American Journal of Medicine最新文献

Background: Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) is a complex, debilitating condition characterised by severe fatigue that is not relieved by rest and is often exacerbated by physical or mental activity. A key challenge for individuals with ME/CFS is energy management and to date, the only recommended strategy is "activity pacing." This approach involves balancing activity and rest to avoid overexertion and minimise the risk of symptom exacerbation, commonly known as "post-exertional malaise"(PEM). A recent systematic review highlighted significant shortcomings in activity pacing interventions for ME/CFS, noting that they lacked rigour, were brief, and did not follow guidelines or integrate recommended technology, limiting their relevance for modern energy management. To address these gaps, the present study aimed to explore ME/CFS patients' and health practitioners' perspectives on approaches to energy management, how their understanding of energy management has evolved over time, and their recommendations for future interventions concerning energy management.

Method: Eight individuals with ME/CFS participated in six one-hour long online co-production workshops with two researchers, with the option to provide input through written responses. Additionally, three health practitioners shared their perspectives via email. Thematic analysis of the data identified several key recommendations for improving ME/CFS care.

Results and conclusions: Workshops highlighted the need for early support, healthcare provider training, and public education to combat stigma and misconceptions around ME/CFS. Participants emphasised patient collaboration, research-informed practices, rigorous research, multidisciplinary teams, and the integration of technologies like mHealth, along with a comprehensive approach including sleep, diet, and psychological support for better symptom management and activity pacing.

Background: Emerging evidence suggests sodium-glucose cotransporter 2 inhibitors (SGLT2i) benefits may extend to patients with amyloid cardiomyopathy, including transthyretin and amyloid light-chain amyloidosis subtypes. This study explores the broader implications of SGLT2i therapy across the spectrum of amyloidosis.

Methods: This retrospective cohort study used de-identified electronic health records from the TriNetX platform, encompassing data from 101 healthcare organizations between 2009 and 2024. Two cohorts of amyloidosis patients with heart failure were compared based on SGLT2i use. One cohort without a diagnosis of heart failure was also tested. Propensity score matching was applied to balance baseline characteristics. The primary outcome was all-cause mortality, and secondary outcomes included acute heart failure, acute myocardial infarction, stroke, and chronic kidney disease.

Results: The matched cohorts included 5,612 patients, with a mean age of 74 years and 64% male. SGLT2i-treated patients exhibited a higher 5-year survival probability (62.6%) compared to non-SGLT2i patients (39.1%) (HR 0.54, 95% CI 0.50-0.59; p<0.001). In amyloidosis patients without heart failure (n=1,490), SGLT2i therapy was associated with a significant reduction in all-cause mortality (HR 0.57, 95% CI 0.43-0.74; p <0.001). Sub-cohorts of transthyretin and amyloid light-chain amyloidosis in heart failure patients demonstrated consistent benefits with reduced mortality and favorable trends for acute myocardial infarction and stroke.

Conclusion: SGLT2i therapy is associated with significant survival benefits in amyloidosis patients with HF and may offer broader advantages across the amyloidosis spectrum, including amyloid patients without heart failure.

In the last few years, the longevity of Americans has fallen for the first time in our history. Obesity has mushroomed, heart disease still kills approximately 600,000 Americans and stroke 150,000. This review will cover the 8 most important non-genetic risk factors for heart disease and stroke. Meanwhile, recent research has clarified the root cause of atherosclerosis. The approval of tirzepatide to treat obesity in November 2023 by the FDA turns out to have enormous implications for medicine and surgery and the food industry.

Valvular heart disease is a common problem seen by primary care providers (PCPs). Transcatheter techniques used in the treatment in valvular heart disease have evolved lowering the risk of intervention. This allows for safer valve repair or replacement. Successful transcatheter valvular intervention is truly incredible. These lower risk procedures are changing who and when to refer patients as intervention may be safer than the risk of waiting. This issue is most critical in isolated chronic tricuspid regurgitation, as these patients were often felt to be too high risk for tricuspid surgical intervention. Now there exist multiple transcatheter interventions that can benefit patients with tricuspid regurgitation and right ventricular failure. Many of these procedures are still undergoing study and yet it appears clear that patients receive benefit from intervention. In addition, many patients with chronic tricuspid regurgitation and right ventricular failure are no longer seen by cardiology. It is imperative that PCPs are aware of which patients could potentially benefit from tricuspid valve intervention for tricuspid regurgitation for optimal referral and treatment.