(Press-News.org) Embargoed for release until 5:00 p.m. ET on Monday 24 July 2023
Annals of Internal Medicine Tip Sheet
@Annalsofim
Below please find summaries of new articles that will be published in the next issue of Annals of Internal Medicine. The summaries are not intended to substitute for the full articles as a source of information. This information is under strict embargo and by taking it into possession, media representatives are committing to the terms of the embargo not only on their own behalf, but also on behalf of the organization they represent.
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1. ACP Says the U.S. Needs Immediate Action to Prepare for Future Pandemics
Abstract: https://www.acpjournals.org/doi/10.7326/M23-0768
Editorial: https://www.acpjournals.org/doi/10.7326/M23-1894
URL goes live when the embargo lifts
The United States has significant gaps in its pandemic and public health emergency response system leaving it unprepared for future emergencies, says the American College of Physicians (ACP) in a new policy paper. In the paper, ACP makes recommendations about what needs to be done to ensure the U.S. is in a strong position to mitigate the consequences of future pandemics. The paper is published in Annals of Internal Medicine.
ACP calls for a federal pandemic preparedness plan that is adequately funded and prioritizes health equity. They also ask that federal and state agencies provide consistent and timely communications about risk and strategies to combat risk in order to build trust and combat misinformation. They call for a national public health data infrastructure capable of real-time bidirectional data sharing among public and private public health stakeholders. The paper recommends securing and bolstering the health care supply chain. They also call for improved support for a health care workforce that is sufficient to provide surge capacity in emergencies, including the development of a reserve of physicians and other health care professionals. ACP affirms the importance of safety and well-being during emergencies, this must include safety for the public, patients and physicians and other professionals. The paper also calls attention to the need for support for medical practices during emergencies, measures to reduce infections in workplaces, and universal sick leave policies. Finally, ACP calls for expedited and equitable vaccine development and distribution, vaccine use in accordance with scientific recommendations, and ACP calls on physicians to promote vaccine uptake among their patients.
The recommendations need to be built on a strong public health sector, as outlined in an ACP paper recently published in Annals of Internal Medicine. Modernizing the United States’ Public Health Infrastructure: A Position Paper from the American College of Physicians, updates recommendations ACP made in 2012 for the U.S. public health infrastructure with new policies on establishing federal public health leadership, protecting public health workers, reversing workforce shortages, and the need to integrate primary care and public health.
An accompanying editorial by Ashish K. Jha, MD, MPH, former White House COVID-19 Response Coordinator, suggests that there are significant gaps to address in the American public health response to COVID-19 and future pandemics, but there are several key areas where there were successes to be improved upon for the future. Dr. Jha highlights the success of scaled and sustained pandemic-era innovations, including rapid testing and treatment mobile units and Operation Warp Speed. He also emphasizes the role of physicians and healthcare professionals as trusted sources of information to patients and the importance of professional organizations like ACP to lead physicians in speaking to patients exposed to medical misinformation. Finally, he argues for greater partnership between healthcare institutions and public health agencies, particularly focusing on greater data integration and the use of healthcare workers as a reserve for public health crises.
Media contacts: For an embargoed PDF, please contact Addison Dunlap at adunlap@acponline.org. To speak with someone from ACP, please contact Andrew Hachadorian at ahachadorian@acponline.org.
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2. Statins underused for primary prevention of cardiovascular disease in racial, ethnic minorities and women
Findings suggest that factors within the health care setting may contribute to unequal treatment
Abstract: https://www.acpjournals.org/doi/10.7326/M23-0720
URL goes live when the embargo lifts
An analysis of persons eligible for statin use to prevent atherosclerotic cardiovascular disease (ASCVD) found disparities in the prevalence of statin use for primary or secondary prevention of ASCVD among racial and ethnic minorities and women. According to the authors, these disparities were not explained by measurable differences in disease severity or access to resources, and instead suggest that factors within the health care setting, including bias, stereotyping, and mistrust, contribute to unequal treatment. The analysis is published in Annals of Internal Medicine.
Although statins are a class I recommendation for prevention of ASCVD and its complications, their use is suboptimal. The consequences of underutilization of statins may contribute to disparities in cardiovascular health outcomes. Understanding racial, ethnic, and gender-based differences in statin use could inform strategies to improve population-level ASCVD outcomes. However, the current literature presents estimates of statin-use disparities derived from heterogeneous populations.
