Public Release: 

Annals of Internal Medicine tip sheet for Nov. 2, 2004

American College of Physicians

Annals of Internal Medicine is published by the American College of Physicians, an organization of 116,000 internal medicine physicians and medical students. These highlights are not intended to substitute for articles as sources of information. For an embargoed copy of an article, call 1-800-523-1546, ext. 2656, or 215-351-2656. Leave fax or e-mail and article topics.

1. Treating Atrial Fibrillation: Control Heart Rate or Heart Rhythm?

A study of two common therapies for atrial fibrillation found that using drugs to slow heart rate (rate control) was more cost-effective than using drugs to restore normal heart rhythm (rhythm control) (Article, p. 653). The researchers used data from a major trial of treatment for atrial fibrillation to calculate the cost-effectiveness of rate and rhythm control. Rate control was more cost-effective.

In an accompanying article, other writers note that the major studies of atrial fibrillation have not included significant numbers of the people who are most likely to benefit from controlling heart rhythm with anti-arrhythmic drugs (Perspective, p. 720). They discuss the drugs and typical patient profiles.

Finally, editorial writers comment that although heart rate control is safe, less costly and is the preferred first treatment option for atrial fibrillation, rhythm control is still appropriate for some people. They note that new therapies, such as catheter ablation, are emerging as effective non-drug therapy (Editorial, p. 727).

2. New Study Says U.S. Will Need 200,000 More Doctors by 2020

Using a model based on long-term economic and demographic trends, a writer says that the United States now faces a shortage of physicians and will need 200,000 more physicians by 2020. (Medicine and Public Issues, p.705).

"In simple numeric terms, the number of physicians is no longer keeping up with population growth." The current situation has been disguised by growth in the number of nonphysician clinicians, international medical graduates and osteopathic physicians.

Editorial writers say the future need for physicians is very unpredictable and will be affected by many trends: older people who may be healthier than their ancestors and so need fewer services, new technologies that can prevent subsequent illness and disability, trends toward higher health insurance deductibles that will cause patients to be more concerned about price when deciding to seek care.

They also say that the "plausible but unproven link" between physician supply and the volume of medical care could mean that more doctors will generate more medical services and therefore higher health expenditures.

For all these reasons, the editorial writers say, "even when we have done our homework, increasing the supply of physicians gradually, in small increments -- ones that would not require major new investments in capital or teaching personnel -- is a prudent strategy."

3. Screen High Risk Adults for HCV Infection? Yes! No, No Evidence. 2 Views (In the Balance, p. 715)

4. Meta-analysis: ARBs Suitable Alternative to ACE Inhibitors for Heart Illnesses (Review, p. 693.)

5. In-Depth Study of SARS Outbreak in Hong Kong in 2003 Finds Patterns (Article, p. 662.)


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