Beta-Blockers after Myocardial Infarction and Preserved Ejection Fraction (REDUCE-AMI)
Yndigegn T et al. NEJM (April 2024)
Bottom line: This parallel-group, open-label trial enrolled 5020 patients with acute myocardial infarction and preserved left ventricular ejection fraction (≥50%) who underwent early coronary angiography. They were randomly assigned to receive long-term treatment with a beta-blocker (metoprolol or bisoprolol) or no beta-blocker treatment. The primary outcome was a composite of death from any cause or new myocardial infarction, and the median follow-up was 3.5 years. The results showed no significant difference in the primary outcome between the two groups, with a primary end-point event occurring in 199 of 2508 patients (7.9%) in the beta-blocker group and in 208 of 2512 patients (8.3%) in the no–beta-blocker group (hazard ratio, 0.96; 95% confidence interval, 0.79 to 1.16; P=0.64). There were also no significant differences in safety outcomes. Therefore, long-term beta-blocker treatment did not lead to a lower risk of death from any cause or new myocardial infarction in this patient population.
Early Diagnosis and Treatment of COPD and Asthma – A Randomized, Controlled Trial (UCAP2)
Aaron S et al. NEJM (May 2024)
Bottom Line: This multicenter, randomized, controlled trial evaluated whether early diagnosis and treatment of COPD or asthma in adults reduces health care utilization for respiratory illness and improves health outcomes. 595 participants with previously undiagnosed, symptomatic COPD or asthma, identified by targeted case finding, underwent randomization and were assigned to receive either the intervention of pulmonologist-directed treatment (evaluation by a pulmonologist and an asthma–COPD educator who were instructed to initiate guideline-based care) or usual care by their primary care practitioner. The primary outcome was the annualized rate of participant-initiated health care utilization for respiratory illness. The intervention group had a significantly lower annualized rate of primary outcome events compared to the usual care group (0.53 vs. 1.12 events per person-year; incidence rate ratio, 0.48; 95% confidence interval [CI], 0.36 to 0.63; P<0.001). Secondary outcomes included improvements in disease-specific quality of life as assessed by the St. George Respiratory Questionnaire (SGRQ), symptom burden, and forced expiratory volume in 1 second, all three of which were more favourable in the intervention group. The incidence of adverse events was similar in both groups. This trial highlights the benefits of early diagnosis and treatment for undiagnosed COPD or asthma in reducing health care utilization for respiratory illness.
AI-enabled electrocardiography alert intervention and all-cause mortality: a pragmatic randomized clinical trial
Lin CS et al. Nature Medicine (April 2024)
Bottom Line: This randomized controlled trial involved 39 physicians and 15,965 hospitalized patients and evaluated the use of an AI-enabled electrocardiogram (ECG) to identify patients at high risk of mortality. The AI-ECG alert intervention, which included an AI report and warning messages, was associated with a significant reduction in all-cause mortality within 90 days: 3.6% patients in the intervention group died within 90 days, compared to 4.3% in the control group (hazard ratio (HR) = 0.83, 95% confidence interval (CI) = 0.70–0.99). This reduction was primarily observed in patients with high-risk ECGs (HR = 0.69, 95% CI = 0.53–0.90). In an analysis of secondary outcomes, patients in the intervention group with high-risk ECGs also received increased levels of intensive care and had a significant reduction in the risk of cardiac death (0.2% in the intervention arm versus 2.4% in the control arm, HR = 0.07, 95% CI = 0.01–0.56). These results suggest that AI-enabled ECG alerts assist in the detection of high-risk patients, prompting timely clinical care and reducing mortality.
