American journal of medicine open最新文献

{"title":"The Association of SGLT2i vs DPP4i on Fracture: A Cohort Study in Veterans with Diabetes","authors":"Kathryn Snyder MD, MPH ,&nbsp;Katherine Griffin MPH ,&nbsp;Amber Hackstadt PhD ,&nbsp;Amir Javid PhD ,&nbsp;Adriana Hung MD, MPH ,&nbsp;Robert Greevy PhD ,&nbsp;Christianne L. Roumie MD, MPH","doi":"10.1016/j.ajmo.2025.100105","DOIUrl":"10.1016/j.ajmo.2025.100105","url":null,"abstract":"<div><h3>Background</h3><div>Increased bone turnover is associated with use of SGLT2i. Patients with diabetes experience adverse effects on bone metabolism. Our aim was to evaluate if SGLT2i was associated with fractures vs DPP4i as add-on therapy to diabetes regimens.</div></div><div><h3>Methods</h3><div>We assembled a retrospective cohort of Veterans with diabetes combining Veterans Administration, Medicare, and National Death Index databases. Using an active comparator new user design, patients starting on SGLT2i or DPP4i were followed from prescription fill until a fracture event, death, stopping medication, loss of follow-up, or study end. Fractures included: face/skull, spine, ribs, long bones, hand/feet/digits, or hip. Fractures were identified based on a validated algorithm with positive predictive value 91.3% (86.8, 94.4). Cox models compared the association of fractures between SGLT2i and DPP4i in a propensity score-weighted cohort that balanced 70+ covariates including comorbidities, vital signs, labs, vitamin D levels, smoking, and medications.</div></div><div><h3>Results</h3><div>The unweighted sample included 115,124 SGLT2i episodes (104,086 Veterans; 94% empagliflozin; 4% canagliflozin; 2% dapagliflozin) and 213,095 DPP4i episodes (173,724 Veterans; 45% saxagliptin; 15% sitagliptin; 34% alogliptin; 6% Linagliptin). After propensity score calculation and matched weighting, the cohort included 76,072 SGLT2i and 75,833 DPP4i episodes. Median age was 69.3 years and diabetes duration 9.7 (6.1, 14.0) years. In the matched weighted analyses, there were 1431 and 1564 fractures among SGLT2i and DPP4i users, respectively. There were no clinical differences in fractures per 1000 person-years: 18.2 (17.4, 19.1) vs 19.8 (19.0, 20.6). The adjusted hazard ratio (adjusted hazard ratio 0.93 [0.87, 0.99]) excluded increased risk of fractures (adjusted hazard ratio &gt; 1) in SGLT2i users.</div></div><div><h3>Conclusions</h3><div>SGLT2i use as add-on treatment for diabetes was not associated with increased fracture outcomes compared to DPP4i.</div></div>","PeriodicalId":72168,"journal":{"name":"American journal of medicine open","volume":"14 ","pages":"Article 100105"},"PeriodicalIF":0.0,"publicationDate":"2025-05-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144313389","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Enhancing Resident Note Documentation: A Quality Improvement Initiative to Accurately Capture Patient Complexity","authors":"De-Vaughn Williams MD,&nbsp;Scott Keller MHA,&nbsp;Jennifer Mcentee MD, MPH, MAEd,&nbsp;Escher Howard-Williams MD,&nbsp;Cristin M. Colford MD","doi":"10.1016/j.ajmo.2025.100104","DOIUrl":"10.1016/j.ajmo.2025.100104","url":null,"abstract":"<div><div>Provider notes serve as a critical component of physician workflow, documenting essential aspects of patient care while also fulfilling regulatory and billing requirements. With increasing documentation complexity introduced by the Centers for Medicare and Medicaid Services and the 2021 mandate for open access to clinical notes, physicians in training must develop skills to accurately document patient complexity. This quality improvement initiative aimed to enhance inpatient note documentation by internal medicine residents, focusing on improving the capture of medical complexity in coding and billing standards.