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One-Minute Telegram Archive 2024

Last updated: January 14, 2025

Introductiontoggle arrow icon

The One-Minute Telegram is a biweekly digest of the latest medical research. It is designed for our colleagues who want to keep up with medical literature without having to comb through a flood of new research. Every paper has been carefully selected and summarized by our team of physician editors to bring you the most important developments as concisely as possible. Integration of AMBOSS tooltips and links to related content ensures you have all the context you need at your fingertips. Whether you're on your way home from a long shift or just taking a break on a busy day, you'll always find a minute to stay current. Subscribe by clicking on the image or via the link in “Tips and Links” below.

See also the current One-Minute Telegram, One-Minute Telegram Archive 2023, One-Minute Telegram Archive 2022, One-Minute Telegram Archive 2021, and One-Minute Telegram Archive 2020.

Q4 2024toggle arrow icon

Edition 113 - December 21, 2024toggle arrow icon

2024 U.S. Preventive Services Task Force: summary of recommendations

One-Minute Telegram 113-2024-1/2

10-second takeaway

The U.S. Preventive Services Task Force (USPSTF) updated its breast cancer screening recommendations this year to advise that individuals assigned female at birth begin screening at 40 years of age instead of 50. The USPSTF also recommended behavioral interventions for children ≥ 6 years of age and adolescents with a high BMI and interventions to prevent falls in community-dwelling adults ≥ 65 years of age. Several other recommendations were reviewed, and there is still insufficient evidence to recommend for or against screening or supplementation for iron deficiency anemia in pregnancy, primary care interventions to prevent child maltreatment, or screening asymptomatic children ≤ 5 years of age for speech and language delay.

Recommendations breakdown

A searchable overview of the recommendations can be found on the USPSTF website. [1]

Holiday edition: cookie cravings and time-warp mysteries

One-Minute Telegram 113-2024-2/2

  • ‘Tis the season for sweet decisions: In a festive study, researchers unwrapped the secrets of Christmas cookie cravings. Using eye-tracking glasses (to see who’s eating naughty or nice), they found that sugar-packed Christmas cookies were the jingle bell rock stars of the buffet, while sugar-free alternatives got the side-eye. It turns out that labeling cookies as “sugar-free” made them about as appealing as a lump of coal in your stocking. Participants stared at them more frequently but for less time, probably hoping that they had miraculously been transformed into something tasty.
  • Does it feel like just yesterday you read the 2023 Holiday edition of the One-Minute Telegram? You’re not alone! A study found that 76% of people think the holidays arrive quicker every year, with festive cheer and some questionable memory lapses working as Santa’s mischievous elves. If you love the holidays, have a buzzing social life, and consume one too many eggnogs (who's counting?!), you’re more likely to feel like Christmas is coming at warp speed. Meanwhile, for those feeling isolated, the time between holiday seasons drags longer than Aunt Karen's fruitcake story. The solution? Spread the cheer! Invite your neighbors over to help demolish your sugary cookies and, in return, they might help untangle those @#$%! Christmas lights.

This holiday season, balance is key. Skip the sugar-shaming and embrace the holiday spirit, whether it’s the thrill of gift-giving, decking the halls, or indulging in a sweet treat (or 5), Christmas doesn’t just fly, it sleighs!

Original studies

  • Cookie cravings - examining the impact of sugar content information on Christmas treat preferences via mobile eye-tracking. [2]
  • Distortions to the passage of time for annual events: exploring why Christmas and Ramadan feel like they come around more quickly each year. [3]

Edition 112 - December 7, 2024toggle arrow icon

Colchicine for inflammation after MI: not a silver bullet?

One-Minute Telegram 112-2024-1/3

10-second takeaway

Inflammation is known to play a role in the development of atherosclerosis, but recent trials using the antiinflammatory drug colchicine to improve cardiovascular outcomes in patients with existing atherosclerotic disease have shown conflicting results. In this multicenter, prospective, randomized, placebo-controlled trial, colchicine treatment after percutaneous coronary intervention (PCI) for myocardial infarction (MI) did not decrease the incidence of death from cardiovascular causes, recurrent MI, stroke, or unplanned coronary revascularization compared to placebo. Current recommendations by the European Society of Cardiology and the American Heart Association for the use of colchicine in patients with coronary artery disease may need to be reviewed.

Study breakdown

  • Study population: 7062 patients (mean age, 61 years; 20% female) undergoing PCI for either large NSTEMI (with LVEF ≤ 45%, diabetes mellitus, multivessel CAD, previous MI, and/or age > 60 years) or STEMI
  • Study design: international, multicenter, prospective, randomized, placebo-controlled trial
    • Setting: 104 centers in 14 countries between February 2018 and November 2022
    • Intervention: treatment with colchicine or placebo as soon as possible after PCI
    • Primary outcome was a composite of:
    • Secondary outcomes included:
      • Composite of death from cardiovascular causes, recurrent MI, or stroke
      • Total number of primary outcome events
    • Additional assessments included:
      • CRP levels
      • Safety outcomes
  • Main results
    • Median follow-up: 3 years
    • No significant difference between the colchicine and placebo groups in:
      • Incidence of a primary outcome event: 9.1% in the colchicine group vs. 9.3% in the placebo group (HR, 0.99; 95% CI, 0.85 to 1.16)
      • Incidence of the individual components of the primary outcome
      • Death from cardiovascular causes, recurrent MI, or stroke
      • Number of primary outcome events
      • Incidence of serious adverse events
    • Incidence of diarrhea was higher in the colchicine group than in the placebo group.
    • CRP at 3 months was lower in the colchicine group than in the placebo group: mean difference, -1.28 mg/L (-1.81 to -0.75).
  • Limitations include:
    • Women and minority groups were underrepresented.
    • Discontinuation of the trial regimen was higher than anticipated.
    • Adherence was self-reported.
  • Study funding: Canadian Institutes of Health Research, the Population Health Research Institute, and Boston Scientific (Marlborough, MA); trial drugs partially donated by Tiofarma, Oud-Beijerland, Netherlands
  • Original study: Colchicine in acute myocardial infarction [4]
  • Related AMBOSS articles: Acute coronary syndrome, Myocardial infarction, Coronary artery disease

Systolic hypertension treatment in T2DM: intensify treatment to lower CV risk

One-Minute Telegram 112-2024-2/3

10-second takeaway

Systolic hypertension is a common and important cause of increased cardiovascular risk in patients with T2DM, but optimal systolic blood pressure (SBP) targets in this population remain undetermined. In this randomized clinical trial conducted in China, participants with T2DM who received intensive hypertension treatment (target SBP < 120 mm Hg) had a significantly lower incidence of major cardiovascular events compared to those who received standard treatment (target SBP < 140 mm Hg). These results support the use of intensive blood pressure control in patients with T2DM.

Study breakdown

  • Study population: 12,821 adults aged ≥ 50 years (mean age, 64 years; 45% female) with T2DM, elevated SBP, and increased risk of cardiovascular disease
  • Study design: multicenter, prospective, randomized clinical trial
    • Setting: 145 clinical sites in China between February 2019 and December 2021
    • Intervention: intensive hypertension treatment (target SBP < 120 mm Hg) or standard hypertension treatment (target SBP < 140 mm Hg)
    • Primary outcome was a composite of first occurrence of:
    • Secondary outcomes included:
  • Main results
    • Median follow-up: 4.2 years
    • Mean SBP at 1 year
      • 122 mm Hg in the intensive treatment group and 133 mm Hg in the standard treatment group
      • Between-group difference was sustained throughout the trial.
    • Compared to the standard treatment group, the intensive treatment group experienced:
  • Limitations include:
    • Lack of blinding of participants and trial physicians (but not outcome assessors) to treatment group assignments
    • Some of the data collected during the COVID-19 pandemic was based on telephone interviews and home blood pressure monitoring, which may have led to data inaccuracies.
    • Findings may not be generalizable to patients of non-Chinese ethnicity.
  • Study funding: grants from the National Key Research and Development Program of the Ministry of Science and Technology of China, National Natural Science Foundation of China, Shanghai Municipal Government, Shanghai Shenkang Hospital Development Center, and others
  • Original study: Intensive blood-pressure control in patients with type 2 diabetes [5]
  • Related AMBOSS articles: Hypertension, Diabetes mellitus

Pick midlines over PICC for OPAT

One-Minute Telegram 112-2024-3/3

10-second takeaway

Midline catheters are currently recommended over peripherally inserted central catheters (PICCs) for administration of outpatient parenteral antimicrobial therapy (OPAT) with a planned duration of ≤ 14 days, but evidence supporting this recommendation is limited. In this retrospective cohort study, midline catheters for OPAT were associated with a significantly lower risk of major complications than PICCs, particularly when dwell time was ≤ 14 days. These results support current guideline recommendations.

Study breakdown

  • Study population: 2824 adults (median age, 67 years; 54% male) who received a vascular access device for OPAT after hospitalization in a general medicine unit
  • Study design: retrospective cohort study
    • Setting: 69 hospitals in Michigan between January 2017 and November 2023
    • Exposure: midline catheter or PICC insertion for OPAT
    • Primary outcome: occurrence of a major device complication, i.e., catheter-related bloodstream infection (CRBSI) or catheter-related venous thromboembolism (CR-VTE)
    • Secondary outcomes included:
      • Minor complications (e.g., catheter dislodgement, occlusion, tip migration, infiltration, superficial thrombophlebitis, exit site concerns)
      • Device failure (removal of the device for any complication)
    • Follow-up: to device removal, death, or 30 days from device placement, whichever occurred first
  • Main results
    • Median dwell time
    • Device distribution
    • After accounting for dwell time and covariates, compared to PICCs, midline catheters were associated with a:
      • Lower risk of major complications overall (0.8% vs. 3.4%; aHR, 0.46; 95% CI, 0.23–0.91) and with dwell time ≤ 14 days (aHR, 0.29; 0.12–0.68)
      • Similar risk of major complications with dwell time > 14 days (aHR, 0.42; 0.13–1.40)
      • Similar risk of CRBSI and CR-VTE as individual outcomes, minor complications, and device failure
  • Limitations include:
    • Data was limited to accessible information from existing medical records.
    • Retrospective study design allows for residual confounders and cannot be used to infer causality.
    • Complications occurring after device removal or after 30 days of follow-up were not captured.
    • Inadequate power to detect differences in outcomes beyond 14 days
  • Study funding: the Blue Cross Blue Shield of Michigan and Blue Care Network as part of the Blue Cross Blue Shield of Michigan Value Partnerships program
  • Original study: Midline vs peripherally inserted central catheter for outpatient parenteral antimicrobial therapy [6]
  • Related AMBOSS articles: Vascular access, Hospital-acquired infections

Edition 111 - November 23, 2024toggle arrow icon

Timing meals to trim body weight

One-Minute Telegram 111-2024-1/3

10-second takeaway

Meal-timing strategies for weight loss, such as time-restricted eating (TRE), are gaining attention, as long-term adherence to conventional calorie-restriction methods can be challenging. This systematic review and meta-analysis found that meal-timing interventions may result in a small reduction in body weight, BMI, and waist circumference, as well as improved metabolic health. However, the clinical significance of these findings is uncertain, demonstrating the ongoing challenge of obesity and overweight management.

Study breakdown

  • Study population: 2485 adults aged ≥ 18 years (mean age, 44 years; 69% female; mean BMI, 33 kg/m2)
  • Study design: systematic review and meta-analysis of 29 randomized clinical trials in multiple countries
    • Intervention: TRE, reduced meal frequency, or earlier caloric distribution (i.e., front-loading calories in the morning)
    • Primary outcomes: change in body weight, BMI, and waist circumference
    • Secondary outcomes included HbA1c and fasting glucose levels.
    • Median follow-up: 12 weeks
  • Main results
    • All feeding interventions were associated with a reduction in body weight and BMI compared to control.
    • Body weight
      • TRE: mean difference, -1.37 kg (95% CI, -1.99 to -0.75 kg)
      • Reduced meal frequency: -1.84 kg (-3.55 to -0.13 kg)
      • Earlier daily caloric distribution: -1.75 kg (-2.37 to -1.13 kg)
    • BMI
      • TRE: -0.44 kg/m2 (-0.67 to -0.2)
      • Reduced meal frequency: -0.65 kg/m2 (-1.09 to -0.21)
      • Earlier daily caloric distribution: -1.06 kg/m2 (-1.82 to -0.3)
    • Waist circumference
      • TRE: -1.96 cm (-3.24 to -0.68 cm)
      • Reduced meal frequency: no difference
      • Earlier daily caloric distribution: -1.77 cm (-2.89 to -0.65)
    • TRE was associated with a modest decrease in HbA1c (-0.08%; -0.15 to -0.01%) and fasting plasma glucose levels (-1.15 mg/dL; -1.77 to -0.53 mg/dL).
  • Limitations include:
    • Generalizability may be limited, as participants were primarily recruited from clinical rather than community settings.
    • Studies on calorie distribution did not include male participants.
    • Some evidence was low quality with a high risk of bias, and study designs were inconsistent.
    • Relatively short follow-up periods limit the assessment of long-term effects.
  • Study funding: Australian National Health and Medical Research Council Investigator Grant
  • Original study: Meal timing and anthropometric and metabolic outcomes: a systematic review and meta-analysis. [7]
  • Related AMBOSS articles: Obesity and metabolic syndrome

Bone vs. vein: the race against time for drug delivery during cardiac arrest

One-Minute Telegram 111-2024-2/3

10-second takeaway

Timely drug administration during an out-of-hospital cardiac arrest is critical for patient survival, but it is unclear if outcomes improve with intraosseous (IO) access vs. intravenous (IV) access. This study found no improvement in 30-day survival with IO-first access compared to IV-first access. Emergency medical services providers should continue to choose the most feasible and rapid access route based on the clinical situation.

Study breakdown

  • Study population: 6082 adults aged ≥ 18 years (mean age, 68 years; 34.7% female) with out-of-hospital cardiac arrest requiring vascular access for drug administration
  • Study design: multicenter, open-label, randomized trial
  • Main results
    • No difference in survival at 30 days: 4.5% in the IO-first group vs. 5.1% in the IV-first group (adjusted odds ratio, 0.94; 95% CI, 0.68–1.32)
    • No difference in favorable neurological function at hospital discharge: 2.7% in the IO-first group vs. 2.8% in the IV-first group (0.91; 0.57–1.47)
    • Lower ROSC in the IO-first group compared to the IV-first group (36.0% vs. 39.1%; aOR, 0.86; 0.76–0.97)
  • Limitations include:
    • Correct placement of IO cannulas could not be confirmed.
    • The study was not blinded.
  • Study funding: National Institute for Health and Care Research (NIHR) Health Technology Assessment Programme
  • Original study: A randomized trial of drug route in out-of-hospital cardiac arrest. [8]
  • Related AMBOSS articles: Cardiac arrest and cardiopulmonary resuscitation

Digital interventions help prevent childhood obesity

One-Minute Telegram 111-2024-3/3

10-second takeaway

Growth in the first 2 years of life is a predictor of chronic obesity and cardiovascular disease, but past efforts to prevent early childhood obesity have been mostly ineffective. This study found that adding a digital intervention to clinic-based health behavior counseling improved child weight-for-length trajectories and reduced childhood obesity at 24 months in a racially and ethnically diverse population. Clinicians may consider adding a digital intervention to well-child visits.

