Effect of Addition of a Statin to Warfarin on Thromboembolic Events in Japanese Patients With Nonvalvular Atrial Fibrillation and Diabetes Mellitus.

Statins have been shown to decrease stroke risk in patients with cardiovascular risk factors but not to prevent recurrence of ischemic stroke in patients with atrial fibrillation (AF). The present subanalysis aimed to clarify the efficacy of combined use of warfarin and statins in patients with nonvalvular AF (NVAF) with coronary artery disease, diabetes mellitus (DM), or hypertension. The effects of adding statins to warfarin were compared with those of warfarin alone in patients with NVAF with the data set of J-RHYTHM Registry, a prospective, observational study with a 2-year follow-up. End points included thromboembolism, major hemorrhage, all-cause mortality, and cardiovascular mortality. Of 7,406 patients with NVAF and follow-up data, 6,404 patients received warfarin at baseline. Of these, 1,605 patients also received a statin. Patients in the warfarin plus statin group showed significantly lower all-cause mortality compared with those on warfarin alone (hazard ratio [HR] 0.57, 95% confidence interval [CI] 0.38 to 0.87, p = 0.0089), although thromboembolic event rates did not differ significantly (HR 0.73, 95% CI 0.44 to 1.20, p = 0.21). In contrast, in 1,223 patients with DM, the warfarin plus statin group showed significantly lower thromboembolic event rates than the warfarin-alone group (HR 0.33, 95% CI 0.11 to 0.96, p = 0.041). Interestingly, in patients with coronary artery disease or with hypertension, the addition of statin to warfarin did not decrease the frequency of thromboembolic events. In conclusion, in Japanese patients with NVAF with DM, a combination of warfarin and a statin could be clinically beneficial for preventing thromboembolic events.

Training family medicine residents in HIV primary care: a national survey of program directors.

BACKGROUND AND OBJECTIVES: As the number of people living with HIV steadily increases, severe shortages in the HIV provider workforce in the United States are projected. With an increased emphasis on HIV education during residency, family physicians could play a major role in meeting this need. METHODS: A nationwide survey of family medicine residency program directors (PDs) was conducted to determine their attitudes toward training residents in HIV care. RESULTS: Of 440, 224 (51%) PDs responded to the electronic survey. Teaching HIV care was a high priority for 20% of PDs. Twenty percent of PDs reported residents in their program were providing care to at least five HIV-infected patients. Twenty-five percent of PDs felt that their graduates had the skills to be HIV care providers. Fewer than 25% of PDs reported having a formal HIV curriculum or faculty with adequate HIV expertise. The most favored approaches to strengthen the HIV curriculum by PDs were: (1) a half-day mini-course (30%) and (2) developing a faculty member's expertise in HIV care (17%). A total of 79% of directors saw a need to modify their existing curriculum. CONCLUSIONS: Despite growing numbers of HIV-infected patients, only 25% of family medicine PDs felt that their graduates were adequately trained in HIV primary care, and most saw a need to modify their HIV curricula. Family medicine residency training programs have an important opportunity to develop residency curricula and increase faculty competence to train the next generation of clinicians in HIV care.