Internal Medicine Journal最新文献

{"title":"Patient-driven personal importation in the face of cost barriers to care: can we do better?","authors":"Narcyz Ghinea,&nbsp;Hazel Heal,&nbsp;Mark Danta","doi":"10.1111/imj.16569","DOIUrl":"10.1111/imj.16569","url":null,"abstract":"<p>Australia has a robust public health system that helps to make medicines affordable. However, evidence shows that a significant proportion of Australians still cannot afford medicines prescribed to them and that some patients import medicines from abroad as a result. The strongest predictor of whether patients import medicines is whether they have discussed it with their doctor. In this article we explore options available to patients and physicians for access to unapproved medicines when approved medicines are unaffordable. Although personal importation is the most obvious option, regulation leaves scope for other possibilities. We propose that guidance should be developed to help physicians address cost-related medicine non-adherence in practice and to help them understand their options and how to navigate them at the individual, speciality and professional levels.</p>","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":"55 1","pages":"130-133"},"PeriodicalIF":1.8,"publicationDate":"2025-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143004651","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"2024 IMJ REVIEWERS*","authors":"","doi":"10.1111/imj.16640","DOIUrl":"https://doi.org/10.1111/imj.16640","url":null,"abstract":"","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":"55 1","pages":"9-11"},"PeriodicalIF":1.8,"publicationDate":"2025-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143115346","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Perspectives on the perceived complexities of modern patient care","authors":"Isaac K. S. Ng,&nbsp;Li Feng Tan,&nbsp;Wilson G. W. Goh,&nbsp;Desmond B. Teo","doi":"10.1111/imj.16621","DOIUrl":"10.1111/imj.16621","url":null,"abstract":"","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":"55 1","pages":"169-170"},"PeriodicalIF":1.8,"publicationDate":"2025-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143004657","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of distance from liver transplant centre on outcomes following liver transplantation: an Australian single-centre study","authors":"Simone Chin,&nbsp;Charlotte Kench,&nbsp;Rena Cao,&nbsp;Christina Lee,&nbsp;Karen Waller,&nbsp;Susan Virtue,&nbsp;Claire West,&nbsp;Talal Valliani,&nbsp;David G. Bowen,&nbsp;Rachael Jacob,&nbsp;Madeleine Gill,&nbsp;Carlo Pulitano,&nbsp;Michael Crawford,&nbsp;Simone I. Strasser,&nbsp;Geoffrey W. McCaughan,&nbsp;Ken Liu","doi":"10.1111/imj.16631","DOIUrl":"10.1111/imj.16631","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Access to liver transplantation (LT) is affected by geographic disparities. Higher waitlist mortality is observed in patients residing farther from LT centres, but the impact of distance on post-LT outcomes is unclear.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>To evaluate whether the distance LT recipients reside from their LT centre affects graft and patient outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We retrospectively studied consecutive adult patients who received deceased donor LT at a statewide LT referral centre, Royal Prince Alfred Hospital (RPAH), 2006–2021. The primary outcome was overall patient survival.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 973 patients who underwent LT during the study period were analysed. The median distance from patient residence to RPAH was 44.9 km (interquartile range 21.9–168.0). Of these, 64.2% lived ≤100 km from RPAH. Compared to patients living ≤100 km from RPAH, those living &gt;100 km away were less likely to be male, have chronic hepatitis B as their cause of liver disease or have hepatocellular carcinoma as their primary indication for LT. Living &gt;100 km from RPAH was associated with fewer face-to-face clinic visits in the first year after LT (10 vs 11 visits, <i>P</i> &lt; 0.001) and fewer readmissions to RPAH (32.4% vs 67.6%, <i>P</i> &lt; 0.001). Distance from RPAH, regional code and socioeconomic code did not affect long-term graft or patient survival based on Kaplan–Meier survival analysis (log-rank <i>P</i> &gt; 0.1).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>In our single-centre Australian study, patients living farther from their LT centre had different demographics. Distance from the LT centre was not associated with long-term inferior graft or patient survival after LT.</p>\u0000 </section>\u0000 </div>","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":"55 4","pages":"564-572"},"PeriodicalIF":1.8,"publicationDate":"2025-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142970557","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Proposal and exploration of a novel score to quantify patient-perceived burden of inflammatory bowel disease under routine care","authors":"Joseph L. Pipicella,&nbsp;Bonita Gu,&nbsp;Jack McNamara,&nbsp;William Wilson,&nbsp;Lyle J. Palmer,&nbsp;Susan J. Connor,&nbsp;Jane M. Andrews","doi":"10.1111/imj.16634","DOIUrl":"10.1111/imj.16634","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The burden of inflammatory bowel disease (IBD) is often reported on from a system or cost viewpoint. We created and explored a novel patient-perceived burden of disease (PPBoD) score in a large Australasian cohort.