Cefepime-taniborbactam superior to meropenem in treating complicated UTIs and acute pyelonephritis: NEJM

Carbapenem-resistant Enterobacterales species and multidrug-resistant Pseudomonas aeruginosa pose significant global health threats. Cefepime–taniborbactam is an investigational β-lactam and β-lactamase inhibitor combination with activity against these organisms.

A study published in The New England Journal of Medicine (NEJM) concluded that Cefepime-taniborbactam was more effective than meropenem in treating complicated urinary tract infections involving acute pyelonephritis and had a safety profile comparable to meropenem.
In this phase 3 trial, researchers assigned hospitalized adults with complicated UTIs to receive either cefepime-taniborbactam or meropenem for seven days, with the possibility of extending treatment for an additional seven days if bacteremia was present. The composite success rate on days 19-23 in the microbiologic intention-to-treat population determined the primary outcome. After confirming non-inferiority, a prespecified superiority analysis was conducted.
Key findings from the study are:
  • Six hundred sixty-one patients underwent randomization; 436 of these were included in the microITT population.
  • Patients’ mean age was 56, and nearly 38 % were 65 or older.
  • In the microITT population, UTI, acute pyelonephritis and bacteremia were detected in 57.8%, 42.2% and 13.1%, respectively.
  • 70.6 % in cefepime–taniborbactam and 58 % in the meropenem group had composite success.
  • Considering the primary outcome, Cefepime–taniborbactam was superior to meropenem with a treatment difference of 12.6 percentage points.
  • Differences in treatment response were sustained at late follow-up (when Cefepime–taniborbactam had higher composite success and clinical success.
  • In the Cefepime–taniborbactam and the meropenem groups, adverse events occurred in 35.5% and 29.0% of patients, respectively.
  • Adverse events included headache, diarrhoea, constipation, hypertension, and nausea. The frequency of SAEs was similar for both groups.
Concluding further, Cefepime-taniborbactam demonstrated superior efficacy to meropenem in managing complicated urinary tract infections with acute pyelonephritis while exhibiting a safety profile similar to that of meropenem. The study received funding from Venatorx Pharmaceuticals.
Reference:
Florian M. Wagenlehner et al.
Cefepime–Taniborbactam in Complicated Urinary Tract Infection
N Engl J Med 2024; 390:611-622

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Taxane-based chemotherapy in Asian breast cancer patients tied to skin changes, hair loss: Study

South Korea: A recent study published in The Journal of Dermatology evaluated the effects of treatment regimens in Asian breast cancer (BC) patients.

The researchers revealed significantly increased odds of experiencing elevated hair loss, a higher melanin index & increased wrinkles six months post-surgery in those in the adjuvant treatment group, particularly those undergoing taxane-based chemotherapy. In the neoadjuvant treatment group, the researchers observed a reversal of hair loss in most patients after the surgery.

With the increasing number of young breast cancer patients worldwide, concerns about skin change and hair loss persist among cancer survivors.

Taxanes (paclitaxel and docetaxel) are among the most commonly prescribed anticancer drugs approved for the treatment of metastatic or locally advanced breast, gastric, non-small cell lung, prostate, head and neck, and ovarian cancers, as well as in the adjuvant setting for operable node-positive breast cancers.

The true incidence of dermatological adverse events (AEs) in patients receiving taxanes is unknown and has not been prospectively analysed, but they represent one of the major AEs associated with these agents. With an increase in the occurrence of cutaneous adverse events during treatment with novel targeted and immunological therapies when used along with taxanes, it is imperative to thoroughly understand the reactions attributable to this class. Moreover, identification and management of dermatological AEs is critical for maintaining the quality of life in cancer patients and for minimizing dose modifications of their antineoplastic regimen.

Against the above background, Joonho Shim, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea, and colleagues aimed to evaluate the skin changes and hair loss in Asian breast cancer patients and to compare them according to the treatment regimens.

Three hundred and twenty-two patients scheduled to undergo breast cancer surgery were enrolled. Skin changes and hair loss were assessed at the following two-time points: one day before surgery and six months after surgery.

