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2 Minute Medicine Rewind December 23, 2024
GOLD COPD Exacerbation History Categories and Disease Outcomes
1. Exacerbations of chronic obstructive pulmonary disease (ECOPD) history categories described by the Global Initiative for Chronic Obstructive Lung Disease (GOLD) are limited in their accuracy in estimating future COPD outcomes.
Evidence Rating Level: 2 (Good)
ECOPD has increasingly been recognized as having important clinical relevance in the course of COPD, forming an important part of the GOLD ABE assessment tool which serves to guide treatment strategies. As per the ABE assessment tool, individuals at high risk of ECOPD (defined as having prior 2 or more moderate ECOPD or 1 or more severe ECOPD) are categorized in group E while patients at low ECOPD risk are categorized into group A or B based on symptom burden. This cohort study therefore sought to investigate the estimating performance of the GOLD ECOPD history categories in assessing moderate and severe ECOPD risk and all-cause mortality in patients with COPD. 2291 patients (mean [SD] age, 65 [8] years; 1396 male [60.9%]) with COPD were included from the German COSYCONET study. Moderate ECOPD were defined as acute significant worsening of disease requiring special measures while severe ECOPD were defined as requiring hospital admission. The area under the receiver operating characteristic curve (AUROC) for 1-year estimation of moderate ECOPD risk was 0.63 (95% CI, 0.60-0.65), while the AUROC for 4-year estimation of moderate ECOPD risk was 0.60 (95% CI, 0.56-0.64). Similarly, the AUROC for 1-year estimation of severe ECOPD risk was 0.62 (95% CI, 0.58-0.66), while the AUROC for 4-year estimation of severe ECOPD risk was 0.61 (95% CI, 0.55-0.66). Overall, this study found that the GOLD ECOPD history categories based on cutoffs of 2 or more moderate ECOPD or 1 or more severe ECOPD had limited estimating performance in predicting future COPD-related outcomes.
Incidence and Risk of Cardiovascular Outcomes in Patients With Anorexia Nervosa
1. Individuals with anorexia nervosa (AN) are at increased risk of cardiovascular outcomes compared to individuals without AN.
Evidence Rating Level: 2 (Good)
Previous studies have shown that individuals with AN are at increased risk of cardiovascular abnormalities compared to those without AN. However, such studies have been limited due to small sample sizes. This matched cohort study therefore sought to investigate the incidence and risk of cardiovascular outcomes in individuals with AN compared to matched controls. 22,891 participants (mean [SD] age, 24.9 [9.9] years; 91.3% female and 8.7% male) which included 2081 patients with AN and 20,810 matched controls patients were identified through the National Health Insurance Research Database (NHIRD) of Taiwan. The primary outcome was the incidence of major adverse cardiovascular events (MACE) and any cardiovascular conditions, with data being extracted over a period of January 1, 2010 to December 31, 2021. The incidence of MACE in individuals with AN was 9.63 per 1000 person-years [95% CI, 7.90-11.72], while the incidence of MACE in matched controls was 1.65 per 1000 person-years [95% CI, 1.42-1.91]. Individuals with AN also had a higher incidence of any cardiovascular condition compared to matched controls (12.55 [95% CI, 10.52-14.96] vs 4.60 [95% CI, 4.21-5.03] per 1000 person-years). At the 5-year follow-up, the cumulative incidence of MACE in individuals with AN was 4.82% (95% CI, 3.85%-6.02%) which was significantly higher than the incidence of MACE in matched controls (0.85% [95% CI, 0.71%-1.01%], P<0.001). Similarly, at the 5-year follow-up the cumulative incidence of any cardiovascular condition was 6.19% (95% CI, 5.19%-7.53%) in the AN group compared to 2.27% (95% CI, 2.04%-2.52%) in the matched control group (P<0.001). Overall, this study found that individuals with AN are at significantly increased risk of MACE and any cardiovascular conditions compared to those without AN.
1. Taxi drivers and ambulance drivers had the lowest proportion of deaths due to Alzheimer’s disease among 443 occupations studied.