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>To create and explore a novel patient-perceived burden of disease (PPBoD) score in a large Australasian cohort, and correlate PPBoD scores with demographics, disease and treatment factors.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>The Crohn Colitis Care Registry was interrogated in October 2023. Data from adults with IBD with an outpatient care encounter in the last 14 months among 17 centres were included. A novel PPBoD score was designed for ulcerative colitis (UC), Crohn disease (CD) and IBD-unclassified (IBDU). Correlations between PPBoD scores and demographics, disease and treatment factors were examined.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of those with adequate data, 46.7% (2653/5685) had no PPBoD, 34.6% (1969/5685) had mild, 11.3% (641/5685) had moderate and 7.4% (422/5685) had significant PPBoD. New Zealanders were more likely to have higher PPBoD compared to Australians (<i>P</i> = 0.047). Greater PPBoD was seen in patients with CD and IBDU compared to patients with UC (<i>P</i> &lt; 0.001) and females were more likely to have significant PPBoD (8.7%) than males (6.1%) (<i>P</i> &lt; 0.001). People with no or mild PPBoD were more likely to be on advanced therapies (55.7% and 59.5% respectively) than those with significant PPBoD (46.3%) (<i>P</i> &lt; 0.001). The proportion of people on advanced therapies in Australia was higher than in New Zealand (61.2% vs 38.5% respectively, <i>P</i> &lt; 0.001). Steroid usage was significantly higher in people with greater PPBoD (significant BoD 7.1% vs no BoD 1.1%; <i>P</i> &lt; 0.001).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Most of this real-world care cohort had no or mild PPBoD. Data suggest that higher PPBoD levels may be resolved by appropriate therapeutic escalations.</p>\u0000 </section>\u0000 </div>","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":"55 4","pages":"589-598"},"PeriodicalIF":1.8,"publicationDate":"2025-01-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/imj.16634","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142964606","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risk factors associated with 30-day mortality following COVID-19 infection in patients receiving kidney replacement therapy in Australia and New Zealand","authors":"Peter Kolovos,&nbsp;Christopher E. Davies,&nbsp;Feruza Kholmurodova,&nbsp;Georgina Irish,&nbsp;Hemant Kulkarni,&nbsp;Kevan R. Polkinghorne,&nbsp;Claire Dendle,&nbsp;Andrew Pilmore,&nbsp;Daniela Potter,&nbsp;Matthew Roberts,&nbsp;Subi Thomas,&nbsp;Sradha Kotwal,&nbsp;Solomon Menahem","doi":"10.1111/imj.16628","DOIUrl":"10.1111/imj.16628","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background and Aims</h3>\u0000 \u0000 <p>The COVID-19 pandemic impacted greatest among patients with pre-existing chronic health conditions, including chronic kidney disease. This retrospective cohort study aimed to investigate the 30-day mortality of patients receiving kidney replacement therapy (KRT) after infection with COVID-19, living in Australia and New Zealand between 2020 and 2022, including patients on haemodialysis (HD), peritoneal dialysis (PD) and renal transplant (KT) recipients.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This is a retrospective cohort study using data from the Australian and New Zealand Dialysis and Transplant Registry (ANZDATA). Patients were included if they tested positive for COVID-19 infection while receiving KRT between the first reported infection in January 2020 and the end of November 2022. Multivariable logistic regression was used to assess the relationship between KRT modality and 30-day mortality following COVID-19 infection, with all potential confounders included.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 9828 patients requiring KRT tested positive for COVID-19 within Australia and New Zealand between 2020 and 2022. The crude mortality rate by KRT modality was 3.0% for HD, 3.8% for PD and 2.4% for KT. In the adjusted model, there was a significant increase in the odds of mortality for increasing age, diabetes, peripheral vascular disease, having ever smoked and having received dialysis for ≥5 years. Relative to HD, KT recipients had increased odds of death in 2021 and 2022 but not 2020.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The 30-day mortality rate following COVID-19 infection in patients requiring KRT was significantly higher than the general population, with several risk factors identified associated with increased mortality rates.</p>\u0000 </section>\u0000 </div>","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":"55 4","pages":"622-629"},"PeriodicalIF":1.8,"publicationDate":"2025-01-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142964199","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ward-delivered nasal high-flow oxygen and non-invasive ventilation are safe for people with acute respiratory failure: a cohort study","authors":"Catherine Buchan,&nbsp;Yet Hong Khor,&nbsp;Rebecca Disler,&nbsp;Matthew T. Naughton,&nbsp;Natasha Smallwood","doi":"10.1111/imj.16624","DOIUrl":"10.1111/imj.16624","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background and Aims</h3>\u0000 \u0000 <p>Ward-delivered non-invasive respiratory supports (NIRS) (conventional oxygen therapy (COT), high-flow nasal oxygen (HFNO), continuous positive airway pressure (CPAP) and non-invasive ventilation (NIV)), are often used to treat hospitalised patients with acute respiratory failure (ARF) both in high acuity and general wards. This study aimed to describe the processes of care adopted and examine patient outcomes from a specialist, ward-delivered NIRS service caring for people with COVID-19 in general wards or in a respiratory care unit (RCU).