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Review | Orthostatic tachycardia after covid-19

14 Mar, 2023 | 13:48h | UTC

Orthostatic tachycardia after covid-19 – The BMJ

Commentary: Key steps for diagnosis and management of orthostatic tachycardia after COVID-19 – News Medical

 

RCT | Three-year outcomes after transcatheter or surgical aortic valve replacement in low-risk patients with aortic stenosis

14 Mar, 2023 | 13:47h | UTC

Three-Year Outcomes After Transcatheter or Surgical Aortic Valve Replacement in Low-Risk Patients with Aortic Stenosis – Journal of the American College of Cardiology (link to abstract – $ for full-text)

News Release: Benefits of TAVR Remain Consistent in Patients at Low Surgical Risk at Three Years – American College of Cardiology

 

Commentary on Twitter

 

SR | Myocardial revascularization in patients with ischemic cardiomyopathy: for whom and how

14 Mar, 2023 | 13:46h | UTC

Myocardial Revascularization in Patients With Ischemic Cardiomyopathy: For Whom and How – Journal of the American Heart Association

 

CDC recommends HBV screening at least once in a lifetime for all adults aged ≥18 years

13 Mar, 2023 | 15:14h | UTC

Summary: The Centers for Disease Control and Prevention (CDC) has issued new recommendations for screening and testing for hepatitis B virus (HBV) infection in the US.

The recommendations include screening for HBV infection at least once in a lifetime for adults aged ≥18 years and more frequent testing for persons at increased risk for HBV infection. The risk groups include:

  • Persons incarcerated or formerly incarcerated in jail, prison, or other detention settings.
  • Persons with a history of sexually transmitted infections or multiple sex partners.
  • Persons with a history of hepatitis C virus infection.

The CDC recommends using the triple panel (HBsAg, anti-HBs, and total anti-HBc) for initial screening to help identify persons who have an active HBV infection, have resolved infection and might be susceptible to reactivation, are susceptible and need vaccination, or are vaccinated.

Article: Screening and Testing for Hepatitis B Virus Infection: CDC Recommendations — United States, 2023 – Morbidity and Mortality Weekly Report

Commentaries:

Universal Adult Hepatitis B Screening and Vaccination as the Path to Elimination – JAMA

CDC recommends hepatitis B screening for all adults – CIDRAP

CDC Recommends Universal Screening for Hepatitis B Virus – HCP Live

 

Commentary on Twitter

 

RCT | Localized prostate cancer treatment options have similar 15-year survival outcomes

13 Mar, 2023 | 15:12h | UTC

Summary: The study followed 1643 men diagnosed with localized prostate cancer (diagnosed by screening with PSA) in the United Kingdom between 1999 and 2009 who were randomly assigned to receive active monitoring, prostatectomy, or radiotherapy.

After a median follow-up of 15 years, the study found that while prostatectomy and radiotherapy decreased metastasis, local progression, and the need for long-term androgen deprivation therapy, death from prostate cancer was low regardless of the treatment assigned, with 17 deaths (3.1%) in the active-monitoring group, 12 deaths (2.2%) in the prostatectomy group, and 16 (2.9%) deaths in the radiotherapy group (P=0.53). Additionally, the study found that overall deaths were similar between the groups.

The authors suggest that the choice of therapy for localized prostate cancer involves weighing the benefits and harms associated with each treatment option.

Article: Fifteen-Year Outcomes after Monitoring, Surgery, or Radiotherapy for Prostate Cancer – New England Journal of Medicine (link to abstract – $ for full-text)

News Release: Delaying treatment for localised prostate cancer does not increase mortality risk, trial shows – University of Bristol

 

Commentary on Twitter

 

RCT | Immediate complete revascularization non-inferior to staged approach in ACS patients with multivessel disease

13 Mar, 2023 | 15:10h | UTC

Summary: Patients with an acute coronary syndrome and multivessel disease not presenting with cardiogenic shock usually benefit from complete revascularization by percutaneous coronary intervention (PCI). Complete revascularization involves treating all significant blockages in the coronary arteries, including those not causing symptoms (non-culprit lesions).

The BIOVASC randomized non-inferiority trial investigated whether patients with acute coronary syndrome and multivessel coronary disease should undergo immediate complete revascularization during the index procedure or undergo a staged approach with PCI of the culprit lesion only during the index procedure followed by another procedure within 6 weeks of all non-culprit lesions deemed to be clinically significant. The exclusion criteria were:

  • Previous coronary artery bypass surgery.
  • Cardiogenic shock.
  • Single-vessel coronary disease.
  • The presence of a chronic coronary total occlusion.

