft” recommendation by being in the “may be considered” category, and he also noted that it received broad support from about 90% of the members of the statement’s 60-member writing group (Heart Rhythm. 2017 Oct;14[10]:e445-e494).

In addition, he personally believed that an amber light for this strategy made a lot of sense.

Mitchel L. Zoler/Frontline Medical News

The ideal candidate for this approach would be a relatively young patient, say someone in their 50s, who is identified as having AF incidentally, such as someone with an irregular pulse that’s found during a routine examination that leads to an ECG and definitive identification of AF despite the patient’s complete denial of having symptoms.

The next step, Dr. Calkins suggested, would be to treat the patient with an antiarrhythmic drug, such as amiodarone or flecainide, and with cardioversion and see whether this stops the AF and makes the patient feel better. If the patient reports improvement, it suggests the AF really is symptomatic and management could then proceed as with any case of symptomatic AF. But if the patient perceives no change and the AF then recurs in a persistent presentation despite drug treatment, the cardiologist could then discuss with the patient the pros and cons of an ablative procedure.

The pros for immediate ablation are that, when left unablated, the patient will face a substantially increased lifetime risk for stroke, dementia, and new onset heart failure, and after 2-3 years of continued persistent AF the left atrium would remodel and become much less likely to respond to ablation with little prospect for the patient ever returning to a normal sinus rhythm. “It’s either a rhythm control strategy now, or we’ll leave you in AF for the rest of your life,” Dr. Calkins explained. “If I were 50 years old and had asymptomatic AF, there’s no way I’d want to have AF for the rest of my life.” The risks from ablation are that the procedure has about a 68% success rate and about a 1% rate of complications.

“A patient with asymptomatic paroxysmal AF doesn’t have much to lose by waiting and seeing whether symptoms develop, but for the patient with persistent AF there is a penalty for allowing continuous AF, because after 2-3 years you won’t be able to successfully ablate it. In the past, we left patients with asymptomatic AF that way for the rest of their life, but now we know that if patients remain in AF over time, they will lose the option to have it ablated, and their risk of stroke, dementia, and heart failure will increase.”Dr. Calkins has been a consultant or adviser to or received honoraria from Abbott, AtriCure, Boehringer Ingelheim, Boston Scientific, iRhythm, Medtronic, Pfizer, St. Jude, and Toray, He has also received research funding from Boston Scientific and Medtronic.

[email protected]

This article was updated 2/9/18.

Compared with the general population, patients with newly diagnosed symptomatic epilepsy have reduced life expectancy, according to an investigation published in the November 2017 issue of Epilepsia. Patients with newly diagnosed idiopathic or cryptogenic epilepsy, however, have a normal or prolonged life expectancy. The year of diagnosis and the type of epilepsy appear to influence life expectancy.

Previous Estimates Had Weaknesses

Many studies have suggested increased mortality among patients with epilepsy. Two previous investigations have reported the more specific measure of life expectancy in epilepsy, but both had methodologic weaknesses and were prone to substantial bias, said Claudia A. Granbichler, MD, PhD, a neurology resident in Tel-Aviv.

Dr. Granbichler and colleagues examined data for all patients visiting the epilepsy outpatient clinic of Innsbruck Medical University in Austria to calculate their life expectancy. They included 1,112 adults who presented between January 1, 1970, and December 31, 2010, in their analysis. Patient data were recorded and updated continuously over time. Dr. Granbichler and colleagues compared patients’ life expectancies at the year of diagnosis and at five, 10, 15, and 20 years following diagnosis to those of the general population.

The authors classified patients’ epilepsies as symptomatic, idiopathic, or cryptogenic. They defined symptomatic epilepsy as the result of a known or suspected CNS disorder. Epilepsies not preceded by another disorder were considered idiopathic. The authors defined epilepsies of unknown cause as cryptogenic.

