Abstract:
Background:Stroke rates in patients with nonvalvular atrial fibrillation (AF) who are not receiving anticoagulant therapy vary widely across published studies; the resulting effect on the net clinical benefit of anticoagulation in AF is unknown. Objective:To determine the effect of variation in published AF stroke rates on the net clinical benefit of anticoagulation. Design:Markov model decision analysis. Warfarin was the base case, and non-vitamin K antagonist oral anticoagulants (NOACs) were modeled in a secondary analysis. Setting:Community-dwelling adults. Patients:33 434 adults with incident AF. Measurements:Quality-adjusted life-years (QALYs). Results:Of the 33 434 patients, 27 179 had a CHA2DS2-VASc (congestive heart failure, hypertension, age, diabetes, stroke, and vascular disease) score of 2 or more. The population benefit of warfarin anticoagulation for these patients was least using stroke rates from the ATRIA (AnTicoagulation and Risk Factors In Atrial Fibrillation) study and greatest using those from the Danish National Patient Registry (6290 QALYs [95% CI, ±2.3%] vs. 24 110 QALYs [CI, ±1.9%]; P < 0.001). The optimal CHA2DS2-VASc score threshold for anticoagulation was 3 or more using stroke rates from ATRIA, 2 or more using those from the Swedish AF cohort study, 1 or more using those from the SPORTIF (Stroke Prevention using ORal Thrombin Inhibitor in atrial Fibrillation) study, and 0 or more using those from the Danish National Patient Registry. Accounting for lower rates of NOAC-associated intracranial hemorrhage decreased optimal CHA2DS2-VASc score thresholds, but these thresholds still varied widely. Limitation:Measured benefit may not generalize to other populations. Conclusion:Variation in published AF stroke rates for patients not receiving anticoagulant therapy results in multifold variation in the net clinical benefit of anticoagulation. Guidelines should better reflect the uncertainty in current thresholds of stroke risk score for recommending anticoagulation. Primary Funding Source:None.
journal_name
Ann Intern Medjournal_title
Annals of internal medicineauthors
Shah SJ,Eckman MH,Aspberg S,Go AS,Singer DEdoi
10.7326/M17-2762subject
Has Abstractpub_date
2018-10-16 00:00:00pages
517-527issue
8eissn
0003-4819issn
1539-3704pii
2703439journal_volume
169pub_type
杂志文章abstract:BACKGROUND:The risk for and determinants of transmission of tuberculosis in hospitals caring for moderate numbers of patients with tuberculosis remain uncertain. OBJECTIVE:To study the association of tuberculin conversion among health care workers with ventilation of patient care areas. DESIGN:Cross-sectional observa...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-133-10-200011210-00010
更新日期:2000-11-21 00:00:00
abstract::Glomerular-fixed antibody was eluted from the kidney of a 17-year-old patient who died 2 weeks after the onset of acute poststreptococcal glomerulonephritis. Elevated titers of antibodies to streptococcal enzymes were found in the serum but not in the glomerular eluate. Streptococcal M protein and anti-M protein react...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-92-4-478
更新日期:1980-04-01 00:00:00
abstract::We compared the efficacy of orally administered ampicillin, 2 g/d, with that of trimethoprim-sulfamethoxazole, 320 mg/d-1600 mg/d, given for 2 or 6 weeks for outpatient management of acute uncomplicated renal infection in women. Of 98 women participating in the trial, 60 had renal infections with susceptible strains, ...
journal_title:Annals of internal medicine
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.7326/0003-4819-106-3-341
更新日期:1987-03-01 00:00:00
abstract::Two cases of patients having calcification within the sella turcica (pituitary stones) have been studied and followed up, one patient for 18 years. A detailed analysis of the radiographic findings and endocrinologic profiles of these two patients is presented. The rarity of bona fide pituitary stones and their benign ...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-83-1-66
更新日期:1975-07-01 00:00:00
abstract::A 34-year-old man had polar extremes of B cell dysfunction: systemic lupus erythematosus evolving into common variable hypogammaglobulinemia. He presented in 1974 with seizures and six other criteria for systemic lupus erythematosus; his antinuclear antibody titer was 1:1024 and IgG level, 2870 mg/dL. After 5 months o...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-99-1-32
更新日期:1983-07-01 00:00:00
abstract::We evaluated the usefulness of computed tomography (CT) brain scanning in alcoholic patients with withdrawal seizures (n = 151) and other neurologic problems (n = 87) and compared the findings of a detailed neurologic examination to the results of CT scanning. In patients with seizures, nearly 50% of CT scans were nor...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-94-4-519
更新日期:1981-04-01 00:00:00
abstract::The observations that have provided the foundation of the sodium hypothesis of human hypertension are reviewed. Clinical observations made over 125 years ago initiated an investigative effort that has encompassed epidemiologic data, development of salt-related experimental models, and elucidation of theoretical mechan...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-98-5-720
更新日期:1983-05-01 00:00:00
abstract:BACKGROUND:Despite advances in prevention and treatment, sexually transmitted infections (STIs) remain an important cause of morbidity and mortality in the United States. PURPOSE:To systematically review the evidence for behavioral counseling interventions to prevent STIs in adolescents and adults (nonpregnant and pre...