Patients who had received systemic anticancer treatment prior to surgery were assigned to the neoadjuvant treatment group, while patients who were scheduled to receive systemic anticancer treatment were assigned to the adjuvant treatment group.

The key findings of the study were as follows:

  • In the adjuvant treatment group, patients with taxane-based chemotherapy had significantly higher odds of increased hair loss, an increased volume of wrinkles, and a higher melanin index.
  • In the neoadjuvant treatment group, hair loss was reversed in most patients at six months after surgery.

“Clinicians should inform breast cancer patients about the potential for hair loss and skin changes and provide supportive care to mitigate the effects on the patient’s quality of life,” the researchers concluded.

Reference:

Shim, J., Noh, H., Kim, H., Joo, B., Lee, J., Oh, S. J., Lee, J. H., Lee, D., Lee, S. K., & Park, J. Assessment of hair loss and skin changes during treatment in Asian breast cancer patients: A prospective cohort study. The Journal of Dermatology. https://doi.org/10.1111/1346-8138.17092

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Cardio-oncology patients may have a high prevalence of sleep apnea and risk of CHF

Cardio-Oncology Patients may have high prevalence of sleep apnea and risk of CHF suggests a new study published in the American College of Cardiology.

Sleep apnea is prevalent among patients at higher risk for developing congestive heart failure (CHF) following cancer treatment and could be used as a risk factor to identify patients who would benefit from earlier treatment, according to a study being presented at ACC’s Advancing the Cardiovascular Care of the Oncology Patient course. Obstructive sleep apnea (OSA), the focus of this study, has a prevalence of 48-52% among patients with CHF in the general population. To determine the prevalence of OSA in cardio-oncology patients, researchers administered the STOP-BANG questionnaire, a well-established screening tool for sleep apnea, among 218 cardio-oncology patients and 296 general cardiology patients. Data were collected on traditional risk factors, STOP-BANG scores and history of sleep for both groups. Baseline echocardiogram left ventricular ejection fraction (LVEF)and Global Longitudinal LV Strain (GLS) results were measured for the cardio-oncology population. Other research has shown that LVEF and GLS can predict early cancer-therapy-related cardiomyopathy, and OSA is also linked to LV dysfunction, CHF and abnormal LV-GLS. “Echocardiogram has evolved to be a useful tool to detect and therefore treat cardiomyopathy early in patients with sleep apnea and in the cardio-oncology population, so we also wanted to see if there are shared echo markers that identify patients who are at greater risk as they start their journey to treat their cancer,” says Mini K. Das, MD, FACC, medical director of the cardio-oncology program at Baptist Health in Louisville, KY, and the study’s primary author. Results showed that the incidence of sleep apnea was 39% in the cardio-oncology group and 54% in the general cardiology group. The researchers note that individuals with untreated sleep apnea and those at higher risk for sleep apnea have abnormal baseline LV strain, a common echo parameter linked to adverse cardiovascular events. “Identifying these individuals may allow early intervention in a risk factor clearly associated with HF now recognized to affect cancer therapy and survivorship,” Das says. Notably, the study showed that the prevalence of sleep apnea in the cardio-oncology group was equal to or greater than other traditional risk factors used in current risk factor profile algorithms and that LV GLS was more abnormal in patients with untreated sleep apnea or a high STOP-BANG score. “Sleep apnea should be incorporated into current risk algorithms and a larger study is needed to evaluate the impact of sleep apnea in this high-risk population. We feel that sleep apnea assessment must be a part of routine risk assessment for patients undergoing cancer therapeutics,” says Das. Advancing the Cardiovascular Care of the Oncology Patient, being held Feb. 9 to 11, is an interdisciplinary course that highlights emerging strategies and best practices for managing the heart health of cancer patients.

Reference:

Sleep Apnea a Risk Factor For Heart Failure From Cancer Therapy. Feb 09, 2024. ACC News Story

Keywords:

Cardio-Oncology Patients, high prevalence, sleep apnea, risk of CHF

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Study identifies association of haemoglobin levels with BMD and fracture risk in patients with type 2 diabetes

China: A recent study published in Frontiers in Endocrinology has identified an association between haemoglobin (Hb) levels and bone mineral density (BMD) and 10-year fracture risk among a population with type 2 diabetes (T2D). 