A total of 1525 patients with acute coronary syndrome and multivessel coronary disease were randomly assigned to either an immediate complete revascularization group (764 patients) or a staged complete revascularization group (761 patients). The primary outcome was a composite of all-cause mortality, myocardial infarction, unplanned ischemia-driven revascularization, or cerebrovascular events at 1 year after the index procedure. The study found that immediate complete revascularization was non-inferior to staged complete revascularization for the primary outcome.

Article: Immediate versus staged complete revascularisation in patients presenting with acute coronary syndrome and multivessel coronary disease (BIOVASC): a prospective, open-label, non-inferiority, randomised trial – The Lancet (free registration required)

News Release: Immediate Complete Revascularization as Safe and Effective as Staged Procedure in Treating Multi-Vessel Disease – American College of Cardiology

Commentaries:

Revascularisation in acute coronary syndromes: change in practice? – The Lancet (free registration required)

No Downside to Immediate Complete Revascularization in ACS: BIOVASC – TCTMD

Percutaneous Complete Revascularization Strategies Using Sirolimus-Eluting Biodegradable Polymer-Coated Stents in Patients Presenting With Acute Coronary Syndrome and Multivessel Disease – BIOVASC – American College of Cardiology

Immediate Complete Revascularization Non-Inferior to Staged Procedure in BIOVASC Trial – HCP Live

Related:

The optimal timing for non-culprit percutaneous coronary intervention in patients with multivessel coronary artery disease: A pairwise and network meta-analysis of randomized trials – Frontiers in Cardiovascular Medicine

Multivessel Versus Culprit-Only Revascularization in STEMI and Multivessel Coronary Artery Disease: Meta-Analysis of Randomized Trials – Journal of the American College of Cardiology

Complete Revascularization During Primary Percutaneous Coronary Intervention Reduces Death and Myocardial Infarction in Patients With Multivessel Disease: Meta-Analysis and Meta-Regression of Randomized Trials – JACC: Cardiovascular Interventions

Complete Revascularization with Multivessel PCI for Myocardial Infarction – New England Journal of Medicine

One-Year Outcomes after PCI Strategies in Cardiogenic Shock – New England Journal of Medicine

PCI Strategies in Patients with Acute Myocardial Infarction and Cardiogenic Shock – New England Journal of Medicine

 

Review | Commonly missed findings on chest radiographs: causes and consequences

13 Mar, 2023 | 15:07h | UTC

Commonly Missed Findings on Chest Radiographs: Causes and Consequences – CHEST (free for a limited period)

See also: Reducing Errors Resulting From Commonly Missed Chest Radiography Findings – CHEST (free for a limited period)

 

Review | Reducing errors resulting from commonly missed chest radiography findings

13 Mar, 2023 | 15:06h | UTC

Reducing Errors Resulting From Commonly Missed Chest Radiography Findings – CHEST (free for a limited period)

See also: Commonly Missed Findings on Chest Radiographs: Causes and Consequences – CHEST (free for a limited period)

 

Brief Review | How we escalate vasopressor and corticosteroid therapy in patients with septic shock

13 Mar, 2023 | 15:04h | UTC

How We Escalate Vasopressor and Corticosteroid Therapy in Patients With Septic Shock – CHEST (free for a limited period)

 

New WHO guidelines to boost the use of life-saving safety restraints in vehicles

10 Mar, 2023 | 14:40h | UTC

News Release: New global guidelines to boost the use of life-saving safety restraints in vehicles – World Health Organization

Guideline: Occupant Restraints: A Road Safety Manual for Decision-Makers and Practitioners – World Health Organization

 

WHO urges countries to implement comprehensive sodium reduction policies to combat cardiovascular disease

10 Mar, 2023 | 14:43h | UTC

Summary:

A new report from the World Health Organization (WHO) has shown that the world needs to catch up to achieve its global target of reducing sodium intake by 30% by 2025. The report highlights that only 5% of WHO member states have mandatory and comprehensive sodium reduction policies.

Sodium, found in table salt and other condiments, increases the risk of heart disease, stroke, and premature death when eaten in excess. Implementing highly cost-effective sodium reduction policies could save an estimated seven million lives globally by 2030.

WHO suggests a number of policies, such as reducing the amount of sodium in food products, introducing front-of-pack labeling, launching mass media campaigns, and enforcing public policies related to food service and sales.