Study breakdown

  • Study population: 900 parent-infant pairs (median gestational age, 39.2 weeks; 45.0% Hispanic, 20.6% White non-Hispanic, 15.9% Black non-Hispanic, and 18.3% other)
  • Study design: multicenter, randomized, parallel-group trial
    • Setting: outpatient clinics at 6 US medical centers
    • Randomized 1:1 to counseling, health literacy-informed responsive text messages, and a web-based dashboard (intervention) or booklets (control)
    • Primary outcome: child weight-for-length trajectory
    • Secondary outcomes included weight-for-length z-score, BMI z-score, and the percentage of children with overweight or obesity according to WHO and CDC criteria.
    • Follow-up: 24 months
  • Main results
    • The intervention group had improved outcomes compared to the control group.
      • Lower mean weight-for-length trajectory: -0.33 kg/m (95% CI, -0.57 to -0.09)
      • Weight-for-length z-score: adjusted mean difference, -0.19 (-0.37 to -0.02)
      • BMI z-score: adjusted mean difference, -0.19 (-0.36 to -0.01)
      • Lower percentage of children with:
        • Overweight based on WHO criteria: 12.4% vs.16% (adjusted risk ratio, 0.68; 0.48 to 0.93)
        • Obesity based on WHO criteria: 2.6% vs. 5.7% (0.46; 0.24 to 0.89)
        • Obesity based on CDC criteria: 7.4% vs. 12.7% (0.56; 0.36 to 0.88)
    • The effect size was greatest in children with food insecurity.
  • Limitations include:
    • Lack of generalizability to individuals whose preferred language is not English or Spanish
    • Inability to assess which components of the web-based dashboard contributed to positive outcomes
  • Study funding: Patient-Centered Outcomes Research Institute
  • Original study: A digital health behavior intervention to prevent childhood obesity: the Greenlight Plus randomized clinical trial [9]
  • Related AMBOSS articles: Well-child visits

Edition 110 - November 9, 2024toggle arrow icon

Improving control of hypertension: a triple beats a double

One-Minute Telegram 110-2024-1/3

10-second takeaway

Recent guidelines recommend initiating treatment for hypertension with a combination of two medications, ideally as a single-pill combination (SPC), and three-drug combinations have increasingly proven to be even more efficacious for blood pressure control. This randomized controlled trial demonstrated that an SPC containing low-dose telmisartan, amlodipine, and indapamide resulted in better blood pressure control than combinations of any two of the individual components. SPCs containing three antihypertensive medications for treatment initiation or intensification are well tolerated and may significantly improve blood pressure control.

Study breakdown

  • Study population: 1385 adults aged ≥ 18 years with hypertension (mean age, 59 years; 51% female)
  • Study design: randomized, double-blind, active-controlled trial
    • Setting: 83 international outpatient clinics
    • All participants were switched from existing antihypertensive regimens to a half dose of GMRx2 (a triple SPC containing 40 mg telmisartan, 5 mg amlodipine, and 2.5 mg indapamide) for 4 weeks.
    • At 4 weeks, participants were randomized 2:1:1:1 to:
    • At 6 weeks, doses of all drugs were doubled.
    • Primary efficacy outcome: change in home SBP from randomization to 12 weeks
    • Primary safety outcome: treatment discontinuation due to an adverse event from randomization to 12 weeks
  • Main results
    • At 12 weeks, home SBP was lower in the triple SPC group (mean, 126 mm Hg) compared with each of the dual-therapy groups.
    • Least squares difference in SBP change from randomization to 12 weeks
    • No statistically significant difference in the primary safety outcome between the groups
  • Limitations include:
    • The trial design did not allow for comparison between half-dose and standard-dose combinations or between the trial drugs and other commonly used drugs and doses.
    • Some participants were not uptitrated from the half-dose regimen, which may have led to underestimation of the differences between groups.
    • Almost 40% of participants who entered the 4-week run-in period were excluded from randomization, which may limit generalizability.
    • Important patient groups (e.g., those with cardiovascular disease, uncontrolled diabetes, or significant kidney disease) were excluded.
  • Study funding: George Medicines
  • Original study: Efficacy and safety of a novel low-dose triple single-pill combination of telmisartan, amlodipine and indapamide, compared with dual combinations for treatment of hypertension: a randomised, double-blind, active-controlled, international clinical trial [10]
  • Related AMBOSS articles: Hypertension

Keep the safety on for individuals with Alzheimer disease

One-Minute Telegram 110-2024-2/3

10-second takeaway

Up to 60% of adults with Alzheimer disease and related dementias (ADRD) in the US have a firearm at home, but caregivers typically have little guidance on the prevention of firearm-related injury. This randomized trial found that while an online firearm safety decision aid for ADRD caregivers had a statistically significant but small increase in the preparation for decision-making about firearm access, there was no short-term effect on the reduction of firearm access compared to a control group. While the decision aid showed some benefit in increasing caregivers’ preparedness for decision-making, the long-term impact on firearm safety is unknown.

Study breakdown

  • Study population: 500 adult caregivers aged ≥ 18 years (mean age, 47 years; 69% female) for community-dwelling adults with ADRD and access to a firearm
  • Study design: randomized controlled trial in the US
    • Participants were recruited through social media advertisements and relevant organizations and were compensated for participation.
    • 1:1 randomization to either:
    • Outcomes were assessed using web-based questionnaires.
      • Primary outcome: self-reported preparation for decision-making (PDM) as measured on the PDM scale (range, 0–100) immediately after the intervention
      • Secondary outcome: any self-reported step taken to reduce firearm access, assessed at 2 weeks and 2 months
  • Main results
    • Significantly higher PDM score in the SiD group than in the control group (69.8 vs. 64.8): mean difference, 4.8 (95% CI, 0.53 to 9.07)
    • No difference between the groups in steps taken to reduce firearm access
  • Limitations include:
    • Participants were self-selected and all had internet access, which may have biased results.
    • The control group received some information about firearm safety, which may have attenuated the comparative effect on the SiD group.
    • At baseline, 47% of participants had already taken steps to reduce firearm access, which may have limited the effect on the secondary outcome.
  • Study funding: National Institute on Aging (part of the National Institutes of Health)
  • Original study: The effect of the “Safety in Dementia” online tool to assist decision making for caregivers of persons with dementia and access to firearms: a randomized trial [11]
  • Related AMBOSS articles: Alzheimer disease

Suicide prevention: integrating care beyond the crisis

One-Minute Telegram 110-2024-3/3

10-second takeaway

Many individuals who died by suicide saw a primary care physician in the month before their death. A cluster randomized trial found that implementing population-based suicide care (SC) combined with treatment for depression and a substance use program led to a significant reduction in suicide attempts within 90 days of a primary care visit. These findings support the importance of expanding suicide prevention services in primary care.

Study breakdown

  • Study population: 333,593 adults (mean age, ∼ 50 years; ∼ 60% female; ∼ 70% White) across 19 primary care practices
  • Study design: secondary analysis of a stepped-wedge cluster randomized trial
    • 19 primary care practices with staggered SC implementation from January 2015 to July 2018
    • SC intervention (including depression and substance use screening and treatment, suicide risk assessment, and suicide safety planning) vs. usual care (UC)
    • Data was obtained from electronic medical records and insurance claims.
    • Primary outcomes: rate of suicide safety planning and suicide attempts
    • Follow-up: 90 days
  • Main results. Compared to UC, SC was associated with:
    • Higher suicide safety planning rates: 38.3 vs. 32.8 per 10,000 patients (difference, 5.5; 95% CI, 2.3 to 8.7)
    • Fewer suicide attempts within 90 days: 4.5 vs. 6.0 per 10,000 patients (difference, -1.5; -2.6 to -0.4)
      Significantly higher depression screening rates: 8278.8 vs. 2923.7 per 10,000 patients
  • Limitations include:
  • Study funding: National Institute of Mental Health
  • Original study: Effectiveness of integrating suicide care in primary care: secondary analysis of a stepped-wedge, cluster randomized implementation trial [12]
  • Related AMBOSS articles: Suicide

Edition 109 - October 26, 2024toggle arrow icon

Ghosts, zombies, and vampires: a Halloween thriller

One-Minute Telegram 109-2024-1/3: As Halloween creeps closer, you don't need to leave home for a fright: Your body is its very own house of horrors! From cardiac ghosts and zombies lurking in blood vessels to vampire facials, truth is stranger than fiction.

  • Ghost in the atrium: In a chilling case report, doctors performing a transesophageal echocardiogram spotted a fibrous tissue ‘ghost’ in a 75-year-old's right atrium after a pacemaker lead extraction. While some ghosts fly around the atrium, this one was stable, shackled to the arterial wall. Ghosts used to strike fear into the hearts of cardiologists (as well as their hosts) in case they threw off a deadly clot, but, despite their eerie presence, these spirits are usually more Casper than Bloody Mary, requiring no exorcism (or medical intervention). The real fright here? Misidentifying harmless ghosts as something more sinister, leading to unnecessary treatment. Remember, not every ghost is a threat; sometimes, they just need a little space to float around.
  • Rise of the zombie cells: In a research paper straight out of a horror movie, scientists discuss a real-life zombie invasion of our blood vessels! Senescent cells, or ‘zombie cells,’ refuse to die, but instead of munching on brains, these undead cells secrete toxic substances that speed up aging of the heart and blood vessels. Researchers aren’t taking this lying down, though. Everyone knows that to kill zombies, you need to double tap with senolytics (to take out these cellular freeloaders) and senomorphics (to neutralize their secretions). The plot twist? Leave a few cells behind. Eliminate too many too soon, and you might miss out on their occasional (and surprisingly helpful) role in healing.
  • Forever young: While vampires would cause most people to run screaming, some celebrities are doing the chasing. After Kim Kardashian posted pictures of her vampire facial (more boringly known as microneedling with platelet-rich plasma) back in 2013, everyone wanted a face full of blood. However, a recent overview of systematic reviews suggests that the evidence for vampire facials, much like the evidence for vampires, is sadly lacking.

This Halloween, make room for friendly ghosts and useful zombies, and remember that face paint is better than blood for a spooktacular costume.

Original studies

A weight off your shoulders: tirzepatide’s dual impact on sleep apnea and weight

One-Minute Telegram 109-2024-2/3

10-second takeaway

Obstructive sleep apnea (OSA) is closely linked to obesity, making weight management a crucial component of treatment. In two phase 3 trials, tirzepatide significantly reduced both apnea-hypopnea index (AHI) and body weight at 52 weeks compared to placebo, regardless of whether positive airway pressure (PAP) therapy was used. These findings suggest a potential new pharmacological option for individuals with OSA, especially those struggling with adherence to PAP therapy.

Study breakdown

  • Study population: 469 adults with moderate to severe OSA and obesity in two trials
    • Trial 1: 234 adults unwilling or unable to use PAP therapy (mean age, 47.9 years; 67.1% men; 65.8% White)
    • Trial 2: 235 adults who used PAP therapy (mean age, 51.7 years; 72.3% men; 73.1% White)
  • Study design: two phase 3, double-blind, randomized controlled trials
    • Setting: 60 sites in 9 countries
    • Intervention: 1:1 randomization to tirzepatide (up to a maximum tolerated dose of 10 mg or 15 mg) or placebo
    • Primary outcome: change in AHI at 52 weeks
    • Secondary outcomes included changes in:
  • Main results
    • Mean change in AHI
      • Trial 1: -25.3 events/hour with tirzepatide vs. -5.3 events/hour with placebo (difference, -20.0 events/hour; 95% CI, -25.8 to -14.2; P < 0.001)
      • Trial 2: -29.3 events/hour with tirzepatide vs. -5.5 events/hour with placebo (difference, -23.8 events/hour; -29.6 to -17.9; P < 0.001)
    • Significant results related to secondary outcomes included:
      • Body weight reduction with tirzepatide vs. placebo
        • Trial 1: -17.7% vs. -1.6%
        • Trial 2: -19.6% vs. -2.3%
      • Improvements in subjective sleep impairment and disturbance scores in both trials
      • Reductions in SBP, high-sensitivity CRP, and hypoxic burden in both trials
  • Limitations include:
    • Short trial duration (52 weeks) limits assessment of long-term cardiovascular outcomes.
    • May not be generalizable to individuals without obesity
  • Study funding: Eli Lilly
  • Original study: Tirzepatide for the treatment of obstructive sleep apnea and obesity [17]
  • Related AMBOSS articles: Obesity and metabolic syndrome, Obstructive sleep apnea

Edition 108 - October 12, 2024toggle arrow icon

Can high-intensity NIPPV prevent intubation in AECOPD?

One-Minute Telegram 108-2024-1/3

10-second takeaway

Noninvasive positive-pressure ventilation (NIPPV) reduces the rate of endotracheal (ET) intubation in patients with acute exacerbation of COPD (AECOPD), but the effects of high- vs. low-intensity NIPPV remain unknown. In this randomized single-blind clinical trial, fewer participants with AECOPD and persistent hypercapnia who received high-intensity NIPPV met criteria for endotracheal (ET) intubation compared to those who received low-intensity NIPPV. Rates of ET intubation were similar in both groups. Further studies are needed to elucidate the role of high-intensity NIPPV in the management of AECOPD.

Study breakdown

  • Study population: 300 adults aged ≥ 18 years (mean age, 73 years; 68% men) with AECOPD and persistent hypercapnia after receiving 6 hours of low-intensity NIPPV
  • Study design: single-blind, multicenter, randomized trial
  • Main results
    • Primary outcome
      • Criteria for ET intubation were met in 4.8% of participants in the intervention group and 13.7% in the comparator group.
      • Absolute difference: -9% (95% CI, -15.4% to -2.5%)
    • Secondary outcomes
      • No significant difference in the rate of ET intubation between groups
      • The composite outcome occurred in 3.4% of participants in the intervention group and 11.1% in the comparator group.
    • Absolute difference: -7.7% (95% CI, -13.5% to -1.9%)
    • Safety outcomes: Abdominal distention occurred more frequently in the intervention group, but few serious adverse events were reported in either group.
  • Limitations include:
    • The study was terminated early because of logistical challenges related to COVID-19 and an interim analysis showing a significant difference in the primary outcome between groups.
    • Investigators and study physicians were not blinded to the intervention, potentially biasing treatment decisions.
    • Patients who met criteria for ET intubation could switch to high-intensity NIPPV, lowering the likelihood of detecting a difference in ET intubation rates between groups.
  • Study funding: Beijing Hospitals Authority Youth Programme
  • Original study: Effect of high-intensity vs low-intensity noninvasive positive pressure ventilation on the need for endotracheal intubation in patients with an acute exacerbation of chronic obstructive pulmonary disease: the HAPPEN randomized clinical trial [18]
  • Related AMBOSS content: NIPPV, AECOPD

Is 24/7 oxygen necessary for severe hypoxemia?