The study provided a new perspective on the association of Hb level and BMDs with fracture risk.

The study further revealed that relatively high haemoglobin levels protected bone quality in an older male population with type 2 diabetes, but lower Hb levels were associated with lower BMD and high future fracture risk in a non-older female population with T2D.

“The bone-protective effect of haemoglobin is influenced by sex and age and persists only in older men and non-older women with T2DM,” the researchers wrote.

Osteoporosis is a disease characterized by weaker, more fragile bones, and lowered bone density—patients with diabetes experience an increased osteoporosis risk, particularly in the Asian population. Anaemia incidence is also higher in T2D patients compared with the general population. Previous research has identified an association between anaemia and osteoporosis in people with T2D, irrespective of sex and without stratification by age.

Against the above background, Ren-xuan Li, Shandong University, Jinan, Shandong, China, and colleagues aimed to investigate the associations between haemoglobin Levels and BMD and fracture risk in type 2 diabetes populations of different ages.

For this purpose, they conducted a cross-sectional study comprising 641 patients with T2DM (57.9% males). BMD of the femoral neck (FN), lumbar spine (LS), and total hip (TH) were measured using dual-energy X-ray absorptiometry.

The 10-year probability of fracture was evaluated using a fracture risk assessment tool (FRAX). Haemoglobin and other biochemical indices were measured in a certified laboratory at a hospital. Generalized additive models (GAMs) were used to identify the associations between Hb and BMD and fracture risk.

The study led to the following findings:

  • Patients with osteoporosis have lower haemoglobin levels than the non-osteoporotic population and lower FN BMD in patients with anaemia than in the non-anaemic population.
  • In patients with T2DM, there was sex- and age-related variability in the correlation between HGB levels and BMDs and fracture risk.
  • In older men, haemoglobin level was an independent determinant of BMD and was positively correlated with FN and TH BMD.
  • In non-older women, haemoglobin level was an independent determinant of BMD and fracture risk, positively associated with BMDs, and negatively associated with the 10-year probability of fracture risk.
  • GAMs revealed a positive linear association between haemoglobin level and BMDs in non-older female patients but not in older male patients.

“The present study showed for the first time that lower haemoglobin levels are associated with lower FN and TH BMD in older male T2D population and that lower Hb levels are associated with lower BMD and higher future fracture risk in a non-older female T2D population,” the researchers wrote. “Relatively low HGB levels in this population may be an independent risk factor for osteoporosis and osteoporotic fractures.”

“There is a need for further studies to confirm these results and investigate the potential mechanisms,” they concluded.

Reference:

Li R-x, Xu N, Guo Y-n, Wang Y, Liang Y-w, Zhou X-l, Jiang W-t, Wei J-x, Zhang X-y, Zhou L-n, Zhu L, Zhou Y-m and Xu J (2024) Hemoglobin is associated with BMDs and risk of the 10-year probability of fractures in patients with type 2 diabetes mellitus. Front. Endocrinol. 15:1305713. doi: 10.3389/fendo.2024.1305713

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Increased age-related macular degeneration risk in patients with CKD: Study

A recent study conducted by the Asian Eye Epidemiology Consortium discovered a significant association between Chronic Kidney Disease (CKD) and susceptibility to Age-Related Macular Degeneration (AMD) in Asian populations. The findings published in the Ophthalmology journal highlighted the shared risk factors, pathogenic mechanisms and genetic polymorphisms that may elevate the risk of AMD in individuals with CKD.

The research employed a cross-sectional design to explore the intricate relationship between CKD and AMD with a sample size of 51,253 participants in total from 10 distinct population-based Asian studies. While CKD was defined as an estimated glomerular filtration rate (eGFR) below 60 mL/min/1.73m², AMD was classified using established grading systems.

