No products in the cart.
2 Minute Medicine Rewind April 21, 2025
1. High adherence to antidiabetics or statin monotherapy was associated with a reduced all-cause mortality
2. Adherence to antihypertensives, antidiabetics, and statins did not reduce cardiovascular disease risk
Evidence Rating Level: 2 (Good)
This retrospective cohort study of 36,211 Canadian primary care patients (2008–2016) with comorbid diabetes and hypertension evaluated the impact of medication adherence (assessed via proportion of days covered, PDC) on cardiovascular outcomes. High adherence to antidiabetic or statin monotherapy (PDC ≥80%) was associated with a 33% and 32% reduction in all-cause mortality, respectively (p<0.001), but concurrent adherence to all three medications (antihypertensives, antidiabetics, and statins) did not significantly reduce CVD risk, despite improving intermediate outcomes like diastolic blood pressure and LDL-C over 18 months. Overall adherence to the triple therapy regimen was low (11.1%), suggesting that polypharmacy complexity may hinder optimal outcomes. The findings underscore the importance of simplifying treatment regimens and improving adherence in this high-risk population, as monotherapy adherence demonstrates clear mortality benefits while highlighting challenges in managing multimorbid patients. These results support targeted adherence interventions in primary care to optimize long-term cardiovascular risk reduction.
1. Standalone motivational interviewing post-discharge did not reduce rehospitalization in older multimorbid patients
Evidence Rating Level: 1 (Excellent)
This randomized controlled trial evaluated the effects of a post-discharge motivational interviewing intervention (Supporting Patient Activation in Transition to Home, sPATH) on rehospitalization and patient activation in 207 Swedish patients with heart failure or chronic obstructive pulmonary disease (COPD). Participants were randomized to receive five motivational interviewing sessions (n=103) or usual care (n=104). The intervention, delivered by trained coaches, focused on self-management areas like medication adherence and symptom recognition. Results showed no significant differences between groups in rehospitalization rates (p=0.33–0.41) or Patient Activation Measure (PAM) scores over 180 days (B=-1.67 to -0.83, p=0.38–0.68). Notably, PAM scores improved over time in both groups, suggesting intrinsic recovery post-discharge. The high disease burden (mean Charlson Comorbidity Index >5) and advanced age (mean 75 years) may have limited intervention efficacy. The study concludes that standalone motivational interviewing post-discharge may not reduce rehospitalization in older, multimorbid patients, highlighting the need for integrated pre- and post-discharge support or alternative care models for this population.
1. The Critical-Care Pain Observation Tool (CPOT) showed strong correlations with other validated pain observation tools in pediatric patients
Evidence Rating Level: 3 (Average)
The Critical-Care Pain Observation Tool (CPOT), a behavioral pain assessment scale validated in adults, was evaluated for use in critically ill pediatric patients, particularly in mixed-age intensive care units where a single, versatile tool is beneficial. This prospective observational study included 91 children (165 assessments) aged 0–18 years in an open pediatric ICU. CPOT scores were compared with the FLACC scale and an observational Visual Analog Scale (VAS obs) to assess criterion and construct validity. The CPOT showed strong correlations with FLACC (ρ = 0.84) and VAS obs (ρ = 0.87), with especially high agreement among intubated and non-intubated patients. A CPOT cutoff score of ≥3 demonstrated excellent diagnostic performance (AUC = 0.98, sensitivity 100%, specificity 96.7%). CPOT scores significantly increased during painful medical interventions (p < 0.01), supporting its responsiveness to procedural pain. Inter-rater reliability was high (weighted κ = 0.89), confirming consistency across observers. While further validation is needed in larger, more diverse populations and among patients with neurological impairments, these findings suggest that CPOT is a valid, reliable, and practical tool for assessing pain in critically ill pediatric patients and may facilitate standardized pain management across age groups and care settings.
Upper Extremity Pain Trajectories and Functional Arm Recovery After Stroke
1. A third of stroke survivors experienced upper extremity pain, which was associated with poor arm functional recovery at 12 months post-stroke
Evidence Rating Level: 2 (Good)
Upper extremity pain is common post-stroke and may impede motor recovery, yet its progression and impact on long-term functional outcomes remain poorly understood. This prospective study from the Stroke Arm Longitudinal Study at the University of Gothenburg (SALGOT) followed 122 first-ever stroke patients with impaired upper limb function over 12 months, using repeated assessments with the Fugl-Meyer Upper Extremity Assessment and Action Research Arm Test (ARAT). Latent class analysis identified two distinct pain trajectories: stable low pain (64%) and increasing pain (36%). Patients in the increasing pain group had more severe motor, sensory, and cognitive impairments, limited range of motion, and higher stroke severity at baseline. Pain in this group rose significantly between 10 days and 3 months post-stroke before partially declining, whereas pain remained minimal in the stable group. Importantly, increasing pain was independently associated with poor functional arm recovery at 12 months (adjusted OR = 4.99; 95% CI 1.53–16.30; p = 0.008), even after accounting for stroke severity. These findings suggest that early identification of individuals on an increasing pain trajectory, particularly those with atrial fibrillation, dependency, or spasticity—could guide targeted interventions. Effective pain management in the early subacute phase may be critical for optimizing upper limb recovery. Further research should explore the underlying mechanisms of post-stroke pain and the impact of tailored rehabilitation strategies on long-term function.
1. Regardless of hemorrhage subtype, hemorrhagic transformation after endovascular treatment for acute ischemic stroke is independently associated with poorer functional outcomes and higher mortality
Evidence Rating Level: 2 (Good)
In this population-based study, researchers investigated the impact of asymptomatic hemorrhagic transformation (HT) on outcomes after endovascular treatment (EVT) for anterior circulation acute ischemic stroke (AIS). While symptomatic HT is known to worsen prognosis, the clinical relevance of asymptomatic HT remains debated. The study analyzed 3,067 patients from 10 comprehensive stroke centers in Catalonia (2017–2023), excluding those without HT classification or 3-month modified Rankin Scale (mRS) data. HT was classified using ECASS-II/III criteria, and asymptomatic HT was defined as radiographic HT without death or ≥4-point increase in NIHSS. Asymptomatic HT occurred in 20% of patients and was independently associated with worse functional outcomes (common odds ratio [cOR] 2.24; 95% CI 1.89–2.66) and higher mortality (adjusted odds ratio [aOR] 1.50; 95% CI 1.17–1.91) at 3 months. Among HT subtypes, asymptomatic parenchymal hemorrhage type 2 (PH2) conferred the highest risk (cOR 3.15). Multivariable analyses controlled for age, stroke severity, ASPECTS, baseline disability, and recanalization success. Factors associated with asymptomatic HT included higher baseline glycemia and systolic blood pressure, lower ASPECTS, and more EVT passes. These findings suggest that even without clinical deterioration, asymptomatic HT after EVT is not benign and should be considered a safety endpoint in stroke trials and clinical practice. Early recognition and risk factor management may mitigate adverse outcomes.
Image: PD
©2025 2 Minute Medicine, Inc. All rights reserved. No works may be reproduced without expressed written consent from 2 Minute Medicine, Inc. Inquire about licensing here. No article should be construed as medical advice and is not intended as such by the authors or by 2 Minute Medicine, Inc.
