American journal of medicine open最新文献

{"title":"GLP-1 Receptor Agonists Initiation and Risk of Acute Pancreatitis and Pancreatic Cancer: A Real-World Comparative Study","authors":"Omar Faour MD ,&nbsp;Moheb Boktor MD ,&nbsp;Hanford Yau MD ,&nbsp;Mustafa Kinaan MD ,&nbsp;Ishak A Mansi MD","doi":"10.1016/j.ajmo.2025.100114","DOIUrl":"10.1016/j.ajmo.2025.100114","url":null,"abstract":"<div><h3>Background</h3><div>Glucagon-like peptide 1 receptor agonist (GLP-1RA) medications are widely used in managing type 2 diabetes because of their cardio-renal-metabolic benefits. However, concerns persist regarding their potential association with acute pancreatitis (AP) and pancreatic cancer. This study’s objective was to examine the association of GLP-1RAs with the risk of AP and pancreatic cancer.</div></div><div><h3>Methods</h3><div>This retrospective propensity score-matched cohort study used Veterans Health Administration national data during fiscal years 2006 to 2021. Using a new-user active comparator design, we included veterans who initiated either GLP-1RA or dipeptidyl peptidase-4 inhibitor (DPP-4i) medication, the latter as an active comparator. The primary outcomes were incident AP and pancreatic cancer. We excluded patients with a history of pancreatitis, pancreatic tumors, pancreatic congenital anomalies, and alcohol use. Secondary analysis included adjusting for confounders that may have been introduced during the follow-up period, such as gallbladder diseases, and <em>post hoc</em> analysis restricted analysis to people who had normal serum lipase during follow-up.</div></div><div><h3>Results</h3><div>We matched 88,972 pairs of GLP-1RA and DPP-4i users on all characteristics. AP was diagnosed in 214 (0.24%) DPP-4i users versus 273 (0.31%) GLP-1RA users (OR 1.28; 95% CI, 1.07-1.53), and pancreatic cancer was diagnosed in 154 (0.17%) DPP-4i users versus 211 (0.24%) GLP-1RA users (OR 1.37; 95% CI, 1.11-1.69). Secondary and <em>post hoc</em> analyses showed results consistent with the primary analysis.</div></div><div><h3>Conclusions</h3><div>GLP-1RAs are associated with a modest but statistically significant increase in the risk of AP and pancreatic cancer compared to DPP-4i.</div></div><div><h3>Clinical significance</h3><div>GLP-1RA use is associated with modestly increased odds ratio of acute pancreatitis and pancreatic cancer. Whereas the increased risk seems modest compared to their benefits as shown in the literature, vigilance is recommended, specifically, when GLP-1RAs are used for off label indications.</div></div>","PeriodicalId":72168,"journal":{"name":"American journal of medicine open","volume":"14 ","pages":"Article 100114"},"PeriodicalIF":0.0,"publicationDate":"2025-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145046095","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":"The Impact of Different Antidiabetic Drugs on Fracture Risk in Patients With Type 2 Diabetes Mellitus: A Systematic Review and Network Meta-analysis of Randomized Controlled Trials With a Focus on SGLT2 Inhibitors","authors":"Bushra Admani MBBS ,&nbsp;Fizza Zehra Raza MBBS ,&nbsp;Fatima Siddiqui MBBS ,&nbsp;Muhammad Talal Ashraf MBBS ,&nbsp;Muhammad Khuzzaim Khan MBBS ,&nbsp;Ifra Habib MBBS ,&nbsp;Ayesha Usman MBBS ,&nbsp;Bareeha Mansoor MBBS ,&nbsp;Zaira Nadeem MBBS ,&nbsp;Rana Jahanzeb Ghaffer MBBS ,&nbsp;Muhammad Riyyan MBBS ,&nbsp;Sawaira Sajid MBBS ,&nbsp;Muhammad Hassan Ali Chania MBBS ,&nbsp;Mahnoor Saleem MBBS ,&nbsp;Saad Javaid MBBS ,&nbsp;Nikhil Duseja MBBS ,&nbsp;Hussam Al Hennawi MD ,&nbsp;Sunita Lakhani MD","doi":"10.1016/j.ajmo.2025.100115","DOIUrl":"10.1016/j.ajmo.2025.100115","url":null,"abstract":"<div><div>SGLT2 inhibitors are a new class of antidiabetic drugs that have shown cardiovascular benefits in patients with type 2 diabetes mellitus (T2DM) and cardiovascular