The results revealed a compelling connection between CKD and late AMD. The individuals with CKD expressed significantly higher odds of late AMD, with an odds ratio (OR) of 1.46, after adjusting for various confounders such as age, sex, hypertension, diabetes and smoking status. Also, compromised kidney function which was indicated by a decrease in eGFR was also associated with a higher likelihood of late AMD, with an OR of 1.12 per 10-unit eGFR decrease. This study did not find a significant association between CKD or eGFR and early AMD. Despite this, the outcomes of the research underscore the importance of ocular examinations in CKD patients after considering the increased susceptibility to late AMD.

The study emphasized the significance of the pooled analysis from 10 distinct Asian population-based studies which highlights the crucial link between CKD and late AMD. This underlines the importance of vigilance in monitoring ocular health in CKD patients to detect and manage AMD at its earliest stages. This groundbreaking research deepens the understanding of the intricate relationship between kidney function and ocular health and also underscore the necessity for comprehensive healthcare strategies that mentions the interconnectedness of various physiological systems.

Source:

Xue, C. C., Sim, R., Chee, M. L., Yu, M., Wang, Y. X., Rim, T. H., Hyung, P. K., Woong, K. S., Song, S. J., Nangia, V., Panda-Jonas, S., Wang, N. L., Hao, J., Zhang, Q., Cao, K., Sasaki, M., Harada, S., Toru, T., Ryo, K., … Tham, Y.-C. (2023). Is Kidney Function Associated with Age-Related Macular Degeneration? Findings from the Asian Eye Epidemiology Consortium. In Ophthalmology. Elsevier BV. https://doi.org/10.1016/j.ophtha.2023.12.030

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Bacteriophage therapy helps treat drug-resistant E. faecium infection: Case study

 It was a last-ditch effort. For years doctors had tried to keep a patient’s recurrent drug-resistant bacterial blood infection at bay, but it kept coming back and antibiotics were no longer working.

The family agreed to try an experimental treatment that uses viruses to kill bacteria. The patient’s Enterococcus faecium bacterial strain, which had become zombie-like and was almost impossible to treat with currently available antibiotics, was tested against wastewater collected from across the country to find a viru-called a bacteriophage-that scientists theorized would specifically target the drug-resistant bacteria.

It worked so well the patient was able to leave the hospital for a much-anticipated vacation with her family. The case study by University of Pittsburgh School of Medicine scientists is published today in the American Society for Microbiology journal mBio.

“I was pleasantly surprised, but others on our team were, frankly, shocked at how quickly it worked,” said senior author Daria Van Tyne, Ph.D., assistant professor of infectious diseases at Pitt. “Of course, this is what we wanted, what we hoped for. But the patient’s response was so much better than we expected.”

The case study, which required emergency investigational new drug approval from the U.S. Food and Drug Administration (FDA), is one of only a handful that have used bacteriophage therapy to treat E. faecium infection. The researchers expect the results from this study will inform future use of the therapy.

Bacteriophages – known informally as ‘phages’ – are viruses that target and infect bacteria, killing the bacteria as they replicate. Different phages target different bacteria and can be so selective that they only target a specific strain of a bacterium and won’t infect other bacteria or injure human cells. Phages are abundant and can be found everywhere from water and soil to the human body. Wastewater from sewage treatment plants is a common source researchers use to isolate new phages.

Doctors are increasingly interested in phage therapy when all else fails to fight a deadly bacterial infection. But as the therapy is not currently standardized or approved by the FDA, it is not widely available. Several clinical trials-including at Pitt-are underway to confirm its safety and test its efficacy.

The patient in the case study was a 57-year-old woman who had a complex medical history and an autoimmune condition that required immunosuppression to treat. Along the course of her medical journey, drug-resistant E. faecium colonized her gut and spread to her blood, causing recurrent bloodstream infections that required multiple and prolonged hospitalizations between 2013 and 2020. Finally, in late 2020, after a month-long hospitalization, doctors determined that antibiotics were no longer working and suggested phage therapy.

Scientists at the University of Colorado discovered the phage that targeted her bacterial strain and sent it to Pittsburgh where it was grown and prepared in Van Tyne’s lab and then given to the patient alongside antibiotics.

“Phages attack bacteria in a different way than antibiotics,” said lead author Madison Stellfox, M.D., Ph.D., postdoctoral infectious diseases fellow at Pitt. “We believe that the phage therapy worked in tandem with the antibiotics to help the patient fight the infection.”