One-Minute Telegram 108-2024-2/3

10-second takeaway

Previous studies suggested that continuous long-term oxygen therapy increases survival in patients with severe hypoxemia. In this randomized national registry-based trial of patients with severe hypoxemia, continuous oxygen therapy for 24 hours a day was not associated with a lower risk of hospitalization or death compared to oxygen therapy for 15 hours a day. Further studies are needed to explore the potential benefits of a shorter daily duration of oxygen therapy.

Study breakdown

  • Study population: 241 adults aged ≥ 18 years (mean age, 76 years; 59% women) with chronic severe hypoxemia who had been started on long-term oxygen therapy within the previous 28 days
  • Study design: randomized, multicenter, national registry-based trial
    • Setting: 20 respiratory outpatient clinics in Sweden
    • Intervention: continuous oxygen therapy for 15 hours vs. 24 hours a day
    • Primary outcome: hospitalization or death from any cause within 1 year
    • Secondary outcomes included hospitalizations, deaths, and patient-reported health status and perceived well-being at 3 and 12 months.
  • Main results
    • Primary outcome: 24-hour vs. 15-hour group
      • No significant difference in risk of hospitalization or death (HR, 0.99; 95% CI, 0.72–1.36)
      • 24-hour oxygen therapy was not superior to 15-hour therapy (90% CI, 0.76–1.29; P = 0.007 for nonsuperiority).
    • Secondary outcomes: no significant difference between the groups
  • Limitations include:
    • Adherence to daily treatment duration was self-reported.
    • The primary outcome and analysis population were amended to allow for a smaller sample size because of low recruitment.
    • A benefit of 24-hour oxygen therapy cannot be completely excluded, as a wide margin was used to demonstrate nonsuperiority.
    • Data on adverse events was limited.
  • Study funding: Crafoord Foundation and others
  • Original study: Long-term oxygen therapy for 24 or 15 hours per day in severe hypoxemia [19]
  • Related AMBOSS articles: Respiratory failure and arrest

Confronting diagnostic discordance in pneumonia

One-Minute Telegram 108-2024-3/3

10-second takeaway

Pneumonia remains a leading cause of death from an infectious disease. While multiple studies and guidelines have focused on pneumonia management, the accuracy of diagnosis has received less scrutiny. In this retrospective nationwide cohort study, more than half of patients who were treated in the hospital for pneumonia had discordant diagnoses from admission to discharge. Additional research is needed to determine factors affecting diagnostic accuracy.

Study breakdown

  • Study population: 317,437 adult hospitalizations (mean age, 72 years; 96% men, 75% White) with a diagnosis of pneumonia at the time of admission from the ED or at discharge
  • Study design: retrospective nationwide cohort study
    • Setting: 118 U.S. Veterans Affairs medical centers from January 2015 to January 2022
    • Data collection: natural language processing of diagnosis codes, provider notes, radiology reports, and antimicrobial administration records
    • Primary outcomes: concordance between ED diagnosis, chest imaging findings, and discharge diagnosis
    • Secondary outcomes included illness severity, 30-day mortality, and diagnostic uncertainty reflected in provider notes.
  • Main results
  • Limitations include:
    • Some discordance may have been attributable to documentation and coding errors.
    • Results may not be generalizable to women or other health care systems.
    • The study was not designed to assess causal relationships between diagnostic discordance and clinical outcomes.
  • Study funding: the Gordon and Betty Moore Foundation
  • Original study: Diagnostic discordance, uncertainty, and treatment ambiguity in community-acquired pneumonia: a national cohort study of 115 U.S. Veterans Affairs hospitals [20]
  • Related AMBOSS articles: Pneumonia

Q3 2024toggle arrow icon

Edition 107 - September 28, 2024toggle arrow icon

Shocking news: defibrillator pad positioning may affect ROSC in cardiac arrest

One-Minute Telegram 107-2024-1/3

10-second takeaway

Early defibrillation is essential for survival after an out-of-hospital cardiac arrest (OHCA). However, the optimum initial positioning of defibrillator pads remains unknown. In this prospective cohort study of individuals with OHCA, anterior-posterior (AP) pad placement was associated with a higher return of spontaneous circulation (ROSC) than anterior-lateral (AL) placement, but there was no significant difference in the presence of pulses at ED arrival, survival to hospital admission, survival to hospital discharge, or neurological outcome. Further studies are needed to determine the impact of defibrillator pad placement on outcomes after OHCA.

Study breakdown

To mask or not to mask: wearing face masks may help prevent respiratory infections

One-Minute Telegram 107-2024-2/3

10-second takeaway

Observational studies suggest that wearing a mask may help reduce the risk of respiratory infections, including COVID-19, but some randomized trials have shown no benefit. In this pragmatic randomized superiority trial, participants who wore a surgical mask in public reported fewer respiratory infection symptoms over 14 days than those who did not wear a mask. More studies are needed to determine if wearing a mask protects against respiratory infections.

Study breakdown

  • Study population: 4575 adults aged ≥ 18 years (mean age, 51 years; 60.9% women)
  • Study design: pragmatic randomized superiority trial
    • Setting: Norway from February to April 2023
    • Intervention: wearing a surgical face mask in public places such as shopping centers and public transportation (intervention group) vs. not wearing a surgical mask (control group)
    • Primary outcome: self-reported respiratory infection symptoms
    • Secondary outcomes included:
      • Self-reported and registered positive COVID-19 test results
      • Self-reported sick leave
      • Follow-up: 14 days
  • Main results
    • Primary outcome
      • Self-reported respiratory symptoms occurred in:
        • 8.9% of participants in the intervention group
        • 12.2% of participants in the control group
    • Intention-to-treat analysis
    • Secondary outcomes: No significant difference was found for positive COVID-19 test results or sick leave.
    • Adverse effects occurred in 3.4% of participants in the intervention group and included:
      • Unpleasant comments from others
      • Facial discomfort
      • Fogging of glasses
  • Limitations include:
    • Missing outcome data (13.7% in the control group and 20.7% in the intervention group) may have led to incorrect conclusions.
    • Only 25% of participants in the intervention group reported wearing the mask as recommended (i.e., all the time), possibly affecting the strength of the conclusions.
    • Most data was self-reported.
    • Participant blinding was not possible
  • Study funding: the Centre for Epidemic Interventions Research and Norwegian Institute of Public Health
  • Original study: Personal protective effect of wearing surgical face masks in public spaces on self-reported respiratory symptoms in adults: pragmatic randomised superiority trial [22]
  • Related AMBOSS articles: Upper respiratory tract infection, COVID-19 (coronavirus disease 2019)

Rivaroxaban plus aspirin in PAD: the combo that walks the walk

One-Minute Telegram 107-2024-3/3

10-second takeaway

In individuals with peripheral arterial disease (PAD), rivaroxaban combined with aspirin reduces the risk of major adverse cardiovascular and limb events compared to aspirin alone. However, little is known about the effect of rivaroxaban plus aspirin in individuals with PAD and intermittent claudication. In this randomized clinical trial, participants with PAD and intermittent claudication taking rivaroxaban plus aspirin for 24 weeks experienced significant improvement in their total walking distance compared to participants taking aspirin alone. The combination of rivaroxaban and aspirin may be beneficial in reducing intermittent claudication symptoms, but further research is needed to substantiate this finding.

Study breakdown

  • Study population: 88 adults aged ≥ 18 years (mean age, 67 years; 54% female) with PAD and intermittent claudication
  • Study design: randomized, open-label, multicenter trial
  • Main results
    • Primary efficacy outcome
      • Walking distance improved by:
      • Absolute difference: 68 ± 24 m (95% CI, 19–116 m; P = 0.007)
    • Primary safety outcome: 2 participants in the intervention group had a clinically relevant nonmajor bleeding event.
    • Secondary outcomes: greater improvement in the intervention group than the aspirin alone group
      • Treadmill walking test: total walking distance difference of 79 ± 36 m (95% CI, 7–150 m)
      • Modified Walking Impairment Questionnaire: increased reported walking distance and number of stair flights climbed
  • Limitations include:
    • Small sample size led to imbalances in baseline characteristics.
    • Results may not be generalizable, as 89% of individuals who were potentially eligible were not included in the study.
    • Quality of life was not assessed and is a meaningful outcome for potential future studies.
  • Study funding: Bayer S.A.
  • Original study: Rivaroxaban for patients with intermittent claudication [23]
  • Related AMBOSS articles: Peripheral arterial disease

Edition 106 - September 14, 2024toggle arrow icon

Liberal vs. restrictive transfusion strategy in traumatic brain injury

One-Minute Telegram 106-2024-1/2

10-second takeaway

Restrictive transfusion strategies for anemia are now accepted as an appropriate treatment for most critically ill patients, but the best transfusion strategy for minimizing neurological injury in traumatic brain injury (TBI) remains unclear. In this multicenter, international randomized trial, a liberal transfusion strategy did not significantly reduce the risk of unfavorable outcomes in ICU patients with a moderate or severe TBI at 6 months compared to a restrictive transfusion strategy. However, a liberal transfusion strategy was associated with better scores on some quality of life measures. A restrictive transfusion strategy for managing anemia in patients with a TBI may be appropriate, but further research is needed to assess the impact on nuanced measures of neurological recovery.

Study breakdown

  • Study population: 742 adults aged ≥ 18 years (mean age, 48.7 years; 72.7% men) with an acute moderate or severe TBI (GCS score 3–12) and hemoglobin ≤ 10 g/dL
  • Study design: prospective, randomized, open, blinded end-point trial
    • Setting: 34 neurocritical care units in Canada, the UK, France, and Brazil
    • Participants were randomized 1:1 to a transfusion threshold of:
    • Primary outcome: unfavorable outcome at 6 months
    • Secondary outcomes
      • Mortality
      • Functional Independence Measure (FIM) score
      • Quality of life measures (EuroQol visual analogue scale, EuroQol five-dimension five-level utility index, Quality of Life after Brain Injury scale)
      • PHQ-9 score
    • Follow-up: 6 months
  • Main results
    • The incidence of unfavorable outcomes was similar in the liberal group (68.4%) and the restrictive group (73.5%): RR, 0.93 (95% CI, 0.83–1.04).
    • Mortality was similar in the liberal group (26.8%) and the restrictive group (26.3%).
    • Compared to the restrictive group, the liberal group had:
      • Higher FIM scores (median difference, 4.34; 95% CI, 0.22–8.45)
      • Higher scores on EuroQol visual analogue scale (median difference, 5.19; 0.52–9.86) and EuroQol five-dimension five-level utility index (median difference, 0.06; 0.01–0.10)
      • Similar Quality of Life after Brain Injury and PHQ-9 scores
  • Limitations include:
    • Higher than expected baseline risk levels may have hampered the ability to detect small treatment effects.
    • Statistical analysis of secondary outcomes was not adjusted for multiple comparisons, limiting the ability to assign significance to the findings.
    • Treatment providers were not blinded to study groups.
  • Study funding: Canadian Institutes of Health Research and Canadian Accelerating Clinical Trials Consortium
  • Original study: Liberal or restrictive transfusion strategy in patients with traumatic brain injury. [24]
  • Related AMBOSS articles: Traumatic brain injury

Real-world implications of dialysis vs. medical management in older adults with CKD

One-Minute Telegram 106-2024-2/2

10-second takeaway

Choosing whether to start dialysis can be difficult for older adults with chronic kidney disease (CKD) because there is limited practical data to guide their decision-making. In this observational cohort study of older adults with CKD, early initiation of dialysis was associated with a very modest, statistically nonsignificant increase in survival compared to medical management alone, but it was also associated with significantly less time spent at home. Including this information in decision aids and shared decision-making conversations can help patients with CKD make choices that align with their personal values and health care goals.

Study breakdown

  • Study population: 20,440 adults aged ≥ 65 years (mean age, 77.9 years, 2% women) with CKD, eGFR < 12 mL/min/1.73 m2, and no planned kidney transplant
  • Study design: observational cohort target trial emulation study
    • Setting: U.S. Department of Veterans Affairs from 2010 to 2018
    • The target trial emulation study was constructed using health record data.
    • Exposure: starting dialysis within 30 days vs. medical management
    • Outcomes
      • Mean survival
      • Cumulative days spent at home (i.e., not in a medical facility)
    • Analysis
      • Intention-to-treat (primary): included patients who crossed over from medical management to dialysis
      • Per-protocol: excluded patients who crossed over from medical management to dialysis
    • Follow-up: until 1 of the 3 endpoints (3 years, participant death, or trial termination) was reached for each patient
  • Main results
    • Survival over 3 years was similar in the dialysis group (770 days) and the medical management group (761 days): difference, 9.3 days (95% CI, -17.4 to 30.1 days).
    • The dialysis group had 13.6 fewer days at home than the medical management group (7.7 to 20.5 fewer days).
    • 49% of patients in the medical management group crossed over to dialysis.
    • In the per-protocol analysis, starting dialysis vs. never starting dialysis was associated with:
      • Increased survival: HR, 0.74 (95% CI, 0.71 to 0.79)
      • More days of survival: 77.6 more days (62.8 to 91.1 more days)
      • 14.7 fewer days at home (11.2 to 16.5 fewer days)
  • Limitations include:
    • Results are not generalizable to women and patients receiving care outside the Veterans Affairs system.
    • There was no assessment of uremic symptoms, which frequently influence the decision to undergo dialysis.
    • The type of treatment in the medical management group was not assessed.
  • Study funding: U.S. Department of Veterans Affairs and National Institutes of Health
  • Original study: Effect of starting dialysis versus continuing medical management on survival and home time in older adults with kidney failure: a target trial emulation study. [25]
  • Related AMBOSS articles: Chronic kidney disease

Edition 105 - August 31, 2024toggle arrow icon

Fenofibrate for diabetic retinopathy: can we see clearly now?

One-Minute Telegram 105-2024-1/3

10-second takeaway

Affordable and effective early treatment for diabetic retinopathy can help prevent disease progression and vision loss. In this randomized placebo-controlled trial, fenofibrate reduced the progression of diabetic retinopathy compared to placebo in individuals with diabetes mellitus and early retinal changes. However, no effect was observed on vision or quality of life. These findings suggest fenofibrate is an effective treatment for early diabetic retinopathy. Further studies are needed to elucidate its role in the early management of diabetic eye disease.