</div><div>Our intervention included the development and implementation of a standardized progress note template, a structured scoring rubric, multidisciplinary rounds and curriculum integrating faculty and peer-led feedback. The study measured documentation improvements through rubric scores, Length of Stay Index (LOSi), and complications or comorbidities (CC) and major complications or comorbidities (MCC) capture rates.</div><div>Results demonstrated improvements in LOSi and enhanced CC/MCC capture, leading to improved institutional performance metrics. This initiative highlights the necessity of integrating formal note-writing training within residency curricula to meet evolving documentation demands.</div></div>","PeriodicalId":72168,"journal":{"name":"American journal of medicine open","volume":"14 ","pages":"Article 100104"},"PeriodicalIF":0.0,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144262157","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Implementation of High-Sensitivity Troponin for Early Rule-Out of Acute Myocardial Infarction in Emergency Department","authors":"Alexandra M. Cruz Pabón ,&nbsp;Eric Pyles ,&nbsp;Daniel Peach ,&nbsp;Sarfraz Ahmad ,&nbsp;Paul Blake O’Brien ,&nbsp;Michael Kuhlman ,&nbsp;Sarah Steiner ,&nbsp;Lara Crown ,&nbsp;Elizabeth Purinton ,&nbsp;James Priano","doi":"10.1016/j.ajmo.2025.100103","DOIUrl":"10.1016/j.ajmo.2025.100103","url":null,"abstract":"<div><h3>Background/Purpose</h3><div>Chest pain is a common reason for ED visits. Implementing a HEART score-based algorithm previously increased early discharges by 99%. This study aims to determine if the transition from cTnT to hs-cTnT assays affected patient disposition rates.</div></div><div><h3>Methods</h3><div>This retrospective observational study was conducted in a multi-site hospital system. Adults presenting to the ED with chest pain and a low HEART score (≤3) between November 9, 2020, and November 10, 2022, were included. The primary outcome was the change in patient disposition. Secondary outcomes included length-of-stay (LOS), rates of provocative testing, ED returns, and major adverse cardiovascular events (MACE).</div></div><div><h3>Results</h3><div>We evaluated 32,968 patients (17,173 in the cTnT group and 15,795 in the hs-cTnT group). Both groups had a similar median age, but the hs-cTnT group had a higher proportion of patients with baseline troponin elevations. The ED discharge rate was higher in the hs-cTnT group (87.5%) compared to the cTnT group (85.3%; <em>P &lt; .</em>001), with a corresponding decrease in observation and inpatient admissions. Additionally, the implementation of hs-cTnT was associated with a reduced LOS and a decrease in patients undergoing further testing. Finally, there was a reduction in ED re-visits without a difference in 30- or 60-day MACE after the implementation of hs-cTnT.</div></div><div><h3>Conclusions</h3><div>Integration of hs-cTnT into our chest pain clinical pathway resulted in increased ED discharges, reduced LOS, and fewer additional tests without a change in MACE. This translates to a savings of almost 7,000 ED hours annually without compromising safety.</div></div>","PeriodicalId":72168,"journal":{"name":"American journal of medicine open","volume":"14 ","pages":"Article 100103"},"PeriodicalIF":0.0,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144313321","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Institutional Accountability for Developing the Next Generation of Faculty Leaders","authors":"Julia Loewen ,&nbsp;Paul Salow BBA, MBA ,&nbsp;Patricia Andreski MA ,&nbsp;David J Brown MD ,&nbsp;Kanakadurga Singer MA, MD","doi":"10.1016/j.ajmo.2025.100102","DOIUrl":"10.1016/j.ajmo.2025.100102","url":null,"abstract":"<div><div>Faculty retention provides a competitive advantage in an academic medical center. Faculty surveys show that lack of career advancement and leadership opportunities are primary reasons faculty seek employment elsewhere. Leadership roles for faculty are frequently locally maintained and not available for institutional leaders to assess leadership opportunities and gaps, especially for women and race/ethnicity groups underrepresented in academic medicine.