Within 24 hours of receiving phage therapy, the patient’s blood infection had resolved and she could go home, where she continued the phage and antibiotic combination. She developed a few short-lived breakthrough infections, which indicated the bacteria was getting around the therapy, so the researchers found an additional phage that targeted her bacteria.

With the addition of the new phage, the patient was blood infection-free for four months and able to travel out of state for a for a family beach vacation.

However, just over six months after starting phage therapy, the blood infection returned, and the phage-antibiotic combination was thought to be no longer effective. The patient died in 2022.

In order to learn why the infections recurred despite the combination being previously effective, laboratory testing revealed that the patient’s immune system had likely activated in a way that blocked the phages from attacking the bacteria. Van Tyne and Stellfox suspect that either the addition of the second phage or the increased dose of the phage combination-or both-had prompted the immune response.

“What we learned from this patient and her allowing us to follow and document her medical journey will help future patients,” said Van Tyne. “Phage therapy could be a powerful tool against the ever-growing threat of antibiotic resistance and the data from her case will help shape clinical trials that could one day make it widely available to patients in need.”

Reference:

Madison E. Stellfox, Carolyn Fernandes, Ryan K. Shields, Ghady Haidar, Kailey Hughes Kramer, Emily Dembinski, Mihnea R. Mangalea, Garima Arya, Gregory S. Canfield, Bacteriophage and antibiotic combination therapy for recurrent Enterococcus faecium bacteremia, mBio, https://doi.org/10.1128/mbio.03396-23.

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AVP-786 disappoints in treatment of agitation-associated dementia due to Alzheimer’s in initial findings

Agitation associated with dementia caused by Alzheimer’s disease is a prevalent neuropsychiatric symptom affecting approximately half of all Alzheimer’s dementia patients. This condition substantially impacts the quality of life for patients, their families, and caregivers. Agitation associated with dementia caused by Alzheimer’s disease encompasses various behaviors such as pacing, gesturing, profanity, shouting, shoving, and hitting. Additionally, this symptom is a consistent predictor of nursing home admission.

Results from a phase 3 study evaluated the efficacy and safety of AVP-786 for treating agitation associated with dementia due to Alzheimer’s disease.
AVP-786 combines deudextromethorphan hydrobromide (d6-DM) and quinidine sulfate (Q), a CYP2D6 inhibitor. Deuteration reduces susceptibility to cytochrome P450 (CYP2D6) enzyme metabolism, increasing bioavailability.
The study included 600+ patients aged 50+ with dementia due to Alzheimer’s disease and moderate to severe agitation. In a randomised, double-blind, parallel-design trial, participants received AVP-786 or a placebo twice daily for 12 weeks.
AVP-786 treatment did not significantly improve agitation in dementia patients with Alzheimer’s disease, as shown by the change in the Cohen-Mansfield Agitation Inventory total score (primary endpoint). Falls were reported more frequently in the AVP-786 groups (8.6% for high dose, 9.1% for low dose, 2.8% for placebo)
Dr. John Kraus, executive vice president and chief medical officer at Otsuka, mentioned that the complete study findings still need to be released. Further, prespecified and exploratory analyses will be conducted to determine AVP-786’s full potential. Otsuka intends to submit the trial results for publication at a later date. They thanked the study participants, their caregivers, and the investigators who participated in this trial.
Otsuka Pharmaceutical Co., Ltd. is a global healthcare corporation dedicated to developing innovative products for better health worldwide. The company focuses on pharmaceutical products to address unmet medical needs and nutraceutical products to maintain everyday health. Otsuka is a leader in mental, renal, and cardiovascular health and also has research programs in oncology and under-addressed diseases like tuberculosis.
References:
Otsuka announces phase 3 topline results of AVP-786 in the treatment of agitation associated with dementia due to Alzheimer’s disease. News release. Otsuka Pharmaceutical. February 12, 2024. Accessed February 13, 2024. https://www.businesswire.com/news/home/20240212652874/en/Otsuka-Announces-Phase-3-Topline-Results-of-AVP-786-in-the-Treatment-of-Agitation-Associated-With-Dementia-Due-to-Alzheimer%E2%80%99s-Disease.