Life Expectancy Improved With Time

The difference in life expectancy between patients with epilepsy and the general population depended on the type of epilepsy and the time of diagnosis. Between 1970 and 1980, patients diagnosed with symptomatic epilepsy had a substantially greater reduction in life expectancy (–7.4 years in women and –7.2 years in men) than people diagnosed with idiopathic epilepsy (–5.5 years in women and –5.2 years in men) and people diagnosed with cryptogenic epilepsy (–1.8 years in women and –1.4 years in men).

Regardless of the type of epilepsy, patients diagnosed in subsequent decades had progressively smaller reductions in life expectancy, relative to the general population, or prolonged life expectancy. For all three groups, life expectancy increased with increasing duration of epilepsy.

Participants diagnosed with cryptogenic epilepsy between 2001 and 2010 had increased life expectancy, compared with the general population (2.5 years in women and 3.4 years in men). This increased life expectancy could be explained by lower mortality resulting from decreased engagement in risky activities such as driving motorcycles, skiing, and mountain climbing, said Dr. Granbichler. People with epilepsy also may benefit from more frequent medical follow-ups and laboratory testing.

A potential limitation of the study is that patients had different follow-up durations because of their varying dates of entry and the investigation’s fixed end date. The comparatively short follow-up duration may have introduced positive bias into the estimates of life expectancy for patients diagnosed after 2000, said Dr. Granbichler.

—Erik Greb

Suggested Reading

Granbichler CA, Zimmermann G, Oberaigner W, et al. Potential years lost and life expectancy in adults with newly diagnosed epilepsy. Epilepsia. 2017;58(11):1939-1945.

Compared with the general population, patients with newly diagnosed symptomatic epilepsy have reduced life expectancy, according to an investigation published in the November 2017 issue of Epilepsia. Patients with newly diagnosed idiopathic or cryptogenic epilepsy, however, have a normal or prolonged life expectancy. The year of diagnosis and the type of epilepsy appear to influence life expectancy.

Previous Estimates Had Weaknesses

Many studies have suggested increased mortality among patients with epilepsy. Two previous investigations have reported the more specific measure of life expectancy in epilepsy, but both had methodologic weaknesses and were prone to substantial bias, said Claudia A. Granbichler, MD, PhD, a neurology resident in Tel-Aviv.

Dr. Granbichler and colleagues examined data for all patients visiting the epilepsy outpatient clinic of Innsbruck Medical University in Austria to calculate their life expectancy. They included 1,112 adults who presented between January 1, 1970, and December 31, 2010, in their analysis. Patient data were recorded and updated continuously over time. Dr. Granbichler and colleagues compared patients’ life expectancies at the year of diagnosis and at five, 10, 15, and 20 years following diagnosis to those of the general population.

The authors classified patients’ epilepsies as symptomatic, idiopathic, or cryptogenic. They defined symptomatic epilepsy as the result of a known or suspected CNS disorder. Epilepsies not preceded by another disorder were considered idiopathic. The authors defined epilepsies of unknown cause as cryptogenic.

Life Expectancy Improved With Time

The difference in life expectancy between patients with epilepsy and the general population depended on the type of epilepsy and the time of diagnosis. Between 1970 and 1980, patients diagnosed with symptomatic epilepsy had a substantially greater reduction in life expectancy (–7.4 years in women and –7.2 years in men) than people diagnosed with idiopathic epilepsy (–5.5 years in women and –5.2 years in men) and people diagnosed with cryptogenic epilepsy (–1.8 years in women and –1.4 years in men).

Regardless of the type of epilepsy, patients diagnosed in subsequent decades had progressively smaller reductions in life expectancy, relative to the general population, or prolonged life expectancy. For all three groups, life expectancy increased with increasing duration of epilepsy.

Participants diagnosed with cryptogenic epilepsy between 2001 and 2010 had increased life expectancy, compared with the general population (2.5 years in women and 3.4 years in men). This increased life expectancy could be explained by lower mortality resulting from decreased engagement in risky activities such as driving motorcycles, skiing, and mountain climbing, said Dr. Granbichler. People with epilepsy also may benefit from more frequent medical follow-ups and laboratory testing.

