Issues

Dhruv S. Kazi, MD, MSc, MS; Joanne Penko, MS, MPH; Pamela G. Coxson, PhD; David Guzman, MSPH; Pengxiao C. Wei, BS, MPH; Kirsten Bibbins-Domingo, PhD, MD, MAS

The high price of prescription drugs in the United States has been a barrier to adoption of potentially lifesaving therapies. The authors propose that cost-effectiveness analyses be performed in a timely manner so that this information can help influence drug pricing shortly after approval. They illustrate how this process might work by describing their recent experience with PCSK9 (proprotein convertase subtilisin/kexin 9) inhibitors—monoclonal antibodies that lower cholesterol levels in the blood.

Ann Intern Med. 2019;170(4):221-229. doi:10.7326/M18-1776

Pontus Henriksson, PhD; Hanna Henriksson, PhD; Per Tynelius, MSc; Daniel Berglind, PhD; Marie Löf, PhD; I-Min Lee, MBBS, ScD; Eric J. Shiroma, ScD; Francisco B. Ortega, PhD

The relationship between a healthy lifestyle during adolescence and chronic disease later in life is not well understood. This study, which involved a large cohort of male adolescents in Sweden, examined the relationship of cardiorespiratory fitness and obesity with receipt of a disability pension later in life.

Ann Intern Med. 2019;170(4):230-239. doi:10.7326/M18-1861

April Jorge, MD; Zachary S. Wallace, MD, MSc; Na Lu, MPH; Yuqing Zhang, DSc; Hyon K. Choi, MD, DrPH

Renal transplantation is associated with increased survival among patients with end-stage renal disease (ESRD). However, the benefits of renal transplant in patients whose ESRD is due to lupus nephritis (LN-ESRD) is uncertain. This analysis compared survival among patients with LN-ESRD who did and did not have a kidney transplant.

Ann Intern Med. 2019;170(4):240-247. doi:10.7326/M18-1570

Desiree Wussler, MD; Nikola Kozhuharov, MD; Zaid Sabti, MD; Joan Walter, MD; Ivo Strebel, MS; Letizia Scholl, MD; Oscar Miró, PhD; Xavier Rossello, MD, PhD; Francisco Javier Martín-Sánchez, MD, PhD; Stuart J. Pocock, PhD; Albina Nowak, MD; Patrick Badertscher, MD; Raphael Twerenbold, MD; Karin Wildi, MD; Christian Puelacher, MD; Jeanne du Fay de Lavallaz, MD; Samyut Shrestha, MD; Olivia Strauch; Dayana Flores, MD; Thomas Nestelberger, MD; Jasper Boeddinghaus, MD; Carmela Schumacher, MSc; Assen Goudev, PhD; Otmar Pfister, MD; Tobias Breidthardt, MD; Christian Mueller, MD

The MEESSI-AHF (Multiple Estimation of risk based on the Emergency department Spanish Score In patients with Acute Heart Failure [AHF]) risk score was developed to predict 30-day mortality in patients presenting with AHF to emergency departments in Spain. The performance of the score in other countries was unknown. In this study, the authors externally validated the MEESSI-AHF score in a cohort of unselected patients with AHF who presented to 4 emergency departments in Switzerland.

Ann Intern Med. 2019;170(4):248-256. doi:10.7326/M18-1967

Christina M. Yuan, MD

Last year, a “well-being survey” was added to the annual faculty survey from the Accreditation Council for Graduate Medical Education. In this commentary, a program director ponders the survey's purpose and the possible ramifications for faculty who respond to it.

Ann Intern Med. 2019;170(4):257-258. doi:10.7326/M18-2302

Katy J.L. Bell, MBChB, MMed(Clin Epi), PhD; Jenny Doust, BMBS, PhD; Paul Glasziou, MBBS, PhD; Louise Cullen, MBBS(Hon), PhD; Ian A. Harris, MBBS, MMed(Clin Epi), PhD; Leon Smith, MBBS; Rachelle Buchbinder, MBBS(Hons), MSc, PhD; Alexandra Barratt, MBBS, MPH, PhD

Overdiagnosis is commonly conceptualized as an unintended consequence of early disease detection in asymptomatic persons but can also occur in persons with symptoms. This commentary poses ways to identify this problem and examines the use of high-sensitivity cardiac troponin assays to diagnose type 1 myocardial infarction as an example of the potential for overdiagnosis.

Ann Intern Med. 2019;170(4):259-261. doi:10.7326/M18-2645

Rhanderson Cardoso, MD; Khurram Nasir, MD, MPH, MSc; Roger S. Blumenthal, MD; Michael J. Blaha, MD, MPH

This commentary addresses the 2018 American Heart Association and American College of Cardiology risk assessment and cholesterol management recommendations about “risk enhancers” and coronary artery calcium testing.

Ann Intern Med. 2019;170(4):262-263. doi:10.7326/M18-3675

Mark A. Hlatky, MD

PCSK9 inhibitors substantially reduce cholesterol levels, but the U.S. Food and Drug Administration–approved PCSK9 inhibitors, alirocumab and evolocumab, came to market priced at $14 000 per year—more than 100 times the cost of a generic statin. Kazi and colleagues' cost-effectiveness analysis of alirocumab in secondary prevention is based on new trial results and updated pricing. The editorialist discusses the findings and what it takes for preventive therapies to be cost-effective.