journal_title:Annals of internal medicine
pub_type: 杂志文章,评审
doi:10.7326/0003-4819-149-7-200810070-00011
更新日期:2008-10-07 00:00:00
abstract::Two patients with chronic liver disease developed elevated serum aluminum concentrations and biopsy-proven osteodystrophy. Neither patient had chronic renal failure but both had received aluminum-containing antacids for long periods. We measured biliary and urinary aluminum excretion during antacid loading in patients...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-104-6-782
更新日期:1986-06-01 00:00:00
abstract:BACKGROUND:Short-term aspirin therapy can lower the risk for venous thromboembolism (VTE) in high-risk patients, but whether the long-term use of low-dose aspirin reduces risk in healthy adults is uncertain. OBJECTIVE:To test the efficacy of long-term aspirin therapy for preventing VTE. DESIGN:Secondary analysis of a...
journal_title:Annals of internal medicine
pub_type: 杂志文章,随机对照试验
doi:10.7326/0003-4819-147-8-200710160-00004
更新日期:2007-10-16 00:00:00
abstract::Antinuclear antibodies are present in most patients receiving procainamide. To ascertain whether IgG antiguanosine antibodies are associated with the development of the symptoms of systemic lupus erythematosus, we compared the levels of these antibodies in the sera of 65 patients receiving procainamide: 18 with procai...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-104-3-310
更新日期:1986-03-01 00:00:00
abstract:BACKGROUND:Because clinical diagnosis is inaccurate, objective testing is usually considered necessary when patients present with suspected deep venous thrombosis (DVT). OBJECTIVE:To determine whether a negative result on a quantitative latex D dimer assay eliminates the need for further investigation in patients with...
journal_title:Annals of internal medicine
pub_type: 杂志文章,多中心研究
doi:10.7326/0003-4819-138-10-200305200-00006
更新日期:2003-05-20 00:00:00
abstract:OBJECTIVE:To determine whether the use of non-potassium-sparing diuretics and beta-blockers is associated with an excess risk for sudden cardiac death in hypertensive patients. DESIGN:Case-control study. SETTING:Rotterdam, the Netherlands. PATIENTS:257 case-patients who had died suddenly while receiving drug therapy...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-123-7-199510010-00001
更新日期:1995-10-01 00:00:00
abstract:OBJECTIVE:To determine the most effective and safe dose of enoxaparin to prevent deep venous thrombosis in high-risk surgical patients. DESIGN:A double-blind, randomized, multicenter clinical trial. SETTING:Private, university, and government hospitals in the United States. PATIENTS:572 patients having elective hip ...
journal_title:Annals of internal medicine
pub_type: 临床试验,杂志文章,多中心研究,随机对照试验
doi:10.7326/0003-4819-121-2-199407150-00001
更新日期:1994-07-15 00:00:00
abstract:BACKGROUND:Electrical cardioversion in patients with atrial fibrillation is associated with an increased risk for embolic stroke. Screening for atrial thrombi with transesophageal echocardiography (TEE) before cardioversion should, in many patients, safely permit cardioversion to be done earlier than would be possible ...
journal_title:Annals of internal medicine
pub_type: 临床试验,杂志文章,多中心研究,随机对照试验
doi:10.7326/0003-4819-126-3-199702010-00004
更新日期:1997-02-01 00:00:00
abstract:BACKGROUND:Retail clinics are an increasingly popular source for medical care. Concerns have been raised about the effect of these clinics on the cost, quality, and delivery of preventive care. OBJECTIVE:To compare the care received at retail clinics for 3 acute conditions with that received at other care settings. D...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-151-5-200909010-00006
更新日期:2009-09-01 00:00:00
abstract:DESCRIPTION:Although approximately 85 million units of red blood cells (RBCs) are transfused annually worldwide, transfusion practices vary widely. The AABB (formerly, the American Association of Blood Banks) developed this guideline to provide clinical recommendations about hemoglobin concentration thresholds and othe...
journal_title:Annals of internal medicine
pub_type: 杂志文章,实务指引,评审
doi:10.7326/0003-4819-157-1-201206190-00429
更新日期:2012-07-03 00:00:00
abstract:PURPOSE:To review current management of intractable constipation. DATA SOURCES:Original articles and reviews published in the English-language literature between 1965 and 1993 identified by MEDLINE search. Verbal feedback from attendees after presentation of the document as a clinical symposium at the 14th Internation...
