Public Release: 

Cognitive decline may be uncommon after heart procedures

American College of Physicians

1. Evidence questions link between heart procedures and cognitive decline
Free abstract: http://www.annals.org/article.aspx?doi=10.7326/M14-2793
URLs go live when embargo lifts

A systematic evidence review published in Annals of Internal Medicine suggests that cognitive decline following regularly performed invasive heart procedures may be uncommon in older adults. However, researchers stress that evidence was limited and individual study quality was low.

Coronary and carotid revascularization, cardiac valve procedures, and catheter ablation for atrial fibrillation are commonly performed heart procedures that have been linked to an increased risk for cognitive impairment. Researchers reviewed 17 randomized controlled trials and four cohort studies to evaluate intermediate and long-term cognitive outcomes following the procedures for patients 65 years and older. Evidence was further examined to determine if the associations were modified by procedural and patient characteristics and by procedure-related stroke or transient ischemic attack.

Of the few eligible studies identified, little to no difference in cognitive outcomes between or with treatment groups were found. According to the authors, these results may be somewhat reassuring to patients. Physicians should advise patients preparing to undergo one of these heart procedures that while there is some uncertainty about the estimates, current data suggest cognitive risk may be small.

Notes: For an embargoed PDF, please contact Angela Collom or Cara Graeff. To speak with the lead author, Dr. Howard Fink, please contact Ralph Heussner at ralph.heussner@va.gov or 612-467-3012.


2. Antibiotics overprescribed in the VA health system
Free abstract: http://www.annals.org/article.aspx?doi=10.7326/M14-1933
URLs go live when the embargo lifts

Antibiotic prescribing for acute respiratory infections (ARI) increased over an 8-year period in the Veterans Affairs (VA) health system, despite efforts to reduce their use. Results of this retrospective, cross-sectional study are published in Annals of Internal Medicine.

Unnecessary antibiotic use contributes to the emergence of antibiotic-resistant pathogens, a major public health concern. Clinical practice guidelines discourage prescribing antibiotics for ARIs because their benefits are limited. However, recent studies have demonstrated a dramatic increase in the use of broad-spectrum antibiotics for ARIs, particularly macrolides. Tracking national practice patterns and identifying sources of variation in antibiotic use could inform and improve intervention efforts.

Researchers reviewed health records for VA outpatient facilities to measure national trends in antibiotic prescribing for ARIs during an 8-year period. They found that clinical presentation, type of provider, and type of clinical setting did not influence antibiotic prescribing for ARIs. Prescribing varied widely at the individual provider level, but overall prescription of antibiotics, including macrolides, increased during the study period. According to the researchers, these findings are important because they may influence the development of provider-targeted decision support tools that can help clinicians make better prescribing decisions.

Notes: For an embargoed PDF, please contact Angela Collom or Cara Graeff. To reach the lead author, Dr. Barbara Jones, please contact Julie Kiefer at jkiefer@neuro.utah.edu or 801-587-1293.

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