pharmacist

Subcutaneous ICD (S-ICD), which overcomes the disadvantages of transvenous-ICD (TV-ICD), which requires electrode wires to be inserted into the blood vessels and heart, is establishing itself as a next-generation runner.

With the accumulation of Rewall World Data (RWD) following comparative clinical trials with various TV-ICDs, evidence is being established that it is no inferior to ‘standard status’.

Even in the largest post-approval study in which 1637 patients were enrolled, it received a passing score in terms of the incidence of complications and the shock effect of eliminating ventricular fibrillation over a period of 5 years.

The clinical results of S-ICD PAS, which observed the complications of S-ICD and the efficacy of electric shock for 5 years, were published in the August issue of the Journal of the American College of Cardiology (JCC) (doi.org/10.1016/j.jacc.2023.05.034).

TV-ICD has been the defibrillator standard for 40 years. The problem is that due to the nature of electrode wires being inserted into blood vessels and the heart, they are not free from side effects such as infection or electrode wire defects when they remain in the blood vessels for a long time.

The currently commercialized S-ICD is the only emblem developed by Boston Scientific.

On the other hand, S-ICD overcomes the disadvantages of existing ICDs by adopting a method in which electrode lines are located outside the heart to avoid direct contact with the heart and blood vessels.

Since S-ICD is a relatively new technology, various verifications in the medical world are continuing.

Clinical studies such as PRAETORIAN, ATLAS, and EFFORTLESS focused on ‘comparison’ of the incidence rate of complications and incidence of inappropriate electric shock between the two groups of S-ICD and TV-ICD, while recent studies are ‘comparison’ that examines long-term clinical efficacy and safety in the field after commercialization. RWD rationale’ is focused on.

Both the EHRA 22 clinical trial published in 2021 and the ELISIR clinical trial published in 2022 analyzed the actual effects of S-ICD in heart failure patients. The S-ICD PAS clinical trial, which was released this month, was followed up for five years on efficacy and safety, including shock efficacy and complications and complications related to the transplant procedure, at 86 medical institutions in the United States.

In an analysis of a total of 1643 patients, the mean shock efficacy for individual occurrences of ventricular tachycardia or ventricular fibrillation was 98.4%, which remained similar during the follow-up period.

The rates without S-ICD-related complications and electrode-related complications were 93.4% and 99.3%, respectively.

Only 1.6% of patients had their device replaced with a TV-ICD as needed, with a cumulative all-cause mortality rate of 21.7% and an inappropriate shock rate of 15.8%, similar shock rates to TV-ICD.

“This study is the largest in terms of scale among prospective studies on S-ICD that have been conducted so far,” said Michael R. Gold of the University of South Carolina Medical School, USA. It proves safety and efficacy.”

As S-ICD entered the insurance benefit right in Korea in 2019, efforts to upgrade the recommended grade in the guidelines and calculate RWD are currently in progress.

Professor A of Cardiovascular Internal Medicine at Seoul National University Hospital said, “Since the S-ICD insertion was performed, we have been monitoring patients in the hospital.” Complications definitely tend to be less,” he said.

As the international guidelines recommend the use of S-ICD for high-risk patients such as infections and chronic diseases, the Korean Heart Failure Society also added a new implantable cardioversion defibrillator item last year and said, “subcutaneous cardioversion defibrillators are difficult to access to blood vessels or have previously been It is useful in patients who have had an infection from a defibrillator.”

2023-08-21 20:30:00

#Implantable #defibrillator #RWD #verified #anotherIs #generational #change #accelerating

To minimize the fracture side effects of corticosteroids, a study has found that focus should be placed on duration rather than dose.

In the case of short and thick one-time use, the risk of fracture increased and the frequency of taking osteoporosis drugs increased compared to those who were consistently prescribed a similar cumulative dose.

The results of a study on the risk of fracture by corticosteroid use and dose, conducted by researchers including Julian Matthewman of the London School of Hygiene and Tropical Medicine, UK, were published in the international journal JAMA on the 9th (doi:10.1001/jamadermatol.2023.2495). ).

As a result of cohort analysis of the London School of Hygiene and Tropical Medicine in the UK, the duration of steroid administration has an effect on the risk of fracture.

Steroids are widely prescribed as effective anti-inflammatory agents in chronic inflammatory diseases. Steroids begin to lose bone within a few weeks of administration, increasing the risk of fracture, so short-term prescription is recommended for eczema, asthma, and COPD, except for rheumatoid arthritis.