The report urges member states to implement sodium intake reduction policies without delay, and calls on food manufacturers to set ambitious targets for sodium reduction in their products.

Article: WHO global report on sodium intake reduction – World Health Organization

News Release: Massive efforts needed to reduce salt intake and protect lives – World Health Organization

Related:

Reducing daily salt intake in China by 1 g could prevent almost 9 million cardiovascular events by 2030: a modelling study – BMJ Nutrition Prevention & Health

Adding salt to foods and hazard of premature mortality – European Heart Journal

New WHO benchmarks help countries reduce salt intake and save lives – World Health Organization

WHO global sodium benchmarks for different food categories – World Health Organization

 

Commentary on Twitter

 

RCT | Treat-to-target strategy is noninferior to high-intensity statin therapy in patients with coronary artery disease

10 Mar, 2023 | 14:44h | UTC

Summary: This randomized, multicenter, noninferiority trial in South Korea enrolled 4,400 patients with known coronary artery disease. Patients were randomly assigned to one of two groups: a treat-to-target group and a high-intensity statin group.

The treat-to-target group received moderate or high-intensity statins and titrated their medication to achieve an LDL-C goal of 50-70 mg/dL, while the high-intensity statin group received rosuvastatin 20 mg or atorvastatin 40 mg. The primary endpoint was a 3-year composite of death, myocardial infarction, stroke, or coronary revascularization.

The study found that the primary endpoint occurred in 8.1% of the treat-to-target group and 8.7% of the high-intensity statin group, indicating that the treat-to-target strategy was noninferior to the high-intensity statin strategy.

Overall, the results of this study indicate that a treat-to-target strategy could be an appropriate substitute for high-intensity statin therapy in patients with coronary artery disease. This approach enables a personalized treatment plan that accounts for variations in individual drug response to statin therapy.

Article: Treat-to-Target or High-Intensity Statin in Patients With Coronary Artery Disease: A Randomized Clinical Trial – JAMA (free for a limited period)

Commentaries:

Investigating treat-to-target low-density lipoprotein-cholesterol versus high-intensity statins for coronary artery disease – News Medical

Not all patients with coronary artery disease require high intensity statins – MedicalResearch.com

 

Commentary on Twitter

 

WHO Meta-Analysis | Saturated fat and trans-fat intakes and their replacement with other macronutrients

9 Mar, 2023 | 14:24h | UTC

Saturated fat and trans-fat intakes and their replacement with other macronutrients: a systematic review and meta-analysis of prospective observational studies – World Health Organization

 

Commentary on Twitter

 

Crossover RCT | Atrial pacing to increase exercise HR did not improve performance in HFpEF patients with chronotropic incompetence

9 Mar, 2023 | 14:22h | UTC

Summary: The RAPID-HF randomized clinical trial investigated whether implanting and programming a pacemaker for rate-adaptive atrial pacing would improve exercise performance in patients with heart failure with preserved ejection fraction (HFpEF) and chronotropic incompetence.

The study involved 29 patients with symptomatic HFpEF and chronotropic incompetence who underwent pacemaker implantation for the study and then were randomized to atrial rate responsive pacing or no pacing for four weeks, followed by a four-week washout period and then crossover for an additional four weeks.

The study found that atrial pacing increased early and peak exercise heart rate, but there was no improvement in exercise performance or quality of life. Despite a higher exercise heart rate, there was no increase in exercise cardiac output due to a decrease in stroke volume. Moreover, pacemaker implantation was associated with adverse events.

Article: Rate-Adaptive Atrial Pacing for Heart Failure With Preserved Ejection Fraction: The RAPID-HF Randomized Clinical Trial – JAMA (free for a limited period)

Editorial: Rate-Adaptive Pacing for Heart Failure With Preserved Ejection Fraction – JAMA (free for a limited period)

Commentaries:

RAPID-HF: Rate-Adaptive Pacing Doesn’t Help in HFpEF – TCTMD

Atrial Pacing for HFpEF Shows Lack of Benefit on Exercise Capacity – HCP Live

 

Commentary on Twitter

 

Evidence Analysis | Menière’s disease: experience, evidence gaps & treatment choices

9 Mar, 2023 | 14:21h | UTC

Menière’s disease: experience, evidence gaps & treatment choices – Evidently Cochrane

New Cochrane Reviews:

