BLOGS Voices Follow

27 Feb 2012

Selections from Richard Lehman’s Weekly Review: Week of February 27th

CardioExchange is pleased to reprint selections from Dr. Richard Lehman’s weekly journal review blog at BMJ.com. Selected summaries are relevant to our audience, but we encourage members to engage with the entire blog.

Week of February 27th

JAMA  22 Feb 2012  Vol 307

MIs without Chest Pain? (pg. 813): When an Italian team of physicists reported that they had detected neutrinos traveling faster than light, the televisual physicist Jim Al-Khalili promised to eat his boxer shorts if it proved to be true. It turns out to have been a measurement error due to faulty wiring. Unbelievable results either shatter the laws of the known universe, or else they are wrong. So if a study tells us that 42% of women and 31% of men presenting with myocardial infarction do not have chest pain (or even pain in the arm or jaw), this either overturns clinical medicine as we know it – from experience and from several other large cohort studies – or else it is due to lousy recording. Guess which. This retrospective study is based on a single tick in a box completed by busy physicians looking after over a million patients coming into American hospitals with heart attacks between 1994 and 2006. It could be that they had better things to do than record the obvious. If these figures are true, then I will eat my elegant black Marks & Spencer long johns. These thermal underpants have proved very effective at protecting my lower parts from the ravages of winter on the eastern seaboard of America, and I just wish journal editors were as effective at protecting us against the ravages of bad data.

Ann Intern Med  21 Feb 2012  Vol 156

Cardiovascular Family History Taking (pg. 253): I can’t think of many studies from British primary care that have appeared in the Annals, and this one receives a rave review in the editorial: “That this study was done at all speaks to the better support for high-quality research in primary care in the United Kingdom; finding support for a study like this would be extraordinarily difficult in the United States.” It’s not that easy in the UK either, and the praise is deserved: a 4-university collaborative did a cluster-randomized trial of cardiovascular family history taking by patient-completed questionnaire. It had a 98% uptake and showed that this is useful and practicable and resulted in a 4.5% increase in patients categorized as high risk.