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A cohort study was undertaken including all consecutive patients admitted to a quaternary hospital with ARF secondary to COVID-19 and requiring ward-delivered NIRS between 28 February 2020 and 18 March 2022. NIRS use, processes of care and patient outcomes were examined.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Six hundred sixty-eight patients were included, with 61% male and a mean age of 64 years (interquartile range 48–79 years). All received COT. Fifty eight percent of patients required additional NIRS: HFNO (36.2%), CPAP (19.8%) and NIV (1.9%). Eighty-two percent of patients had oxygen saturation targets documented. After the implementation of the RCU, significantly more nurse consultant-led CPAP prescriptions were initiated (<i>P</i> = 0.004) and fewer patients required review by the ICU team (<i>P</i> = 0.001) or transfer to ICU (<i>P</i> = 0.050). Forty-nine patients died (7.3%), with most (62.8%) being discharged directly home.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>This study highlights that ward-delivered NIRS is feasible and safe for people with COVID-19 and ARF. The combination of ward and RCU-delivered NIRS was particularly effective. Further research is required to determine the optimal models of respiratory care required for a broader range of patients and to understand how these should be implemented.</p>\u0000 </section>\u0000 </div>","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":"55 4","pages":"645-654"},"PeriodicalIF":1.8,"publicationDate":"2025-01-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/imj.16624","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142964312","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Journal in 2024","authors":"Jeff Szer","doi":"10.1111/imj.16636","DOIUrl":"10.1111/imj.16636","url":null,"abstract":"&lt;p&gt;&lt;i&gt;There is nothing permanent except change&lt;/i&gt;. Attributed to Heraclitus, 6th Century BCE.&lt;/p&gt;&lt;p&gt;As I began by writing 12 months ago, change continues in so much of our professional lives and this is definitely seen to continue in 2024 in our journal, the &lt;i&gt;Internal Medicine Journal&lt;/i&gt; (IMJ). Most directly we were affected by additional key resignations from the Editorial Board but enthusiastically have received new members of the Board in a process guided by the relevant specialist societies.&lt;/p&gt;&lt;p&gt;Professor Velandai Srikanth, Geriatric Medicine editor since 2019, was replaced by his successor Associate Professor Paul Yates, Austin Health and University of Melbourne. Professor Janet Hardy, Palliative Medicine editor, with an impressive 18-year stay, was replaced by Professor Jennifer Philip, St Vincent's Hospital, Melbourne. Janet was particularly proactive in soliciting editorials. Her editorial on euphemisms&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; (published in 2016) and promoting the usage of the word ‘death’ while avoiding the term ‘passing away’ has become part of our style manual. The specialty of Palliative Medicine placed a major emphasis on encouraging openness in discussions around death and making decisions around end-of-life care. Professor Christian Gericke, Public Health Medicine editor since February 2024, left a departing gift of a podcast on Pomegranate Health in August on the topic of readmissions. He was replaced by Associate Professor Phillip Hider from the University of Otago, Christchurch, New Zealand, in July. Phillip is an experienced public health physician who has also served on multiple committees of the Australasian Faculty of Public Health Medicine. Most recently, Dr Elizabeth Potter, Internal Medicine editor since February 2023, announced her resignation, given her competing substantive roles as unit director and chair of the IMSANZ research network. Her successor is yet to be confirmed. We welcome our new additions and thank those leaving for other ventures.&lt;/p&gt;&lt;p&gt;No one has been unaffected by the rise of artificial intelligence (AI) models and systems. There were increasing submissions around this theme in 2024, notable as its impact on medicine and science remains fundamentally uncertain and its place in publishing still undefined. The editorial by Paul Komesaroff in the October 2024 issue of IMJ entitled ‘How should journals respond to the emerging challenges of artificial intelligence’&lt;span&gt;&lt;sup&gt;2&lt;/sup&gt;&lt;/span&gt; makes a start at addressing the challenges this developing entity creates for us all. On your behalf, I attended the meeting of the Asia Pacific Association of Medical Journal Editors in Newcastle this year and this subject was a major topic of discussion, with many of the potential pitfalls being aired. The topic of AI authorship was discussed seriously and I am pleased to say that there was universal acknowledgement that AI, in any form, could not be a named author on a paper.