2 Minute Medicine Rewind July 20, 2026

Advanced Medical Care at Home Among Patients With Acute Heart Failure

1. Following hospitalization for acute decompensated heart failure (HF), there was no difference in all-cause readmissions and mortality between patients treated with an advanced medical care at home (AMCAH) program compared with brick-and-mortar (BAM) hospitalization.  

Evidence Rating Level: 2 (Good)

Acute hospital care at home programs have seen a dramatic increase in implementation since the COVID-19 pandemic. Such programs may improve patient comfort while reducing risks of hospitalization such as nosocomial infection, but investigations into the role of AMCAH programs in HF are limited. This retrospective cohort study therefore sought to evaluate the association between AMCAH programs following initial HF admission and the risk of readmission, mortality and utilization of guideline-directed medical therapy (GDMT). 307 pairs of patients exposed to AMCAH programs or BAM hospitalization were matched (mean [SD] age, 75 [12.6] years; 374 [61%] male). By 30 days, 73 (24%) primary safety events occurred in the AMCAH group while 80 events (26%) occurred in the BAM group (OR, 0.89 [95% CI, 0.61 to 1.28]; P = .51). The mean[SD] GDMT score was similar between the AMCAH group (3.2[2.2]) compared with the BAM group (3.1[2.5]) (β = 0.13 [95% CI, −0.23 to 0.50]; P = .47) at 30 days). The mean[SD] days alive and out of hospital at 30 days were also comparable between both groups (28.2[4.9] days for the AMCAH group compared with 28.3[4.2] days for the BAM group (β = −0.12 [95% CI, −0.85 to 0.60]; P = .74)). Overall, this study found that use of an AMCAH program after initial HF admission is associated with similar safety and quality outcomes as continued BAM hospitalization.  

Diagnosis-to-Ablation Time and Atrial Arrhythmia Recurrence After Ablation

1. Patients with atrial fibrillation (AF) treated with catheter ablation 1 to 4 years after AF diagnosis had a 48% higher chance of AF recurrence compared to those treated within 1 year.

2. Patients with atrial fibrillation (AF) treated with catheter ablation 5 years or greater after AF diagnosis had a 110% higher chance of AF recurrence compared to those treated within 1 year.

Evidence Rating Level: 2 (Good)

AF is associated with significant morbidity and mortality and the role of early rhythm control has been emphasized previously. The diagnosis-to-ablation time (DAT) has been previously reported to be an important predictor of longterm efficacy. As such, this prospective, multicentre cohort study therefore sought to further investigate the association between DAT and AF recurrence. 3724 patients undergoing ablation for AF from the United States and Canada (mean[SD] age, 67.0[10.0] years; 40.1% female) were included in the study. The rate of recurrence of AF was lowest among those with a DAT of less than 1 year (133 of 1084 [12.3%]), compared with the 1 to 4 year group (303 of 1843 [16.4%]) and the 5 or greater years group (174 of 797 [21.8%]). Under multivariate analysis, patients with a DAT of 1 to 4 years had a 48% higher chance of AF recurrence (HR, 1.48; 95% CI, 1.08-2.01; P = .01) and patients with a DAT of 5 or more years had a 110% higher chance of AF recurrence compared to the less than 1 year group (HR, 2.10; 95% CI, 1.46-3.02; P < .001). Overall, this study found that among patients with AF undergoing ablation, a DAT of less than 1 year was associated with the lowest risk of AF recurrence.  

Epidural analgesia in labour and neonatal and childhood outcomes: national population based cohort study

1. Epidural analgesia in labour is not associated with significant risk of neonatal neurological morbidity, neonatal morbidity or mortality. 