disease. However, their effects on fracture risk are unclear and may depend on the type and duration of treatment. This meta-analysis compares the fracture risk of different antidiabetic drugs, including SGLT2 inhibitors, based on data from randomized controlled trials (RCTs). We searched 4 databases for RCTs that reported fracture events in patients with T2DM who received different antidiabetic drugs. We included 117 RCTs that compared 9 types of antidiabetic drugs: SGLT2 inhibitors, DPP-4 inhibitors, α-glucosidase inhibitors, thiazolidinediones, insulin, GLP-1 receptor agonists, meglitinides, biguanides, and sulfonylureas. We used a statistical method called Frequentist meta-analysis to combine data from different studies and compare different treatments. The results showed that SGLT2 inhibitors were the only drug that significantly reduced the fracture risk compared to placebo and other drugs (OR 0.85; 95% CI, 0.74-0.98). The other antidiabetic drugs did not show any significant difference from placebo or from each other. The mechanisms behind the effects of SGLT2 inhibitors on bone health are not well understood and may involve changes in calcium, phosphate, sodium, and arginine vasopressin levels in the body. SGLT2 inhibitors demonstrated a favorable skeletal safety profile among antidiabetic drugs. More long-term studies focused on fracture as a primary outcome are needed to fully understand how SGLT2 inhibitors affect bone health and fracture risk in patients with T2DM.</div></div>","PeriodicalId":72168,"journal":{"name":"American journal of medicine open","volume":"14 ","pages":"Article 100115"},"PeriodicalIF":0.0,"publicationDate":"2025-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145046096","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":"Hypermobile Ehlers-Danlos Syndrome: Cerebrovascular, Autonomic and Neuropathic Features","authors":"Peter Novak MD, PhD ,&nbsp;David M. Systrom MD ,&nbsp;Sadie P. Marciano PA-C ,&nbsp;Alexandra Witte PA-C ,&nbsp;Arabella Warren MD, PhD ,&nbsp;Donna Felsenstein MD ,&nbsp;Matthew P. Giannetti MD ,&nbsp;Matthew J. Hamilton MD ,&nbsp;Jennifer Nicoloro-SantaBarbara PhD ,&nbsp;Mariana Castells MD ,&nbsp;Khosro Farhad MD ,&nbsp;David M. Pilgrim MD ,&nbsp;William J. Mullally MD ,&nbsp;Mark C. Fishman MD ,&nbsp;Jeff M. Milunsky MD ,&nbsp;Aubrey Milunsky MD ,&nbsp;Joel Krier MD","doi":"10.1016/j.ajmo.2025.100111","DOIUrl":"10.1016/j.ajmo.2025.100111","url":null,"abstract":"<div><h3>Background</h3><div>Hypermobile Ehlers-Danlos syndrome (hEDS) affects multiple systems, but comprehensive evaluations of a larger sample of hEDS patients are lacking. The objective of this study was to describe cerebrovascular, autonomic, and neuropathic features of hEDS.</div></div><div><h3>Methods</h3><div>This retrospective case-control study was conducted at Brigham and Women’s Faulkner Hospital between 2016-2023. Data from hEDS patients who completed autonomic testing and skin biopsies were analyzed. Outcome measures include validated surveys (Survey of Autonomic Functions, Neuropathy Total Symptom Score-6 (SAS)) and autonomic function testing (Valsalva maneuver, deep breathing, head-up tilt and sudomotor), cerebrovascular (cerebral blood flow velocity (CBFv) in the middle cerebral artery), respiratory (capnography), and neuropathic (skin biopsies for assessment of small fiber neuropathy) testing and inflammatory/ autoimmune markers.</div></div><div><h3>Results</h3><div>Total 270 hEDS patients were analyzed and compared to 29 healthy controls. Common hEDS complaints (prevalence &gt; 90% ) were orthostatic sudomotor, vasomotor, gastrointestinal, and pain. Orthostatic cerebral blood flow velocity was reduced in 79% of hEDS and correlated with orthostatic dizziness. The head-up tilt test revealed postural tachycardia syndrome (prevalence 33%), hypocapnic cerebral hypoperfusion (22%), orthostatic cerebral hypoperfusion syndrome (18%), and neurogenic orthostatic hypotension (9%). Widespread but mild autonomic failure was present in 90% of hEDS patients on autonomic testing. Small fiber neuropathy using structural criteria was detected in 64%, and using combined structural and functional criteria in 82%.