American Journal of Medicine最新文献

Rapid shifts in evidence-based medicine challenge clinicians to adapt their practices based on new information. Synthesizing relevant evidence can drive clinical advancements. To enhance knowledge of practice-changing literature, a group of six internists reviewed titles and abstracts from seven internal medicine journals with the highest impact factors and relevance to outpatient general internal medicine. New England Journal of Medicine (NEJM), The Lancet, Annals of Internal Medicine, Journal of the American Medical Association (JAMA), JAMA Internal Medicine, British Medical Journal (BMJ), and Public Library of Science (PLoS) Medicine were reviewed. In addition, collections of article synopses and databases were also reviewed: American College of Physicians Journal Club, NEJM Journal Watch, BMJ Evidence-Based Medicine, McMaster ACCESSSS/DynaMed Evidence Alerts, and Cochrane Reviews. A modified Delphi method was used to reach consensus based on relevance to outpatient internal medicine, impact on practice, and strength of evidence. Articles pertaining to the same topic were considered together. In total,7 practice-changing articles were included.

Objectives: Military service requires intense exercise, increasing the risk of sudden cardiac arrest, which is typically fatal without bystander cardiopulmonary resuscitation (CPR) combined with immediate defibrillation. Out-of-hospital cardiac arrest survival rates average 10%. The US military emphasizes team responsibility for providing immediate rescue to individual members. Data suggest that CPR and bystander defibrillation rates are higher on military bases than off bases. We hypothesized that sudden cardiac arrest rates would be greater in the military, but survival post-hospitalization would be better than in civilian cohorts.

Methods: The Military Health System Data Repository (MDR) was queried from fiscal years (FYs) 2016 to 2019 for the diagnoses of cardiac arrest, torsades de pointes, ventricular fibrillation, and ventricular flutter in a cross-sectional study of actively serving U.S. military members ages 17-64 years.

Results: 958 military personnel were identified with sudden cardiac arrest/Ventricular Arrhythmia from FYs 2016 to 2019 with a sudden cardiac arrest rate of 10.8 per 100,000 person-years. 30-day survival rates were high at 73% for subjects aged < 35 and 76% for those aged 35-64 years.

Conclusions: Despite a high incidence of sudden cardiac arrest in the military, survival beyond 30 days for those transported to the hospital was excellent. While greater efforts towards preventing sudden cardiac arrest in the military are indicated, these data suggest that increased rates of bystander CPR and defibrillation result in meaningful gains in survival.

Background: The widespread use of coronary computed tomographic angiography (CCTA) has increased the number of cases of coronary stenosis in asymptomatic individuals. In this population, we aimed to analyze the net benefit of aspirin, which is currently recommended for secondary cardiovascular prevention.

Methods: This propensity score-matching study screened 41,441 asymptomatic individuals who underwent CCTA during health checkups between 2007 and 2022. Ultimately, 1,483 patients with incidentally diagnosed coronary stenosis were enrolled after excluding ineligible individuals. Using a 1:1 propensity score matching, data from 636 individuals (318 new aspirin users and 318 controls) were analyzed. The primary outcome variable was composite cardiovascular events (cardiovascular death, nonfatal myocardial infarction, and nonfatal ischemic stroke/transient ischemic attack), with/without major bleeding.

Results: At a median follow-up of 6.3 years, 11 and 18 individuals experienced composite events in the aspirin and control groups (2.1 and 3.2/1,000 person-years; hazard ratio [HR] 0.62; P=0.20), respectively. Conversely, composite events and major bleeding occurred in 26 and 23 individuals in the aspirin and control groups (4.9 and 4.1/1,000 person-years; HR 1.16; P=0.60), with a higher bleeding risk in the aspirin group. Kaplan-Meier curves demonstrated no significant difference in composite events without (log-rank P=0.21) or with major bleeding (P=0.61). Furthermore, age, chronic kidney disease, and low high-density lipoprotein cholesterol were identified as predictors of composite events and bleeding.

Conclusions: Aspirin showed no benefit for composite events and bleeding in asymptomatic individuals with coronary stenosis. Thus, personalized aspirin use rather than universal aspirin use may be more appropriate for this population.