It has been known that the cumulative steroid dose is the largest factor in the decrease in bone density and the risk of fracture, but it has not been confirmed whether the total number of days of administration affects the risk.

Focusing on the fact that the elderly are vulnerable to the risk of steroid-induced fractures, the research team focused on cumulative administration of 450 mg of Prednisolone for a short period of time (high-intensity group), and when 5 mg or more daily was administered over a relatively long time or divided into several times (low-intensity group). We analyzed whether there was a change in fracture risk.

A total of 93,869 patients with eczema, asthma, or COPD (UK cohort 65,195, Canada cohort 28,674) aged 66 years or older who took cumulative oral prednisolone ≥ 450 mg within 6 months for fracture prevention according to increased fracture risk Prescription medications and rates of major osteoporotic fractures were compared.

As a result of risk analysis using a Cox proportional hazards regression model, the risk of receiving fracture prevention treatment was up to twice as high in the high-intensity group who received short-term oral corticosteroids once (UK cohort HR 2.34, Canadian cohort 1.49).

However, the rates of major osteoporotic fractures in both the high- and low-intensity groups were similar (UK HR 1.07, Canada 0.87).

“Previous studies have looked at the association between oral corticosteroid prescribing patterns and fracture risk, but no study has investigated the association with cumulative doses,” the researchers said. Compared to the high-intensity group, the risk of receiving fracture prevention treatment was reduced by half.”

2023-08-21 03:19:00

#Strategies #preventing #steroid #fractures #changed #short #thick #wrong

A study has found that removal of the thymus gland increases the risk of death and cancer.

Although it is involved in the development of immune function, it gradually degenerates with the maturation of the human body, and unlike in adults, where it was considered safe to remove it because its function was unclear, thymectomy in adults resulted in a worsening prognosis.

The results of a study on the correlation between thymus removal and health in adults, in which Professor Cameron A. Kooshesh of the Center for Regenerative Medicine at Massachusetts General Hospital in the U.S. participated, was published in the international journal NEJM on the 3rd (DOI: 10.1056/NEJ Moa2302892).

Located behind the breastbone and in front of the heart and aorta, the thymus gland is an organ that makes immune cells. It started to develop in newborns, reached its largest size during puberty, then degenerated, and changed to small adipose tissue in adults, after which its function was thought to be unclear.

A study has found that removing the degenerated thymus gland after adulthood increases the risk of cancer and death.

In particular, as it is known that thymectomy is effective in the treatment of myasthenia gravis, thymus removal is being performed in various surgical procedures including myasthenia gravis.

The researchers hypothesized that even in adults, the thymus gland is required to maintain immunity and overall health, and in a cohort comparing mortality, cancer and autoimmune disease rates in adult patients who underwent thymectomy with a control group who underwent similar thoracic surgery without thymectomy. embarked on

Registry-enrolled 1420 patients who underwent thymectomy and 6021 controls were included in the study, and 1146 of the patients who underwent thymectomy had a demographically matched control group.

As a result of the analysis, the all-cause mortality rate at 5 years after surgery was 8.1% in the resection group and 2.8% in the control group.

There was no significant difference in the risk of autoimmune disease among the groups in the entire cohort, but when patients with preoperative infection, cancer, or autoimmune disease were excluded from the analysis, the autoimmune disease rate was higher in the resection group at 12.3% versus 7.9%.

The results were similar when the follow-up period was extended to more than 5 years.

All-cause mortality was higher in the thymectomy group than in the general population (9.0% vs. 5.2%), and mortality from cancer was higher (2.3% vs. 1.5%).

A subgroup of patients (22 thymectomy patients, 19 control patients) for whom T cell production and plasma cytokine levels were measured was followed up for an average of 14.2 years after surgery. wrote

This means that the thymus is mostly replaced by fat in adulthood and degenerates, but it is still in charge of ‘functions’ such as generating T cells.

“This study confirmed that all-cause mortality and cancer risk were higher in patients who underwent thymectomy,” said the researchers. When excluded from the analysis, it was found to be associated with an increased risk of autoimmune disease.”

2023-08-03 02:53:16

#thymus #useless #organ.. #Increased #risk #death #cancer #resection

Recently, a study has found that the combination of heat waves and air pollution is fatal to the heart while the world is suffering from abnormally high temperatures. The risk of heart attack doubled, with women and the elderly particularly vulnerable.