</div></div><div><h3>Conclusions</h3><div>This study provided evidence of cerebrovascular dysregulation with reduced orthostatic cerebral blood flow velocity associated with symptoms of cerebral hypoperfusion, frequent small fiber neuropathy, and widespread but mild autonomic failure in hEDS.</div></div>","PeriodicalId":72168,"journal":{"name":"American journal of medicine open","volume":"14 ","pages":"Article 100111"},"PeriodicalIF":0.0,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144827126","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":"Upadacitinib Monotherapy for Treatment of Pyoderma Gangrenosum","authors":"Mohamad R. Taha ,&nbsp;Harrison P. Nguyen ,&nbsp;Stephen K. Tyring","doi":"10.1016/j.ajmo.2025.100112","DOIUrl":"10.1016/j.ajmo.2025.100112","url":null,"abstract":"<div><div>Pyoderma gangrenosum (PG) is a rare, neutrophilic dermatosis that results in progressive, painful ulcers most commonly affecting the lower extremities. Although immunosuppressants are frequently used for therapy, there is no standard treatment approach, and recurrences are common. The pathogenesis of PG is believed to involve dysregulation of the Janus kinase (JAK)/signal transducer and activator of transcription (STAT) pathway, supporting the potential use of JAK/STAT inhibitors as a treatment option. This case series describes the successful use of upadacitinib, a selective JAK inhibitor, in the management of PG.</div></div>","PeriodicalId":72168,"journal":{"name":"American journal of medicine open","volume":"14 ","pages":"Article 100112"},"PeriodicalIF":0.0,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144827127","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":"Initiating Medications During Hospitalization and Strategies for Ensuring Linkage at Discharge for Patients With Opioid Use Disorder: A Scoping Review","authors":"Austin Drysch ,&nbsp;Kathryn Fink ,&nbsp;Nikhil Sriram ,&nbsp;Marianne Kanaris ,&nbsp;Scott Wu ,&nbsp;Deep Upadhyay ,&nbsp;Katherine Welter ,&nbsp;Lisa Blankenship ,&nbsp;Melissa Bregger ,&nbsp;Kelli Scott ,&nbsp;Brent Schnipke ,&nbsp;Ashti Doobay-Persaud","doi":"10.1016/j.ajmo.2025.100113","DOIUrl":"10.1016/j.ajmo.2025.100113","url":null,"abstract":"<div><div>Hospitalization presents a critical opportunity to initiate medications for opioid use disorder (MOUD) and improve long-term outcomes for patients with opioid use disorder (OUD). While inpatient MOUD initiation significantly reduces mortality and relapse, many patients lack appropriate follow-up care after discharge. This scoping review synthesizes evidence from 52 studies on hospital discharge practices for patients with OUD initiated on MOUD to identify best practices that support continued treatment and recovery. Inpatient addiction consultation services, standardized protocols, and clinician education emerged as key facilitators of MOUD initiation. Transitional care strategies, such as bridge clinics, peer navigation, telemedicine, and structured discharge planning, were associated with increased outpatient linkage, reduced readmissions, and improved retention in treatment. Despite policy advances including X-waiver elimination, systemic barriers persist and disproportionately affect rural and minoritized populations. Multidisciplinary, patient-centered discharge pathways that integrate medical treatment with social support are critical. Effective linkage strategies must address both structural and individual barriers to care. We propose six pillars of MOUD continuity, including early initiation, warm handoffs, peer support, bridge care models, telemedicine integration, and attention to social determinants. Implementing these strategies is essential to closing care gaps and improving outcomes in the evolving landscape of MOUD treatment.