This Week in JAMA FREE

To assess whether recent advances in technology, new clinical trial evidence, and updated clinical practice guidelines have influenced the volume and distribution of coronary revascularization procedures in the United States, Epstein and colleagues analyzed nationally representative hospital discharge data and assessed trends in the rates and types of coronary revascularization procedures performed from 2001 to 2008. The authors found that the annual rate of coronary revascularization decreased 15% between 2001 and 2008. During this time, the annual rate of coronary artery bypass grafting decreased substantially, but rates of percutaneous coronary interventions did not change significantly.

Extrapolations from observational studies and short-term intervention trials suggest that population-wide moderation of salt intake might reduce the cardiovascular event rate. However, whether individuals with lower salt intake have lower blood pressure and lower risks of cardiovascular events—in the long term—is not clear. In a prospective cohort study involving individuals who at baseline were normotensive and without cardiovascular disease, Stolarz-Skrzypek and colleagues examined the association of 24-hour urinary sodium excretion with cardiovascular morbidity and mortality. Participants were followed up for a median 7.9 years. Among the authors' findings were that lower sodium excretion was associated with higher cardiovascular mortality and the risk of hypertension did not increase across tertiles.

Comparative efficacy information on new drugs would be most useful shortly after marketing approval, when observational data from routine care and from head-to-head trials are not yet available. In a review of drug approval information for new molecular entities approved by the US Food and Drug Administration (FDA) between 2000 and 2010, Goldberg and colleagues assessed whether comparative efficacy data were available at the time of FDA approval. The authors report that comparative efficacy data were included in publicly available FDA approval materials for about half of all new molecular entities and for two-thirds of new molecular entities for which alternative treatment options existed.

Umpierre and colleagues Article report results of a systematic review and meta-analysis of data from 47 randomized trials that examined the association of structured exercise training (aerobic, resistance, or both) or physical activity advice with reductions in hemoglobin A_1c (HbA_1c) in patients with type 2 diabetes. Among the authors' findings were that patients who received structured exercise training experienced greater reductions in HbA_1c than control group patients, and exercise interventions that exceeded 150 minutes per week were associated with greater HbA_1c decreases than exercise interventions of shorter weekly duration. Physical activity advice was associated with HbA_1c reductions only when combined with dietary recommendations. In an editorial, Pahor Article discusses the cost-effectiveness of structured exercise programs, particularly for high-risk populations.

“Balancing my personal life and my career was already a challenge. Why complicate things now?” From “It's Never Too Late.”

Scientists are probing the effects of anesthetic agents on long-term outcomes in pediatric patients.

Accountable care organizations and patient empowerment

Physician-patient communication

Conscience-based care refusals and quality medical care

What next for QALYs?

John Harvey Kellogg and the pursuit of wellness

Join Lydia A. Bazzano, MD, PhD, Wednesday, May 18, from 2 to 3 PM eastern time to discuss antihypertensive treatment and cardiovascular disease (CVD) prevention for normotensive individuals with CVD. To register, go to http://www.ihi.org/AuthorintheRoom.

A patient has a renal mass discovered with MRI that was not addressed clinically for several months. How would you improve physician communication? Go to www.jama.com to read the case. Submit your response by May 8 for possible online publication.

For your patients: Information about rheumatoid arthritis.