Public Release: 

Tip sheet from Annals of Internal Medicine, March 10, 2015

American College of Physicians

1. 'Appropriate use' criteria for diagnostic catheterization may not be reliable for guiding clinical decisions

Criteria developed to validate use of diagnostic cardiac catheterization may not be helpful for guiding clinical practice, according to an article being published in Annals of Internal Medicine. Appropriate use criteria were designed to encourage more rational consumption of health care resources. A procedure is deemed appropriate if its anticipated benefits outweigh its harms. In the field of cardiovascular disease, dramatically increasing health care costs have threatened sustainability. Diagnostic cardiac catheterization is an example of a procedure with substantial geographic variability and for which there have been questions of overuse. Researchers applied the appropriate use criteria that were established in 2012 for cardiac catheterization to a cohort of 48,336 patients without a history of coronary artery disease (CAD) to address the validity of the criteria and identify knowledge gaps. Patients were given an appropriateness score of appropriate, inappropriate, or uncertain based on data collected at the time of the index angiography. The study found that obstructive CAD is more likely to be diagnosed when the invasive angiography is rated as appropriate. However, a substantial portion of patients with inappropriate or uncertain scores also had CAD, which shows the need for future studies to be done to evaluate the appropriateness criteria. The author of an editorial says that the study highlights some of the challenges and opportunities of applying the appropriate use criteria to large data sets.

Note: The URL will be live when the embargo lifts. For an embargoed PDF, please contact Megan Hanks. For an interview, please contact Marie Sanderson at marie.sanderson@sunnybrook.ca or 416-480-4040.


2. Vaccine refusal will likely lead to more measles outbreaks

More measles outbreaks will undoubtedly occur because vaccine refusal has left enough individuals susceptible, according to a commentary being published in Annals of Internal Medicine. The recent Disneyland-associated measles outbreak captured public attention because vulnerable populations contracted the disease. The relative absence of measles in most areas of the United States for many years has led to an under appreciation of measles-related complications and mortality, and unfounded fears about the association between vaccines and autism have contributed to vaccine hesitancy and the resurgence of measles. Author, Neal Halsey, MD, of Johns Hopkins Bloomberg School of Public Health writes that parents should be able to take all children to Disneyland and all public places without fear of measles exposure. Ramped up efforts must focus on making sure all eligible U.S. children are vaccinated and greater collaboration to increase vaccination internationally should also be pursued. Following the framework recommended by the Institute of Medicine, constant surveillance and additional studies of vaccine safety to address public concerns should be a priority. Adult primary care clinicians can assist their pediatric colleagues in boosting community protection by routinely reviewing immunization records as they see patients who are transitioning from pediatric care, among other safety measures. Physicians may also need to become familiar with clinical presentation of measles since most practicing clinicians in 2015 will never have seen an actual case.

Note: The URL will be live when the embargo lifts. For an embargoed PDF or author contact information, please contact Megan Hanks.

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