</div></div>","PeriodicalId":72168,"journal":{"name":"American journal of medicine open","volume":"14 ","pages":"Article 100113"},"PeriodicalIF":0.0,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144878295","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":"Association Between Sleep Duration and Angina Characteristics in United States Adults","authors":"Maslahuddin HA Alhaque Roomi MD ,&nbsp;Nehal Eid MBBCh ,&nbsp;Aayush Visaria MD","doi":"10.1016/j.ajmo.2025.100109","DOIUrl":"10.1016/j.ajmo.2025.100109","url":null,"abstract":"<div><h3>Background</h3><div>Sleep is now recognized as a key factor in cardiovascular health by the American Heart Association's Life’s Essential 8. However, the relationship between sleep duration and stable angina remains unexplored.</div></div><div><h3>Methods</h3><div>This nationally representative cross-sectional study analyzed data from 18,385 U.S. adults aged 40 and older using the National Health and Nutrition Examination Survey (2005-2018). Daily sleep duration was categorized as &lt;7 hours, 7-8 hours (reference), and &gt;8 hours. Angina was assessed with the Rose Angina Questionnaire and classified by severity (Grade 1 or 2) and pain location (typical vs atypical). Covariates were identified a priori based on previous literature, and clinical relevance.</div></div><div><h3>Results</h3><div>Our study included 18,385 adults with a mean age of 57.6 years (SE 0.16). Out of these, 48.6% were female and 70% were non-Hispanic Whites. A total of 954 (5.2 %) participants reported experiencing angina. Among those with angina, 109 (11%) reported atypical symptoms. Univariate analysis revealed that both short (&lt;7 hours) and long (&gt;8 hours) sleep durations were associated with higher odds of Grade 2 angina compared to adequate sleep (7-8 hours). Adjusted analysis showed significantly higher odds of Grade 2 angina in individuals sleeping &gt;8 hours (OR [95% CI]: 2.16 [1.08-4.32] for females; 2.69 [1.15-6.29] for males). Additionally, sleep &lt;7 hours was associated with a greater likelihood of atypical angina presentation (OR: 1.77 [1.21-3.05]).</div></div><div><h3>Conclusion</h3><div>Our findings suggest that sleeping over 8 hours increases the likelihood of Grade 2 angina, while under 7 hours is linked to atypical presentations, complicating diagnosis. Clinicians could incorporate brief sleep assessments—asking about duration and quality—alongside angina tools like the ROSE questionnaire to identify potential sleep-related factors. While promising, these associations require further research before being translated into definitive clinical guidelines for angina management.</div></div>","PeriodicalId":72168,"journal":{"name":"American journal of medicine open","volume":"14 ","pages":"Article 100109"},"PeriodicalIF":0.0,"publicationDate":"2025-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144631130","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":"Can Statistical Data Replace Pathophysiologic Rationale?: A Belated Question for the Second Quarter of the 21st Century","authors":"Masis Perk","doi":"10.1016/j.ajmo.2025.100110","DOIUrl":"10.1016/j.ajmo.2025.100110","url":null,"abstract":"","PeriodicalId":72168,"journal":{"name":"American journal of medicine open","volume":"14 ","pages":"Article 100110"},"PeriodicalIF":0.0,"publicationDate":"2025-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144634096","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":"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}