</div><div>Offices of Faculty Affairs, Faculty Development and Health Equity &amp; Inclusion launched a collaboration to frame and define the current state of faculty leadership at one institution. A desired faculty leadership philosophy, best practices, role descriptions, and overall title framework were developed and reviewed with department leaders. Departments identified all current faculty leaders using the title framework, and titles were entered as additional appointments into our human resource database at the faculty level.</div><div>Baseline demographic analysis of faculty leadership appointments demonstrated a gender and race/ethnicity disparity between the population of faculty and those in leadership roles. With the expanded tracking, the number of faculty leadership roles increased approximately sevenfold. While gender and race/ethnicity gaps closed substantially, the data revealed differences in higher-level leadership roles with more equity in mid-level and emerging roles.</div><div>Results enhanced awareness of the importance of tracking and evaluating leadership roles at all levels. Consequently, faculty leadership data were translated into real-time data visualizations. Tracking of who holds leadership positions increases accountability for initiatives designed to diversify leadership in an academic medical center, and demonstrates a commitment to diversity, equity, and inclusion.</div></div>","PeriodicalId":72168,"journal":{"name":"American journal of medicine open","volume":"14 ","pages":"Article 100102"},"PeriodicalIF":0.0,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144212635","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of Stress Hyperglycemia in a Cohort of Brazilian Patients With COVID-19","authors":"Ana Julia de Magalhães Pina MS ,&nbsp;Luís Fernando de Oliveira Mr ,&nbsp;Letícia de Oliveira Nascimento MS ,&nbsp;Deborah Maciel Cavalcanti Rosa MS ,&nbsp;Jefferson Barela Mr ,&nbsp;Bruno Martinelli PhD ,&nbsp;Carlos Antonio Negrato PhD","doi":"10.1016/j.ajmo.2025.100101","DOIUrl":"10.1016/j.ajmo.2025.100101","url":null,"abstract":"<div><h3>Purpose</h3><div>To evaluate the impact of stress hyperglycemia (SH) in a cohort of Brazilian patients with COVID-19 admitted to a tertiary care level hospital.</div></div><div><h3>Methods</h3><div>This retrospective cohort study enrolled 754 patients with COVID-19 hospitalized at Hospital Estadual de Bauru, São Paulo, in 2020. Data were collected from the E-pront system and covered sociodemographic, clinical, and laboratory aspects, including mechanical ventilation, comorbidities, and outcomes. Included patients were those &gt;18 years old, with confirmed COVID-19 diagnosis, who required hospitalization, with or without preexisting type 2 diabetes (T2DM), or who developed SH. Patients younger than 18 years, with other types of diabetes, or incomplete data were excluded.</div></div><div><h3>Results</h3><div>Patients with SH had longer hospital and intensive care unit (ICU) stay (<em>P</em> &lt; .001) as well as longer mechanical ventilation duration (<em>P</em> &lt; .001). Additionally, this group needed a higher number of orotracheal intubations (<em>P</em> &lt; .001) and presented higher mortality rates (<em>P</em> &lt; .001) and fewer discharges 284 (<em>P</em> &lt; .001) compared to patients with T2DM and normoglycemia.</div></div><div><h3>Conclusions</h3><div>Patients who developed SH presented poorer clinical outcomes; needed more frequently orotracheal intubation, mechanical ventilation, and longer hospitalization and ICU stay; and had higher mortality rates and fewer discharges compared to patients with T2DM and normoglycemia.