Study breakdown

  • Study population: 1151 adults with diabetes (mean age, 61 years; 73% male, 26% with type 1 diabetes) and nonreferable diabetic retinopathy or maculopathy (i.e., early changes not requiring a specialist referral)
  • Methods: pragmatic, national, randomized, parallel-group, double-masked, placebo-controlled trial
    • Setting: Participants were recruited using the national Diabetic Eye Screening (DES) program (a routine retinal screening service offered to adults with diabetes) at 16 sites in mainland Scotland.
    • Nonreferable disease was defined according to the DES grading scheme.
    • Intervention: fenofibrate 145 mg PO or placebo daily, or every other day in participants with impaired renal function (eGFR < 60 mL/min/1.73 m2)
    • Primary outcome: composite of time to development of referable diabetic retinopathy or maculopathy or initiation of interventional treatment
    • Median follow-up: 4 years
  • Main results
    • Compared to the placebo group, participants in the fenofibrate group had a significantly lower occurrence of:
      • The primary outcome: 22.7% vs. 29.2% (HR, 0.73; 95% CI, 0.58–0.91)
      • Retinopathy or maculopathy progression: 32.1% vs. 40.2% (HR, 0.74; 0.61–0.90)
      • Development of macular edema: 3.8% vs. 7.5% (HR, 0.50; 0.30–0.84)
    • No differences were observed in visual function, visual acuity, or quality of life.
    • Trial-averaged eGFR was 7.9 (95% CI, 6.8–9.1) mL/min/1.73 m2 lower in the fenofibrate group than in the placebo group.
    • Serious adverse events occurred in ∼ 36% of participants, with no significant difference between groups.
  • Limitations include:
    • Macula-centered images used to screen individuals for diabetic retinopathy excluded portions of the peripheral retina, potentially leading to underdiagnosis.
    • Adherence to treatment was self-reported.
    • The trial may have been underpowered to detect differences in visual function, visual acuity, and quality of life, given the mild disease at baseline.
    • Results may not be generalizable to non-White populations or medical systems outside of Scotland.
  • Study funding: Primarily funded by the National Institute for Health and Care Research Health Technology Assessment Programme
  • Original study: Effect of fenofibrate on progression of diabetic retinopathy [26]
  • Related AMBOSS articles: Diabetic retinopathy

The wonder drug semaglutide: treating diabetes, obesity, and now tobacco use disorder?

One-Minute Telegram 105-2024-2/3

10-second takeaway

There is anecdotal evidence that individuals taking GLP-1 receptor agonists (GLP-1RAs) for diabetes or obesity have a reduced desire to smoke. In this target trial emulation study, individuals with tobacco use disorder (TUD), type 2 diabetes, and a new prescription for semaglutide had a lower risk of TUD-related health care measures compared to individuals with new prescriptions for other antidiabetic drugs. Randomized controlled trials are needed to determine if semaglutide is effective for smoking cessation.

Study breakdown

Blind dating with AI: predicting gestational age

One-Minute Telegram 105-2024-3/3

10-second takeaway

Ultrasound is a key tool used in comprehensive prenatal care assessments and allows for estimation of gestational age (GA). However, health care providers in many resource-limited settings lack the training necessary for accurate interpretation. In this prospective diagnostic accuracy study, a low-cost point-of-care AI tool allowed novice ultrasound users to estimate GA between 14 and 27 weeks’ gestation as accurately as credentialed sonographers. AI-powered ultrasound could substantially increase the availability of accurate GA estimation in low-resource settings.

Study breakdown

  • Study population: 400 individuals (median age, 29 years) with viable, single, nonanomalous, first-trimester pregnancies
  • Methods: prospective diagnostic accuracy study
    • Setting: outpatient clinics in Lusaka, Zambia and Chapel Hill, North Carolina
    • True baseline GA was estimated by trained sonographers using transvaginal crown-rump length measurement at the first study visit.
    • At follow-up visits, users with no prior ultrasound training obtained blind sweeps of the maternal abdomen using an AI-enabled device (index test) and trained sonographers used fetal biometry (study standard) to estimate GA.
    • Primary outcome: difference in mean absolute error (MAE) between the index test and study standard in the primary evaluation window (14 0/7 weeks’ to 27 6/7 weeks’ gestation)
    • Secondary outcomes included:
      • Difference in MAE between 28 0/7 weeks’ and 36 6/7 weeks’ gestation (secondary evaluation window)
      • Difference in MAE between 37 0/7 weeks’ and 40 6/7 weeks’ gestation (tertiary evaluation window)
  • Main results
    • Differences in MAE between the index test and study standard met the predefined equivalency margin (± 2 days) in both primary and secondary evaluation windows.
      • Primary evaluation window: MAE of 3.2 vs. 3.0 days (difference, 0.2 days; 95% CI, -0.1 to 0.5 days)
      • Secondary evaluation window: MAE of 6.0 vs. 7.1 days (difference, -1.1 days; -1.7 to -0.4 days)
    • Neither test performed well in the tertiary evaluation window: MAE of 11.5 vs. 9.1 days (difference, 2.4 days; 1.2 to 3.7 days).
    • Results were similar across study sites.
  • Limitations include: lack of generalizability
    • Few individuals with conditions associated with inaccurate GA estimation (e.g., hypertension, diabetes, class III obesity) were included.
    • Individuals with known fetal anomalies were excluded.
  • Study funding: Bill & Melinda Gates Foundation
  • Original study: Diagnostic accuracy of an integrated AI tool to estimate gestational age from blind ultrasound sweeps [28]
  • Related AMBOSS articles: Prenatal care

Edition 104 - August 17, 2024toggle arrow icon

Twice-yearly lenacapavir may prevent HIV infection in cisgender women

One-Minute Telegram 104-2024-1/3

10-second takeaway

Adherence to the current required daily regimen of HIV preexposure prophylaxis (PrEP) is poor and effectiveness remains limited. In the randomized active-controlled PURPOSE 1 trial, no incident cases of HIV infection occurred in young cisgender women receiving twice-yearly subcutaneous lenacapavir. Long-acting lenacapavir injections may improve adherence and be more effective for HIV PrEP in individuals at high risk for HIV compared to current daily oral regimens, although costs may be prohibitive for widespread use, particularly in low- and middle-income countries.

Study breakdown

  • Study population: 5338 young cisgender women 16–25 years of age (median age, 21 years) in South Africa and Uganda who were sexually active with men and HIV-negative at the time of study randomization
  • Methods: phase 3, multicenter, double-blind, randomized active-controlled trial
  • Main results
    • Number of incident HIV infections
    • No significant difference in HIV incidence between F/TAF and F/TDF
    • Adherence to lenacapavir was high (92.8% at 52 weeks); adherence to oral regimens was low.
  • Limitations include:
    • Early study termination may have limited the ability to assess for long-term adverse effects.
    • Results may not be generalizable to other populations (e.g., men, older women, non-African populations).
    • Medication costs may impact real-world effectiveness outside of a trial setting.
  • Study funding: Gilead Sciences
  • Original study: Twice-yearly lenacapavir or daily F/TAF for HIV prevention in cisgender women [29]
  • Related AMBOSS content: Prevention of HIV

Do ABIM certification exam scores predict clinical competence?

One-Minute Telegram 104-2024-2/3

10-second takeaway

ACGME milestone ratings and ABIM certification exam scores are considered surrogate measures of clinical competency, but this assumption is largely untested. In this analysis of recently trained hospitalists, hospitalized patients cared for by providers with high certification exam scores had lower 7-day mortality and readmission rates than patients cared for by providers with low exam scores. There was no association between milestone ratings and hospitalization outcomes. These results suggest that the ABIM certification exam may be a useful tool for assessing the clinical competence of internal medicine residents at the end of training.

Study breakdown

  • Study population: 6898 hospitalists who completed internal medicine training between 2016 and 2018 and cared for hospitalized patients with Medicare fee-for-service
  • Methods: observational retrospective cohort study
    • Medicare claims data was reviewed from 455,120 hospitalizations of patients ≥ 65 years of age between 2017 and 2019
    • Exposures
      • Treating physician’s American Board of Internal Medicine (ABIM) initial certification examination score quartile
      • Treating physician’s residency milestone ratings (overall and knowledge-related)
    • Primary outcomes
      • 7-day patient mortality rate after hospital admission
      • 7-day patient readmission rate after discharge
  • Main results
    • Primary outcomes for providers in the highest ABIM exam quartile were lower than for providers scoring in the lowest quartile.
      • 7-day mortality (percentage difference, 8.0%; 95% CI, -13.0% to -3.1%)
      • 7-day readmission (percentage difference, 9.3%; -13.0% to -5.7%)
    • No significant difference in 7-day mortality or 7-day readmission rates for providers with high vs. low overall residency milestone ratings
    • No significant difference in 7-day mortality or 7-day readmission rates for providers with high vs. low knowledge-related residency milestone ratings
    • ABIM certification exam scores and core competency ratings frequently did not align, e.g., a high exam score but a low competency score.
  • Limitations include:
    • Unmeasured confounders in this observational study may influence findings.
    • Results may not be generalizable to competency assessments implemented after the study period.
    • Several authors were employed by the ABIM, which may pose a conflict of interest.
  • Study funding: Not reported
  • Original study: Associations of internal medicine residency milestone ratings and certification examination scores with patient outcomes. [30]

Get the mammo? Breast cancer screening preferences among women in their 40s

One-Minute Telegram 104-2024-3/3

10-second takeaway

The USPSTF currently recommends initiating breast cancer screening at 40 years of age for all women, but prior to 2024, the USPSTF recommended that screening women aged 40–49 years should be an individual decision. In this survey study conducted before the 2024 USPSTF update, 27% of women aged 39–49 years preferred to delay screening mammography; this increased to 38.5% after participants reviewed a decision aid describing the potential risks and benefits. Decision aids can impact screening preferences and should incorporate the most recent evidence-based recommendations to enable individuals to make informed health decisions.

Study breakdown

  • Study population: 495 women aged 39–49 years (mean age, 43.9 years; 58.4% White) with no personal history of breast cancer or a known BRCA mutation
  • Methods: pre-post survey study
    • Screening preferences in the US were determined using an online survey from January to April 2022.
    • Intervention: decision aid including recommendations and potential risks and benefits of screening, breast cancer risk estimate, and decision-making exercises
    • Outcomes
  • Main results
    • Before viewing the decision aid, 27.0% of participants preferred to delay breast cancer screening; this increased to 38.5% after viewing the decision aid (P < 0.001).
    • Women who did not want to delay screening typically had a higher estimated breast cancer risk than those who wanted to delay.
    • 37.4% of participants were surprised by the information on overdiagnosis with mammography screening.
  • Limitations include:
    • The decision aid was created specifically for this study before the most recent USPSTF guidelines were released.
    • The majority of study participants had already been screened for breast cancer, which may have affected their preferences.
    • Information about the preferred frequency of screening was not collected.
    • The assessment of screening preferences was not based on a validated tool.
    • An error in survey wording impacted 20% of participants.
  • Study funding: National Cancer Institute
  • Original study: Mammography screening preferences among screening-eligible women in their 40s: a national U.S. survey [31]
  • Related AMBOSS articles: Breast cancer screening

Edition 103 - August 3, 2024toggle arrow icon

Bariatric surgery yields greater weight loss and lower mortality than GLP-1RAs in individuals with obesity and diabetes

One-Minute Telegram 103-2024-1/3

10-second takeaway

Obesity and diabetes are synergistically associated with adverse health effects, including increased overall and cardiovascular mortality. In this cohort study, bariatric metabolic surgery (BMS) was associated with reduced mortality and greater weight loss compared to glucagon-like peptide-1 receptor agonists (GLP-1RAs) in individuals with obesity and diabetes for ≤ 10 years. Based on these results, BMS may be more effective than GLP-1RAs in selected individuals with obesity and diabetes.

Study breakdown

  • Study population: 6070 individuals (3035 matched pairs) ≥ 24 years of age (mean age, 51.0 years; 64.9% women) with diabetes (diagnosed after 21 years of age) and a BMI ≥ 30 kg/m2
  • Methods: observational retrospective cohort study
  • Main results
    • Primary outcome
      • Individuals with diabetes for ≤ 10 years
        • BMS was associated with lower mortality than GLP-1RAs (HR, 0.38; 95% CI, 0.25–0.58).
        • This was mediated by greater weight loss in the BMS group.
      • Individuals with diabetes for > 10 years: no significant difference in mortality between treatment groups (HR, 0.65; 0.39–1.08)
    • Secondary outcomes
      • No difference in risk of nonfatal MACEs between treatment groups (HR, 0.74; 0.49–1.10)
      • Maximal and long-term BMI decrease was greater in the BMS group than the GLP-1RA group.
  • Limitations include:
  • Study funding: Not reported
  • Original study: Bariatric metabolic surgery vs glucagon-like peptide-1 receptor agonists and mortality [32]
  • Related AMBOSS articles: Obesity and metabolic syndrome; Diabetes mellitus

Start strong: lifelong benefits of early intensive treatment for diabetes

One-Minute Telegram 103-2024-2/3

10-second takeaway

The UK Prospective Diabetes Study (UKPDS) previously showed that compared to diet alone, intensive pharmacological glycemic control in individuals newly diagnosed with type 2 diabetes led to better diabetes-related outcomes, which were sustained after a 10-year follow-up period. In this study, extended follow-up of the original participants of the UKPDS for a further 14 years revealed continued legacy benefits of early intensive pharmacological glycemic control. Pharmacotherapy should be initiated early in patients with newly diagnosed diabetes for a lasting reduction in diabetes-related complications.

Study breakdown

  • Study population: 1489 individuals with diabetes who participated in the original UKPDS and 10-year follow-up period (mean age at baseline, 50.2 years; 41.3% female)
  • Study design: extended follow-up of a prospective randomized controlled trial
  • Main results
    • Up to 24 years after the trial ended, compared to the conventional therapy group, there was a significant overall relative risk (RR) reduction:
    • There was no significant risk reduction for stroke or PVD in either group.
  • Limitations include:
    • Nonfatal event data could not be shared for 130 participants in Northern Ireland.
    • Some events may not have been captured if hospital admission or a procedure were not required.
  • Study funding: University of Oxford Nuffield Department of Population Health Pump Priming
  • Original study: Post-trial monitoring of a randomised controlled trial of intensive glycaemic control in type 2 diabetes extended from 10 years to 24 years (UKPDS 91) [33]
  • Related AMBOSS articles: Diabetes mellitus

A missed CHANCE: colchicine does not prevent early recurrent stroke

One-Minute Telegram 103-2024-3/3

10-second takeaway

Patients are at high risk of recurrence in the first 3 months after a TIA or acute ischemic stroke, and colchicine has been shown to reduce the risk of stroke after acute MI. However, in the randomized, placebo-controlled CHANCE-3 trial, colchicine did not reduce the risk of recurrent stroke within 90 days after mild-to-moderate ischemic stroke or high-risk TIA. More research is needed to find effective interventions to prevent early recurrent stroke.

Study breakdown

Edition 102 - July 20, 2024toggle arrow icon

Telehealth for medication abortion may be as effective and safe as in-person care

One-Minute Telegram 102-2024-1/3

10-second takeaway

Recent policy changes in the US have resulted in significant challenges to accessing abortion. This prospective study in the US showed that a no-test strategy involving telehealth screening and mailing of abortion medications was noninferior to in-person care with ultrasound in individuals seeking elective abortion. This no-test abortion strategy demonstrates how innovative solutions can help health care providers overcome challenges and deliver optimal patient care.

