(Circulation. 2001;104:e9003.)
© 2001 American Heart Association, Inc.
Cardiovascular News
Circulation Newswriter
Delay in Influenza Vaccine Supply Predicted
A delay in supplies of influenza vaccine for the 2001–2002 season can be expected, said officials with the US Centers for Disease Control and Prevention (CDC) in Atlanta in an official statement. However, they noted that the delay is not expected to be as severe as that of the year before.
The CDC predicts that 64% of the vaccine needed for the new flu season will be available by October 2001, approximately twice the amount available in October 2000. The remaining needed doses should be available in November and December.
In May, the CDC advised physicians and health clinics to order their vaccine early, but they also said the agency did not anticipate a delay in the production of the vaccine, citing assurances from manufacturers and the US Food and Drug Administration. Now the delay in production is being blamed on a reduced number of licensed manufacturers of the vaccine. Only 3 manufacturers are currently producing the vaccine. There were 4 in 1999.
As it did last year, the CDC is recommending that early supplies of the vaccine be reserved for high-risk patients, including the elderly, those with chronic health conditions, and healthcare workers.
Mortality Rates Decline for Major Killers
The CDC reported declines in death rates for several leading mortality causes for the year 1999 in a July 26, 2001, report.
Age-adjusted mortality rates for both heart disease and cancer declined slightly, although the diseases remained the top causes of death. The age-adjusted mortality rate for diseases of the heart in 1998 was 269.7 deaths per 100 000 people. That declined to 267.7 deaths in 1999. The age-adjusted death rate for cancer in 1998 was 204.4, but that declined to 202.6 in 1999. Other mortality rates dropped even more, with deaths from suicide, homicide, and firearms decreasing an estimated 6% between 1998 and 1999.
However, other leading causes of death showed increases in 1999, including septicemia (6.6%), hypertension (5%), chronic lower respiratory diseases (4%), and diabetes (3.3%). Mortality from HIV infection continued a 3-year downward trend, decreasing almost 4% between 1998 and 1999. "We’re paying very close attention to the trend in HIV mortality," said CDC Director Jeffrey P. Koplan in a released statement. "Although HIV as a cause of death has dropped in rank in recent years, we must guard against complacency and continue to emphasize prevention as a key weapon in fighting this disease."
The report can be found online at the CDC web site (http://www.cdc.gov/nchs).
Patients With Myocardial Infarction More Likely to Survive When Treated by High-Volume Physicians
Heart attack patients treated by physicians who admit >24 patients with myocardial infarction to the hospital each year are more likely to survive than those who are treated by physicians who admit <5 such patients, according to a study in the June 27, 2001, issue of the Journal of the American Medical Association (2001;285:3116–3122).
The study, which was performed by public health and clinical researchers from the Institute for Clinical Evaluative Sciences in Toronto, the Sunnybrook and Women’s College Health Sciences Center, and the University of Toronto, retrospectively evaluated the outcomes of 98 194 patients treated by 5374 physicians between April 1, 1992, and March 31, 1998, in the Canadian province of Ontario. They compared the mortality risk rates for patients at 30 days after the heart attack and at 1 year. The rates were adjusted by physician volume and patient, physician, and hospital characteristics. For all patients, the 30-day mortality rate was 13.5% and the 1-year rate was 21.8%. However, the mortality rates were inversely proportional to the experience of the admitting physician. For example, the 30-day risk-adjusted mortality rate was 15.3% for physicians who treated 
5 heart attack patients each year compared with 11.8% for physicians who treated >24 patients. The 1-year risk-adjusted mortality rate was 24.2% for physicians who treated 5 heart attack patients compared with 19.6% for those who treated >24 patients.
The physicians were classified into 1 of the following 4 groups: cardiologists, general internists, family physicians, or other specialists. The likelihood that a patient was treated by a cardiologist varied with the location of the hospital. Cardiologists were more likely to provide the care for patients admitted to teaching and large community hospitals, whereas family physicians were more likely to care for patients in small community facilities.
The researchers, who were led by Jack V. Tu, MD, PhD, of the Institute for Clinical Evaluative Sciences, noted that their data do not allow them to define a minimum annual volume of patients with myocardial infarction that a physician should treat to "optimize patient outcomes. Nevertheless, our results do suggest that significant reductions in acute myocardial infarction (AMI) mortality could be achieved by shifting the primary responsibility for treating more AMI patients to a smaller number of high-volume physicians. Developing strategies to improve the clinical expertise of low-volume physicians might also lead to better patient outcomes."
National Institutes of Health to Study Effects of Weight Loss and Exercise on Type 2 Diabetes
A long-term study of the effects of weight loss on people with type 2 diabetes was launched June 25, 2001, at the annual meeting of the American Diabetes Association in Philadelphia. The study is said to be the largest study of the effects of weight loss intervention ever funded by the National Institutes of Health.
Dubbed "Look AHEAD (Action for Health in Diabetes)," the study will enroll 
5000 volunteers with type 2 diabetes in a multicenter, randomized, clinical trial to determine the effect of weight loss interventions on the incidence of heart attack, stroke, and cardiovascular-related death. Those who wish to enroll should be between the ages of 45 and 75 years, be diagnosed with type 2 diabetes, and be classified as overweight or obese.
Those who qualify will be assigned to the projects Lifestyle Program or its Diabetes and Education Program. The Lifestyle Program uses an intensive diet and exercise program to enable participants to lose 7% to 10% of their weight in the first year. The patients in the other program will attend sessions on nutrition and physical activity and be given the option of attending support groups with other people who have diabetes.
The individuals in the program will be followed for >11 years while researchers track cardiovascular risk factors, diabetes control, complications, general health, and quality of life. Agencies sponsoring the study include the National Institute of Diabetes and Digestive and Kidney Diseases; the National Heart, Lung, and Blood Institute; the National Institute of Nursing Research; the National Center for Minority Health and Health Disparities; the Office of Research on Women’s Health; all of the National Institutes of Health; and the Centers for Disease Control and Prevention.
| ||||||||||||||||||||||||||||||||||||||||||||||||||||