</div></div>","PeriodicalId":72168,"journal":{"name":"American journal of medicine open","volume":"14 ","pages":"Article 100101"},"PeriodicalIF":0.0,"publicationDate":"2025-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144220985","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Health Disparity Clusters of Off Label Prescriptions for Glucagon-Like Peptide 1 Receptor Agonists","authors":"Kateri J. Spinelli ,&nbsp;Allison H. Oakes ,&nbsp;Shih-Ting Chiu ,&nbsp;Mary T. Imboden ,&nbsp;Austin Miller ,&nbsp;Sanjula Jain ,&nbsp;Ty J. Gluckman","doi":"10.1016/j.ajmo.2025.100100","DOIUrl":"10.1016/j.ajmo.2025.100100","url":null,"abstract":"<div><h3>Background</h3><div>Off-label prescribing of glucagon-like peptide 1 receptor agonists (GLP-1 RAs) may exacerbate health disparities.</div></div><div><h3>Methods</h3><div>We performed a retrospective analysis of data from the Trilliant Health national all-payer claims database, US Census Bureau data (race, ethnicity, median household income), and Centers for Disease Control and Prevention social vulnerability index (SVI). Patients with prescriptions for GLP-1 RAs approved for type 2 diabetes mellitus (T2DM) between January 1, 2022, and December 31, 2022 were included. Those without an ICD-10 code for T2DM in their medical claims were considered off-label. Correlations between county-level off-label rates and health disparity variables were examined using visual mapping, geographically weighted regression models, and hierarchical clustering on principle components (HCPC).</div></div><div><h3>Results</h3><div>A total of 3,688,430 GLP-1 RA prescriptions from 2783 (89%) US counties were included. The median off-label prescribing rate was 37.7% [30.0%-46.3%]. Higher household income was modestly correlated with a higher off-label prescribing rate. HCPC modeling produced seven clusters with distinct geographic locations. The highest off-label prescribing rate (51.6%) occurred in a cluster of counties in Hawaii with high median income ($92,124). The lowest off-label prescribing rate (31.2%) occurred in a cluster of counties that included American Indian Tribal reservation lands, with low median income ($52,437) and high SVI (0.88). Other clusters showed unique patterns of racial and ethnic diversity, income, SVI, and off-label prescribing rates.</div></div><div><h3>Conclusions</h3><div>We identified distinct populations with varying GLP-1 RA off-label prescribing and known health disparities. These results could inform clinical and market strategies to increase access to GLP-1 RAs in underserved populations.</div></div>","PeriodicalId":72168,"journal":{"name":"American journal of medicine open","volume":"13 ","pages":"Article 100100"},"PeriodicalIF":0.0,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144124749","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Measuring Patient-Reported Outcomes in Ischemic Heart Disease: Validation of the Greek HeartQoL Questionnaire","authors":"Ioanna Dimitriadou ,&nbsp;Christi Deaton ,&nbsp;Evangelos C. Fradelos ,&nbsp;John Skoularigis ,&nbsp;Ioannis Vogiatzis ,&nbsp;Evangelos Sdogkos ,&nbsp;Aikaterini Toska ,&nbsp;Eleni Tsiara ,&nbsp;Anastasios Christakis ,&nbsp;Dimitra Anagnostopoulou ,&nbsp;Maria Saridi","doi":"10.1016/j.ajmo.2025.100098","DOIUrl":"10.1016/j.ajmo.2025.100098","url":null,"abstract":"<div><h3>Background</h3><div>The Greek HeartQoL questionnaire is designed to assess health-related quality of life (HRQoL) in patients with ischemic heart disease.</div></div><div><h3>Objectives</h3><div>This study aims to validate its psychometric properties in Greek patients diagnosed with angina pectoris, myocardial infarction, and ischemic heart failure.</div></div><div><h3>Methods</h3><div>A cross-sectional study was conducted with 158 patients from five clinical sites in Greece. Participants completed the Greek HeartQoL, the Short Form-36 Health Survey, and the Hospital Anxiety and Depression Scale. Psychometric evaluations included Mokken scale analysis, reliability testing with Cronbach's alpha, and validity assessments through Spearman correlation coefficients, and analysis of covariance.