Study breakdown

  • Study population: 585 individuals ≥ 15 years of age (mean age, 27 years; 49% White) seeking abortion at ≤ 70 days’ gestation (median gestational duration, 45 days)
  • Methods: prospective observational study with noninferiority analysis
    • Setting: 4 abortion-providing organizations in the US from May 2021 to March 2023
    • Participants in all groups received mifepristone and misoprostol.
    • Primary exposure
    • Primary outcome
      • Abortion effectiveness without need for follow-up medication or procedure (prespecified 5% noninferiority margin)
      • Based on self-reported data (up to 1 month after receiving medications) and chart review data
    • Secondary outcome: safety (absence of abortion-related serious adverse events, i.e., blood transfusion, hospitalization, surgery, or death)
  • Main results
    • Effectiveness: Telehealth was noninferior to in-person care.
      • 94.4% (95% CI, 90.7–99.2%) in the telehealth group vs. 93.3% (88.3–98.2%) in the in-person group
      • Risk difference adjusted for age, race or ethnicity, and gestational duration: 1.2% (-4.1% to 6.4%)
    • Safety: Telehealth was noninferior to in-person care.
      • A total of 7 serious adverse events occurred in 3 participants in each group (1.1% of participants); there were no reported deaths.
      • Adjusted risk difference: 0.4% (-1.0% to 1.7%)
  • Limitations include:
    • Risk for attrition bias: 8% of participants were lost to follow-up.
    • Risk for measurement bias: 4 weeks may have been insufficient to capture all participants who required follow-up care.
  • Study funding: Grants from the Demartini Family Foundation and The Susan Thompson Buffett Foundation
  • Original study: Comparison of no-test telehealth and in-person medication abortion [35]
  • Related AMBOSS articles: Induced abortion

Large-scale study suggests screening for CVD using resting ECG is beneficial

One-Minute Telegram 102-2024-2/3

10-second takeaway

The clinical utility of routine resting ECG to screen for cardiovascular disease (CVD) has not been established; the USPSTF recommends against resting ECG for individuals with low CVD risk and does not issue recommendations for those with intermediate or high risk. In this cohort study conducted in more than 3.5 million working-age adults in Japan, baseline ECG abnormalities were associated with future cardiovascular events and future major ECG abnormalities regardless of baseline CVD risk. This study may be the first step toward new recommendations for screening asymptomatic individuals for CVD.

Study breakdown

  • Study population: 3,698,429 asymptomatic working-age (35–65 years) Japanese adults (mean age, 47 years; 67% male) with no history of major ECG abnormalities or established CVD
  • Methods: cohort study
    • Setting: annual health screening data from an insurance database, obtained from April 2015 to March 2022
    • Exposure: baseline ECG findings
    • Primary outcome: composite of overall death and CVD hospital admission due to MI, stroke, or heart failure, adjusted for baseline CVD risk
    • Secondary outcome: incidence of new major ECG abnormality
    • Median follow-up: 5.5 years
  • Main results
    • Primary outcome: Compared to a normal ECG, baseline ECG abnormalities were associated with a higher incidence of death or CVD hospital admission.
      • Normal ECG: incidence rate of 92.7 per 10,000 person-years (95% CI, 92.2–93.2)
      • 1 minor abnormality: 128.5 (127.2–129.9); adjusted HR (aHR), 1.19 (95% CI, 1.18–1.20)
      • ≥ 2 minor abnormalities: 159.7 (156.6–162.9); aHR, 1.37 (1.34–1.39)
      • Major abnormality: 266.3 (259.9–272.3); aHR, 1.96 (1.92–2.02)
    • Secondary outcome: The presence and number of minor ECG abnormalities were associated with a higher risk of future major ECG abnormalities.
  • Limitations include:
    • Possibility of misclassification: Outcomes were based on ICD-10 codes, and the specific cause of death was not available in the database.
    • Risk of self-selection bias: Only individuals who underwent annual health screening were included; lower socioeconomic groups may be underrepresented.
  • Study funding: Research study grants from several organizations, including the Japan Health Insurance Association
  • Original study: Routine electrocardiogram screening and cardiovascular disease events in adults [36]
  • Related AMBOSS articles: ASCVD

Antidepressants and weight: gaining perspective

One-Minute Telegram 102-2024-3/3

10-second takeaway

Weight gain is a well-known side effect of many antidepressants, but there is limited evidence on weight changes with specific antidepressants relative to one another. This study showed that weight change after 6 months of antidepressant treatment varies, with bupropion showing the least gain and escitalopram the most. This information can help clinicians tailor antidepressant choices to minimize adverse metabolic effects.

Study breakdown

Edition 101 - July 6, 2024toggle arrow icon

New CDC guidelines: doxy PEP for bacterial STI prevention

One-Minute Telegram 101-2024-1/3

10-second takeaway

The incidences of syphilis, chlamydia, and gonorrhea are increasing, and men who have sex with men (MSM) and transgender women (TGW) are disproportionately affected. In this 2024 clinical guideline, the CDC recommends postexposure prophylaxis with doxycycline (doxy PEP) to help prevent syphilis, chlamydia, and gonorrhea in MSM and TGW diagnosed with a bacterial STI in the past 12 months. Doxy PEP should be routinely offered to individuals with a high risk for bacterial STIs.

Recommendation breakdown

USPSTF: offer exercise interventions to older adults at high risk of falls

One-Minute Telegram 101-2024-2/3

10-second takeaway

Fall-related injuries are a common and preventable cause of morbidity and mortality among older adults in the US. The US Preventive Services Task Force (USPSTF) has reaffirmed its recommendations on exercise and individualized multifactorial interventions for fall prevention in community-dwelling older adults with a high risk for falls. These interventions should be offered to older adults by health care providers to help prevent fall-related sequelae.

Recommendations breakdown

  • Recommendations:
    • Older adults should be offered exercise interventions to prevent falls.
    • Multifactorial interventions for fall prevention should be considered on a case-by-case basis.
  • Rationale: The USPSTF concluded with moderate certainty that exercise interventions provide a moderate net benefit and multifactorial interventions provide a small net benefit for fall-related injury prevention among older adults at increased risk of falls.
  • Applicable population: community-dwelling adults ≥ 65 years of age with a high risk for falls
  • Additional information
    • High-risk features include:
      • Increasing age
      • Prior falls
      • Cognitive and/or sensory deficits
      • Comorbid conditions
      • High-risk medications, alcohol, and/or drug use
      • Environmental, home, and/or occupational hazards
    • Exercise intervention
      • Options include supervised individual physical therapy and group exercise classes.
      • Recommendations are based on studies of exercise programs of ≥ 2 months duration (most commonly 2–3 times/week for 12 months).
      • Exercise components assessed included:
        • Gait, balance, and functional exercises
        • Strength and resistance training
        • Flexibility training
        • Endurance training
    • Multifactorial interventions
      • Perform an initial assessment of modifiable risk factors, e.g.:
        • Balance, gait, vision
        • Postural blood pressure
        • Medications
        • Environment
        • Cognition and psychological health
      • Customize individual interventions based on identified risk factors. Examples include:
        • Exercise therapy
        • Psychological treatment
        • Nutrition therapy
        • Medication management
        • Environmental interventions
        • Specialist referral
    • Potential harms: exercise-related musculoskeletal discomfort and pain; risk of serious harm (e.g., bone fractures) is low
  • Limitations include:
    • Data on the efficacy of single exercise intervention components is limited.
    • Lack of accurate and validated risk-assessment tools
    • Fall prevention intervention availability and access may be limited.
  • Original study: Interventions to prevent falls in community-dwelling older adults: US Preventive Services Task Force recommendation statement [39]
  • Funding: Agency for Healthcare Research and Quality (AHRQ)
  • Related AMBOSS content: Fall prevention in older adults

Prolonged antibiotic infusions for sepsis and septic shock

One-Minute Telegram 101-2024-3/3

10-second takeaway

Antibiotic treatment is crucial in sepsis and septic shock management, but the most effective method of antibiotic infusion is uncertain. In this systematic review and meta-analysis, prolonged β-lactam antibiotic infusions were associated with decreased mortality in critically ill patients with sepsis and septic shock compared to intermittent infusions. Health care providers should consider prolonged antibiotic infusions for the treatment of sepsis and septic shock.

Study breakdown

Q2 2024toggle arrow icon

Edition 100 - June 22, 2024toggle arrow icon

We've reached 100! We’d like to express our heartfelt thanks to our dedicated readers.

Shining a light on vitamin D supplementation

One-Minute Telegram 100-2024-1/3

10-second takeaway

Vitamin D supplementation and laboratory testing for 25(OH)D levels are common in the US due to the association between low vitamin D status and many diseases, but causal links have not been established for most diseases. The new clinical practice guideline from the Endocrine Society recommends against routine 25(OH)D testing and that empiric vitamin D supplementation should only be used in individuals who are aged 1–18 years or ≥ 75 years, are pregnant, or have high-risk prediabetes. These recommendations do not apply to individuals with established indications for vitamin D testing or supplementation.

Recommendations breakdown

  • Recommendations include:
    • No routine 25(OH)D testing for healthy individuals
    • Empiric vitamin D supplementation above the RDA for the following groups:
      • Children and adolescents 1–18 years of age (to reduce the risk of rickets and URIs)
      • Adults ≥ 75 years of age (to lower the risk of mortality)
      • Pregnant individuals (to reduce the risk of preeclampsia and fetal and neonatal morbidity and mortality)
      • Individuals with high-risk prediabetes, i.e., an abnormality in ≥ 2 of the following: fasting glucose, HbA1c, OGTT (to reduce the risk of disease progression)
    • Daily, lower dose vitamin D supplementation is preferred over nondaily, higher dose supplementation in adults ≥ 50 years of age.
  • Applicable population: healthy individuals with no established indication for 25(OH)D testing or vitamin D treatment, e.g., hypocalcemia
  • Additional information: Optimal dosing for empiric vitamin D supplementation remains unclear.
  • Limitations include:
    • The number of trials involving patients with low baseline 25(OH)D levels was limited, which may have biased the results against the benefits of vitamin D supplementation.
    • Recommendations were based on studies that did not control common but important variables, such as sun exposure and dietary vitamin D intake.
    • As the included trials used varied doses and administration schedules for vitamin D, it was not possible to make specific dose recommendations.
  • Funding: The Endocrine Society
  • Original study: Vitamin D for the prevention of disease: an Endocrine Society clinical practice guideline. [41]
  • Related AMBOSS articles: Vitamin D deficiency

Less is more with low-risk prostate cancer

One-Minute Telegram 100-2024-2/3

10-second takeaway

Active surveillance is a recommended management strategy for most patients with favorable-risk prostate cancer (i.e., low-risk and very low-risk prostate cancer), but many clinicians remain fearful of undertreating cancer and choose more aggressive treatments, increasing the risk of unnecessary iatrogenic complications. In this long-term study of protocol-directed active surveillance of favorable-risk prostate cancer, half of the participants had no disease progression or treatment; in the other half, late disease progression and treatment were not associated with worse outcomes than earlier treatment. Clinicians and patients should feel comfortable choosing active surveillance as a strategy to manage favorable-risk prostate cancer.

Study breakdown

  • Study population: 2155 men with localized prostate cancer (median age, 63 years; 83% White; 90% with grade group 1 cancer)
  • Methods: multicenter, prospective cohort study
    • Men with newly diagnosed localized prostate cancer were enrolled from 10 North American medical centers.
    • Participants were reexamined every 6 months.
    • PSA was measured every 3–6 months.
    • Prostate biopsies were obtained at 6–12 months after diagnosis, 2 years after diagnosis, and every 2 years thereafter.
    • Definitive treatment was offered if biopsy reclassification (disease progression) was identified.
    • Outcomes included:
      • Biopsy reclassification
      • Initiation of definitive treatment
      • Metastasis
      • Disease-specific mortality
      • Overall mortality
    • Median follow-up: 7.2 years after diagnosis
  • Main results (10 years after diagnosis)
    • Incidence of biopsy grade reclassification: 43% (95% CI, 40–45%)
    • Incidence of treatment: 49% (47–52%)
    • Rate of metastasis: 1.4% (0.7–2%)
    • Disease-specific mortality: 0.1% (0–0.4%)
    • Overall mortality: 5.1% (3.8–6.4%)
    • Results were similar in patients treated immediately after confirmatory biopsy and those treated after several years of surveillance.
  • Limitations include:
    • Enrollment began before the widespread use of multiparametric MRI studies and novel biomarkers; further reduction in recurrence and metastasis may occur in later cohorts.
    • The study cohort does not reflect national demographics; participants were more likely to be White, educated, and insured than the general population.
    • The follow-up time of 7.2 years may be too short to demonstrate an effect of early versus late treatment on the incidence of metastasis and mortality.
  • Study funding: Canary Foundation, NIH, and Institute for Prostate Cancer Research
  • Original study: Long-term outcomes in patients using protocol-directed active surveillance for prostate cancer. [42]
  • Related AMBOSS articles: Prostate cancer

Blood pressure management in undifferentiated stroke: one size does not fit all

One-Minute Telegram 100-2024-3/3

10-second takeaway

The optimal management of blood pressure during acute stroke is unclear. In this study, ambulance-delivered rapid reduction of elevated blood pressure in patients with undifferentiated stroke did not improve functional outcomes overall, but was associated with better outcomes in patients with hemorrhagic stroke and worse outcomes in those with ischemic stroke. Quickly determining whether a stroke is hemorrhagic or ischemic remains a critical first step in stroke management.

Study breakdown

  • Study population: 2404 adults with presumed acute stroke and hypertension (mean age, 70 years; 61.7% men)
  • Methods: open-label, randomized trial with blinded outcome assessment conducted in China
    • Eligibility was determined at the time of ambulance arrival and required all of the following:
      • FAST stroke score ≥ 2
      • Arm motor deficit
      • SBP ≥ 150 mm Hg
      • Ability to start BP management within 2 hours of symptom onset
    • Patients were randomized 1:1 to either:
      • Intervention group: urapidil 25 mg IV bolus, repeated once if necessary to achieve SBP 130–140 mm Hg
      • Usual care group: prehospital BP treatment only for SBP ≥ 220 mm Hg or DBP ≥ 110 mm Hg
    • Primary outcome: functional status (measured using the modified Rankin scale) at 90 days
    • Safety outcome: any serious adverse event
  • Main results
  • Limitations include:
    • Subgroup analysis was not part of the statistical plan, limiting inferences about causality.
    • Results may not be generalizable outside of China because the proportion of strokes caused by ischemia or hemorrhage varies from that in North America and Europe.
  • Study funding: National Health and Medical Research Council of Australia and others
  • Original study: Intensive ambulance-delivered blood-pressure reduction in hyperacute stroke. [43]
  • Related AMBOSS articles: Ischemic stroke, Intracerebral hemorrhage

Edition 99 - June 8, 2024toggle arrow icon

Specialized care of newly diagnosed asthma and COPD leads to better outcomes

One-Minute Telegram 99-2024-1/3

10-second takeaway

Many individuals with chronic obstructive pulmonary disease (COPD) or asthma remain undiagnosed and untreated. In this trial, a strategy for early diagnosis and pulmonologist-directed treatment of individuals with respiratory symptoms reduced health care visits for respiratory illness and improved patients' respiratory health compared to early diagnosis and usual care. Early diagnosis and specialized care of asthma and COPD may reduce the burden on patients and health care systems.