Ann Intern Med. 2019;170(4):264-265. doi:10.7326/M18-3632

Nitender Goyal, MD; Daniel E. Weiner, MD, MS; Andrew S. Levey, MD

Jorge and colleagues examined data from 1995 to 2014 to assess outcomes of patients with lupus nephritis who initiated dialysis and were placed on the waitlist for a kidney transplant. The editorialists discuss the findings in light of slow progress in the treatment of lupus nephritis. Given higher patient and allograft survival with both preemptive and early kidney transplant, it is essential that transplant be considered as promptly as possible for patients with lupus nephritis.

Ann Intern Med. 2019;170(4):266-267. doi:10.7326/M18-3721

The Editors

The ever-growing popularity of Annals Graphic Medicine has prompted us to expand it to include regular monthly features from 2 talented physician artists. Look for a new installment of “Dr. Mom” on the first Tuesday of the month and “Progress Notes” on the third Tuesday.

Ann Intern Med. 2019;170(4):268. doi:10.7326/M19-0058

Jessica Zitter, MD, MPH

There was relief in knowing that my colleague could offer what this woman needed even when I couldn't—especially when I couldn't.

Ann Intern Med. 2019;170(4):269-270. doi:10.7326/M18-2294

Richard B. Weinberg, MD

“Children don't fear death—they fear pain and abandonment. Even the wee ones can sense who can give them shelter.”

Ann Intern Med. 2019;170(4):271-272. doi:10.7326/M18-2678

Ann Intern Med. 2019;170(4):275-277. doi:10.7326/M18-2042

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Ann Intern Med. 2019;170(4):284. doi:10.7326/L19-0024

Sadhana Kalidindi

Ann Intern Med. 2019;170(4):273. doi:10.7326/M18-2649

Lawrence J. Hergott, MD

Ann Intern Med. 2019;170(4):274. doi:10.7326/M18-2537

Henry S. Sacks, PhD, MD, FACP, FIDSA

Ann Intern Med. 2019;170(4):JC14. doi:10.7326/ACPJ201902190-014

William G. Herrington, MD; Doreen Zhu, MBChB; Richard Haynes, DM

Ann Intern Med. 2019;170(4):JC15. doi:10.7326/ACPJ201902190-015

Roger R. Dmochowski, MD, MMHC, FACS

Ann Intern Med. 2019;170(4):JC16. doi:10.7326/ACPJ201902190-016

Bruce E. Johnson, MD

Ann Intern Med. 2019;170(4):JC17. doi:10.7326/ACPJ201902190-017

Christine F. McDonald, MBBS, PhD; Christopher J. Worsnop, MBBS

Ann Intern Med. 2019;170(4):JC18. doi:10.7326/ACPJ201902190-018

Xavier Calvet, MD, PhD

Ann Intern Med. 2019;170(4):JC19. doi:10.7326/ACPJ201902190-019

Gregory E. Simon, MD, MPH

Ann Intern Med. 2019;170(4):JC20. doi:10.7326/ACPJ201902190-020

Reza Mirza, MD; Gordon Guyatt, MD

Ann Intern Med. 2019;170(4):JC21. doi:10.7326/ACPJ201902190-021

Joseph F. Rappold, MD, FACS

Ann Intern Med. 2019;170(4):JC22. doi:10.7326/ACPJ201902190-022

Adam J. Nelson, MD; Christopher B. Granger, MD

Ann Intern Med. 2019;170(4):JC23. doi:10.7326/ACPJ201902190-023

Geno J. Merli, MD; Howard H. Weitz, MD

Annals Consult Guys brings a new perspective to the art and science of medicine with lively discussion and analysis of real-world cases and situations. They address medically relevant topics—whether they be poignant, thought-provoking, or just plain entertaining.

Ann Intern Med. 2019;170(4):CG1. doi:10.7326/W18-0041

Darren B. Taichman, MD, PhD

Ann Intern Med. 2019;170(4):ED4. doi:10.7326/AWED201902190

David H. Wesorick, MD; Vineet Chopra, MD, MSc

Ann Intern Med. 2019;170(4):HO1. doi:10.7326/AWHO201902190

Pramod K. Garg, MD

This commentary discusses management of patients who present to the hospital with acute pancreatitis.

Ann Intern Med. 2019;170(4):HO2-HO3. doi:10.7326/M19-0008

Robert M. Centor, MD; Gustavo R. Heudebert, MD

In this episode of Annals On Call, Dr. Centor discusses the estimation of stroke risk in patients with atrial fibrillation with Dr. Gustavo Heudebert, a professor of medicine at the University of Alabama.

Ann Intern Med. 2019;170(4):OC1. doi:10.7326/A18-0014

Michael Natter, MD

Progress Notes explores the everyday emotional, clinical, humorous, and ethical challenges of the medical residency training process. It appears monthly in Annals Graphic Medicine at Annals.org.

Ann Intern Med. 2019;170(4):W73-W77. doi:10.7326/G19-0002

Christopher L. Bennett, MD, MA

Annals Graphic Medicine brings together original graphic narratives, comics, animation/video, and other creative forms by those who provide or receive health care. They address medically relevant topics##mdash;whether they be poignant, thought-provoking, or just plain entertaining.

Ann Intern Med. 2019;170(4):W78-W79. doi:10.7326/G18-0034

Ann Intern Med. 2019;170(4):I-32. doi:10.7326/P18-0022