2 Minute Medicine Rewind December 29th, 2025
1. Middle-aged and older Canadian adults at high risk of obstructive sleep apnea (OSA) had worse mental health outcomes than those who were not at high risk of OSA.
Evidence Rating Level: 2 (Good)
Mental health conditions are significant contributors to the worldwide disease burden, with high costs in terms of global productivity. OSA is a highly prevalent health condition which has previously been linked to adverse health outcomes such as cardiometabolic disorders and decreased productivity. This prospective cohort study therefore sought to investigate the association between OSA and the incidence of concurrent and future mental health conditions in middle-aged and older adults. Individuals between the ages of 45 and 85 from the Canadian Longitudinal Study on Aging (CLSA) national prospective cohort study were included. The primary outcome was a pre-determined composite of poor mental health. 30,097 individuals (median age[IQR], 62[54-71] years) were included in a baseline cohort and 27,765 patients were included in a follow-up cohort (median age[IQR], 65[57-73] years). After adjustment for confounding variables, being at high risk for OSA was significantly associated with increased odds of a composite poor mental health outcome (odds ratio [OR], 1.39; 95% CI, 1.28-1.50) and follow-up (OR, 1.40; 95% CI, 1.30-1.50). Among individuals who did not meet criteria for poor mental health at baseline, high risk of OSA was associated with an increased chance of a composite poor mental health outcome at follow-up of 20% (OR, 1.20; 95% CI, 1.03-1.40). Overall, this study found that among middle-aged and older Canadian adults, being at high risk of OSA was associated with an increased chance of worse mental health outcomes.
Neighborhood Deprivation and Days Spent at Home After Fall-Related Hip Fracture
1. Among older adults with a fall-related hip fracture, residence in an economically deprived area was associated with fewer days spent at home within the 12 months following the fracture.
Evidence Rating Level: 2 (Good)
Among adults over the age of 65, the vast majority of hip fractures are due to a fall. Such injuries are associated with significant healthcare costs and a reduction in long-term function in many patients. While several social factors associated with aging following such a fracture have been investigated, there is a lack of research examining neighbourhood socioeconomic status and its association with this injury. This study therefore sought to investigate the association between neighbourhood socioeconomic status and days spent at home following hip fracture. Data from adults aged 65 and older who underwent surgery for a fall-related hip fracture were obtained using standard Centers for Medicare & Medicaid Services (CMS) research identifiable files. Neighborhood deprivation was defined using the Area Deprivation Index (ADI), which incorporates items related to poverty, education and housing. 52,012 older adults (mean[SD] age, 82.2[8.1] years; 73.8% women) were included for analysis. Individuals living in the highest neighborhood deprivation group had fewer days at home in the 12-month recovery period following fracture (mean[SD] days at home, 246.1[127.5] days) compared with patients in the middle deprivation group (mean[SD] days at home, 257.4[120.4] days) and lowest deprivation group (mean[SD] days at home, 272.2[109.3] days). Overall, this study found that among older adults with a fall-related hip fracture, residence in higher neighborhood deprivation groups was associated with fewer days spent at home during the 12-month recovery period following the fracture.
1. 3 months of dual antiplatelet therapy (DAPT) in patients treated with Firehawk stents was non-inferior to 12 months of DAPT for the primary composite event of all-cause death, myocardial infarction, cerebrovascular accident and major bleeding at 18 months.
