HEART ARTICLES

JAMA 16 Sep 2009 Vol 302
1195 Another study from the indefatigable American Heart Association team looks at cardiopulmonary resuscitation outcomes in the USA. (Some readers will realise that when I use the word indefatigable it’s a sort of code name for Harlan Krumholz). If you are black, your chances of making it out of the hospital door alive are about 20% worse than for whites, and most of this is explained by the performance of the hospitals you are likely to get admitted to. Don’t socialize American medicine! Praise the Lord and shoot the moose.
http://jama.ama-assn.org/cgi/content/abstract/302/11/1195

BMJ 26 Sep 2009 Vol 339
735 A lot of women get pregnant while taking serotonin reuptake inhibitors for depression, and many of them continue taking them. This will probably remain the case following this comprehensive cohort study from Denmark, covering nearly half a million births from 1996 to 2003, even though it shows an overall doubling of septal heart defects in babies born to women taking SSRIs. The highest risk seems to come from sertraline and the lowest from fluoxetine. There is no additional risk of other major congenital malformations. It is unclear whether discontinuing these drugs after conception will make much difference.
http://www.bmj.com/cgi/content/full/339/sep23_1/b3569

736 Now for the thigh circumference paper which caused much furrowing of brows when it first appeared on the BMJ website. Denmark is famous for its hams but if these diminish below a certain size in humans of both sexes, then the risk of heart disease and premature death goes up steeply, irrespective of other biometrics. Odd. Strange. Queer. Puzzling. Your guess is as good as mine.http://www.bmj.com/cgi/content/full/339/sep03_2/b3292

Arch Intern Med 14 Sep 2009 Vol 169
1484 If you are going to use thrombolysis for occlusive stroke, the sooner you do it the better: if this sounds obvious now, consider how unobvious it sounded ten years ago, or even five to most people in the street. The number needed to treat is still very high, and if this German cluster-randomised trial of a public awareness campaign had used a hard end-point, like overall reduction of disability or death from stroke, it would have had a zero result. Instead, it yielded a 27% increase in women with stroke reaching hospital within three hours. I think that we can conclude that personal letters with bookmarks and stickers are not a cost-effective basis for a stroke awareness campaign.
http://archinte.ama-assn.org/cgi/content/abstract/169/16/1484

1491 We move now to Adelaide, a city of free Australian settlers named after Her Serene Highness Princess Adelaide of Saxe-Meiningen. “She is doomed, poor dear innocent young creature, to be my wife”, wrote the vast libidinous Prince George, heir to the British throne, in 1818. In fact they were improbably happy together, living with a selection of the prince’s illegitimate children in Hanover, though all Adelaide’s pregnancies miscarried or the babies died early. So it came about that this five-syllable German girl’s name became a three syllable south Australian place name, scene of the CADENCE study looking at the prevalence of weekly angina among patients in primary care. Chronic stable angina is something we tend to consign to repeat prescribing and once a year nurse checks, but one in three of these patients gets an attack at least once a week, and there is probably room for better audit and control. After all, we do not want these patients to get cremated, as Beethoven implies his heart will be in the final cadence of Adelaide:Eine Blume der Asche meines HerzensDeutlich schimmert auf jedem Purpurblättchen:Adelaïde!
http://archinte.ama-assn.org/cgi/content/abstract/169/16/1491

1500 If I had advanced heart failure, I would want to keep open the exit of sudden arrhythmic death, knowing what the other exit is like. But plenty of HF patients, especially in the USA, have been expensively fitted with implantable cardioverter-defibrillators to prevent such an outcome. This meta-analysis shows that they do not in fact reduce all-cause mortality in women with advanced HF. The shocking truth.
http://archinte.ama-assn.org/cgi/content/abstract/169/16/1500