Researchers from the University of Pittsburgh’s School of Medicine and School of Public Health and the VA Pittsburgh Healthcare System conducted a cross-sectional analysis of data from the National Health and Nutrition Examination Survey (NHANES) of persons eligible for statin therapy based on 2013 and 2018 American College of Cardiology/American Heart Association blood cholesterol guidelines. The authors used the Institute of Medicine framework for examining unequal treatment and calculated adjusted prevalence ratios (aPRs) to estimate disparities in statin use adjusted for age, disease severity, access to health care, and socioeconomic status relative to non-Hispanic White men. The authors found a lower prevalence of statin use for primary prevention among non-Hispanic Black men and non-Mexican Hispanic women compared with non-Hispanic White men. They also found a lower prevalence of statin use for secondary prevention for non-Hispanic Black men, Other/Multiracial men, Mexican American women, non-Mexican Hispanic women, non-Hispanic White women, and non- Hispanic Black women compared with non-Hispanic White men.
Media contacts: For an embargoed PDF, please contact Addison Dunlap at adunlap@acponline.org. To speak with the corresponding author Ravy K. Vajravelu, MD, MSCE, please contact Wendy Zellner at zellnerwl@upmc.edu.
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3. Patients with diabetes and gout may benefit from treatment with SGLT2is
Abstract: https://www.acpjournals.org/doi/10.7326/M23-0724
URL goes live when the embargo lifts
A study of persons with gout and type 2 diabetes found that the use of sodium–glucose cotransporter-2 inhibitors (SGLT2is) may reduce recurrent flares and gout-primary emergency department (ED) visits and hospitalizations compared to treatment with dipeptidyl peptidase 4 inhibitors (DPP-4is). SGLT2is may also provide greater cardiovascular benefits in this population. The findings are published in Annals of Internal Medicine.
Gout is an increasingly common metabolic inflammatory disease. Suboptimal care of the disease is associated with recurrent flares, increasing ED visits, and hospitalizations. Gout flares have also been associated with an increased cardiovascular risk and many cardiometabolic comorbidities accompany gout, including type 2 diabetes, metabolic syndrome, chronic kidney disease, and cardiovascular disease. Interventions that can address both gout flares and cardiometabolic risk may be beneficial for many patients.
Researchers from Massachusetts General Hospital conducted a propensity score–matched, new-user cohort study of 8150 persons with both gout and type 2 diabetes. They found that the use of SGLT2is was associated with a 34 percent lower rate of recurrent gout flare compared to DPP-4is, and a 48 percent lower rate of flares requiring an ED visit or hospitalization. The authors also found that SGLT2i use was associated with a relative risk reduction of 31 percent for myocardial infarction. According to the authors, these findings suggest that SGLT2is could have a much-needed ability to simultaneously reduce the burden of recurrent gout flares and coronary sequelae in patients with gout and type 2 diabetes.
Media contacts: For an embargoed PDF, please contact Addison Dunlap at adunlap@acponline.org. To speak with the corresponding author, Hyon K. Choi, MD, DrPH, please contact HCHOI@mgh.harvard.edu
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4. Researchers describe case of tecovirimat-resistant mpox variant in patient with prolonged infection
Abstract: https://www.acpjournals.org/doi/10.7326/L23-0131
Authors from the Institute of Tropical Medicine, Nationalestraat, Antwerp, Belgium describe a case of tecovirimat-resistant mpox virus (MPXV) identified at the autopsy of a severely immunocompromised patient with prolonged disease. Tecovirimat, an antiviral used to treat severe mpox virus, has a low barrier to resistance, which makes this case particularly unusual. The case report is published in Annals of Internal Medicine.
A 53-year-old patient presented with severe symptoms of MPXV that had been present for several weeks. The patient had several co-infections including active HIV infection, chronic hepatitis B virus infection, latent syphilis, and anal Chlamydia. Oral tecovirimat was started 1 day after the confirmation of MPXV and the initial 2-week course was successful. However, the anorectal viral load remained high up to day 48 and detectable up to the end of follow-up. Retrospective MPXV sequencing of the anorectal samples revealed a dominant variant population. This mutation was associated with a 350-fold increase in the half maximal effective concentration of tecovirimat compared with typical virus.
According to the authors, this case confirms the potential rapid selection of resistant mutant virus during tecovirimat monotherapy and could be the first to study this phenomenon longitudinally. The rapid selection of resistance in this patient highlights the risk of tecovirimat monotherapy, especially in the context of prolonged disease and immunosuppression. In such cases, the authors advocate for surveillance for resistant variants, emphasis on immune reconstitution, monitoring of viral clearance, and strict adherence to infection prevention measures.
Media contacts: For an embargoed PDF, please contact Addison Dunlap at adunlap@acponline.org. To speak with the corresponding author, Koen Vercauteren, please email kvercauteren@itg.be.
END
ACP says the US needs immediate action to prepare for future pandemics
2023-07-24
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