</div></div><div><h3>Results</h3><div>The Greek HeartQoL exhibited excellent internal consistency, with Cronbach's alpha values exceeding 0.90. Factor analysis confirmed the questionnaire's two-factor structure, effectively capturing physical and emotional dimensions of HRQoL. Convergent validity was demonstrated by strong correlations with Short Form-36 Health Survey (<em>r</em> &gt; 0.70), and discriminative validity was confirmed by significant differences in HRQoL scores between patients with angina pectoris, myocardial infarction, and ischemic heart failure (<em>P</em> &lt; .001).</div></div><div><h3>Conclusions</h3><div>The findings suggest that the Greek HeartQoL demonstrates strong reliability and validity in assessing HRQoL in Greek ischemic heart disease patients. However, further studies with larger and more diverse samples are needed to confirm its psychometric properties across different clinical populations.</div></div>","PeriodicalId":72168,"journal":{"name":"American journal of medicine open","volume":"14 ","pages":"Article 100098"},"PeriodicalIF":0.0,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144271649","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"“Step-Up” to Internal Medicine: An Experiential Curriculum to Assist with the Transition of Becoming a Senior Resident","authors":"Manoj Ambalavanan ,&nbsp;James S. Love ,&nbsp;Nan Lv ,&nbsp;Colin Goodman ,&nbsp;Conner M. Olsen ,&nbsp;Adam E. Mikolajczyk","doi":"10.1016/j.ajmo.2025.100099","DOIUrl":"10.1016/j.ajmo.2025.100099","url":null,"abstract":"<div><h3>Background</h3><div>The transition from a postgraduate year (PGY)-1 resident to a PGY-2 resident is often stressful for trainees. Despite various preparatory efforts, the lack of hands-on experiences remains a challenge. In response, we developed the \"Step-Up\" curriculum, allowing PGY-1 residents to assume the senior resident role in a supervised environment.</div></div><div><h3>Methods</h3><div>During the final blocks of the 2021-2023 academic years, categorical PGY-1 residents divided into eligible and ineligible groups for the \"Step-Up\" curriculum. Preliminary, off-service and transition-year residents were excluded from the study. Eligible participants were those who rotated on inpatient or specialty wards and received a rubric outlining senior residents' best practices to encourage self-reflection and feedback from supervising attendings and senior residents. The ineligible group were residents that rotated on critical care or outpatient rotations and served as the control group. Pre- and postcurriculum surveys, with 19 Likert-scale questions (rated 1 [strongly disagree] to 5 [strongly agree]), were administered. Two-sample Wilcoxon rank-sum tests compared ordinal measures between the intervention and control groups.</div></div><div><h3>Results</h3><div>Of 76 residents, 49 (64.5%) were in the intervention group and 27 (35.5%) were in the control group. No significant differences in survey responses were noted before the curriculum. Following it, participants displayed increased confidence in various competencies compared to nonparticipants. \"Step-Up\" participants also felt significantly more confident transitioning to the senior resident role. Of the 42 completing the curriculum, 39 (93%) agreed that the curriculum facilitated their transition.</div></div><div><h3>Conclusions</h3><div>Our study highlights the effectiveness of a hands-on curriculum where PGY-1 residents assume the senior resident role, offering a satisfying experience and enhancing comfort with the role and specific competencies. This novel approach addresses challenges in the PGY-1 to PGY-2 transition, providing valuable insights for medical education programs.