Systemic pharmacological interventions for Ménière’s disease – Cochrane Library

Intratympanic gentamicin for Ménière’s disease – Cochrane Library

Intratympanic corticosteroids for Ménière’s disease – Cochrane Library

Positive pressure therapy for Ménière’s disease – Cochrane Library

Lifestyle and dietary interventions for Ménière’s disease – Cochrane Library

Surgical interventions for Ménière’s disease – Cochrane Library

 

RCT | Bempedoic acid shows modest reduction in cardiovascular events for statin-intolerant patients

8 Mar, 2023 | 14:39h | UTC

Summary:

Bempedoic acid is an ATP citrate lyase inhibitor that reduces LDL cholesterol levels and is associated with a low incidence of muscle-related adverse events. The study enrolled 13,970 patients at increased cardiovascular risk, with 6,992 randomized to bempedoic acid and 6,978 randomized to placebo, with a median duration of follow-up of 40.6 months.

The study found that bempedoic acid was associated with a statistically significant 13% reduction in the primary endpoint of major adverse cardiovascular events, which included death from cardiovascular causes, nonfatal myocardial infarction, nonfatal stroke, or coronary revascularization. However, the absolute risk reduction of events was modest, at 1.6% over nearly four years.

The study also reported higher incidences of gout and cholelithiasis with bempedoic acid compared to placebo, as well as small increases in serum creatinine, uric acid, and hepatic-enzyme levels.

Article: Bempedoic Acid and Cardiovascular Outcomes in Statin-Intolerant Patients – New England Journal of Medicine (link to abstract – $ for full-text)

Commentaries:

CLEAR Positives and Cautions With Bempedoic Acid for Statin Intolerance – Medscape (recommended reading – free registration required)

Cardiovascular Outcomes After “Statin-Intolerant” Patients Take Bempedoic Acid – NEJM Journal Watch (free for a limited period)

 

Commentary on Twitter

 

CDC Study | Estimates of serial interval and incubation period for mpox virus infection in the US

8 Mar, 2023 | 14:34h | UTC

Summary:

Monkeypox cases have been reported globally since May 2022, with most transmission occurring through close physical contact associated with sexual activities among men who have sex with men.

This study presented the estimated mean serial interval and incubation period for monkeypox virus infection based on data collected from 12 US health departments. The serial interval is the time between symptom onset in a primary case-patient and symptom onset in the secondary case-patient. It is critical for estimating the effective reproduction number and forecasting incidence, both of which are important for understanding the course of an outbreak and the effect of interventions.

The results indicate that the mean estimated serial interval for symptom onset is 8.5 days, while the mean estimated incubation period is 5.6 days.

Article: Interval and Incubation Period for Monkeypox Virus Infection in the United States: Findings from 12 Health Departments” – Emerging Infectious Diseases

Commentary: 8.5 days elapse between successive mpox cases, study estimates – CIDRAP

 

RCT | Combination of intravenous doxycycline and azithromycin better than either drug alone for severe scrub typhus

8 Mar, 2023 | 14:36h | UTC

Summary:

The study aimed to compare the efficacy of intravenous doxycycline, azithromycin, or a combination of both drugs in treating severe scrub typhus. The study randomized 794 patients with severe scrub typhus and at least one organ involvement to receive a 7-day course of intravenous doxycycline, azithromycin, or both.

The primary outcome was a composite of death from any cause at day 28, persistent complications at day 7, and persistent fever at day 5. The study found that combination therapy with intravenous doxycycline and azithromycin was a better therapeutic option for treating severe scrub typhus than monotherapy with either drug alone.

Article: Intravenous Doxycycline, Azithromycin, or Both for Severe Scrub Typhus – New England Journal of Medicine (link to abstract – $ for full-text)

News Release: A combination therapy is found to be more effective on severe scrub typhus – University of Oxford

 

Commentary on Twitter

 

M-A | Non-occupational physical activity and risk of cardiovascular disease, cancer and mortality outcomes

8 Mar, 2023 | 14:33h | UTC

Summary:

The study aimed to determine the association between non-occupational physical activity and chronic disease and mortality outcomes in the general adult population. The systematic review and meta-analysis included 196 articles covering 94 cohorts and over 30 million participants.

The results showed that higher activity levels were associated with a lower risk of all outcomes. The strongest associations were observed for all-cause and cardiovascular disease mortality, with weaker associations for cancer incidence.

The study also found that appreciable population health benefits could be gained from increasing physical activity levels of people who are inactive to just half the current health recommendations; doing that could prevent one in 10 premature deaths.