Study breakdown

  • Study population: 508 adults with previously undiagnosed COPD or asthma (median age, 63 years; 61% male)
  • Methods: multicenter, randomized, controlled trial conducted in Canada
    • Case-finding approach utilizing questionnaires and spirometry to identify undiagnosed COPD or asthma in symptomatic adults
    • Participants were randomized 1:1 to either:
      • Intervention group: initiation of guideline-directed care by a pulmonologist and an asthma-COPD educator
      • Control group: usual care by a primary care practitioner
    • Primary outcome: annualized rate of participant-initiated health care utilization for respiratory illness
    • Secondary outcomes
    • Follow-up at 6 and 12 months with repeat spirometry and assessment of secondary outcomes
  • Main results
    • The intervention group had better outcomes compared to the usual care group.
      • Lower annualized rate of health care utilization (incidence rate ratio, 0.48; 95% CI, 0.36 to 0.63)
      • At 12 months, the intervention group had greater improvements in:
        • SGRQ scores: -10.2 vs. -6.8 points (difference, -3.5 points; 95% CI, -6.0 to -0.9)
        • CAT scores: -3.8 vs. -2.6 points (difference, -1.3 points; -2.4 to -0.1)
        • FEV1: increase of 119 mL vs. 22 mL (difference, 94 mL; 50 to 138)
      • The incidence of adverse events was similar in both groups.
  • Limitations include:
    • The study did not examine the effect of early diagnosis through active case-finding, as participants in both groups were diagnosed and treated.
    • Referral to a pulmonologist and asthma-COPD educator may not be feasible in settings with limited access to specialists.
    • Results may not be generalizable beyond the Canadian health care system.
  • Study funding: Canadian Institutes of Health Research
  • Original study: Early diagnosis and treatment of COPD and asthma - a randomized, controlled trial [44]
  • Related AMBOSS articles: Asthma, COPD

Acetaminophen for sepsis?

One-Minute Telegram 99-2024-2/3

10-second takeaway

Cell-free hemoglobin levels are elevated in the serum of critically ill patients with sepsis and are associated with the development of organ dysfunction. Acetaminophen is known for its antipyretic and antiinflammatory effects and can block hemoglobin-induced oxidative damage. This study found that in patients with sepsis, IV acetaminophen was safe but did not significantly increase the number of days patients were alive and free of organ support compared to placebo. Results did not differ in patients with high baseline cell-free hemoglobin levels.

Study breakdown

  • Study population
    • 447 adults treated for sepsis (mean age, 64 years; 51% female, 74% White) at 40 US academic hospitals
    • Sepsis was defined as an antibiotic-treated infection with either respiratory or circulatory dysfunction.
  • Methods: phase 2b randomized, double-blind, placebo-controlled trial
    • Randomized 1:1 to 1 g of IV acetaminophen every 6 hours for 5 days or placebo
    • Primary outcome: days alive and free of organ support to day 28
    • Follow-up: 90 days
  • Main results
    • No significant difference in the primary endpoint: 20.2 days (acetaminophen) vs. 19.6 days (placebo); P = 0.56
    • Significant differences in 2 of 15 secondary endpoints
    • No significant difference in 28-day or 90-day mortality between groups
    • No significant difference in acetaminophen treatment effect between participants with high and low baseline cell-free hemoglobin levels
  • Limitations include:
    • The study may have been underpowered to detect differential treatment effects among patient subgroups.
    • Lack of adjustment for multiple secondary outcomes increases the risk of type I error, meaning some statistically significant findings could be due to chance.
    • Participants received an average of 12 doses instead of the intended 20, possibly leading to an underestimation of the full potential effect of acetaminophen.
  • Study funding: National Heart, Lung, and Blood Institute (NHLBI)
  • Original study: Acetaminophen for prevention and treatment of organ dysfunction in critically ill patients with sepsis: the ASTER randomized clinical trial [45]
  • Related AMBOSS articles: Sepsis

Early initiation of dapagliflozin during hospitalization for AHF

One-Minute Telegram 99-2024-3/3

10-second takeaway

Hospital management of acute heart failure (AHF) includes rapid decongestion and optimization of guideline-directed medical therapy. Previous trials demonstrated improved intermediate and long-term outcomes with the initiation of SGLT2 inhibitors at the end of hospitalization. In the DICTATE-AHF trial, initiation of dapagliflozin within 24 hours of admission for hypervolemic AHF did not improve dose-based diuretic efficiency but was associated with lower cumulative loop diuretic doses, improved diuresis and natriuresis, and a higher likelihood of early hospital discharge compared to usual care. These findings suggest that initiation of dapagliflozin on the first day of hospitalization for AHF is safe and may enhance diuresis.

Study breakdown

  • Study population: 240 adults hospitalized with AHF
  • Methods: multicenter, randomized, open-label study
    • Randomized 1:1 within 24 hours of hospital presentation to dapagliflozin 10 mg once daily or structured usual care
    • Both groups received protocolized diuretic titration with IV loop diuretics
    • Primary outcome: diuretic efficiency, defined as cumulative weight change per cumulative loop diuretic dose
    • Secondary outcomes: worsening inpatient HF, 30-day HF-related or diabetes-related rehospitalization
    • Study duration: until discharge or day 5 of hospitalization, whichever occurred first
  • Main results
    • Primary outcome: no significant difference in diuretic efficiency (OR, 0.65; 95% CI, 0.41–1.02)
    • No significant difference in secondary outcomes
    • Dapagliflozin was significantly associated with the following exploratory outcomes:
      • Reduced cumulative loop diuretic doses: 560 mg (IQR, 260–1150 mg) vs. 800 mg (380–1715 mg); P = 0.006
      • Improved median 24-hour natriuresis (P = 0.025) and increased urine output (P = 0.005)
      • Higher likelihood of hospital discharge by day 5 (52% vs. 33%)
    • No significant difference in diabetic, renal, or cardiovascular safety events
  • Limitations include:
    • The open-label design may have introduced bias despite standardized protocols.
    • Potential sampling bias, as only 10% of screened patients were enrolled in the trial
    • The trial may have been underpowered to detect a difference in the primary outcome.
  • Study funding: AstraZeneca with additional support from NIH grants
  • Original study: Efficacy and safety of dapagliflozin in patients with acute heart failure [46]
  • Related AMBOSS articles: Acute heart failure

Edition 98 - May 25, 2024toggle arrow icon

USPSTF update: start breast cancer screening at 40 years of age

One-Minute Telegram 98-2024-1/3

10-second takeaway

Breast cancer is the second most common type of cancer and cause of cancer-related death. The USPSTF now recommends that individuals assigned female at birth should start screening at 40 years of age rather than 50 years of age. Screening frequency of every two years until 74 years of age remains unchanged. Individuals with positive screening should receive evidence-based management.

Recommendation breakdown

Female physicians, better patient outcomes

One-Minute Telegram 98-2024-2/3

10-second takeaway

Sex-based inequities in the health care system affect the overall care of female patients. This study found that hospitalized patients treated by a female physician had lower mortality and readmission rates than those treated by a male physician and that female patients had the greatest benefit. Research is needed to understand why treatment by a female physician may lead to better patient outcomes.

Study breakdown

  • Study population: 776,927 Medicare fee-for-service beneficiaries aged ≥ 65 years hospitalized with a medical condition between 2016 and 2019 who were treated by hospitalists
  • Methods: retrospective observational study
    • Data was obtained from 20% of Medicare beneficiaries selected at random from the Medicare Data on Provider Practice and Specialty database to determine if they were treated by female or male hospitalists.
    • Primary outcomes: 30-day mortality and readmission rates in female and male patients
  • Main results
    • 31.1% of female (n/N = 142,465/458,108) and 30.6% of male (n/N = 97,500/318,819) patients were treated by a female physician.
    • Treatment by a female physician resulted in lower mortality for all patients.
    • The benefit was greater for female patients than male patients: -0.16% (95% CI, -0.42 to 0.10%).
    • Outcomes were similar for readmission rates.
  • Limitations include:
    • Lack of generalizability to a younger population and the outpatient setting
    • As claims data used for the study contained limited clinical information, it was not possible to identify why female patients had better outcomes when treated by a female physician.
  • Study funding: Gregory Annenberg Weingarten
  • Original study: Comparison of hospital mortality and readmission rates by physician and patient sex [48]

Racial and ethnic disparities linked to child mortality

One-Minute Telegram 98-2024-3/3

10-second takeaway

Mortality rates among children in the US are increasing, despite efforts to improve health care and child safety. This study found that Black, Hispanic, and American Indian or Alaska Native children had higher mortality rates (mainly injury-related mortality) compared to White children. This emphasizes the need for targeted interventions to address systemic factors contributing to health disparities in marginalized communities.

Study breakdown

  • Study population: 491,680 children aged 1–19 years who died between 1999 and 2020 (65.1% male; 54.4% White)
  • Methods: cross-sectional study
  • Main results
    • 53% of deaths (n = 262,098) occurred in teenagers.
    • Pooled all-cause mortality rates by group per 100,000
      • American Indian or Alaska Native youth: 48.79 (95% CI, 46.58–51.00)
      • Black youth: 42.33 (41.81–42.86)
      • Hispanic youth: 21.48 (21.19–21.77)
      • White youth: 24.07 (23.86–24.28)
      • Asian or Pacific Islander youth: 15.25 (14.75–15.76)
    • Injury-related mortality was the dominant cause, except in Asian or Pacific Islander youth.
    • Specific rates by group per 100,000 (from 2016 to 2020)
      • Homicide in Black youth: 12.81 (12.52–13.10); 10.20 times that of White youth
      • Suicide in American Indian or Alaska Native youth: 11.37 (10.30–12.43); 2.60 times that of White youth
      • Firearm mortality
        • Black youth: 12.88 (12.59–13.17); 4.14 times that of White youth
        • American Indian or Alaska Native youth: 6.67 (5.85–7.49); 2.14 times that of White youth
      • Asthma mortality in Black youth: 1.10 (1.01–1.18); 7.80 times that of White youth
  • Limitations include:
  • Study funding: none disclosed
  • Original study: Racial and ethnic disparities in all-cause and cause-specific mortality among US youth [49]

Edition 97 - May 11, 2024toggle arrow icon

Beta blockers after MI: no longer a knee-jerk reaction

One-Minute Telegram 97-2024-1/3

10-second takeaway

Current guidelines call for the initiation of beta-blocker therapy after most myocardial infarctions (MI), but this recommendation is based on research conducted before the widespread implementation of percutaneous reperfusion, high-intensity statins, and renin-angiotensin-aldosterone system antagonists. In this large randomized clinical trial, long-term beta-blocker therapy after an MI did not lower the risk of death and/or new MI in patients who had early coronary angiography and preserved left ventricular ejection fraction (LVEF) compared to no beta-blocker therapy. Re-evaluating historical treatment recommendations for MI may be warranted, given advances in ASCVD management.

Study breakdown

Underutilization of appropriate but high-cost antibiotics

One-Minute Telegram 97-2024-2/3

10-second takeaway

Antimicrobial resistance is a growing public health concern, but the development of new antibiotics designed for difficult-to-treat resistance (DTR) has been hampered by low sales of these expensive medications. This large retrospective study found that physicians frequently use older, generic antibiotics to treat infections with a DTR profile even though newer antibiotics specifically approved for this purpose are available and have better safety-efficacy profiles. To avoid this serious public health concern from worsening, strategies are necessary to improve the utilization of new antibiotics against resistant organisms and incentivize the development of these niche medications.

Study breakdown

Two big toes up for SGLT2i in type 2 diabetes

One-Minute Telegram 97-2024-3/3

10-second takeaway

Gout is primarily thought of as painful arthritis, but the inflammation that accompanies acute flares of gout increases the risk for acute major cardiovascular events (MACE). In this study of patients with type 2 diabetes (T2DM) on metformin, addition of a sodium-glucose cotransporter-2 inhibitor (SGLT2i) decreased the risk of both gout and MACE compared to the addition of a sulfonylurea. SGLT2i therapy may serve double duty in patients with T2DM, reducing both gout and cardiometabolic morbidity.

Study breakdown

Edition 96 - April 13, 2024toggle arrow icon

An aspirin a day keeps the hepatologist away

One-Minute Telegram 96-2024-1/3

10-second takeaway

Metabolic dysfunction-associated steatotic liver disease (MASLD) affects almost a third of US adults, but there are no approved drugs that safely reverse hepatic steatosis and prevent disease progression. In this preliminary trial, patients with MASLD who received 81 mg of aspirin a day had significantly reduced hepatic fat content at 6 months compared to those who received placebo. Large-scale studies are needed to confirm these promising results and ascertain whether aspirin has a positive clinical effect in patients with MASLD.

Study breakdown

  • Study population: 80 adults aged 18–79 years with MASLD and without cirrhosis (mean age, 48 years; 55% women; mean hepatic fat fraction, 35.2%)
  • Methods: preliminary randomized, double-blind, placebo-controlled trial
    • Randomized 1:1 to aspirin 81 mg or placebo once daily for 6 months
    • Hepatic fat fraction measured by proton magnetic resonance spectroscopy (MRS) at baseline and 6 months
    • Primary outcome: absolute change in hepatic fat fraction on MRS
    • Secondary outcomes
      • Percentage change in hepatic fat fraction (relative reduction)
      • 30% reduction in hepatic fat (a level previously found to have clinical significance)
  • Main results
    • Aspirin treatment significantly reduced hepatic fat content compared to placebo.
      • Absolute change in hepatic fat content: -6.6% with aspirin vs. 3.6% with placebo (mean difference, -10.2%; 95% CI, -27.7% to -2.6%)
      • Relative change in hepatic fat fraction: -8.8 percentage points with aspirin vs. 30 percentage points with placebo (mean difference, -38.8 percentage points; -66.7 to -10.8)
    • The percentage of patients attaining > 30% relative reduction in hepatic fat was higher in the aspirin group (42.5%) than in the placebo group (12.5%).
    • Adverse events were similar in both groups.
  • Limitations include:
    • The study had a small sample size and was limited to 6 months.
    • Neither liver histology nor clinical endpoints were evaluated as part of the study.
    • Bias may have been introduced because missing outcome data from 9 participants was assumed to be random.
  • Study funding: National Institutes of Health
  • Original study: Aspirin for metabolic dysfunction-associated steatotic liver disease without cirrhosis: a randomized clinical trial. [53]
  • Related AMBOSS articles: MASLD

Ultra-processed food: poor health packaged for your convenience

One-Minute Telegram 96-2024-2/3

10-second takeaway

The global consumption of ultra-processed food (UPF) continues to increase despite evidence that it can negatively impact health. In this umbrella review of existing meta-analyses, increased consumption of UPF was associated with an increased risk of many adverse health outcomes, including CVD-related mortality, type 2 diabetes, obesity, anxiety, and combined mental health disorders. Health care providers, public health leaders, and policymakers should promote strategies to decrease the consumption of UPF in favor of fresh produce and other minimally and non-processed food.