</div></div>","PeriodicalId":72168,"journal":{"name":"American journal of medicine open","volume":"14 ","pages":"Article 100099"},"PeriodicalIF":0.0,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144271648","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sex Specific Outcomes With Cardiac Resynchronization Therapy in Patients With Symptomatic Heart Failure Having Reduced Left Ventricular Ejection Fraction: A Systematic Review and Meta-Analysis","authors":"Muhammad Hamayal MBBS,&nbsp;Muhammad Arham Abbas MBBS,&nbsp;Momina Hafeez MBBS,&nbsp;Saira Mahmud MBBS,&nbsp;Warda Shahid MBBS,&nbsp;Saman Naeem MBBS,&nbsp;Hasan Shaukat Abbasi MBBS,&nbsp;Muhammad Danyal Tahir MBBS,&nbsp;Aleea Abbas MBBS,&nbsp;Iqra Iftikhar MBBS,&nbsp;Naaemah Saleem MBBS","doi":"10.1016/j.ajmo.2025.100097","DOIUrl":"10.1016/j.ajmo.2025.100097","url":null,"abstract":"<div><div>Cardiac resynchronization therapy (CRT) has emerged instrumental in managing heart failure. Notably, there is a lack of evidence of CRT efficacy among both sexes. Thus, this meta-analysis focuses on the long-term benefits of CRT in both sexes. PubMed, The Cochrane Library and clinicaltrials.gov were searched for articles from 2010 to 2024. ROB2 was used to assess risk of bias of RCTs. Newcastle Ottawa Scale was used for quality appraisal of cohorts. Meta-analysis was conducted on Revman 5.4. Out of 2722 articles, only 9 RCTs and 18 cohorts were included. Our results demonstrated that females had a significantly lower risk of composite outcomes compared to males in both RCTs (RR 0.80; 95% CI [0.68, 0.94], P = .006) and cohorts (RR 0.76; 95% CI [0.63, 0.92], P = .004). Results were similar for all-cause mortality. For heart failure hospitalization, only cohorts showed a significant lesser risk in females (RR 0.78; 95% CI [0.65, 0.93], P = .006). Left ventricular ejection fraction improved significantly in females but no differences were observed for NYHA class improvement. Males showed a 31% lower survival rate. However future trials are needed to highlight this variation.</div></div>","PeriodicalId":72168,"journal":{"name":"American journal of medicine open","volume":"13 ","pages":"Article 100097"},"PeriodicalIF":0.0,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143821424","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Analysis of Takayasu's Arteritis as a Risk Factor for Acute Coronary Syndrome","authors":"Maria Emilia Romero Noboa MD ,&nbsp;Shilpa Arora MD ,&nbsp;Preeti Kansal MD ,&nbsp;Augustine M. Manadan MD","doi":"10.1016/j.ajmo.2025.100096","DOIUrl":"10.1016/j.ajmo.2025.100096","url":null,"abstract":"<div><h3>Introduction</h3><div>Takayasu's arteritis (TAK) is a rare chronic granulomatous vasculitis that primarily affects the aorta and its major branches but is also known to affect the coronary arteries. This involvement can result in acute coronary syndrome (ACS). This study aims to analyze TAK as an ACS risk factor in a US adult inpatient population.</div></div><div><h3>Methods</h3><div>We performed a retrospective study of ACS in 2016-2020 National Inpatient Sample (NIS) database. TAK and traditional cardiovascular (CV) risk factors were included in a multivariable logistic regression analysis for an outcome of ACS. The results were reported as adjusted odds ratios (OR_adj) with <em>P</em> values &lt;.05 considered significant.</div></div><div><h3>Results</h3><div>There were 148,767,786 adult hospitalizations in the 2016-2020 NIS database. Of the 3,282,749 hospitalizations with ACS, 180 (0.005%) had TAK. Multivariable analysis showed that age (OR_adj 1.02), lowest income quartile (OR_adj 1.03), diabetes (OR_adj 1.19), hypertension (OR_adj 1.06), hyperlipidemia (OR_adj 2.94), nicotine dependence/tobacco use (OR_adj 1.96), obesity (OR_adj 1.21), and TAK (OR_adj 1.78) were associated with a higher odds of ACS.</div></div><div><h3>Conclusions</h3><div>Despite rare occurrence of concurrent ACS and TAK, we found TAK was independently associated with ACS similar to traditional CV risk factors. These results should alert physicians to the high risk of ACS in TAK inpatients.</div></div>","PeriodicalId":72168,"journal":{"name":"American journal of medicine open","volume":"13 ","pages":"Article 100096"},"PeriodicalIF":0.0,"publicationDate":"2025-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143826180","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}