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Migraine and vasomotor symptoms may increase CAD risk among young adults: Study

Migraine and vasomotor symptoms may increase CAD risk among young adults suggests a new study published in the Menopause.

A study was done to examine whether vasomotor symptoms (VMS) and migraine headaches, hypothesized to be vasoactive conditions, are associated with a greater risk for cardiovascular disease (CVD) events including strokes. They performed secondary data analysis of a subset of women (n = 1,954) in the Coronary Artery Risk Development in Young Adults (CARDIA) study, a population-based cohort, which began data collection at 18 to 30 y of age. We examined whether migraine headaches and VMS trajectories (characterized as minimal, increasing, and persistent) at CARDIA year 15 examination were associated with higher risk of CVD events and stroke (both ischemic and hemorrhagic) using Cox proportional hazards regression models and adjustment for traditional CVD risk factors (age, cigarette use, and levels of systolic and diastolic blood pressure, fasting glucose, high- and low-density cholesterol, and triglycerides) and reproductive factors. Results: Among women with minimal VMS (n = 835), increasing VMS (n = 521), and persistent VMS (n = 598), there were 81 incident CVD events including 42 strokes. Women with histories of migraine and persistent VMS had a greater risk of CVD (hazard ratio [HR], 2.25; 95% CI, 1.15-4.38) after adjustment for age, race, estrogen use, oophorectomy, and hysterectomy compared with women without migraine histories and with minimal/increasing VMS. After adjustment for CVD risk factors, these associations were attenuated (HR, 1.51; 95% CI, 0.73-3.10). Similarly, women with histories of migraine and persistent VMS had a greater risk of stroke (HR, 3.15; 95% CI, 1.35-7.34), but these associations were attenuated after adjustment for CVD risk factors (HR, 1.70; 95% CI, 0.66-4.38). Migraines and persistent VMS jointly associated with a greater risk for CVD and stroke, although risk is attenuated with adjustment for traditional CVD risk factors.

Reference:

Kim, Catherine MD, MPH1; Schreiner, Pamela J. PhD2; Yin, Zhe MS3; Whitney, Rachael PhD4; Sidney, Stephen MD, MPH5; Ebong, Imo MD6; Levine, Deborah A. MD, MPH4. Migraines, vasomotor symptoms, and cardiovascular disease in the Coronary Artery Risk Development in Young Adults study. Menopause ():10.1097/GME.0000000000002311, February 13, 2024. | DOI: 10.1097/GME.0000000000002311

Keywords:

Kim, Catherine, Schreiner, Pamela J, Whitney, Rachael, Sidney, Stephen, Ebong, Imo Levine, Deborah A, Migraines, vasomotor symptoms, and cardiovascular disease, Coronary Artery Risk Development, Young Adults, Menopause

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Comparative Safety of Midline Catheters and PICCs in Long-term Intravenous Therapy

In a recent groundbreaking trial conducted at a Danish
academic tertiary care center, researchers have shed light on the safety and
efficacy of midline catheters (MCs) compared to peripherally inserted central
catheters (PICCs) in adult patients requiring intravenous therapy for a
duration of 5 to 28 days. The trial found that there was a low incidence of Catheter-related
bloodstream infections with no significant difference between MCs and PICCs in patients
receiving medium- to long-term intravenous therapy. However, the use of MCs
resulted in a higher incidence of overall catheter-related complications
compared with PICCs.


The trial results were published in the journal JAMA Network
Open.

Midline catheters (MCs) have become a common choice in
medical settings, yet a comprehensive assessment of their safety and efficacy
relative to peripherally inserted central catheters (PICCs) has been lacking.
This critical gap in knowledge has prompted researchers to delve into a
thorough examination of the two catheter types to provide clearer insights into
their comparative performance. Hence, researchers carried out a parallel,
2-group, open-label, randomized clinical trial (RCT) aimed to address the
existing gap in knowledge regarding the two widely used catheter types.

The study, spanning from October 2018 to February 2022,
enrolled a total of 304 patients with a mean age of 64.6 years, of whom 42.8%
were female. Each participant was randomly assigned to either the MC group or
the PICC control group in a 1:1 ratio.