A potential limitation of the study is that patients had different follow-up durations because of their varying dates of entry and the investigation’s fixed end date. The comparatively short follow-up duration may have introduced positive bias into the estimates of life expectancy for patients diagnosed after 2000, said Dr. Granbichler.

—Erik Greb

Suggested Reading

Granbichler CA, Zimmermann G, Oberaigner W, et al. Potential years lost and life expectancy in adults with newly diagnosed epilepsy. Epilepsia. 2017;58(11):1939-1945.

Compared with the general population, patients with newly diagnosed symptomatic epilepsy have reduced life expectancy, according to an investigation published in the November 2017 issue of Epilepsia. Patients with newly diagnosed idiopathic or cryptogenic epilepsy, however, have a normal or prolonged life expectancy. The year of diagnosis and the type of epilepsy appear to influence life expectancy.

Previous Estimates Had Weaknesses

Many studies have suggested increased mortality among patients with epilepsy. Two previous investigations have reported the more specific measure of life expectancy in epilepsy, but both had methodologic weaknesses and were prone to substantial bias, said Claudia A. Granbichler, MD, PhD, a neurology resident in Tel-Aviv.

Dr. Granbichler and colleagues examined data for all patients visiting the epilepsy outpatient clinic of Innsbruck Medical University in Austria to calculate their life expectancy. They included 1,112 adults who presented between January 1, 1970, and December 31, 2010, in their analysis. Patient data were recorded and updated continuously over time. Dr. Granbichler and colleagues compared patients’ life expectancies at the year of diagnosis and at five, 10, 15, and 20 years following diagnosis to those of the general population.

The authors classified patients’ epilepsies as symptomatic, idiopathic, or cryptogenic. They defined symptomatic epilepsy as the result of a known or suspected CNS disorder. Epilepsies not preceded by another disorder were considered idiopathic. The authors defined epilepsies of unknown cause as cryptogenic.

Life Expectancy Improved With Time

The difference in life expectancy between patients with epilepsy and the general population depended on the type of epilepsy and the time of diagnosis. Between 1970 and 1980, patients diagnosed with symptomatic epilepsy had a substantially greater reduction in life expectancy (–7.4 years in women and –7.2 years in men) than people diagnosed with idiopathic epilepsy (–5.5 years in women and –5.2 years in men) and people diagnosed with cryptogenic epilepsy (–1.8 years in women and –1.4 years in men).

Regardless of the type of epilepsy, patients diagnosed in subsequent decades had progressively smaller reductions in life expectancy, relative to the general population, or prolonged life expectancy. For all three groups, life expectancy increased with increasing duration of epilepsy.

Participants diagnosed with cryptogenic epilepsy between 2001 and 2010 had increased life expectancy, compared with the general population (2.5 years in women and 3.4 years in men). This increased life expectancy could be explained by lower mortality resulting from decreased engagement in risky activities such as driving motorcycles, skiing, and mountain climbing, said Dr. Granbichler. People with epilepsy also may benefit from more frequent medical follow-ups and laboratory testing.

A potential limitation of the study is that patients had different follow-up durations because of their varying dates of entry and the investigation’s fixed end date. The comparatively short follow-up duration may have introduced positive bias into the estimates of life expectancy for patients diagnosed after 2000, said Dr. Granbichler.

—Erik Greb

Suggested Reading

Granbichler CA, Zimmermann G, Oberaigner W, et al. Potential years lost and life expectancy in adults with newly diagnosed epilepsy. Epilepsia. 2017;58(11):1939-1945.

Registration is now open for the Vascular Research Initiatives Conference, to be held May 9 at the Hilton San Francisco Union Square. The one-day meeting emphasizes emerging vascular science and is held the day before the American Heart Association's Arteriosclerosis, Thrombosis and Vascular Biology Scientific Sessions.

VRIC registration fees are $275 for members; $300, nonmembers; and $150 for residents, students, candidates and nonmember residents and students.

