1. Poor sense of smell associated with nearly 50 percent higher risk for death in 10 years
Dementia, Parkinson disease, and weight loss are possible drivers, but about 70 percent of the higher mortality not explained
Abstract: http://annals.org/aim/article/doi/10.7326/M18-0775
Editorial: http://annals.org/aim/article/doi/10.7326/M19-1013
Free Summary for Patients: http://annals.org/aim/article/doi/10.7326/P19-0005
URLs go live when the embargo lifts
Poor sense of smell may be an early warning for poor health in older age that goes beyond neurodegenerative diseases. In fact, dementia or Parkinson disease explained only 22 percent of the higher death risk and weight loss 6 percent, leaving more than 70 percent of the higher mortality associated with poor sense of smell unexplained. Findings from a prospective cohort study are published in Annals of Internal Medicine.
Many studies with 5 years or less of follow up have shown an independent association between olfactory impairment and increased all-cause mortality among older adults. However, these studies did not examine whether there are differences by race or sex or the factors that might explain the relationship.
Researchers from Michigan State University studied more than 2,000 adults aged 71 to 82 years to determine the relationship between poor sense of smell and mortality and to investigate potential explanations for the connection. Participants completed a Brief Smell Identification Test (BSIT) of 12 common odors and were asked to identify each odor from 1 of 4 options. Each correct response was given a point. Using the BSIT scores, the researchers classified the participants as having good, moderate, or poor sense of smell. The researchers found that poor olfaction was associated with 46 percent higher mortality at year 10 and 30 percent higher mortality at year 13 compared with good olfaction. The association was robust and could not be explained by measured confounders, such as demographic characteristics, lifestyle, and comorbid conditions. Furthermore, the association was present in both men and women and in both black and white participants, suggesting broad generalizability. The association, however, was largely limited to participants who reported good-to-excellent health at study baseline, suggesting poor sense of smell may be an early and sensitive marker for unrecognized deteriorating health among older adults.
The authors of an accompanying editorial from Johns Hopkins University School of Medicine note that many older adults are unaware that their sense of smell is declining and they are rarely screened for poor olfaction in clinical practice. The authors hope that this study will inform whether and how assessment of smell should be incorporated into routine exams for older adults.
Media contact: For an embargoed PDF, please contact Lauren Evans at laevans@acponline.org. To speak with the lead author, Honglei Chen, MD, PhD [hchen@epi.msu.edu], please contact Sarina Gleason at Sarina.Gleason@cabs.msu.edu.
2. Patients give high rating to convenience and quality of primary care video visits
Abstract: http://annals.org/aim/article/doi/10.7326/M18-3081
URLs go live when the embargo lifts
A survey of patients participating in primary care video visits found that patients gave the encounters high marks for convenience and quality of care. Such visits have the potential to improve patient access to care. Findings from a brief research report are published in Annals of Internal Medicine.
Real-time patient-provider video visits have the potential to engage patients by allowing them to access a clinical encounter without arranging transportation, taking time off from work, or spending time in a waiting room. Although millions of U.S. patients have used direct-to-consumer telemedicine services, evidence is limited from large-scale implementation that is integrated with ongoing health care delivery and providers in community primary care.
Researchers from Kaiser Permanente Division of Research surveyed 1,274 adults who had a scheduled video visit with a primary care provider in September through December 2015 to assess their in-person visit barriers, technology access and experience, visit experience, and sociodemographic characteristics. The participants scheduled primary care video visits with their own physicians (whom they also could see in-person) and reported that they valued the convenience and quality of the video visits and that they strengthened their patient-provider relationship. Patients who had to take time off from work or other responsibilities for an in-person visit reported more often that the video visit reduced their in-person visits. According to the researchers, video telemedicine may be a transformative tool in increasing patient-centered access to health care.
Media contact: For an embargoed PDF, please contact Lauren Evans at laevans@acponline.org. To interview the lead author, Mary E. Reed, DrPH, please contact Janet Byron at Janet.L.Byron@kp.org or Heather Platisha at Hplatisha@webershandwick.com.
