News Release 

A diet rich in fruits and vegetables may protect heart health

American College of Physicians

Below please find summaries of new articles that will be published in the next issue of Annals of Internal Medicine. The summaries are not intended to substitute for the full articles as a source of information. This information is under strict embargo and by taking it into possession, media representatives are committing to the terms of the embargo not only on their own behalf, but also on behalf of the organization they represent.

1. A diet rich in fruits and vegetables may protect heart health

Abstract: http://annals.org/aim/article/doi/10.7326/M20-0336

Editorial: http://annals.org/aim/article/doi/10.7326/M20-2504

URL goes live when the embargo lifts

A diet rich in fruits and vegetables given over a relatively short period of time was associated with significantly lower levels of markers for subclinical cardiac damage and strain in adults without preexisting cardiovascular disease (CVD). Findings from an observational analysis of the DASH trial are published in Annals of Internal Medicine.

Observational studies show that a healthy diet is linked to a reduced risk for CVD events, leading many to advocate for stronger public policy to promote healthy food choices. Critics, however, point to a dearth of evidence to support the hypothesis that adopting a healthy diet directly reduces CVD injury or is effective for the primary prevention of CVD.

Researchers from Beth Israel Deaconess Medical Center studied data and stored serum specimens for 326 participants of the original DASH trial to compare the effects of diets rich in fruits and vegetables with a typical American diet in their effects on cardiac damage, cardiac strain, and inflammation in middle-aged adults without known preexisting CVD. They found that after 8 weeks, participants in both the fruits and vegetables and the DASH diet groups had significantly lower concentrations of the biomarkers for subclinical cardiac damage and strain compared with control group. These associations did not differ between the DASH and fruit and vegetable diets, and none of the diets affected hs- CRP, a marker of inflammation. The authors hypothesize that dietary factors common to both the DASH and fruit-and-vegetable diets, such as higher amounts of potassium, magnesium, and fiber, may partly explain the observed effects. These findings strengthen recommendations for the DASH diet, or increased consumption of fruits and vegetables as a means of optimizing cardiovascular health.

Media contacts: For an embargoed PDF please contact Lauren Evans at laevans@acponline.org. To speak with the lead author, Stephen P. Juraschek, MD, PhD, please contact Lindsey Diaz-MacInnis at ldiaz2@bidmc.harvard.edu.

2. Direct oral anticoagulants associated with lower risk of fracture compared with warfarin for patients with atrial fibrillation

Abstract: http://annals.org/aim/article/doi/10.7326/M19-3671

URL goes live when the embargo lifts

Direct oral anticoagulants (DOAC) are associated with lower risk of osteoporotic fracture compared with warfarin for patients with atrial fibrillation (AF). No difference was found between DOACs for greater fracture reduction. Findings from a population-based cohort study are published in Annals of Internal Medicine.

Osteoporotic fracture is a known serious complication of anticoagulants among patients with AF. It is unclear whether anticoagulant type is associated with degree of risk.

Researchers from the University of Hong Kong and University College London Strategic Partnership Fund studied an electronic health record database for patients newly diagnosed with AF between 2010 and 2017 who received a new prescription for warfarin or a direct oral anticoagulant (DOAC) (apixaban, dabigatran, or rivaroxaban) to compare risk for osteoporotic fracture between anticoagulants. After 24-month follow-up, the data showed that DOAC use was associated with a lower risk for fracture than warfarin use. No differences were seen in all head-to-head comparisons between DOACs at 24 months. According to the authors, these findings may help inform the benefit-risk assessment when choosing between anticoagulants

Media contacts: For an embargoed PDF please contact Lauren Evans at laevans@acponline.org. To speak with the lead author, Wallis C.Y. Lau, PhD, please contact her at wallis.lau@ucl.ac.uk. To speak with the senior author, Ian C.K. Wong, PhD, please contact him at wongick@hku.hk.

3. CMS quality measures for home-based care largely unusable for clinicians caring for homebound seniors

Abstract: http://annals.org/aim/article/doi/10.7326/M20-0235

URL goes live when the embargo lifts

One half of the Centers for Medicare and Medicaid Services (CMS) Merit-Based Incentive Payment System (MIPS) quality measures potentially appropriate for the care of homebound older adults receiving home-based medical care are unusable because they lack appropriate denominator codes. The lack of useable CMS-specified MIPS quality measures severely limits the utility of value-based care. A brief research report is published in Annals of Internal Medicine.

Homebound older adults are a high-need, high-cost population and home-based primary care has been shown to provide high-quality care, while saving money for Medicare. This type of value-based care, as implemented through the CMS MIPS, requires physicians to meet CMS-specified quality measures.

Researchers from Johns Hopkins University School of Medicine and Harvard Medical School reviewed all the 2019 CMS-specified quality measures for the MIPS program to determine the proportion of quality measures that were potentially appropriate for patients receiving home-based medical care and that included denominator codes for such care. Of the measures potentially useable by clinicians caring for homebound older adults, only half of them could actually be used because the CMS-specified measures didn't include home visit codes in the measure specifications. According to the researchers, these findings suggest that homebound patients remain an invisible population to key stakeholders, including quality measure developers and CMS. They say this is unfortunate because strong evidence exists that improving care for frail older adults, particularly those who are homebound, can reduce preventable health care costs.

Media contacts: For an embargoed PDF please contact Lauren Evans at laevans@acponline.org. To speak with the lead author, Bruce Leff, MD, please contact Waun'Shae Blount at wblount1@jhmi.edu.

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