Study breakdown

  • Study population: 45 discrete meta-analyses and systematic reviews from 2009 to 2023 that included 9,888,373 individuals
  • Methods: systematic umbrella review of existing meta-analyses
    • Relevant studies about UPF were identified using key search terms.
    • Outcome data for the following was extracted from all studies:
      • Mortality
      • Cancer
      • Cardiovascular health
      • Metabolic health
      • Mental health
      • Respiratory health
      • Gastrointestinal health
    • Aggregate data was reanalyzed using a previously validated random effects model.
  • Main results
    • There was convincing evidence for a direct association between greater UPF consumption and the following:
    • There was highly suggestive evidence for a direct association between greater UPF consumption and the following:
  • Limitations include:
  • Study funding: none
  • Original study: Ultra-processed food exposure and adverse health outcomes: umbrella review of epidemiological meta-analyses. [54]
  • Related AMBOSS articles: ASCVD

Chocolate: good for dementors and muscle pain

One-Minute Telegram 96-2024-3/3

10-second takeaway

Some cocoa-derived flavanols mitigate the effect of proinflammatory mediators, suggesting that chocolate may have a role in the treatment of acute nociceptive pain. In this study, ingestion of chocolate, irrespective of cocoa content, reduced the intensity of induced muscle pain compared to no ingestion of chocolate. Although the small sample size and multiple study limitations prevent the generalizability of these results, all participants agreed that chocolate Easter bunnies taste better when eaten ears-first.

Study breakdown

  • Study population: 30 healthy adults (aged 19–34 years, 50% women) with no history of temporomandibular disorder
  • Methods: double-blind randomized controlled trial
    • Pain was induced with an intramuscular injection of 0.2 mL hypertonic saline into the masseter muscle.
    • Pain intensity was measured using a self-reported visual analog scale every 15 seconds for 5 minutes and pressure pain threshold every 5 minutes for 30 minutes.
    • The experiment was repeated after pretreatment with ingestion of randomly selected chocolate, either:
      • White chocolate containing 30% cocoa
      • Milk chocolate containing 34% cocoa
      • Dark chocolate containing 70% cocoa
    • All participants repeated the experiment on 3 separate occasions, receiving a different type of chocolate at each session.
  • Main results
    • Pain intensity was lower after chocolate ingestion compared to no chocolate ingestion (P < 0.05).
    • Reduction in pain intensity was similar for all types of chocolate.
    • Men had a greater reduction in pain intensity than women after white chocolate consumption (P < 0.05); no other differences between men and women were significant.
  • Limitations include:
    • The sugar concentration varied between chocolate types, which may have led to confounding.
    • The ingestion of other sweetened food was not controlled.
    • The ingested quantity of cocoa was low compared to other studies investigating the effect of flavanols.
    • The short time between chocolate ingestion and pain testing may have caused an underestimation of the effects.
  • Study funding: none
  • Original study: Chocolate intake and muscle pain sensation: a randomized experimental study [55]

Q1 2024toggle arrow icon

Edition 95 - March 30, 2024toggle arrow icon

Silent killer: plastics’ deadly grip on your heart

One-Minute Telegram 95-2024-1/3

10-second takeaway

Recent data suggests that microplastics and nanoplastics (MNPs) are risk factors for cardiovascular disease. In this study of individuals with asymptomatic carotid stenosis, participants with evidence of carotid plaque MNPs had a higher risk for a composite of myocardial infarction, stroke, or death from any cause than those without evidence of carotid plaque MNPs. Further investigation is needed to better understand the influence of MNP pollution on both general and cardiovascular health.

Study breakdown

Cannabis: a menace to heart health?

One-Minute Telegram 95-2024-2/3

10-second takeaway

Although cannabis use is surging in the US, its effect on cardiovascular health remains poorly understood. This large national cross-sectional study found that self-reported cannabis use was independently associated with myocardial infarction and stroke, and that the association was stronger with more frequent cannabis use. While prospective studies are needed to confirm a causal association, health care providers should address the potential risk of cardiovascular disease in individuals who regularly use cannabis.

Study breakdown

  • Study population: 434,104 adults aged 18–74 years (mean age, 45 years; 51% women; 60% White)
  • Methods: population-based, national cross-sectional study
  • Main results
    • Frequency of cannabis use
      • Daily: 4%
      • Nondaily: 7% (median: 5 days per month)
      • None: 89%
    • Compared to nondaily or no cannabis use, daily cannabis use was associated with greater odds of:
      • MI: adjusted OR (aOR), 1.25 (95% CI, 1.07–1.46)
      • Stroke: aOR, 1.42 (1.20–1.68)
      • Composite outcome: aOR, 1.28 (1.13–1.44)
    • Among nondaily users, the odds of the individual and composite outcomes increased with the number of days of cannabis use.
    • The association between cannabis use and cardiovascular disease was independent of concurrent tobacco use after controlling for confounders.
    • A subgroup analysis of respondents at risk for premature cardiovascular disease (men < 55 years of age, women < 65 years of age) had similar results.
  • Limitations include:
    • Causality cannot be inferred from this cross-sectional study.
    • Self-reporting of exposure and outcomes is susceptible to recall bias.
    • The study examined the association between current cannabis use and prior cardiovascular disease; reverse causality cannot be ruled out.
    • The relatively young study population (mean age 45 years) may have led to underestimation of the impact of cannabis given the slow development of atherosclerotic disease.
  • Study funding: National Center Institute grant and National Heart, Lung, and Blood Institute grant
  • Original study: Association of cannabis use with cardiovascular outcomes among US adults [57]
  • Related AMBOSS content: Cannabis-induced disorders

Diet drinks: sweet AF

One-Minute Telegram 95-2024-3/3

10-second takeaway

Consumption of sugar-sweetened beverages (SSB) and artificially sweetened beverages (ASB) has been associated with cardiometabolic disease, but its relationship with atrial fibrillation (AF) is unknown. In this study, individuals who consumed > 2 L/week of ASB or SSB had a greater risk of developing AF than nonconsumers of these sweetened beverages. Health care providers should consider sweetened beverage intake when providing counseling on healthy eating habits for individuals at risk for AF.

Study breakdown

  • Study population: 201,856 adults aged 37–73 years (mean age, 56 years; 45% men) without a history of AF
  • Methods: nationwide, prospective cohort study
    • Data was obtained from the UK Biobank, a nationwide cohort lifestyle, health, and genetic database in the UK.
    • Mean weekly SB consumption was estimated based on 24-hour dietary recall questionnaires.
    • Sweetened beverages (SB) were classified as SSB, ASB, or pure fruit juice (PJ).
    • Participants were grouped based on SB consumption per week: none, ≤ 1 L, 1–2 L, or > 2 L.
    • Genetic risk for AF was determined using individual genetic data and classified as high, intermediate, or low.
    • AF diagnosis was identified from primary care, hospital, and death records.
    • Median follow-up: 9.9 years
  • Main results
    • 9362 individuals developed AF.
    • Individuals with an intermediate or high genetic risk for AF had a higher risk of AF than those with a low genetic risk.
      • Intermediate risk: adjusted HR, 1.74 (95% CI, 1.61–1.88)
      • High risk: adjusted HR, 3.16 (2.93–3.41)
    • After adjustment for metabolic risk factors, genetic risk, and other dietary components, compared to nonconsumption of SB:
      • ASB consumption > 2 L/week was associated with the highest risk of AF (HR, 1.2; 95% CI, 1.1–1.31).
      • SSB consumption > 2 L/week was associated with an increased risk of AF (HR, 1.10; 1.01–1.2).
      • Consumption of ≤ 2 L/week of AFB or SSB was not associated with AF risk.
      • Moderate to high PJ consumption was not associated with AF risk, but low consumption (≤ 1 L/week) had a negative association with AF risk (HR, 0.92; 0.87–0.97).
    • The effect of genetic predisposition for AF on the association between SB consumption and risk of AF did not reach significance.
  • Limitations include:
    • SB intake estimates based on one or few 24-hour dietary recall questionnaires are susceptible to recall bias and may not reflect long-term consumption.
    • Common potentially sweetened drinks such as tea and coffee were not classed as SB.
    • Results may have been confounded by unmeasured factors, such as the caffeine content of SB.
  • Study funding: National Natural Science Foundation of China and others
  • Original study: Sweetened beverages, genetic susceptibility, and incident atrial fibrillation: a prospective cohort study. [58]
  • Related AMBOSS content: Etiology of atrial fibrillation

Edition 94 - March 16, 2024toggle arrow icon

The effect of caregiver race on shared decision-making in critical illness

One-Minute Telegram 94-2024-1/3

10-second takeaway

Racial disparity in health care delivery is well-documented, but studies investigating the effect of race on shared decision-making are lacking. In this thematic analysis of conversations between critical care providers and caregivers of critically ill patients, Black caregivers frequently received less empathy, less medical information, and/or less acceptance of treatment preferences than White caregivers. Providers should be mindful of the potential impact of unconscious bias on their communication with patients and caregivers and always follow best practices for shared decision-making.

Study breakdown

  • Study population: 39 audio recordings of meetings between caregivers (20 Black: mean age, 47.6 years, 75.0% female; 19 White: mean age, 51.9 years, 73.7% female) and health care providers
  • Methods: thematic analysis of audio recording transcripts from a multicenter randomized clinical trial of a decision aid about prolonged mechanical ventilation
    • A multidisciplinary team coded the transcripts based on preidentified components of shared decision-making and bias in clinical communication.
    • Analysts were blinded to caregiver race during coding.
    • Data collection was stopped after analysis of 39 meetings because no new themes were identified.
    • Outcome: themes describing clinician behaviors during shared decision-making conversations stratified by the self-reported race of patient caregivers
  • Main results
    • Mean meeting durations were similar for Black caregivers (24 minutes) and White caregivers (22 minutes).
    • Compared to White caregivers, Black caregivers were less likely to receive:
      • Personalized empathetic or emotionally supportive statements
      • Acknowledgement of statements of trust and gratitude
      • Full disclosure of medical information
      • Acceptance of preferences for restorative medical care
  • Limitations include:
    • Nonverbal communication was not assessed.
    • This cross-sectional analysis did not account for interactions that occurred in other decision-making conversations between participants.
    • Provider race and sex were not considered.
    • The analysis team did not include any individuals identifying as Black.
  • Study funding: National Institutes of Health grants
  • Original study: Racial differences in shared decision-making about critical illness [59]
  • Related AMBOSS content: Shared decision-making

Gabapentinoids and risk of severe AECOPD

One-Minute Telegram 94-2024-2/3

10-second takeaway

Gabapentinoids are approved for the treatment of epilepsy and neuropathic pain and are frequently used off-label for the treatment of other types of chronic pain to avoid the harms of long-term opioid therapy. In this study, the use of gabapentinoids for any indication was associated with an increased risk of severe acute exacerbation of COPD (AECOPD). Health care providers should consider the increased risk of acute exacerbation in patients with COPD before prescribing gabapentinoids.

Study breakdown

ASA is an ADAPTABLE therapy for ASCVD, regardless of age

One-Minute Telegram 94-2024-3/3

10-second takeaway

The 2021 ADAPTABLE trial established that 81 mg of aspirin a day and 325 mg of aspirin a day had similar effectiveness and safety in patients with established atherosclerotic cardiovascular disease (ASCVD), but the effect of patient age was unclear. In this secondary analysis of the ADAPTABLE trial, patient age was not found to impact the effectiveness or safety of aspirin in patients with established ASCVD taking either aspirin 81 mg or 325 mg daily. Aspirin at either conventional dose is reasonable to prevent future atherothrombotic events in patients with ASCVD, irrespective of age.

Study breakdown

  • Study population: 15,076 adults (median age, 67.6 years; 31% female; 80% White) from the ADAPTABLE trial with established ASCVD and at least one factor further increasing their risk of an incident ASCVD event (e.g., age ≥ 65 years)
  • Methods: secondary analysis of an open-label, multicenter, patient-centered, pragmatic randomized controlled trial
  • Main results
    • No significant differences in primary or secondary outcomes between 81 mg and 325 mg of aspirin when stratified by patient age (secondary analysis)
    • Participants experiencing any primary outcome event
      • < 65 years: 7.54% in the 81 mg group and 6.80% in the 325 mg group (adjusted HR [aHR], 1.23; 95% CI, 1.01–1.49)
      • ≥ 65 years: 7.12% in the 81 mg group and 7.96% in the 325 mg group (aHR, 0.95; 0.82–1.10)
    • Participants experiencing a primary safety outcome event
      • < 65 years: 0.53% in the 81 mg group and 0.65% in the 325 mg group (aHR, 1.08; 0.56–2.07)
      • ≥ 65 years: 0.71% in the 81 mg group and 0.59% in the 325 mg group (aHR, 1.32; 0.80–2.20)
  • Limitations include:
    • Participants were not randomized based on age subgroups, which may have caused confounding.
    • The incidence of significant bleeding may have been underestimated because only bleeding events requiring hospitalization were included in the study.
    • Age ≥ 65 years was considered a factor that further increased ASCVD-event risk, which was required for enrollment; participants aged < 65 years may have been more likely to have additional risk factors, leading to an uneven distribution of risk between the groups.
  • Study funding: Patient‐Centered Outcomes Research Institute
  • Original study: Age and aspirin dosing in secondary prevention of atherosclerotic cardiovascular disease [61]
  • Related AMBOSS articles: ASCVD

Edition 93 - March 2, 2024toggle arrow icon

Type 2 diabetes and MASLD: a sweet victory for SGLT2 inhibitors?

One-Minute Telegram 93-2024-1/3

10-second takeaway

Oral antidiabetic agents can improve metabolic dysfunction-associated steatotic liver disease (MASLD; formerly referred to as NAFLD) in patients with type 2 diabetes mellitus (T2DM), but there is no consensus on which agent is preferred. In this study, SGLT2 inhibitors (SGLT2is) showed higher rates of MASLD regression and fewer adverse liver-related outcomes compared to other oral antidiabetic drugs. Further research is needed to determine whether SGLT2is show similar effectiveness in patients without T2DM.

Study breakdown

Promising malaria vaccine results

One-Minute Telegram 93-2024-2/3

10-second takeaway

Malaria contributes to over 600,000 deaths annually, with 80% of malaria deaths in Africa occurring in children aged < 5 years. In this trial, the R21/Matrix-M malaria vaccine was found to be safe and effective against malaria in young children in sub-Saharan Africa, leading the WHO to issue a policy recommendation and prequalification for R21/Matrix-M. Further research is underway to determine the vaccine’s efficacy in patients living with HIV.

Study breakdown

Atrial cardiopathy without atrial fibrillation: Can a DOAC vanquish the stroke?

One-Minute Telegram 93-2024-3/3

10-second takeaway

Atrial cardiopathy is associated with an increased risk of stroke, but it is unknown if anticoagulation is effective for the prevention of stroke recurrence. In this trial, treatment with apixaban was not more effective than low-dose aspirin therapy for the prevention of recurrent stroke in patients with atrial cardiopathy. Further research is needed on the impact of DOACs on recurrent stroke prevention in the subpopulation of patients with severe left atrial enlargement.

Study breakdown

Edition 92 - February 17, 2024toggle arrow icon

Perinatal depression and risk of death

One-Minute Telegram 92-2024-1/3

10-second takeaway

Perinatal depression is one of the most common complications of pregnancy and has been linked to an increased risk of maternal suicide. In this Swedish study, individuals with perinatal depression had a significantly increased risk of all-cause mortality and suicide compared to those without perinatal depression, especially in the first year after diagnosis. Health care providers should remain vigilant for perinatal depression to reduce the risk of preventable death.

