Cost-Effectiveness of Medical Therapy for Heart Failure With Mildly Reduced and Preserved Ejection Fraction.

BACKGROUND: Three medications are now guideline-recommended treatments for heart failure with mildly reduced or preserved ejection fraction (HFmrEF/HFpEF), however, the cost-effectiveness of these agents in combination has yet to be established. OBJECTIVES: The purpose of this study was to determine the cost-effectiveness of mineralocorticoid receptor antagonists (MRA), angiotensin receptor-neprilysin inhibitors (ARNIs), and sodium glucose co-transporter 2 inhibitors (SGLT2is) in individuals with HFmrEF/HFpEF. METHODS: Using a 3-state Markov model, we performed a cost-effectiveness study using simulated cohorts of 1,000 patients with HFmrEF and HFpEF. Treatment with 1-, 2-, and 3-drug combinations was modeled. Based on a United States health care sector perspective, outcome data was used to calculate incremental cost-effectiveness ratios (ICERs) in 2023 United States dollars based on a 30-year time horizon. RESULTS: Treatment with MRA, MRA+SGLT2i, and MRA+SGLT2i+ARNI therapy resulted in an increase in life years of 1.04, 1.58, and 1.80 in the HFmrEF subgroup, respectively, and 0.99, 1.54, and 1.77 in the HFpEF subgroup, respectively, compared with placebo. At a yearly cost of $18, MRA therapy resulted in ICERs of $10,000 per quality-adjusted life year (QALY) in both subgroups. The ICER for the addition of SGLT2i therapy ($4,962 per year) was $113,000 per QALY in the HFmrEF subgroup and $141,000 in the HFpEF subgroup. The addition of ARNI therapy ($5,504 per year) resulted in ICERs >$250,000 per QALY in both subgroups. If SGLT2i and ARNI were available at generic pricing the ICERs become <$10,000 per QALY in both EF subgroups. Outcomes were highly sensitive to assumed benefit in cardiovascular death. CONCLUSIONS: For patients with heart failure, MRA was of high value, SGLT2i was of intermediate value, and ARNI was of low value in both HFmrEF and HFpEF subgroups. For patients with HFmrEF/HFpEF increased use of MRA and SGLT2i therapies should be encouraged and be accompanied with efforts to lower the cost of SGLT2i and ARNI therapies.

Management of High-Grade Coronary Artery Disease and Concomitant Glanzmann Thrombasthenia.

In the present case report, we describe the management of severe coronary artery disease in a patient with Glanzmann thrombasthenia. To the best of our knowledge, there are no established guidelines for revascularization in this setting, and we pose novel discussion points regarding the nuanced care of this patient. (Level of Difficulty: Intermediate.).

The potential prebiotic effect of 2-Butyloctanol on the human axillary microbiome.

OBJECTIVE: The human axilla is colonized by a wide array of microorganisms that contribute to the generation of body odour. Traditional antiperspirant/deodorant products are used to reduce perspiration in the axillary region and to treat or prevent the growth of bacteria in this region, thereby reducing or eliminating body odour. However, they may also compromise the axillary microbiome balance. The personal care industry has been seeking new ingredients, such as prebiotics or probiotics, to maintain a healthy balance of the skin microbiome by inhibiting odour-causing bacteria, whilst maintaining and promoting the growth of good bacteria. The aim of this study was to investigate the prebiotic effect of a skin-care ingredient, 2-butyloctanol, on the human axillary microbiome. METHODS: An in vitro growth inhibition/promotion assay was performed to test whether 2-butyloctanol inhibited or promoted skin bacterial growth. The impact of 2-butyloctanol on the axillary microbiome was also investigated in a human clinical study using 16S rRNA gene sequencing. RESULTS: In-vitro testing showed that 2-butyloctanol significantly inhibited the growth of corynebacteria at concentrations of 0.64%, 2.56% and 5.12%, whilst the growth of Staphylococcus epidermidis was maintained at the same concentrations. The impact of 2-butyloctanol on the axillary microbiome was also validated in a human clinical study. A deodorant roll-on product containing 3% of 2-butyloctanol significantly reduced the relative abundance of corynebacteria, whilst increasing the relative abundance of Staphylococcus and the ratio of Staphylococcus to corynebacteria after four weeks of application, whilst the placebo showed no significant change. CONCLUSION: For the first time, it was demonstrated that 2-butyloctanol had a potential prebiotic effect on the human underarm microbiome in inhibiting odour-causing Corynebacterium, whilst maintaining and promoting skin-friendly Staphylococcus in both in-vitro and in-vivo studies. Therefore, 2-butyloctanol could be used as a potential prebiotic ingredient in personal care products for underarm microbiome protection.