Evidence Rating Level: 1 (Excellent)
With advancements in drug-eluting stents (DES), the incidence of stent thrombosis has dramatically declined. Current guidelines recommend DAPT for 12 months following stent placement for acute coronary syndrome (ACS). While newer studies have investigated shorter durations of DAPT among caucasian populations, such investigations have not been made in Asian populations. This study therefore sought to investigate the safety and efficacy of 3 months of DAPT versus 12 months of DAPT among a broad population of patients undergoing percutaneous coronary intervention (PCI) with Firehawk stents. Patients from 36 centres in China were randomized in a 1:1 ratio to either 3 months of DAPT or 12 months of DAPT following Firehawk stent placement for ACS. Notably, patients with ST-segment elevation myocardial infarction (STEMI) were excluded due to a higher risk of recurrent ischemia. The primary endpoint was net adverse clinical and cerebral events (NACCE) which was defined as a composite event of all-cause death, myocardial infarction, cerebrovascular accident and major bleeding events. 1222 patients were randomized to 3 months of DAPT (mean[SD] age, 63.4[9.6] years; 66.9% male) and 1223 patients were randomized to 12 months of DAPT (mean[SD] age, 63.4[10.1] years; 67.4% male). At 18 months, the incidence of NACCE was 10.1% (121 patients) in the 3-month DAPT group and 10.9% (131 patients) in the 12-month DAPT group, meeting non-inferiority for the 3-month DAPT group (absolute rate difference, − 0.76%; upper limit of 1-sided 97.5% CI, 1.70%; pnon-inferiority = 0.0003). Overall, this study found that among patients treated with Firehawk stents for ACS, 3 months of DAPT was non-inferior to 12 months of DAPT for NACCE.
1. Among patients with acute pancreatitis (AP), a history of atrial fibrillation (AF) was associated with increased disease severity but not in-hospital mortality.
Evidence Rating Level: 2 (Good)
AP is a condition associated with significant mortality with a rising global incidence in recent years. AF is a cardiac arrhythmia disorder associated with an increased risk of thromboembolic events and substantial disability. While both conditions are associated with significant mortality, there is a lack of research investigating the association between AP and AF. This retrospective cohort study therefore sought to investigate the association between AF and in-hospital mortality with AP in a population of Chinese patients. 3537 patients from 3 Chinese medical centres with a diagnosis of AP were included in this study, among whom 122 patients (3.45%) had a history of AF. A history of AF was not independently associated with increased in-hospital mortality (OR: 1.65, 95% 124 CI: 0.68-3.68; Hosmer and Lemeshow test P value > 0.1). However, a history of AF was independently associated with increased disease severity (OR: 1.65, 95% CI: 1.11-2.44; Hosmer and Lemeshow 127 test P value > 0.1). Overall, this study found that among Chinese patients with AP, a history of AF was associated with increased disease severity but not in-hospital mortality.
1. Among patients with high-risk, early-stage triple-negative breast cancer, the addition of carboplatin to a standard anthracycline/taxane adjuvant chemotherapy regimen significantly improved survival outcomes with a reduction in early recurrence risk.
Evidence Rating Level: 1 (Excellent)
Among the classical subtypes of breast cancer, triple-negative breast cancer is an aggressive disease with higher early recurrence than other subtypes. Neoadjuvant treatment is typically recommended for patients with stage 2 or 3 disease. However, the optimisation of adjuvant regimens for patients with high-risk triple-negative disease remains a topic of investigation. This randomised clinical trial therefore sought to investigate the safety and efficacy of epirubicin and cyclophosphamide, followed by weekly paclitaxel, with and without carboplatin as adjuvant therapy for patients with high-risk triple-negative breast cancer. Between March 2020 and March 2022, 808 patients (median age[range], 47[22-70] years) from the Fudan University Shanghai Cancer Centre were randomised in a 1:1 ratio to either a control group receiving standard chemotherapy or a carboplatin group. The primary outcome was disease-free survival. At 3 years, 92.3% of patients in the carboplatin group were disease-free, compared to 85.5% in the control group (unadjusted hazard ratio 0.64, 95% confidence interval (CI) 0.43 to 0.95; P=0.03). Additionally, patients in the carboplatin group had a statistically significantly greater overall survival than patients in the control group (98.0% versus 94.0%; hazard ratio 0.41, 0.20 to 0.83; P=0.01). Overall, this study found that among patients with high-risk, early-stage triple-negative breast cancer, the addition of carboplatin to standard chemotherapy significantly improved survival outcomes.
Image: PD
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