Archive for category: News

The analysis included over 1.3 million patients (mean age 74.6 years; 34% women) aged 65 years or older who underwent PCI between October 2018 and December 2021. Frailty was evaluated using the Canadian Study of Health and Aging Clinical Frailty Scale (CFS), which assesses the ability to perform both basic and instrumental activities of daily living. Patients were classified into four groups: non-frail (CFS 1-2), prefrail (CFS 3-4), frail (CFS 5-6), and severely frail (CFS 7-9).

The key findings were as follows:

• Frailty was widespread among PCI patients, with 67.8% categorized as prefrail, 21.6% as frail, and 2.2% as severely frail.
• The overall in-hospital mortality rate was 2.4%.
• Mortality increased sharply with frailty: 0.5% in nonfrail patients, 1.1% in prefrail, 3.3% in frail, and 20.3% in severely frail patients.
• More than half of all PCIs were performed in patients over 65 years, who account for nearly 80% of PCI-related mortality.
• The study demonstrated a clear gradient of increasing risk tied to frailty status, independent of bedside mortality scores and across various clinical subgroups.
• Among severely frail patients undergoing complex PCI scenarios, mortality rates were 44.2% following cardiac arrest, 51.0% with cardiogenic shock, 46.1% with mechanical circulatory support, 23.9% with chronic total occlusions, 29.6% for left main coronary interventions, and 22.4% with severe calcification.
• The rates of complications, including bleeding, transfusion need, vascular issues, new dialysis initiation, and stroke, consistently rose with increasing frailty severity.

While the authors caution against using these findings to withhold PCI, especially in acute coronary syndromes, they emphasize the importance of incorporating frailty assessment into routine clinical evaluations. “Frailty status, even at the prefrail level, significantly affects procedural risk and should guide shared decision-making,” the authors noted.

In an accompanying editorial, Dr. John A. Dodson and Dr. Ashok Krishnaswami advocate for incorporating frailty screening into routine patient assessment, similar to vital signs, to enhance outcomes for older adults undergoing PCI.

“To meaningfully improve care for older adults, frailty assessment should become a routine part of clinical practice—integrated into every evaluation just as vital signs are,” they wrote.

Reference:

Peterson, B., Kochar, A., Young, R., Senman, B., Rymer, J., Wojdyla, D., … Bhatt, D. L. (2025). Effect of Frailty on In-Hospital Mortality and Complications of PCI: An NCDR Registry Report (Accepted). Journal of the American College of Cardiology, 85(24), 2416–2420. https://doi.org/10.1016/j.jacc.2025.04.027

Digital inhalers have sensors that provide real-time feedback to patients regarding their medication usage and inhalation technique. These tools aim to address the long-standing issue of poor adherence, estimated to affect around 43% of asthma patients globally.

To better understand their clinical utility, Leonardo Ologundudu, from McMaster University in Ontario, Canada, and colleagues conducted a systematic review of 12 randomized controlled trials involving 2,483 children (ages 4–17) and adults. This work was undertaken in the context of developing new clinical guidelines for severe and difficult-to-control asthma by the American Academy of Allergy, Asthma & Immunology and the American College of Allergy, Asthma, and Immunology Joint Task Force.

Based on the study, the researchers reported the following findings:

• Digital inhalers likely improve asthma symptom control, with 44.3% of users achieving at least a three-point increase in Asthma Control Test scores, compared to 39.8% in the control group.
• The study suggests that digital inhalers may reduce the incidence of severe asthma exacerbations, particularly in patients at high risk, with an 11% relative reduction, though the certainty of this finding is low.
• On average, digital inhalers may result in 45 fewer severe exacerbations per 1,000 patients.
• The review found minimal harm associated with digital inhalers, with a median device failure rate of about 12%.
• Technical issues, such as sensor synchronization with smartphones, were the primary cause of failure.
• One trial reported a case of protected health information exposure, but overall, adverse outcomes were rare.

