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Patient Cognitive Status and Physician Recommendations for Cardiovascular Disease Treatment: Results of Two Nationwide, Randomized Survey Studies
ConclusionIn these randomized survey studies, physicians recommended fewer guideline-concordant AMI and stroke treatments to hypothetical patients with early-stage dementia than those with NC. We did not find evidence that physicians recommend fewer treatments to hypothetical patients with MCI than those with NC.
Source: Journal of General Internal Medicine - August 24, 2023 Category: Internal Medicine Source Type: research

Ambulatory Care Fragmentation, Emergency Department Visits, and Race: a Nationwide Cohort Study in the U.S.
ConclusionsHighly fragmented ambulatory care was an independent predictor of ED visits, especially among Black individuals.
Source: Journal of General Internal Medicine - November 23, 2022 Category: Internal Medicine Source Type: research

Association of Neighborhood Disadvantage and Anticoagulation for Patients with Atrial Fibrillation in the Veterans Health Administration: the REACH-AF Study
ConclusionsAmong Veterans with incident AF, we observed similar initiation of any anticoagulant, though neighborhood deprivation was associated with decreased DOAC use among anticoagulant initiators. Future interventions to improve pharmacoequity in anticoagulant prescribing for AF should consider the role of neighborhood-level determinants of health inequities.
Source: Journal of General Internal Medicine - September 23, 2022 Category: Internal Medicine Source Type: research

Intensive Versus Standard Blood Pressure Lowering and Days Free of Cardiovascular Events and Serious Adverse Events: a Post Hoc Analysis of Systolic Blood Pressure Intervention Trial
ConclusionsOver 4 years, intensive systolic blood pressure lowering provides, on average, 14.7 more MACE-free days than standard treatment, without any difference in SAE-free days. Whether this time-based effect summary improves shared decision-making remains to be elucidated.Trial RegistrationClinicalTrials.gov Registration: NCT01206062
Source: Journal of General Internal Medicine - August 9, 2022 Category: Internal Medicine Source Type: research

CHA2DS2-VASC Score Predicts the Risk of Stroke in Patients Hospitalized to the Internal Medicine Department Without Known Atrial Fibrillation
ConclusionsThe CHA2DS2-VASC score is a predictor for CVA/TIA during the first year after hospitalization in patients without AF. High CHA2DS2-VASC scores warrant work-up for occult AF/AFL and other risk factors for CVA/TIA.
Source: Journal of General Internal Medicine - May 27, 2022 Category: Internal Medicine Source Type: research

The Atrial Fibrillation Better Care (ABC) Pathway and Clinical Outcomes in Patients with Atrial Fibrillation: the Prospective Murcia AF Project Phase II Cohort
ConclusionsIn this real-world prospective cohort of AF patients starting VKA therapy, adherence to the ABC pathway management at baseline significantly reduced the risk of NCOs, all-cause mortality, and cardiovascular death at 2 years.
Source: Journal of General Internal Medicine - April 11, 2022 Category: Internal Medicine Source Type: research

Persistence of Depressive Symptoms and Risk of Incident Cardiovascular Disease With and Without Diabetes: Results from the REGARDS Study
ConclusionsThe persistence of depressive symptoms across 5 years of follow-up in participants without diabetes identifies individuals at increased risk for incident stroke. This was particularly evident in black participants and among those not taking anti-depressants.
Source: Journal of General Internal Medicine - March 1, 2022 Category: Internal Medicine Source Type: research

Prevalent Multimorbidity Combinations Among Middle-Aged and Older Adults Seen in Community Health Centers
ConclusionsCHCs are increasingly seeing more complex multimorbidity patterns over time; these most often involve mental health morbidity and advanced cardiometabolic-renal morbidity.
Source: Journal of General Internal Medicine - January 28, 2022 Category: Internal Medicine Source Type: research

Medicare Claim –Based National Institutes of Health Stroke Scale to Predict 30-Day Mortality and Hospital Readmission
ConclusionsMedicare claim –based NIHSS is significantly associated with 30-day mortality in Medicare patients with ischemic stroke and significantly improves discriminant property relative to the Elixhauser comorbidity index.
Source: Journal of General Internal Medicine - October 26, 2021 Category: Internal Medicine Source Type: research

Effectiveness and Safety of Dabigatran in Atrial Fibrillation Patients with Severe Obesity: a Real-World Retrospective Cohort Study
ConclusionsAmong AF patients with a BMI>40kg/m2 or a weight>120kg in a real-world clinical setting, dabigatran was effective in reducing the risk of thromboembolism and mortality but was associated with an increased risk of bleeding when compared to warfarin. Dabigatran may be a reasonable option for AF patients with severe obesity.
Source: Journal of General Internal Medicine - September 20, 2021 Category: Internal Medicine Source Type: research

The Longer-Term Benefits and Harms of Glucagon-Like Peptide-1 Receptor Agonists: a Systematic Review and Meta-Analysis
DiscussionGLP1RAs reduced cardiovascular risk factors and increased gastrointestinal events compared to placebo and other anti-hyperglycemic medications. GLP1RAs also reduced MACE, stroke, renal events, and mortality in comparisons with placebo; however, analyses were inconclusive for comparisons with other anti-hyperglycemic medications. Given the high costs of GLP1RAs, the lack of long-term evidence comparing GLP1RAs to other anti-hyperglycemic medications has significant policy and clinical practice implications.
Source: Journal of General Internal Medicine - September 10, 2021 Category: Internal Medicine Source Type: research

Atrial Fibrillation Is Associated with Cognitive Impairment, All-Cause Dementia, Vascular Dementia, and Alzheimer ’s Disease: a Systematic Review and Meta-Analysis
ConclusionAF increases the risk of cognitive impairment, all-cause dementia, vascular dementia, and Alzheimer ’s disease. Future studies should employ interventions that may delay or even prevent cognitive decline in AF patients.
Source: Journal of General Internal Medicine - July 9, 2021 Category: Internal Medicine Source Type: research

The Association Between Mild Cognitive Impairment Diagnosis and Patient Treatment Preferences: a Survey of Older Adults
ConclusionWe did not find evidence that patients with MCI want less treatment than patients with NC. These findings suggest that other provider and system factors might contribute to patients with MCI getting less guideline-concordant care.
Source: Journal of General Internal Medicine - May 7, 2021 Category: Internal Medicine Source Type: research

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