OBJECTIF: les aisselles humaines sont colonisées par un large éventail de micro-organismes qui contribuent à la génération de l'odeur corporelle. Les produits antitranspirants/déodorants traditionnels sont utilisés pour réduire la transpiration et traiter ou prévenir la croissance des bactéries dans la région axillaire, réduisant ou éliminant ainsi l'odeur corporelle. Cependant, ils peuvent également compromettre l'équilibre du microbiome axillaire. Le secteur des soins personnels recherche de nouveaux composants, tels que des prébiotiques ou des probiotiques, afin de maintenir un équilibre sain du microbiome cutané, en inhibant les bactéries responsables des odeurs tout en maintenant et en favorisant la croissance des bonnes bactéries. L'objectif de cette étude était d'étudier l'effet prébiotique sur le microbiome axillaire humain du 2-butyloctanol, un composant indiqué dans les soins cutanés. MÉTHODES: un test in vitro d'inhibition/de promotion de la croissance a été mené afin de déterminer si le 2-butyloctanol inhibait ou favorisait la croissance bactérienne cutanée. Les effets du 2-butyloctanol sur le microbiome axillaire a également fait l'objet d'une étude clinique chez l'homme qui reposait sur le séquençage du gène ARNr 16S. RÉSULTATS: les tests in vitro ont montré que le 2-butyloctanol inhibait significativement la croissance des corynébactéries à des concentrations de 0,64 %, de 2,56 % et de 5,12 %, tandis que la croissance de Staphylococcus epidermidis se maintenait aux mêmes concentrations. Une étude clinique chez l'homme a également permis de confirmer les effets du 2-butyloctanol sur le microbiome axillaire. Un produit déodorant à bille contenant 3 % de 2-butyloctanol a réduit significativement l'abondance relative des corynébactéries, tout en augmentant l'abondance relative de Staphylococcus et le rapport entre Staphylococcus et les corynébactéries après quatre semaines d'application, tandis que le placebo n'a montré aucun changement significatif. CONCLUSION: pour la première fois, des études in vitro et in vivo ont démontré que le 2-butyloctanol avait un possible effet prébiotique sur le microbiome axillaire humain, en inhibant Corynebacterium, la bactérie responsable des odeurs, tout en maintenant et en favorisant la croissance de Staphylococcus, une bactérie respectueuse de la peau. Par conséquent, le 2-butyloctanol pourrait servir de possible composant prébiotique dans les produits de soins personnels pour la protection du microbiome axillaire.

Women in Cardiology Twitter Network: An Analysis of a Global Professional Virtual Community From 2016 to 2019.

Background Social media is an effective channel for the advancement of women physicians; however, its use by women in cardiology has not been systematically studied. Our study seeks to characterize the current Women in Cardiology Twitter network. Methods and Results Six women-specific cardiology Twitter hashtags were analyzed: #ACCWIC (American College of Cardiology Women in Cardiology), #AHAWIC (American Heart Association Women in Cardiology), #ilooklikeacardiologist, #SCAIWIN (Society for Cardiovascular Angiography and Interventions Women in Innovations), #WomeninCardiology, and #WomeninEP (Women in Electrophysiology). Twitter data from 2016 to 2019 were obtained from Symplur Signals. Quantitative and descriptive content analyses were performed. The Women in Cardiology Twitter network generated 48 236 tweets, 266 180 903 impressions, and 12 485 users. Tweets increased by 706% (from 2083 to 16 780), impressions by 207% (from 26 755 476 to 82 080 472), and users by 440% (from 796 to 4300), including a 471% user increase internationally. The network generated 6530 (13%) original tweets and 43 103 (86%) amplification tweets. Most original and amplification tweets were authored by women (81% and 62%, respectively) and women physicians (76% and 52%, respectively), with an increase in original and amplification tweets authored by academic women physicians (98% and 109%, respectively) and trainees (390% and 249%, respectively) over time. Community building, professional development, and gender advocacy were the most common tweet contents over the study period. Community building was the most common tweet category for #ACCWIC, #AHAWIC, #ilooklikeacardiologist, #SCAIWIN, and #WomeninCardiology, whereas professional development was most common for #WomeninEP. Conclusions The Women in Cardiology Twitter network has grown immensely from 2016 to 2019, with women physicians as the driving contributors. This network has become an important channel for community building, professional development, and gender advocacy discussions in an effort to advance women in cardiology.

