Monday, January 4, 2016

Predictions for 2016 practice-changers

- Jennifer Middleton, MD, MPH

2015 brought us many provocative medical headlines, and 2016 will likely continue to provide us with a lot to discuss here on the AFP Community Blog. Here are some headlines that we may see in 2016:

SPRINT part 2
Although enrollment in the Systolic Blood Pressure Intervention Trial (SPRINT) was halted last year, data collection is still ongoing regarding two components of the trial: the effect, if any, of intensive blood pressure control on dementia and cognitive function (SPRINT MIND), and continued follow-up on renal function in participants (as an increased rate in renal function decline was noted in participants in the trial's intensive treatment arm). According to the SPRINT website, the researchers plan to complete data collection for both by mid-2016. Given how quickly the initial SPRINT study went to press after enrollment was closed, I wouldn't be surprised to see SPRINT MIND and the follow-up renal function data publicized before the end of 2016.

New hypertension treatment guidelines (again)
The publication of SPRINT last year conflicts with some of the JNC 8 hypertension treatment recommendations from 2013; although JNC 8 advocates for a systolic blood pressure (SBP) goal of 140 for all patients under age 60 and for patients over 60 with CVD risk factors, SPRINT suggests that some patients at high risk of cardiovascular disease (CVD) may benefit from an SBP goal of 120. The National Heart, Lung, and Blood Institute (NHLBI), which sponsored the JNC, is no longer issuing treatment guidelines, but a task force from the American College of Cardiology (ACC) and the American Heart Association (AHA) is currently at work developing new recommendations. Though they've provided no expected publication date, I suspect the desire by many to resolve this SBP goal discrepancy will push them to finish their work sooner rather than later.

USPSTF: dyslipidemia screening & treatment
The United States Preventive Services Task Force (USPSTF) is currently soliciting public comment on 2 topics related to dyslipidemia: dyslipidemia screening and "Statin Use for the Primary Prevention of Cardiovascular Disease in Adults: Preventive Medication." While both of these topics will be relevant to primary care, the second may have the most far-reaching consequences. Dr. Kenny Lin has written before on this blog on the current conflicting recommendations regarding treatment with statins for the primary prevention of CVD; it will be interesting to see what the USPSTF determines.

USPSTF: weight loss medications
I've written previously about the pros and cons of using prescription medications for weight loss on the blog, and the USPSTF is currently drafting its stance on this topic as well.  Will they be finished with this one before the end of 2016? Only time will tell.

Personal health tech goes mainstream?
Dr. Lin wrote last fall about the Family Medicine for America's Health (FMAH)'s technology "tactic team" and their strategies for increasing the use of technology to help patients. In that post, he described a study showing that text messaging to patients with heart disease helped them to reduce CVD risk factors. I'm hoping to see both a lot more studies like this one along with more from FMAH about how to practically implement these technologies in our offices.

Well, those are some of the stories I'll be watching for in 2016. What medical news are you anticipating in the next year?

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