The results of a study on the effects of heat waves and air pollution on myocardial infarction mortality, conducted by Professor Ruijun Xu, Department of Epidemiology, School of Public Health, Zhongshan University, China, were published in the international journal Circulation on the 24th (doi.org/10.1161/CIRCULATIONAHA.122.063504). ).

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Temperature extremes, including heat and cold, are associated with myocardial infarction (MI) incidence, but their effect on MI mortality has not been clearly established.

Particulate matter (PM 2.5) is also known to have an adverse effect on cardiovascular mortality, but whether and how extreme temperature changes and PM 2.5 interact on MI mortality is still unknown.

To confirm this, the researchers conducted a time-stratified case crossover study of 202,678 MI deaths in Jiangsu Province, China from 2015 to 2020 to investigate the association between extreme temperature changes and PM 2.5 incidence and MI mortality, and correlated them. The action effect was evaluated.

Daily temperature and PM 2.5 exposure were evaluated by extracting values ​​from a grid data set validated at each subject’s residential address, and exposure-response analysis was performed by applying a conditional logistic regression model, and the ratio due to crossover and the occurrence due to synergy index We estimated the odds ratio.

As a result of the analysis, the odds ratio of MI mortality related to heat waves and cold waves ranged from 1.18 to 1.74 and 1.04 to 1.12, respectively, and the increase in death risk was particularly large in heat waves.

The risk of fatal MI was 18% higher during a 2-day heat wave with a heat index above the 90th percentile (28.1-36.6°C) and 74% higher during a 4-day heat wave with a heat index above the 97.5th percentile (34.9-43°C).

Exposure to PM 2.5 was also significantly associated with increased mortality from MI, with heatwaves and particulate matter combined generally having higher mortality rates in heatwaves with greater intensity and longer duration.

The risk of fatal MI was twice as high during a 4-day heat wave with PM 2.5 above 37.5 µg/m³, but during a cold wave, elevated PM 2.5 levels did not increase the risk of MI by a similar level.

The risk of death was higher for women than for men during the heat wave and higher for adults over 80 years of age than for younger adults.

“This analysis provides consistent evidence that exposure to extreme heat and PM 2.5 is significantly associated with increased mortality from MI in women and older adults, but not to cold waves,” said the researchers. This suggests that it may be beneficial in preventing premature death due to

2023-08-01 03:04:32

#Heat #wave #fine #dust #fatal #heart #double #incidence #myocardial #infarction

Although the possibility of atrial fibrillation was raised when taking omega-3, a large-scale meta-analysis concluded that the risk was exaggerated.

The results of a meta-analysis of the possibility of atrial fibrillation according to omega-3 intake conducted by researchers including Frank Qian of the Harvard TH School of Public Health in the United States were published in the American Heart Association journal JACC on the 17th (doi.org/10.1016/j.jacc.2023.05.024).

In 2021, a study on the possibility of an increased risk of atrial fibrillation by omega-3 supplements was published in the Journal of the European Heart Association, sparking controversy over the effectiveness of omega-3.

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Various societies recommend high-dose administration of 2 to 4 g of omega-3 per day to prevent cardiovascular disease, but in previous studies, the risk of atrial fibrillation was particularly frequent in the high-dose administration group.

High-dose administration is essential for effectiveness, but it was a situation where the possibility of side effects due to high-dose administration had to be taken into account.

The research team launched a meta-analysis method that comprehensively analyzed 17 studies to determine whether omega-3 administration actually increased the risk of atrial fibrillation.

In the study, which included a total of 54,799 participants, the incidence of atrial fibrillation according to blood levels of each component (EPA, DPA, DHA) was followed up for an average of 13.3 years, and 7720 cases of atrial fibrillation were identified.

In multivariate analysis, the EPA level was not related to incident atrial fibrillation, and rather, the risk (HR) of atrial fibrillation for higher levels of DPA, DHA, and EPA+DHA was 0.89, 0.90, and 0.93, respectively, with a risk reduction of around 10% observed.

“Consumption of omega-3 fatty acids, including EPA, DPA, DHA and EPA+DHA, was not associated with an increased risk of atrial fibrillation,” the researchers concluded.

“With the known benefits of these fatty acids in preventing coronary artery disease, this study suggests that current dietary guidelines recommending the administration of fish or omega-3 supplements may be retained.”

2023-07-21 03:03:49

#Omega #Supplements #Atrial #Fibrillation #Risks #Exaggerated #decrease