journal_title:Annals of internal medicine
pub_type: 杂志文章,评审
doi:10.7326/0003-4819-121-7-199410010-00008
更新日期:1994-10-01 00:00:00
abstract::Clinicians can use data to improve daily clinical practice. This paper offers eight principles for using data to support improvement in busy clinical settings: 1) seek usefulness, not perfection, in the measurement; 2) use a balanced set of process, outcome, and cost measures; 3) keep measurement simple (think big, bu...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-128-6-199803150-00007
更新日期:1998-03-15 00:00:00
abstract:Background:Whether statin type influences hepatocellular carcinoma (HCC) incidence or mortality in chronic hepatitis B or C virus infection is unknown. Objective:To assess the relationship between lipophilic or hydrophilic statin use and HCC incidence and mortality in a nationwide population with viral hepatitis. Des...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/M18-2753
更新日期:2019-09-03 00:00:00
abstract::The 1986 False Claims Act Amendments authorize private citizens to sue on behalf of the U.S. government to recover federal funds from fraudulent recipients. The "relator" receives a share of any proceeds from a successful lawsuit. Originally enacted because of defense procurement scandals, this statute also applies to...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-114-12-1050
更新日期:1991-06-15 00:00:00
abstract:OBJECTIVE:To examine, from the perspective of primary care physicians, the value of mental status findings and ancillary tests in diagnosing dementia or its causes. DATA SOURCES:Studies identified using MEDLINE and bibliographies of pertinent articles. STUDY SELECTION:Selection based on availability of information on...
journal_title:Annals of internal medicine
pub_type: 杂志文章,评审
doi:10.7326/0003-4819-115-2-122
更新日期:1991-07-15 00:00:00
abstract::Arteriohepatic dysplasia (Alagille's syndrome) is presumed to be one of the familial intrahepatic cholestatic syndromes, all of which present with neonatal jaundice or failure to thrive, or both. We report the findings in five patients with this syndrome, four of whom have been followed into adulthood. In addition to ...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-91-4-520
更新日期:1979-10-01 00:00:00
abstract:STUDY OBJECTIVE:To determine the usefulness of the continuous intravenous dexamethasone suppression test in the differential diagnosis of patients with the Cushing syndrome. DESIGN:Comparison of the results of this test with those of other tests in the study population and with data from the literature. SETTING:Refer...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-112-10-738
更新日期:1990-05-15 00:00:00
abstract:OBJECTIVE:To evaluate the relation between skeletal muscle disease (myopathy) and degenerative changes in cardiac muscle (cardiomyopathy) in patients with chronic alcoholism. DESIGN:A cross-sectional study. SETTING:University medical center. PARTICIPANTS:Group A included 24 patients with chronic alcoholism who had d...
journal_title:Annals of internal medicine
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.7326/0003-4819-120-7-199404010-00001
更新日期:1994-04-01 00:00:00
abstract:Background:A 2007 American College of Physicians guideline addressed pharmacologic options for low back pain. New evidence and medications have now become available. Purpose:To review the current evidence on systemic pharmacologic therapies for acute or chronic nonradicular or radicular low back pain. Data Sources:Ov...
journal_title:Annals of internal medicine
pub_type: 杂志文章,评审
doi:10.7326/M16-2458
更新日期:2017-04-04 00:00:00
abstract:OBJECTIVE:To determine the rate of use of prophylaxis for venous thromboembolism in high-risk hospital patients. DESIGN:A retrospective medical record review. SETTING:A community-wide study in 16 short-stay hospitals in central Massachusetts. PATIENTS:A total of 2017 patients with multiple risk factors for venous th...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-591
更新日期:1991-10-15 00:00:00
abstract::A patient with bladder carcinoma metastatic to lung and brain died of pneumonia. Autopsy examination showed a confluent bronchopneumonia with several small abscesses and acute pyelonephritis with abscess formation. Legionella pneumophila, serogroup 4, was isolated in pure culture from lung tissue postmortem and was al...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-93-6-835
更新日期:1980-12-01 00:00:00
abstract::Two patients presented with abnormalities suggestive of pituitary adenoma; one during pregnancy and one in the postpartum period. However, pathologic examination of the pituitary showed extensive destruction by a lymphoplasmacytic infiltrate; no tumor was identified. Both patients developed hypopituitarism. We know of...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-95-2-166
更新日期:1981-08-01 00:00:00
abstract:OBJECTIVE:To validate prospectively the use of an artificial neural network to identify myocardial infarction in patients presenting to an emergency department with anterior chest pain. DESIGN:Prospective, blinded testing. SETTING:Tertiary university teaching center. PATIENTS:A total of 331 consecutive adult patient...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-115-11-843
更新日期:1991-12-01 00:00:00