The primary outcome under scrutiny was the occurrence of
catheter-related bloodstream infection (CRBSI), a critical factor in evaluating
the safety of these catheter types. Secondary outcomes encompassed symptomatic
catheter-related thrombosis and catheter failure, which included issues such as
mechanical causes, phlebitis, infiltration, pain associated with drug or fluid
administration, and leakage from the puncture site.


Findings:


  • Strikingly, the incidence of CRBSI was remarkably low, with
    no reported cases in the MC group and only one case in the PICC control group
    (P > .99).

  • This finding suggests that both MCs and PICCs exhibit
    comparable efficacy in preventing CRBSI in the specified patient population.


  • However, delving into secondary outcomes, the study revealed
    a noteworthy distinction.

  • The MC group exhibited a higher overall catheter-related
    complication rate (13.2%) compared to the PICC control group (7.2%).

  • Further analysis, using the incidence rate ratio (IRR),
    demonstrated a statistically significant IRR of 2.37 (95% CI, 1.12-5.02;
    P = .02) in favor of the PICC group.

  • In a post hoc analysis stratified by catheter dwell time,
    the researchers explored the impact of catheter use for less than 16 days.

  • Interestingly, this subset analysis did not reveal a
    significant difference in complication rates between the two groups (IRR, 1.16;
    95% CI, 0.50-2.68; P = .73).

     


The study’s conclusion emphasizes the low incidence of CRBSI
with both catheter types but highlights the higher incidence of
catheter-related complications with MCs. Researchers recommend a nuanced
approach in the decision-making process, considering individual patient
characteristics and the expected duration of intravenous therapy.            

Further reading: Thomsen SL, Boa R, Vinter-Jensen L, Rasmussen BS. Safety and Efficacy of Midline vs Peripherally Inserted Central Catheters Among Adults Receiving IV Therapy: A Randomized Clinical Trial. JAMA Netw Open. 2024;7(2):e2355716. doi:10.1001/jamanetworkopen.2023.55716

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Heart attack significantly increases risk of other serious long-term health conditions: Study

Having a heart attack significantly increases the risk of developing other serious long-term health conditions, a major new study shows.

Researchers at the University of Leeds have analysed more than 145 million records covering every adult patient admitted to hospital over a nine-year period to establish the risk of long-term health outcomes following a heart attack-in the largest study of its kind.

Whilst heart attacks are a serious and life-threatening condition, the British Heart Foundation estimates that nowadays more than seven in 10 people survive them, provided they receive quick and emergency treatment to get the blood flowing to the heart muscle again. Yet previous research has shown that heart attacks can have health implications for patients including further conditions which affect the heart and circulatory system, but also conditions affecting other parts of the body and mental health conditions.

The new research, part funded by The British Heart Foundation and Wellcome, shows that patients who had a heart attack went on to develop further conditions at a much higher rate than people of the same age and sex who had not had one.

Up to a third of patients went on to develop heart or kidney failure, 7% had further heart attacks and 38% died from any cause within the nine-year study period.

Heart failure, atrial fibrillation, stroke, peripheral arterial disease, severe bleeding, kidney failure, type 2 diabetes and depression all occurred more frequently for people who had a heart attack compared with those who did not; but the risk of cancer was lower overall, and the risk of dementia did not differ overall.

The study also identified that people from more socioeconomically deprived backgrounds were more likely to die or develop serious long-term health conditions following a heart attack. In particular, those from more deprived backgrounds were more likely to develop heart and kidney failure, compared to people from less deprived backgrounds of a similar age.

Lead author Dr Marlous Hall, Associate Professor of Cardiovascular Epidemiology in Leeds’ School of Medicine and Multimorbidity Research in the Leeds Institute for Data Analytics (LIDA), said: “There are around 1.4 million heart attack survivors in the UK who are at high risk of developing further serious health conditions. Our study provides accessible online information of the risk of these health outcomes for specific age, sex and socioeconomic deprivation groups so that individuals surviving a heart attack can be well informed about their future risks, in order to support informed healthcare decision making with their doctor.