Registration is now open for the Vascular Research Initiatives Conference, to be held May 9 at the Hilton San Francisco Union Square. The one-day meeting emphasizes emerging vascular science and is held the day before the American Heart Association's Arteriosclerosis, Thrombosis and Vascular Biology Scientific Sessions.

VRIC registration fees are $275 for members; $300, nonmembers; and $150 for residents, students, candidates and nonmember residents and students.

Registration is now open for the Vascular Research Initiatives Conference, to be held May 9 at the Hilton San Francisco Union Square. The one-day meeting emphasizes emerging vascular science and is held the day before the American Heart Association's Arteriosclerosis, Thrombosis and Vascular Biology Scientific Sessions.

VRIC registration fees are $275 for members; $300, nonmembers; and $150 for residents, students, candidates and nonmember residents and students.

To improve access, efficiency and service to existing and future SVS members, the Society is now reviewing and approving membership applications quarterly, instead of yearly. The first deadline for 2018 is March 1.

Learn more at vsweb.org/JoinSVS and apply today.

The SVS is also the management home for the Society for Vascular Nursing. SVN welcomes nurses and nurse practitioners in the vascular setting at many levels and ranges of expertise. For more information, visit svnnet.org.

To improve access, efficiency and service to existing and future SVS members, the Society is now reviewing and approving membership applications quarterly, instead of yearly. The first deadline for 2018 is March 1.

Learn more at vsweb.org/JoinSVS and apply today.

The SVS is also the management home for the Society for Vascular Nursing. SVN welcomes nurses and nurse practitioners in the vascular setting at many levels and ranges of expertise. For more information, visit svnnet.org.

To improve access, efficiency and service to existing and future SVS members, the Society is now reviewing and approving membership applications quarterly, instead of yearly. The first deadline for 2018 is March 1.

Learn more at vsweb.org/JoinSVS and apply today.

The SVS is also the management home for the Society for Vascular Nursing. SVN welcomes nurses and nurse practitioners in the vascular setting at many levels and ranges of expertise. For more information, visit svnnet.org.

SVS members, please encourage medical or pre-med students interested in vascular surgery to apply for scholarships to attend the 2018 Vascular Annual Meeting. Scholarship applications are due by Feb. 1.

The awards are the General Surgery Resident/Medical Student Travel Scholarship and the Diversity Medical Student Travel Scholarship. Recipients become part of the hugely popular scholarship program, designed to let residents and students explore their interest in vascular surgery.

VAM will be held June 20 to 23, 2018, in Boston, with scientific sessions on June 21-23 and exhibits open June 21-22). 

The SVS Foundation seeks applicants for its Student Research Fellowship awards, designed to stimulate laboratory and clinical vascular research by undergraduate college students and medical students attending universities in the United States and Canada. Urge students you know with an interest in research to apply today.

SVS members, please encourage medical or pre-med students interested in vascular surgery to apply for scholarships to attend the 2018 Vascular Annual Meeting. Scholarship applications are due by Feb. 1.

The awards are the General Surgery Resident/Medical Student Travel Scholarship and the Diversity Medical Student Travel Scholarship. Recipients become part of the hugely popular scholarship program, designed to let residents and students explore their interest in vascular surgery.

VAM will be held June 20 to 23, 2018, in Boston, with scientific sessions on June 21-23 and exhibits open June 21-22). 

The SVS Foundation seeks applicants for its Student Research Fellowship awards, designed to stimulate laboratory and clinical vascular research by undergraduate college students and medical students attending universities in the United States and Canada. Urge students you know with an interest in research to apply today.

SVS members, please encourage medical or pre-med students interested in vascular surgery to apply for scholarships to attend the 2018 Vascular Annual Meeting. Scholarship applications are due by Feb. 1.

The awards are the General Surgery Resident/Medical Student Travel Scholarship and the Diversity Medical Student Travel Scholarship. Recipients become part of the hugely popular scholarship program, designed to let residents and students explore their interest in vascular surgery.