Sudden Cardiac Arrest in a Patient With Myxedema Coma and COVID-19.

SARS-CoV-2 infection is associated with significant lung and cardiac morbidity but there is a limited understanding of the endocrine manifestations of coronavirus disease 2019 (COVID-19). Although thyrotoxicosis due to subacute thyroiditis has been reported in COVID-19, it is unknown whether SARS-CoV-2 infection can also lead to decompensated hypothyroidism. We present the first case of myxedema coma (MC) in COVID-19 and we discuss how SARS-CoV-2 may have precipitated multiorgan damage and sudden cardiac arrest in our patient. A 69-year-old woman with a history of small cell lung cancer presented with hypothermia, hypotension, decreased respiratory rate, and a Glasgow Coma Scale score of 5. The patient was intubated and administered vasopressors. Laboratory investigation showed elevated thyrotropin, very low free thyroxine, elevated thyroid peroxidase antibody, and markedly elevated inflammatory markers. SARS-CoV-2 test was positive. Computed tomography showed pulmonary embolism and peripheral ground-glass opacities in the lungs. The patient was diagnosed with myxedema coma with concomitant COVID-19. While treatment with intravenous hydrocortisone and levothyroxine were begun the patient developed a junctional escape rhythm. Eight minutes later, the patient became pulseless and was eventually resuscitated. Echocardiogram following the arrest showed evidence of right heart dysfunction. She died 2 days later of multiorgan failure. This is the first report of SARS-CoV-2 infection with MC. Sudden cardiac arrest likely resulted from the presence of viral pneumonia, cardiac arrhythmia, pulmonary emboli, and MC-all of which were associated with the patient's SARS-CoV-2 infection.

Biomimetic modification of poly(vinyl alcohol): Encouraging endothelialization and preventing thrombosis with antiplatelet monotherapy.

Poly(vinyl alcohol) (PVA) has shown promise as a biomaterial for cardiovascular application. However, its antifouling properties prevent in vivo endothelialization. This work examined the endothelialization and thrombogenicity of modified PVA with different concentrations of proteins and adhesion peptides: collagen, laminin, fibronectin, GFPGER, YIGSR, and cRGD. Material surface properties were quantified, and the endothelialization potential was determined with human endothelial colony forming cells. Additionally, platelet attachment was assessed in vitro with human platelet rich plasma, and promising samples were tested in an ex vivo shunt model. This well-established arteriovenous shunt model was used with and without clinically-relevant antiplatelet therapies, specifically acetylsalicylic acid (ASA) with and without clopidogrel to examine the minimum necessary treatment to prevent thrombosis. Collagen, laminin, and GFPGER biomolecules increased endothelialization, with GFPGER showing the greatest effect at the lowest concentrations. GFPGER-PVA tubes tested under whole blood did exhibit an increase in platelet (but not fibrin) attachment compared to plain PVA and clinical controls. However, application of ASA monotherapy reduced the thrombogenicity of GFPGER-PVA below the clinical control with the ASA. This work is significant in developing cardiovascular biomaterials-increasing endothelialization potential while reducing bleeding side effects by using an antiplatelet monotherapy, typical of clinical patients. STATEMENT OF SIGNIFICANCE: We modified the endothelialization potential of synthetic, hydrogel vascular grafts with proteins and peptides of the vascular tissue matrix. Cell attachment was dramatically increased with the GFPGER peptide, and while some additional platelet attachment was seen under flow with whole blood, this was completely knocked down using clinical antiplatelet monotherapy. This indicates that long-term patency of this biomaterial could be improved without the associated bleeding risk of multiple platelet therapies.