Current Medical Research and Opinion最新文献

Objective: To describe comorbidity and comedication burden among people living with HHIV(PLWH) compared with matched people without HIV and evaluate 5-year trends among PLWH from 2020-2024.

Methods: This retrospective study used administrative claims data (01/01/2016-01/31/2025) from Optum's de-identified Clinformatics Data Mart Database. The PLWH cohort included adults with ≥1 medical or pharmacy claim for an antiretroviral therapy (ART) agent in 2024 or, for those not treated with ART, an HIV diagnosis code alone (index date: earliest ART or HIV claim). People without HIV were matched 2:1 to PLWH based on age group, sex, race/ethnicity, region, and insurance type. Baseline characteristics, comorbidity burden, and comedication burden were compared between matched cohorts.

Results: 26,078 PLWH and 52,156 matched people without HIV were included (mean age: 59 years). Compared with people without HIV, PLWH had greater baseline Quan-Charlson comorbidity index scores (mean [SD]: 1.24 [1.86] vs. 0.99 [1.85]; p < 0.001) and greater numbers of comorbid conditions (3.70 [3.63] vs. 3.14 [3.79]; p < 0.001) and non-ART comedications (9.2 [7.58] vs 7.1 [7.48]; p < 0.001). Multimorbidity (≥2 comorbidities: 66.4% vs. 53.6%) and polypharmacy (≥5 non-ART drugs: 68.5% vs. 52.7%) were significantly more prevalent in PLWH (both p < 0.001). The most prevalent comorbidities were hypertension (46.9% vs. 41.2%; p < 0.001), hyperlipidemia (46.0% vs. 34.4%; p < 0.001), and type 2 diabetes (21.8% vs. 22.1%, p = 0.393).

Conclusions: PLWH have greater comorbidity and comedication burdens than people without HIV. The findings suggest clinicians should consider these factors when choosing ART to minimize drug interactions and adverse events, thereby improving the long-term health of PLWH.

Objective: Although agitation is a common neuropsychiatric symptom in Alzheimer's dementia, it can be challenging to recognize and diagnose. Caregivers of individuals with Alzheimer's dementia are often the first to encounter agitation behaviors but may struggle to recognize and communicate symptoms to healthcare professionals (HCPs). Here, we describe the development and evaluation of the Agitation in Alzheimer's Screener for Caregivers (AASC), a practical screening tool to identify agitation symptoms and facilitate caregiver-HCP communication.

Methods: The AASC was developed based on the International Psychogeriatric Association (IPA) criteria for agitation in cognitive disorders, input from multidisciplinary experts, and qualitative interviews with caregivers of patients with Alzheimer's dementia. Thereafter, a 2-phase quantitative evaluation study was conducted to refine the AASC and assess the predictive validity of the final tool against IPA criteria. Data were collected from caregiver-HCP dyads, where caregivers completed the AASC and HCPs used IPA criteria to inform their assessment of agitation.

Results: A total of 226 caregiver-HCP dyads were quantitatively evaluated. The mean age of caregivers was 61 years; many were spouses/partners (46%), White (60%), and female (62%), providing an average of 60 h of care weekly (range: 9-168 h). Following initial assessment and refinement, the final AASC, evaluated in a subset of 105 dyads, showed a 73.3% agreement with IPA criteria, with sensitivity of 0.77, specificity of 0.70, and kappa and F1 scores of 0.47 and 0.71, respectively. Most patients were classified as having mild (41%) to moderate (37%) Alzheimer's dementia, while 22% had severe disease.

Conclusion: The AASC is a reliable, easy-to-use, 2-item screener for the presence and impact of agitation, in agreement with IPA criteria. The AASC supports caregivers and HCPs by providing an accessible framework for recognizing agitation throughout all stages of Alzheimer's dementia and prompting comprehensive assessment for diagnosis and appropriate treatment planning.