Evidence Rating Level: 2 (Good)
The hippocampus is a region of the brain highly involved in the pathophysiology of Alzheimer’s disease. A previous study has shown that taxi drivers, an occupation which involves a high degree of spatial processing requiring the hippocampus, develop enhanced functional changes in the hippocampus. This population-based retrospective study therefore sought to investigate Alzheimer’s disease mortality across various occupations, with a special focus on occupations such as taxi drivers and bus drivers which involve high spatial or navigational demands. A total of 8,972,221 individuals comprising 443 occupational groups were included from the National Vital Statistics System, a population-based registry of all deaths occurring in the United States between January 1st, 2020 and December 31st, 2022. 3.88% (348 328/8 972 221) of all individuals had Alzheimer’s disease as their underlying cause of death, while the unadjusted percentage of deaths due to Alzheimer’s disease was 1.03% (171/16 658) among taxi drivers, 0.74% (10/1348) among ambulance drivers and 3.11% (1345/43 295) among bus drivers. When adjusting for age at death, sex, ethnic group and educational attainment, the occupations with the lowest adjusted percentage of deaths from Alzheimer’s disease were taxi drivers (1.03% [95% CI, 0.87% to 1.18%]) and ambulance drivers (0.91% [95% CI, 0.35% to 1.48%]). Overall, this study found that taxi drivers and ambulance drivers, occupations requiring high degrees of spatial and navigational processing, had the lowest proportion of deaths due to Alzheimer’s disease among 443 occupations investigated.
1. Maintenance therapy with adalimumab (ADA) was associated with more frequent objective improvement based on Magnetic Resonance Enterography (MRE) findings than immunomodulator (IM) in pediatric patients with Crohn’s disease (CD).
Evidence Rating Level: 2 (Good)
In recent years, treatment goals for CD have shifted from symptom alleviation to resolution of intestinal inflammation, with the achievement of transmural healing (TH) being associated with improved long-term outcomes. In line with this, in recent years MRE has come to play an increasing role in defining disease extent and location. This prospective observational study therefore sought to investigate the longitudinal attainment of TH in a pediatric cohort and the comparative effectiveness of anti-TNF and IM therapy as maintenance therapy using a novel MRE index, the pediatric inflammatory Crohn’s disease magnetic resonance index (PICMI). 80 patients (median age at diagnosis, 13.5; 73% male) from a tertiary pediatric IBD referral centre with CD who had not received prior anti-TNF were enrolled. The primary outcome was at least mild improvement in PICMI-SB without alteration in therapy, with secondary outcomes being normalization on MRE at the 1-year follow-up. 77% (20/26) of patients receiving ADA and 44% (16/36) receiving IM (P = 0.01) achieved steroid-free clinical remission at 1 year without change in therapy. Based on MRE findings, transmural inflammation improved at least mildly in 54% of patients receiving ADA and 31% in patients receiving IM (P = 0.01). Normalization of MRE occurred in 29% of patients receiving ADA and 14% of patients receiving IM (P = 0.18). Overall, this study found that maintenance therapy with ADA in pediatric CD patients was associated with more frequent objective improvement per MRE findings than maintenance therapy with IM, but that MRE normalization remains infrequent regardless of treatment strategy.
1. The use of electrically heated mittens for 6 weeks was not associated with improved physical hand function in patients with osteoarthritis compared to control mittens.
Evidence Rating Level: 1 (Excellent)
Therapeutic options for osteoarthritis remain limited with existing options such as NSAIDs having notable toxicities in elderly patients, necessitating the development of new effective and safe treatments. The use of heat therapy in the management of hand osteoarthritis has sometimes been recommended, but the evidence behind such recommendations has been limited. This randomized controlled trial therefore sought to investigate the effect of electrically heated mittens on outcomes such as hand function in patients with hand osteoarthritis compared with control mittens without heating elements. 200 participants (mean age, 71 years; 87% female) with hand osteoarthritis from Denmark were randomized to either the heated mittens group or the control mittens group. Patients were assessed at baseline and 2, 4 and 6 week follow-ups and asked to wear their given mittens for at least 15 minutes per day, ideally when their symptoms were at their worst. The primary outcome was the change in hand function as determined by the function subscale of the AUSCAN questionnaire. Secondary outcomes included changes in the AUSCAN pain and stiffness subscales. After 6 weeks, both groups showed improvements in the AUSCAN function subscale score, with a difference of 3.0 points (95% CI −0.4 to 6.3; P=0.09) in favour of the heated mitten group. There was a difference of 5.9 points (95% CI 2.2 to 9.5) in the AUSCAN pain subscale favouring the heated mitten group, and a difference of 6.3 points (95% CI 1.6 to 11.1) in the AUSCAN stiffness subscale group favouring the heated mitten group. Overall, this study found that the use of electrically heated mittens was not associated with significant improvement in function in patients with hand osteoarthritis, but may be associated with minor improvements in pain and stiffness.
Image: PD
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