Highlights
Journal: JAMA Internal Medicine (2014)

Multifaceted Intervention to Improve Cardiac Drug Adherence 186Adherence to cardioprotective medications in the year after acute coronary syndrome (ACS) hospitalization is poor.Ho and coauthors conducted a randomized clinical trial of 253 patients to test a multifaceted intervention against usual care.In the intervention group, 89.3% of patients were adherent compared with 73.9% in the usual care group (P = .003).They found no statistically significant differences in the proportion of patients who achieved blood pressure and low-density lipoprotein cholesterol goals or in clinical events.In an Editor's Note, Redberg urges caution in implementing costly interventions before significant improvement in patient outcomes is demonstrated.Editor's Note 193 Rates of CPR Training in the United States 194While bystander cardiopulmonary resuscitation (CPR) can improve the likelihood of surviving an out-of-hospital cardiac arrest, its use varies among communities in observational studies.Anderson and coauthors sought to determine if regional variations in county-level CPR training exist across the United States and factors associated with low CPR training, using data from the American Heart Association, the American Red Cross, and the Health and Safety Institute on more than 13 100 000 persons trained from July 1, 2010, through June 30, 2011.They found that annual CPR training rates in the United States are low and vary widely across communities: counties located in the South and those with a higher proportion of rural populations, residents of black race and Hispanic ethnicity, and lower median household incomes have lower CPR training than their counterparts.Blewer and Abella discuss the topic in an Invited Commentary. Invited Commentary 201 Long-term Morbidity & Mortality in Chronic Hepatitis C Virus 204Data from large, real-world practice samples are needed to improve risk factor estimates for late-stage liver events and death in hepatitis C virus (HCV).In an observational cohort study of 128 769 patients from the Department of Veterans Affairs HCV clinical registry, McCombs and coauthors found a relationship between HCV infection and nonfatal hepatic events in a significant percentage of patients with milder disease based on early fibrosis stage.A subgroup of patients achieving undetectable viral load with interferon treatment exhibited a 27% reduction in the incidence of nonfatal hepatic events (cirrhosis, liver cancer, and liver-related hospitalizations) and a 45% reduction in mortality.In an Editor's Note, Katz describes the clinician's challenges in effectively treating patients with HCV.Editor's Note 212Continuing Medical Education jamanetworkcme.com CABG vs PCI in Multivessel Disease 223Comparative effects of coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) on long-term mortality and morbidity are not clear.Sipahi and coauthors performed a meta-analysis of contemporary randomized clinical trials examining this issue.Analysis of more than 6000 patients with an average follow-up of 4.1 years revealed a significant 27% relative reduction in total mortality with CABG compared with PCI.Myocardial infarctions and repeat revascularizations were also significantly reduced by CABG, while there was a trend for increase in strokes with CABG compared with PCI.Katz places the findings in historical context in an Editor's Note.