Retinal artery occlusions (RAO) are sentinel markers of systemic vascular disease. Beyond well-established risk factors (hypertension, diabetes, dyslipidemia), accumulating evidence links RAO with atrial fibrillation (AF). This manuscript narratively synthesizes observational cohorts, case-control studies, and registry analyses evaluating the bidirectional association between RAO and AF. We appraise the diagnostic yield of AF screening strategies after ocular events and outline clinical implications for thrombo-embolic risk reduction. Across studies, the prevalence of AF is consistently higher after RAO, although effect sizes vary with study design and ascertainment methods. Brief, single-time-point ECG screening frequently misses paroxysmal AF, whereas prolonged monitoring (e.g. 7-14-day patches and implantable loop recorders) increases detection in selected high-risk patients. Currently, no guidelines recommend routine AF screening after retinal artery occlusion; however, risk-stratified pathways grounded in age, vascular comorbidity, and ocular phenotype appear pragmatic. We propose a practical algorithm for AF detection after RAO and summarize ophthalmology-centered management considerations (timely cardiology referral, antithrombotic therapy, and secondary prevention). Key evidence gaps include standardized AF ascertainment, prospective screening trials, and health-economic evaluation. Addressing these could inform future recommendations and reduce preventable stroke and vision loss.

Objective: To characterize the change in apixaban out-of-pocket (OOP) costs from 2016 to 2017 (after a formulary tier increase) and to assess the association between increased OOP costs and treatment discontinuation among Medicare beneficiaries with atrial fibrillation (AF).

Methods: Medicare fee-for-service claims data (2012-2019) were used to conduct a retrospective cohort study on adult patients with AF who experienced an increase in apixaban OOP costs from 2016 to 2017 due to formulary tier increase. Discontinuation was defined as an apixaban treatment gap of >30 consecutive days without switching to another oral anticoagulant. Multivariable Cox proportional hazards models were used to identify factors associated with treatment discontinuation.

Results: Among 1,153 patients treated with apixaban who experienced increased OOP costs from 2016 to 2017, 321 (27.8%) discontinued treatment in 2017 (mean age 78.3 years, 58.9% male, 92.8% White, 38.6% from the South). From 2016 to 2017, the mean (standard deviation) OOP costs for apixaban increased from $76.61 ($40.75) to $162.41 ($60.16) per month (mean change: $85.80 [$57.12]), which was significantly higher among patients who discontinued treatment than those who did not ($93.42 [$61.40] vs $82.87 [$55.13], respectively; p <.05). After multivariable adjustment, each $50 increase in monthly OOP costs was associated with a 1.27 times higher likelihood of treatment discontinuation (p <.05).

Conclusion: Following the formulary tier increase of apixaban from 2016 to 2017, increases in OOP costs was associated with a significantly higher probability of treatment discontinuation among Medicare beneficiaries with AF.

Objective: This study aimed to elucidate the experiences of family caregivers of people with dementia before and after diagnosis, including regarding medical treatment and support.

Methods: We conducted a survey of 198 family caregivers of people with dementia in Japan to assess caregiver experiences regarding medical examination and diagnosis, patient functional status, and support resources.

Results: The mean time from suspicion of dementia to the start of medical evaluation was 15.1 months, and the mean time from the start of medical evaluation to a confirmed diagnosis was 4.7 months. Time to the initial medical visit was significantly longer when the family caregiver was a child or daughter- or son-in-law, when dementia onset was younger, or when the first noticed symptom was forgetfulness (all p < 0.001). Family caregivers received dementia-related information from medical institutions and community comprehensive support centers, but satisfaction with these resources varied. Early diagnosis was valued for clarifying concerns about observed changes (62.1% of respondents), whereas uncertainty until diagnosis caused the greatest anxiety (34.3%), underscoring the need for coordinated support.

Conclusion: Family caregivers of people with dementia reported barriers to timely diagnosis and post-diagnosis support, highlighting the need for improved care pathways, enhanced collaboration between medical institutions and communities, and better access to support resources.

Objective: Identifying patients with transthyretin amyloid cardiomyopathy (ATTR-CM) in secondary data sets is important for assessing effectiveness and safety of treatments.

Methods: We searched bibliographic databases from inception through February 15, 2025. These were augmented by Google Scholar and hand searches of references from identified studies. Studies were included if they utilized billing code and/or pharmacy record algorithms to identify ATTR-CM (wild-type, variant or both) in secondary datasets. Study characteristics and methodological attributes were summarized.