The authors emphasize considering the benefits of digital inhalers within a broader clinical context. Patients already demonstrating consistent adherence and proper technique may derive limited additional benefit, whereas those requiring ongoing support might find digital inhalers especially helpful.

However, limitations exist. Many studies lacked blinded outcome assessors, and few enrolled older adults above 60. Moreover, the combined effect of digital inhalers and remote clinician monitoring was commonly studied, making it difficult to isolate its standalone impact.

Still, the findings are expected to influence future clinical practice. “These results support the incorporation of digital inhalers into asthma management, particularly for select patient subgroups. Updated guidelines should reflect this evolving landscape,” the researchers concluded.

Reference:

Ologundudu L, Rayner DG, Oppenheimer J, Sumino K, Hoyte F, RiveraSpoljaric K, Perry TT, Nyenhuis SM, Chipps B, Israel E, Shade LE, Press VG, Rangel S, Guyatt GH, McCabe E, O’Byrne PM, Hall L, Orr H, Sue-Wah-Sing D, Melendez A, Winders T, Przywara K, Gardner DD, Rank MA, Bacharier LB, Mosnaim G, Chu DK, Patient-facing digital inhalers for asthma: a systematic review and meta-analysis, The Journal of Allergy and Clinical Immunology: In Practice (2025), doi: https://doi.org/10.1016/j.jaip.2025.04.039.

“The All of Us study revealed that vitiligo patients face significantly higher risks of cardiovascular and autoimmune comorbidities. Notably, they showed increased odds of hyperlipidemia (OR 2.32), atherosclerotic disease (OR 1.78), and hypertension (OR 1.75),” the researchers reported The condition was also linked to bone and joint, endocrine, and psychiatric disorders, highlighting the importance of a comprehensive, multidisciplinary approach to patient care.

Vitiligo, a condition characterized by the loss of skin pigmentation, has long been associated with other autoimmune disorders. However, this new analysis suggests that individuals with vitiligo may also face heightened risks for several systemic health issues.

The researchers examined health data from 1,074 individuals with vitiligo and compared them with 4,296 matched controls. Using conditional logistic regression models, they assessed the odds of developing 29 pre-selected comorbid conditions. P-values were adjusted using the Benjamini-Hochberg method to account for multiple comparisons.

The key findings of the study were as follows:

• Vitiligo patients showed significantly higher odds of hyperlipidemia (OR 2.32).
• They had an increased risk of atherosclerotic disease (OR 1.78).
• The likelihood of developing hypertension was also elevated (OR 1.75).
• Vitiligo was linked to a higher burden of musculoskeletal conditions.
• Endocrine disorders were more prevalent among individuals with vitiligo.
• There was a notable association between vitiligo and autoimmune diseases.
• Psychiatric conditions were also more common in vitiligo patients.
• These findings suggest that vitiligo may involve broader systemic health impacts beyond skin depigmentation.

“These results point to the complex and multifaceted nature of vitiligo,” the authors noted, suggesting that systemic inflammation may be a common underlying factor contributing to these associations.

The findings carry important clinical implications. The authors emphasize the need for integrated care strategies with vitiligo patients facing elevated risks for a broad range of comorbidities. Instead of treating vitiligo in isolation, healthcare providers should consider comprehensive management approaches that address co-existing cardiovascular, autoimmune, endocrine, and mental health issues.

The study contributes to a growing body of evidence highlighting the systemic burden of vitiligo and calls for future research into therapeutic options that target both skin symptoms and underlying inflammatory processes.

The large-scale analysis from the All of Us database sheds new light on the health risks individuals face with vitiligo. The findings advocate for a more holistic treatment approach, emphasizing early identification and management of associated conditions to improve overall patient outcomes.

Reference:

Piontkowski, A. J., Dubin, C., Thakker, S., Orloff, J., Powers, C., Silver, C., Ungar, B., & Gulati, N. Vitiligo and associated comorbidities: A case-control study in the All of Us database. Clinical and Experimental Dermatology. https://doi.org/10.1093/ced/llaf228