Evidence Rating Level: 2 (Good)

Epidural analgesia during labour is regarded as the most effective form of pain control, which is important given that poor pain control may lead to physiological stress in mothers with important consequences on the fetus. However, epidural analgesia is also associated with adverse effects such as maternal hypotension and fetal heart rate abnormalities. This population-based cohort study therefore sought to investigate the association between epidural analgesia in labour and neonatal health outcomes including neonatal neurological morbidity, neonatal morbidity and neonatal mortality. 495,695 women in labour in Scotland between January 2007 and December 2019 were included in this study. Of these women, 114,897 (23.2%) received epidural analgesia. There was no association between epidural analgesia in labour and risk of neonatal neurological morbidity (adjusted relative risk, 0.87 [95% CI: 0.68-1.12]), other neonatal morbidity (adjusted relative risk, 1.17 [95% CI: 0.90-1.51]) or mortality at 28 days (adjusted relative risk, 0.81 [95% CI: 0.62-1.06]). Overall, this study found that the use of epidural analgesia in labour was not associated with significant risk of adverse neonatal health outcomes including neurological morbidity, other causes of morbidity or mortality.  

Abiraterone or Enzalutamide for Patients With Metastatic Castration-Sensitive Prostate Cancer: A Nationwide Veterans Affairs Study

1. The use of enzalutamide and abiraterone in metastatic castration-sensitive prostate cancer (mCSPC) was associated with similar overall survival (OS).

2. The use of enzalutamide was associated with an improved OS among patients over the age of 75 years. 

Evidence Rating Level: 2 (Good)

Enzalutamide and abiraterone are two androgen-receptor pathway inhibitors (ARPI) approved for the treatment of mCPSC. However, while they both target the same pathway, their mechanisms of action differ and no clinical trials have compared these two compounds head-to-head. This retrospective cohort study therefore sought to compare clinical outcomes among patients with mCPSC treated with enzalutamide or abiraterone. 5,135 patients (median[IQR] age, 74.33[69.66-78.88] years) from the Veterans Affairs health care system in the United States were included in the study. When analyzing the OS, the restricted mean survival time (RMST) at 3 years was comparable between the enzalutamide group (27.99 months [95% CI, 27.37 to 28.61]) and the abiraterone group (27.27 months [95% CI, 26.79 to 27.74]). However, among patients 75 years of age or older, the RMST at 3 years for the enzalutamide group was 26.47 months (95% CI, 25.49 to 27.44) compared to 24.82 months for the abiraterone group (95% CI, 24.04 to 25.59). Overall, this study found that among patients with mCPSC, enzalutamide and abiraterone had similar OS outcomes. However, enzalutamide may have a specific benefit among older patients. 

The efficacy of intermittent metformin plus lifestyle intervention for diabetes prevention in women with prediabetes and prior gestational diabetes: a randomized clinical, non-inferiority trial

1. Among women with prediabetes following prior gestational diabetes mellitus (GDM), intermittent metformin in combination with lifestyle modifications was non-inferior to continuous metformin in combination with lifestyle modifications. 

Evidence Rating Level: 1 (Excellent)

Women with GDM are at a significantly increased risk of developing type 2 diabetes mellitus (T2DM) postpartum compared to those without GDM. Current American guidelines recommend either lifestyle modifications or metformin treatment for women with a history of GDM and post-partum prediabetes. This randomized controlled trial therefore sought to investigate whether an intermittent metformin regimen is non-inferior to continuous metformin in preventing T2DM occurrence. 334 postpartum women with prediabetes from several medical centres in China were included in this study for randomization (167 in the continuous metformin group and 167 in the intermittent metformin group) and completed the 3-year follow-up as per protocol. In the intention-to-treat analysis, the incidence of T2DM was similar across both groups (11.1% [95% CI: 6.5-15.7%] for the continuous metformin group compared to 11.5% [95% CI: 6.6-16.4%] for the intermittent metformin group) and met the pre-specified non-inferiority margin. Under the per protocol analysis, the incidence of T2DM was also similar across both groups and similarly met the pre-specified non-inferiority margin (10.2% [95% CI: 6.5-15.7%] for the continuous metformin group compared to 10.8% [95% CI: 6.9-16.4%] for the intermittent metformin group). Overall, this study found that among postpartum women with prediabetes, the use of an intermittent metformin regimen resulted in similar efficacy compared with a continuous metformin regimen in preventing T2DM. 

Image: PD

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