Results: Twenty-five studies (26 analyses) were identified. Analyses were performed in the United States (US)(53.8%) and outside the US (46.2%). They assessed wild-type alone (46.2%), variant-type alone (11.5%) and mixed-type (42.3%). Sixteen analyses (61.5%) used International Classification of Diseases-10th-Revision (ICD-10) codes, 23.1% used ICD-9 and -10 codes, 11.5% analyses used country unique billing codes, and 11.5% relied on tafamidis prescriptions (with/without billing codes) to identify ATTR-CM. Of the 22 analyses (84.6%) using ICD codes, E85.82 alone was most used to identify wild-type (40.9%), and E85.0-E85.2 to identify variant-type. Fourteen studies (53.8%) required diagnosis codes for cardiac conditions. Exclusion criteria included codes for light chain amyloidosis (53.8%), blood cancers (38.5%) and cerebral amyloid angiopathy (30.8%). Five analyses (19.2%) used data from 2018 onward.

Limitations: While we utilized bibliographic databases, gray literature sources and backward citation tracking, it remains possible that not all studies were captured.

Conclusions: Methods for identifying ATTR-CM in studies of secondary datasets were heterogeneous. Future research should focus on optimizing ATTR-CM identification algorithms and performing validation studies.

Background: The Cardiometabolic Index (CMI) is a recognized metabolic marker, but its predictive efficacy for major adverse cardiovascular events (MACEs) in patients with ST-segment elevation myocardial infarction (STEMI) remains uncertain. The primary aim of this study is to investigate the predictive value of CMI for long-term outcomes in patients with STEMI, focusing on inflammation's mediating effects.

Methods: We analyzed data from 905 consecutive STEMI patients undergoing primary percutaneous coronary intervention, with 785 included in the final analysis. The primary endpoint was a composite of cardiovascular death, non-fatal myocardial infarction, revascularization for unstable angina, and rehospitalization for congestive heart failure. We used Cox regression models and subgroup analyses to explore the relationships between CMI and these outcomes, and employed mediation analysis to assess the role of inflammation, specifically using the lymphocyte to C-reactive protein ratio (LCR).

Results: Over an average follow-up of 11 months, 296 MACEs occurred. Multivariable Cox regression showed a significant positive association between CMI and the incidence of MACEs (Hazard Ratio [HR]: 4.584, 95% CI: 3.134-6.704), non-fatal myocardial infarction (HR: 2.142, 95% CI: 1.110-4.135), revascularization (HR: 7.911, 95% CI: 3.986-15.700), and rehospitalization for heart failure (HR: 6.243, 95% CI: 2.779-14.023), but not with cardiovascular death. Mediation analysis indicated that LCR mediated -13.7% and -19.5% of the associations of CMI with MACEs and heart failure rehospitalization, respectively.

Conclusion: Elevated CMI is positively associated with MACEs and rehospitalization for heart failure in STEMI patients, with partial mediation through inflammatory pathways. CMI may thus be a valuable prognostic tool for this patient group.

Objective: To evaluate the real-world effectiveness of once-weekly semaglutide for weight reduction and change in cardiometabolic risk factors at 24 months in patients with obesity or overweight.

Methods: This real-world retrospective, cohort study used the US Komodo Health database, which included adults with obesity or overweight with ≥1 obesity-related condition (ORC) who started semaglutide after June 15, 2021. Eligible patients escalated to and remained on the 1.7-mg or 2.4-mg maintenance dose for the duration of the 24-month follow-up. Change in weight (primary objective) and change in cardiometabolic risk factors (BMI, blood pressure, glycated hemoglobin, cholesterol, and triglycerides; secondary objective) were assessed from index date to the end of 24-month follow-up. Paired t tests were used to compare means at baseline and 24 months.

Results: Of 2592 eligible patients, 630 had 24-month follow-up data for weight, BMI, or cardiometabolic risk factors. The mean (SD) age was 48.6 (9.8) years, 77.8% of patients were female, and musculoskeletal pain and dyslipidemia were the most common baseline ORCs. At 24 months, mean (%) change in body weight was -17.9 kg (-16.6%; p < 0.0001; n = 175) and mean change in BMI was -6.0 kg/m² (p < 0.0001; n = 361). Statistically significant improvements in mean values for all cardiometabolic risk factors were observed at 24 months.

Conclusion: Real-world use of semaglutide was associated with reductions in weight and BMI and improvement in cardiometabolic risk factors at 24 months among patients with obesity or overweight. These findings support the use of semaglutide in clinical practice as an effective treatment for chronic weight management.