&lt;/p&gt;&lt;p&gt;IMJ was directly responsible ","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":"55 1","pages":"7-8"},"PeriodicalIF":1.8,"publicationDate":"2025-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/imj.16636","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142948249","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparative study of management strategies for immune checkpoint inhibitor-induced inflammatory arthritis: rheumatologists versus oncologists","authors":"Jang S. Yoon,&nbsp;Frances Zhao,&nbsp;Hafsa Masood,&nbsp;Ravini De Silva,&nbsp;Jessie Binns,&nbsp;Victoria Atkinson,&nbsp;Ranjeny Thomas,&nbsp;Matthew Terrill","doi":"10.1111/imj.16629","DOIUrl":"10.1111/imj.16629","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Immune checkpoint inhibitors (ICIs) have significantly improved cancer treatment outcomes but are associated with immune-related adverse events (irAEs), such as inflammatory arthritis (ir-IA). Management of ir-IA is evolving, with corticosteroids as the primary treatment, though some cases require steroid-sparing agents.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>This study aimed to compare initial mean prednisolone doses and disease persistence over 12 months in patients with rheumatoid arthritis (RA)-like ir-IA managed by rheumatologists or oncologists.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This retrospective observational study involved patients who developed RA-like ir-IA after ICI treatment for advanced cancers between September 2015 and January 2019 at a tertiary hospital in Brisbane, Australia. Patient records were reviewed up to January 2020 to evaluate chronicity. Data were collected, and statistical analyses compared the management between rheumatologists and oncologists.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 871 patients received ICI and 246 had irAEs, with 20 developing RA-like ir-IA. Nine were managed by an oncologist and 11 by a rheumatologist. The mean dose of prednisolone commenced by a rheumatologist was 14 mg compared to 53.3 mg by an oncologist (<i>P</i> = 0.0058). Patients managed by a rheumatologist were more likely to receive conventional synthetic disease-modifying anti-rheumatic drugs (csDMARD) (odds ratio 16, <i>P</i> = 0.023). Thirteen patients required ongoing maintenance treatment, while seven had resolution within 12 months of disease onset.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>RA-like ir-IA comprised 8% of ICI-related irAEs. During the study period, patients managed by rheumatologists received lower initial prednisolone doses and more frequent csDMARD than oncologists. A multidisciplinary involvement between rheumatologists and oncologists in the event of ir-IA is crucial.</p>\u0000 </section>\u0000 </div>","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":"55 3","pages":"426-434"},"PeriodicalIF":1.8,"publicationDate":"2025-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142948243","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A retrospective analysis of cardiovascular outcomes of clozapine treated individuals within Hunter New England","authors":"Shanathan Sritharan,&nbsp;Kindelan Murray,&nbsp;Dominic Lam,&nbsp;Daniel Wittaker,&nbsp;Aaron Sverdlov,&nbsp;Andrew Boyle,&nbsp;Allan Davies,&nbsp;Trent Williams,&nbsp;Nicholas Collins","doi":"10.1111/imj.16617","DOIUrl":"10.1111/imj.16617","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Clozapine has demonstrated superiority in improving both positive and negative symptoms of treatment-resistant schizophrenia; however, there are associated treatment-limiting side effects, including myocarditis, cardiomyopathy and agranulocytosis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>This retrospective cohort study describes the prevalence of myocarditis, left ventricular (LV) dysfunction, cardiovascular risk factors and outcomes in a cohort of patients maintained on clozapine therapy.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Data were retrospectively collated from patients who had a diagnosis of schizophrenia, had been managed with clozapine at any stage during their care and undergone at least one echocardiogram.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Between March 2020 and September 2021 674 patients were identified, 71% were male, with a mean age of 47 years old (interquartile range (IQR) 40–57). The mean duration of clozapine use was 7 years (IQR 4–13). The overall mortality was 5.54% during the follow-up period. Myocarditis was identified in one patient (0.15%) within the first 30 days, and an additional five cases were identified over the follow-up period (0.89%). The combined incidence of heart failure (HF) and myocarditis was 1.6% during the follow-up period. There was no association between LV size and function at baseline or during follow-up and adverse cardiac outcomes (comprising death, myocarditis, HF). Older age at initiation of therapy and baseline E/<i>e'</i> ratio were associated with risk of HF and myocarditis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The overall incidence of myocarditis and HF during follow-up was low, with surveillance echocardiography offering limited predictive value. Patients maintained on clozapine are at risk of significant cardiovascular sequelae, likely reflecting an adverse risk factor profile.</p>\u0000 </section>\u0000 </div>","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":"55 3","pages":"474-482"},"PeriodicalIF":1.8,"publicationDate":"2025-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142948241","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}