3. Physicians should be prepared for questions and concerns related to DTC genetic test results
Abstract: http://annals.org/aim/article/doi/10.7326/M18-2356
URLs go live when the embargo lifts
Consumers looking to make critical decisions, such as family planning, based on the results of direct-to-consumer (DTC) genetic testing may need guidance to determine what actions to take, or not take, based on their results. A DTC genetic test case scenario designed to educate physicians for this increasingly likely occurrence is published in Annals of Internal Medicine.
Direct-to-consumer (DTC) genetic testing is becoming increasingly popular, and clinicians should be prepared to provide guidance to their patients when presented with results from these tests. To do so, physicians need to be able to communicate to patients about what the results of these tests mean, and what they do not mean.
Authors from Columbia University presented a case scenario of a couple using 23andMe to test for specific disease risks before starting a family. According to the authors, these patients need to be careful about how they interpret their results. DTC tests can provide genetic information to a much broader audience than might otherwise be reached because of difficulties assessing clinical genetic testing, but they are not diagnostic and offer information on a limited number of genes and diseases. In addition, their findings may have limited value and sensitivity for patients who are not of European or Ashkenazi Jewish descent. The authors note that the positive predictive value of many 23andMe genetic tests is limited because risk is often modified by interacting genes, environment, lifestyle, and family history, which are not included in the risk predictions. Patients need to be aware of these limitations and should be referred to a genetic counselor or another qualified provider who can take their individual characteristics into consideration within the context of their findings.
Media contact: For an embargoed PDF, please contact Lauren Evans at laevans@acponline.org. To interview the lead author, Wendy K. Chung, MD, PhD, please contact Lucky Tran at lt2549@cumc.columbia.edu.
4. Mavacamten shows promise for treating patients with obstructive hypertrophic cardiomyopathy
Abstract: http://annals.org/aim/article/doi/10.7326/M18-3016
URLs go live when the embargo lifts
Data from Phase 2 of the PIONEER-HCM study shows that mavacamten may reduce left ventricular outflow tract gradient and improve exercise capacity and symptoms in patients with obstructive hypertrophic cardiomyopathy. Findings from an open-label, nonrandomized, phase 2 trial are published in Annals of Internal Medicine.
Mavacamten, an orally administered small-molecule modulator of cardiac myosin, targets underlying biomechanical abnormalities in obstructive hypertrophic cardiomyopathy. Earlier phase 1 studies of healthy volunteers and patients with obstructive hypertrophic cardiomyopathy showed a favorable safety profile and informed dose selection in phase 2.
Researchers from Oregon Health & Science University and four other academic centers (Duke University Medical Center, Yale New Haven Hospital, Mayo Clinic, and the Hospital of the University of Pennsylvania) studied 21 symptomatic patients with obstructive hypertrophic cardiomyopathy to characterize the effect of mavacamten on left ventricular outflow tract gradient. They found that after 12 weeks of treatment, mavacamten reduced mean postexercise left ventricular outflow tract gradient from 103 mm Hg at baseline to 19 mm Hg with an associated improvement in exercise capacity and symptoms. The resting left ventricular ejecting fraction was also intentionally reduced. The most common adverse events related to treatment were decreased left ventricular ejection fraction at higher plasma concentrations and atrial fibrillation. If confirmed in larger studies, these data suggest a potential role for mavacamten in treatment of obstructive hypertrophic cardiomyopathy.
Media contact: For an embargoed PDF, please contact Lauren Evans at laevans@acponline.org. To speak with the lead author, Stephen B. Heitner, MD, please contact Kate Natoli at gellerk@ohsu.edu.
Also New in this issue:
The Chylomicronemia Syndrome Is Most Often Multifactorial: A Narrative Review of Causes and Treatment
Alan Chait, MD, and Robert H. Eckel, MD
Review
Abstract: http://annals.org/aim/article/doi/10.7326/M19-0203
Precision Medicine in Internal Medicine
Krzysztof Kiryluk, MD, MS; David B. Goldstein, PhD; John W. Rowe, MD; Ali G. Gharavi, MD; Ronald Wapner, MD; and Wendy K. Chung, MD, PhD
Precision Medicine
Abstract: http://annals.org/aim/article/doi/10.7326/M18-0425
Editorial: http://annals.org/aim/article/doi/10.7326/M19-1034
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Journal
Annals of Internal Medicine