The findings support the current physical activity recommendations and suggest that even small increases in non-occupational physical activity in inactive adults can provide substantial protection against chronic disease outcomes.

It’s worth noting, however, that this study has the usual limitations of observational studies since all the included studies are cohort studies. Therefore, the results are subject to residual confounding, meaning that other factors not measured or accounted for in the studies could influence the observed associations.

Article: Non-occupational physical activity and risk of cardiovascular disease, cancer and mortality outcomes: a dose–response meta-analysis of large prospective studies – British Journal of Sports Medicine

News Releases:

One in ten early deaths could be prevented if everyone managed at least half the recommended level of physical activity, say a team led by researchers at the University of Cambridge

1 in 10 early deaths averted if everyone met physical activity targets – BMJ Newsroom

 

Perspective | Antipsychotics are increasingly being prescribed to children – here’s why we should be concerned

8 Mar, 2023 | 14:29h | UTC

Antipsychotics are increasingly being prescribed to children – here’s why we should be concerned – The Conversation

Original study: Cohort Study | Trends in antipsychotic prescribing to children and adolescents in England

 

Perspective | Dangerous selfies aren’t just foolish. We need to treat them like the public health hazard they really are

8 Mar, 2023 | 14:30h | UTC

Dangerous selfies aren’t just foolish. We need to treat them like the public health hazard they really are – The Conversation

 

FDA panel endorses 2 RSV vaccines for older adults, but flag at potential increased risk of Guillain-Barre

8 Mar, 2023 | 14:27h | UTC

Pfizer vaccine:

In close vote, FDA advisers recommend Pfizer RSV vaccine for those 60 and older – CIDRAP

FDA advisors recommend first-ever RSV vaccine from Pfizer, despite possible Guillain-Barre risks – CNBC

GSK’s vaccine:

FDA panel recommends GSK’s RSV vaccine for ages 60 and up – CIDRAP

FDA advisors recommend GSK’s RSV vaccine for older adults, but flag potential safety risks – CNBC

See also: Rare neurological condition is ‘important potential risk’ of Pfizer’s RSV vaccine, FDA says – CNN

 

Perspective | How to not be completely wrong about masks

8 Mar, 2023 | 14:25h | UTC

How to not be completely wrong about masks – The Munro Report

Related:

SR | Physical interventions to interrupt or reduce the spread of respiratory viruses

Let’s Do the Cochrane Review of Physical Measures to Reduce the Spread of Viruses – Sensible Medicine

Hospital masking should be optional – Sensible Medicine

Face masks to prevent transmission of respiratory infections: Systematic review and meta-analysis of randomized controlled trials on face mask use – PLOS One

RCT | Medical masks vs. N95 respirators for preventing COVID-19 among health care workers.

Science, Competing Values, and Trade-offs in Public Health — The Example of Covid-19 and Masking – New England Journal of Medicine

 

Commentary on Twitter

 

#ACC23 – RCT | Intravascular imaging–guided vs. angiography-guided complex PCI

7 Mar, 2023 | 13:20h | UTC

Intravascular Imaging–Guided or Angiography-Guided Complex PCI – New England Journal of Medicine (link to abstract – $ for full-text)

Commentary: Randomized Controlled Trial of Intravascular Imaging Guidance Versus Angiography-Guidance on Clinical Outcomes After Complex Percutaneous Coronary Intervention – RENOVATE-COMPLEX-PCI – American College of Cardiology

 

Commentary on Twitter

 

M-A | Comparison of a short vs. long-course antibiotic therapy for ventilator-associated pneumonia

7 Mar, 2023 | 13:18h | UTC

Summary:

This systematic review and meta-analysis of randomized controlled trials aimed to compare the rates of recurrence and relapse of ventilator-associated pneumonia (VAP) between short-course (≤8 days) and long-course (≥10-15 days) antibiotic therapy strategies. Five relevant studies involving 1069 patients were identified.

Compared to long-course therapy, short-course therapy increased the number of antibiotic-free days without any impact on recurrence and relapses of VAP, 28 days mortality, mechanical ventilation duration, number of extra-pulmonary infections, and length of ICU stay.

However, the study’s limitations, such as the small sample size and the lack of standardized definitions of the assessed outcomes, should be considered when interpreting the results.

Article: Comparison of a short versus long-course antibiotic therapy for ventilator-associated pneumonia: a systematic review and meta-analysis of randomized controlled trials – eClinicalMedicine

Commentary: Study finds benefits in short-course antibiotics for ventilator-associated pneumonia – CIDRAP

 

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