Study breakdown

Connection between recent weight loss and cancer diagnosis

One-Minute Telegram 92-2024-2/3

10-second takeaway

Weight loss is a common symptom encountered in primary care and has a known association with cancer, which is a major cause of death in the US. In this analysis of combined data from two large prospective cohort studies, individuals self-reporting recent weight loss had a significantly higher incident rate of cancer within 12 months than individuals without weight loss. Unintentional weight loss had a stronger association with cancer than intentional weight loss. Awareness of this association is important to ensure timely and appropriate evaluation of patients reporting weight loss.

Study breakdown

  • Study population: 157,474 health professionals in the US aged 40 years and older (median age, 62 years; 71% female, 95% White, 2% Black)
  • Methods: prospective cohort analysis
    • Data was obtained from two large prospective studies on health professionals.
      • Nurses’ Health Study: female health workers followed from June 1978 to June 30, 2016
      • Health Professionals Follow-Up Study: male health workers followed from January 1988 to January 31, 2016
    • Exposure: recent weight change based on biennial self-reported weight
    • Intentionality of weight loss was categorized based on reported physical activity and diet quality.
      • Low: neither increased physical activity nor improved diet quality
      • Medium: either increased physical activity or improved diet quality
      • High: both increased physical activity and improved diet quality
    • Cancer diagnosis and date were confirmed through medical records, death certificates, or cancer registry data.
    • Outcome: rates of cancer diagnosis during the 12 months after weight loss
    • The analysis adjusted for health and lifestyle factors, and race.
    • Mean follow-up: 28 years
  • Main results
    • 15,809 incident cancer cases were identified during 1.64 million person-years of follow-up (incident rate, 964 cases/100,000 person-years).
    • Participants reporting a weight loss of > 10% body weight had higher rates of cancer within 12 months than participants without weight loss: 1362 vs. 869 cancer cases per 100,000 person-years (P < 0.001).
    • Absolute risk of cancer within 12 months was highest in individuals with low intentionality of weight loss and loss of > 10% body weight: 3.2% (95% CI, 2.4–4.0%).
    • Cancer of the upper GI tract was most strongly associated with significant recent weight loss.
  • Limitations include:
    • Weight was self-reported and not objectively verified.
    • Speed of weight loss was not necessarily reflected in biennial reporting; more frequent reporting may have altered the results.
    • Findings may not be generalizable to non-health professionals and/or other countries.
  • Study funding: National Institutes of Health, Swedish Research Council,
    Project P Fund, Broman Family Fund for Pancreatic Cancer, Hale Family Center for Pancreatic Cancer Research, Lustgarten Foundation Dedicated Laboratory Program, Stand Up To Cancer, Pancreatic Cancer Action Network, Noble Effort Fund, Wexler Family Fund, Promises for Purple, and Bob Parsons Fund
  • Original study: Cancer diagnoses after recent weight loss [66]
  • Related AMBOSS articles: Adult health maintenance

Abortion ban and mental health

One-Minute Telegram 92-2024-3/3

10-second takeaway

The Supreme Court decision in Dobbs v. Jackson Women’s Health Organization abolished the federal right to an abortion and led to immediate bans in the 13 states that had previously passed legislation outlawing abortion (trigger laws). In this study, population-level symptoms of anxiety and depression increased following the Dobbs decision, particularly among female individuals of reproductive age in states with trigger laws. Increases were small in magnitude but statistically significant. The effects of national abortion policy on changes in population mental health merit further investigation.

Study breakdown

  • Study population: 718,753 adult respondents to the US Census Bureau’s Household Pulse Survey (HPS) conducted between December 29, 2021, and January 19, 2023 (mean age, 48 years; 51% female)
  • Methods: retrospective analysis of cross-sectional survey data before and after the Dobbs decision
    • Population-level symptoms of anxiety and depression are regularly assessed by the HPS.
      • The Patient Health Questionnaire-4 (PHQ-4) is administered to members of a nationally representative database.
      • The PHQ-4 score range is 0–12; a score of > 5 indicates elevated anxiety and/or depression.
    • Outcome: change in mean PHQ-4 score after the Dobbs decision in 13 states with trigger laws (trigger states) vs. 37 states without trigger laws (nontrigger states)
  • Main results
    • The survey response rate was 6%, of which 87% completed the PHQ-4.
    • Mean PHQ-4 scores increased in both groups after the Dobbs decision.
      • Trigger states: 3.51 (95% CI, 3.44–3.59) to 3.81 (3.75–3.87)
      • Nontrigger states: 3.31 (3.27–3.34) to 3.49 (3.45–3.53)
    • The increase in mean PHQ-4 score was significantly greater in trigger states than nontrigger states (difference +0.11; 0.06–0.16; P < 0.001).
    • Among respondents aged 18–45 years, a significantly greater increase in PHQ-4 scores in trigger states vs. nontrigger states was observed among female individuals (+0.23; 0.08–0.37; P = 0.002) but not among male individuals (P = 0.23).
  • Limitations include:
    • Survey-based studies are subject to response bias.
    • Data came from pooled cross sections of different individuals over time, not a cohort of the same individuals.
    • Potential confounders such as individual respondent views on abortion and factors other than the Dobbs decision that may have influenced changes in population-level anxiety and depression were not assessed.
  • Study funding: None
  • Original study: Anxiety and depression symptoms after the Dobbs abortion decision. [67]
  • Related AMBOSS articles: Induced abortion

Edition 91 - February 3, 2024toggle arrow icon

Once is Ca-nough to prevent preeclampsia

One-Minute Telegram 91-2024-1/3

10-second takeaway

Adherence to recommended calcium supplementation for preventing preeclampsia and preterm birth is challenging because of complex dosing schedules. In this study, calcium 500 mg once daily was noninferior to three times a day dosing for preeclampsia prevention in trials in India and Tanzania. Once-daily dosing effectively reduced the risk of preterm birth in the Indian trial but not in the Tanzanian trial. Simplifying calcium supplementation regimens could mitigate hypertensive pregnancy disorders, although further investigation is required on its effectiveness for preventing preterm birth.

Study breakdown

  • Study population: 22,000 (11,000 each in trials in India and Tanzania) nulliparous pregnant individuals aged ≥ 18 years, at less than 20 weeks’ gestation, and at risk for low dietary calcium intake
  • Methods: two independent, randomized, parallel-group, double-blind, placebo-controlled noninferiority studies
    • Randomized 1:1 to calcium 500 mg once daily plus placebo twice a day or calcium 500 mg three times a day (total 1500 mg)
    • Adherence was assessed by pill count at monthly follow-up visits.
    • Participants in India also received 250 IU of vitamin D3 per day.
    • Primary outcomes: preeclampsia and preterm birth
  • Main results
    • Preeclampsia: 500 mg of calcium per day was noninferior to 1500 mg.
      • India: 3.0% vs. 3.6% (RR, 0.84; 95% CI, 0.68–1.03)
      • Tanzania: 3.0% vs. 2.7% (RR, 1.10; 0.88–1.36)
    • Preterm live birth: conflicting results
      • India: 500 mg calcium was noninferior to 1500 mg (11.4% vs. 12.8%; RR, 0.89; 0.80–0.98).
      • Tanzania: noninferiority margin of 1.17 was exceeded (10.4% vs. 9.7%; RR, 1.07; 0.95–1.21)
  • Limitations include:
    • Misclassification of preterm birth may have occurred due to incorrect estimation of gestational age.
    • No placebo control (because of ethical considerations)
    • Study results may not be generalizable to multiparous individuals.
  • Study funding: Bill and Melinda Gates Foundation, Canadian Institutes of Health Research, National Institute of Diabetes and Digestive and Kidney Diseases
  • Original study: Two randomized trials of low-dose calcium supplementation in pregnancy [68]
  • Related AMBOSS articles: Hypertensive pregnancy disorders

Diagnostic errors, harm, and death in US hospitals

One-Minute Telegram 91-2024-2/3

10-second takeaway

Diagnostic errors are a major contributor to adverse outcomes, but the prevalence and cause of these errors are not well defined. In this study, 23% of hospitalized patients who were transferred to the ICU and/or died experienced a diagnostic error; the most significant errors related to patient assessment and ordering and interpreting diagnostic tests. Targeting these key areas is crucial for quality improvement initiatives aimed at reducing patient harm.

Study breakdown

  • Study population: 2428 adults (mean age, 63.9 years; 45.6% female) admitted to the hospital with general medical conditions who were subsequently transferred to the ICU and/or died after hospital day 2
  • Methods: retrospective multicenter cohort study
    • Patients were randomly selected from a cohort of adults admitted to 29 academic medical centers in the US in 2019.
    • Two physicians trained in error adjudication reviewed each medical record to identify errors and determine associated harms.
    • Agreement by both reviewers was required for confirmation of error and harm.
    • Primary outcome: diagnostic errors
    • Secondary outcome: harms associated with errors
    • The adjusted proportion attributable fraction (aPAF) was used to estimate the opportunity to reduce the error associated with each fault.
  • Main results:
    • A diagnostic error was identified in 23% of patient records (95% CI, 20.9–25.3%).
    • Diagnostic error contributed to:
      • Temporary harm, permanent harm, or death in 17.8% (15.9–19.8%) of all patients and 77.1% (72.3–81.9%) of patients who experienced an error
      • 6.6% (5.3–8.2%) of all patient deaths
      • 29.4% (24.0–35.5%) of deaths in patients who experienced an error
    • Areas with the most opportunity to reduce diagnostic errors were:
      • Patient assessment, e.g., delay in or failure to consider, recognize, and/or prioritize diagnoses and complications (aPAF, 21.4%; 16.4–26.4%)
      • Ordering and interpreting tests (aPAF, 19.9%; 14.7–25.1%)
  • Limitations include:
    • May not be generalizable to patients in community medical centers
    • Inconsistent medical record utilization may have introduced documentation and detection biases.
    • Patient harms other than death or physical injury were not assessed, e.g., financial harm or emotional harm.
  • Study funding: Agency for Healthcare Research and Quality
  • Original study: Diagnostic errors in hospitalized adults who died or were transferred to intensive care [69]
  • Related AMBOSS articles: Quality improvement

Joint pain and tick-borne diseases

One-Minute Telegram 91-2024-3/3

10-second takeaway

While long-term complications of tick-borne diseases are rare, many patients attribute chronic, nonspecific musculoskeletal symptoms to past tick-borne disease exposure. In this study, IgG antibodies against Ehrlichia chaffeensis and/or spotted fever group Rickettsia (SFGR) were not associated with symptoms in any joint or symptomatic radiographic knee osteoarthritis (OA), whereas elevated alpha-gal IgE levels were associated with knee symptoms but not knee OA. Further investigation into the association between alpha-gal syndrome and subsequent joint pathology is needed.

Study breakdown

Edition 90 - January 20, 2024toggle arrow icon

A new tool for PREVENTing CVD

One-Minute Telegram 90-2024-1/3

10-second takeaway

The American Heart Association (AHA) has recently introduced Predicting Risk of CVD Events (PREVENT) equations in an effort to improve the ability to predict 10- and 30-year risks of cardiovascular disease (CVD) in adults aged 30–79 years. PREVENT addresses key gaps in the ACC/AHA pooled cohort equations (PCEs) with the inclusion of cardiovascular-kidney-metabolic (CKM) syndrome metrics and social determinants of health (if available). It also provides risk estimates for CVD subtypes, i.e., ASCVD and heart failure (HF). The development of an online calculator for clinical use is underway.

Statement breakdown

Post-PCI care: de-escalating DAPT in high-risk patients

One-Minute Telegram 90-2024-2/3

10-second takeaway

In most patients, dual antiplatelet therapy (DAPT) de-escalation one month after percutaneous intervention (PCI) for an acute myocardial infarction (MI) is a safe and effective way to balance the risk of bleeding and subsequent ischemic events, but the safety of de-escalation in patients with high ischemic risk is unknown. In this study, DAPT de-escalation from ticagrelor (a potent P2Y12 inhibitor) to clopidogrel (a less potent P2Y12 inhibitor) 4 weeks after PCI was noninferior to continued ticagrelor-based DAPT in patients with high ischemic risk at one year after PCI. Long-term outcomes have not yet been reported.

Study breakdown

PEP challenges amid rising STIs

One-Minute Telegram 90-2024-3/3

10-second takeaway

Postexposure prophylaxis (PEP) with doxycycline is effective in preventing bacterial sexually transmitted infections (STIs) in cisgender men and transgender women at high risk, but there is limited data on its effectiveness in cisgender women. In this study, doxycycline PEP did not significantly reduce the incidence of new bacterial STIs in cisgender women at high risk compared to a screen-and-treat strategy, though adherence to the protocol may have been low. Further research is needed on effective patient-centered STI prevention methods for cisgender women at high risk.

Study breakdown

Referencestoggle arrow icon

  1. Khan SS, Coresh J, Pencina MJ, et al. Novel Prediction Equations for Absolute Risk Assessment of Total Cardiovascular Disease Incorporating Cardiovascular-Kidney-Metabolic Health: A Scientific Statement From the American Heart Association. Circulation. 2023; 148 (24): p.1982-2004.doi: 10.1161/cir.0000000000001191 . | Open in Read by QxMD
  2. Lee M, Byun S, Lim S, et al. Dual Antiplatelet Therapy De-Escalation in Stabilized Myocardial Infarction With High Ischemic Risk. JAMA Cardiol. 2023.doi: 10.1001/jamacardio.2023.4587 . | Open in Read by QxMD
  3. Stewart J, Oware K, Donnell D, et al. Doxycycline Prophylaxis to Prevent Sexually Transmitted Infections in Women. N Engl J Med. 2023; 389 (25): p.2331-2340.doi: 10.1056/nejmoa2304007 . | Open in Read by QxMD
  4. Dwarkanath P, Muhihi A, Sudfeld CR, et al. Two Randomized Trials of Low-Dose Calcium Supplementation in Pregnancy. N Engl J Med. 2024; 390 (2): p.143-153.doi: 10.1056/nejmoa2307212 . | Open in Read by QxMD
  5. Auerbach AD, Lee TM, Hubbard CC, et al. Diagnostic Errors in Hospitalized Adults Who Died or Were Transferred to Intensive Care. JAMA Intern Med. 2024.doi: 10.1001/jamainternmed.2023.7347 . | Open in Read by QxMD
  6. Zychowski DL, Alvarez C, Abernathy H, et al. Tick-Borne Disease Infections and Chronic Musculoskeletal Pain. JAMA Netw Open. 2024; 7 (1): p.e2351418.doi: 10.1001/jamanetworkopen.2023.51418 . | Open in Read by QxMD
  7. Hagatulah N, Bränn E, Oberg AS, Valdimarsdóttir UA, Shen Q, Lu D. Perinatal depression and risk of mortality: nationwide, register based study in Sweden. BMJ. 2024: p.e075462.doi: 10.1136/bmj-2023-075462 . | Open in Read by QxMD
  8. Wang QL, Babic A, Rosenthal MH, et al. Cancer Diagnoses After Recent Weight Loss. JAMA. 2024; 331 (4): p.318.doi: 10.1001/jama.2023.25869 . | Open in Read by QxMD
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