VAM will be held June 20 to 23, 2018, in Boston, with scientific sessions on June 21-23 and exhibits open June 21-22). 

The SVS Foundation seeks applicants for its Student Research Fellowship awards, designed to stimulate laboratory and clinical vascular research by undergraduate college students and medical students attending universities in the United States and Canada. Urge students you know with an interest in research to apply today.

More than 17 years ago, I published an article that was largely ignored, predicating that patient benefit from the sentinel node biopsy procedure was unlikely.

I asserted that the lymph nodes are not a reliable filter for melanoma cells, lymphatic drainage is capricious, and many individuals (especially younger ones) have benign neval rests in their lymph nodes that cannot be distinguished from melanoma deposits, since they are both positive for the S100 protein (Int J Dermatol. 2000 Nov;39[11]:807-11). In addition, multiple uncontrolled studies had shown that locating sentinel nodes, followed by a complete lymph node dissection, had no survival benefit. At the time, I argued that sentinel node biopsy should be performed only if the patient was going to be enrolled in a clinical study.

Dr. Coldiron is in private practice but maintains a clinical assistant professorship at the University of Cincinnati. He cares for patients, teaches medical students and residents, and has several active clinical research projects. Dr. Coldiron is the author of more than 80 scientific letters, papers, and several book chapters, and he speaks frequently on a variety of topics. He is a past president of the American Academy of Dermatology. Dr. Coldiron has no financial or other conflicts of interest with Castle Biosciences, the manufacturer of the DecisionDx-Melanoma genetic expression profile test. Email him at [email protected].

More than 17 years ago, I published an article that was largely ignored, predicating that patient benefit from the sentinel node biopsy procedure was unlikely.

I asserted that the lymph nodes are not a reliable filter for melanoma cells, lymphatic drainage is capricious, and many individuals (especially younger ones) have benign neval rests in their lymph nodes that cannot be distinguished from melanoma deposits, since they are both positive for the S100 protein (Int J Dermatol. 2000 Nov;39[11]:807-11). In addition, multiple uncontrolled studies had shown that locating sentinel nodes, followed by a complete lymph node dissection, had no survival benefit. At the time, I argued that sentinel node biopsy should be performed only if the patient was going to be enrolled in a clinical study.

Dr. Coldiron is in private practice but maintains a clinical assistant professorship at the University of Cincinnati. He cares for patients, teaches medical students and residents, and has several active clinical research projects. Dr. Coldiron is the author of more than 80 scientific letters, papers, and several book chapters, and he speaks frequently on a variety of topics. He is a past president of the American Academy of Dermatology. Dr. Coldiron has no financial or other conflicts of interest with Castle Biosciences, the manufacturer of the DecisionDx-Melanoma genetic expression profile test. Email him at [email protected].

More than 17 years ago, I published an article that was largely ignored, predicating that patient benefit from the sentinel node biopsy procedure was unlikely.

I asserted that the lymph nodes are not a reliable filter for melanoma cells, lymphatic drainage is capricious, and many individuals (especially younger ones) have benign neval rests in their lymph nodes that cannot be distinguished from melanoma deposits, since they are both positive for the S100 protein (Int J Dermatol. 2000 Nov;39[11]:807-11). In addition, multiple uncontrolled studies had shown that locating sentinel nodes, followed by a complete lymph node dissection, had no survival benefit. At the time, I argued that sentinel node biopsy should be performed only if the patient was going to be enrolled in a clinical study.

Dr. Coldiron is in private practice but maintains a clinical assistant professorship at the University of Cincinnati. He cares for patients, teaches medical students and residents, and has several active clinical research projects. Dr. Coldiron is the author of more than 80 scientific letters, papers, and several book chapters, and he speaks frequently on a variety of topics. He is a past president of the American Academy of Dermatology. Dr. Coldiron has no financial or other conflicts of interest with Castle Biosciences, the manufacturer of the DecisionDx-Melanoma genetic expression profile test. Email him at [email protected].