“Effective communication of the likely course of disease and risk of adverse long-term outcomes between patients and healthcare professionals can promote positive lifestyle changes, encourage patients to stick to treatment, and improve patient understanding and quality of life.”

“Our study highlights the need for individual care plans to be revised to take into account the higher demand for care caused by survivorship.”

The researchers analysed the records of all individuals aged 18 years and over, who were admitted to one of 229 NHS Trusts in England between 1 January 2008 and 31 January, 2017. This amounted to 145,912,852 hospitalisations among 34,116,257 individuals. There were 433,361 reports of people who had a heart attack for the first time. The average age of heart attack patients was 67 years, and 66% of patients were male.

The study looked at 11 non-fatal health outcomes detailed below, plus death from any cause, and compared the results to a control group of 2,001,310 individuals.

Health outcomes

The research showed a significantly increased risk of developing some conditions following a heart attack, when compared to the control group of patients.

Most likely was heart failure, with 29.6% of the study group going on to develop the condition within nine years of their heart attack, compared with 9.8% of the control group over the same time frame.

Kidney failure developed in 27.2% of the patients in the study group, compared with 19.8% of the control group.

Some 22.3% of the study group went on to develop atrial fibrillation, compared with 16.8% of the control group.

And new hospitalisation for diabetes was seen in 17% of the study group, compared with 14.3% of the control group.

Other conditions were:

Severe bleeding – Study group: 19%; Control group: 18.4%

Cerebrovascular disease – Study group: 12.5%; Control group: 11.6%

Peripheral arterial disease – Study group: 6.5%; Control group: 4.06%

Death from any cause – Study group: 37.8%; Control group: 35.3%

Overall, hospitalisation records indicating depression occurred in 8.9% of people after a heart attack – which was 6% more likely following a heart attack than in the control group. Women were more likely to develop depression after a heart attack than men, especially those who had their heart attack at a younger age. 21.5% of women who were under the age of 40 at the time of their heart attack had hospitalisation records for depression compared with 11.5% of men in the same age category.

There was no overall difference in the risk of dementia following a heart attack compared with the control group. Whilst the risk of vascular dementia was more likely in the study group, the difference observed was small (study group 2.3%; control group 2.1%).

In contrast with other health outcomes the research showed that cancer was less pronounced in the study group than in the control group. Some 13.5% of the study group went on to develop cancer after their heart attack, but this compared with 21.5% of the control group. Researchers believe there are likely many factors affecting this finding but the specific reasons for fewer cancers after a heart attack remain unclear and require further investigation.

Morag Foreman, Head of Discovery Researchers at Wellcome, said: “This research provides valuable insight into the types of support and interventions that may be needed for patients following a heart attack, helping both doctors and patients make informed decisions during recovery and beyond.”

“This research shows how cohort studies and analysis of large data sets can further our understanding of key health challenges and demonstrates the value to supporting discovery research in the field of population and public health. As survival rates following a heart attack improve, understanding the longer-term impacts on physical and mental health is crucial.”

Professor Bryan Williams, Chief Scientific and Medical Officer at the British Heart Foundation, said: “While more people than ever are surviving heart attacks, there can be longer term consequences. Particularly after a major heart attack, people can be left with irreparable damage to their heart, putting them at increased risk of heart failure.

“This study sheds further light on how heart attacks are associated with increased risk of developing other serious health conditions, including heart failure and atrial fibrillation. It also found that those from more socioeconomically deprived backgrounds are at greater risk of further ill health after a heart attack, and at a younger age. The research suggests that these patients may benefit from additional support and monitoring to help reduce their risk of developing further health conditions.

“It is vital NHS has the resource, including staff, infrastructure and equipment, to deliver the care that patients need to help them stay in the best possible health for longer.” 

Reference:

Marlous Hall ,Lesley Smith,Jianhua Wu,Chris Hayward,Jonathan A. Batty,Paul C. Lambert,Harry Hemingway,Chris P. Gale, Health outcomes after myocardial infarction: A population study of 56 million people in England, PLoS Medicine, https://doi.org/10.1371/journal.pmed.1004343.

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