Tag: pubmed

JAMA Netw Open. 2025 Nov 3;8(11):e2541272. doi: 10.1001/jamanetworkopen.2025.41272.

ABSTRACT

IMPORTANCE: Outpatient follow-up after discharge has been associated with reduced 30-day readmissions. Since universal follow-up is not feasible, identifying for whom and when outpatient follow-up is most beneficial is essential for optimizing resources and reducing readmissions.

OBJECTIVE: To quantify the association between outpatient follow-up within 30, 14, and 7 days postdischarge and 30-day all-cause readmissions and assess differences in outcomes by disease, age, and baseline readmission risk.

DATA SOURCES: MEDLINE (via PubMed), Embase, and CINAHL were searched for studies published between January 1, 2000, and August 4, 2025, using terms related to outpatient follow-up and readmissions.

STUDY SELECTION: English-language studies assessing the association between outpatient follow-up within 30 days of hospital discharge and 30-day all-cause readmissions among adult inpatients were included.

DATA EXTRACTION AND SYNTHESIS: Following Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines, 2 reviewers independently screened titles and abstracts. Data were extracted by 1 author and verified by another, and quality assessment was done independently by 2 authors.

MAIN OUTCOMES AND MEASURES: The primary outcome was all-cause 30-day readmission. Secondary outcomes included all-cause 30-day emergency department (ED) discharge and mortality. Pooled effect sizes (relative risk ratios [RRRs]) were estimated by disease and age group using multilevel random-effects models.

RESULTS: Eighty-three studies were included in the review and 76 in the meta-analysis. Outpatient follow-up within 30 days vs no follow-up was associated with a reduction in risk of 30-day all-cause readmission (RRR, 0.68; 95% CI, 0.60-0.75), with less reduction (RRR, 0.78; 95% CI, 0.67-0.89) when restricted to studies with low to moderate risk of bias (ROB). Among patients with heart failure (HF) and acute myocardial infarction (AMI), the RRRs for 30-day follow-up in studies with low to moderate ROB were 0.65 (95% CI, 0.48-0.83) and 0.56 (95% CI, 0.32-0.80), respectively. Subgroup analysis using studies with low to moderate ROB showed benefits of 30-day follow-up only among patients aged 65 years or older with HF (RRR, 0.65; 95% CI, 0.48-0.83), AMI (RRR, 0.56; 95% CI, 0.32-0.80), and other diseases such as stroke and chronic obstructive pulmonary disease (RRR, 0.73; 95% CI, 0.59-0.87). Early follow-up vs no follow-up within 14 and 7 days was associated with a significant reduction in readmissions only among patients aged 65 years or older with HF (14 days: RRR, 0.63 [95% CI, 0.40-0.87]; 7 days: RRR, 0.68 [95% CI, 0.47-0.89]) and AMI (14 days: RRR, 0.57 [95% CI, 0.22-0.91]; 7 days: RRR, 0.63 [95% CI, 0.34-0.92]).

CONCLUSIONS AND RELEVANCE: In this systematic review and meta-analysis, outpatient follow-up within 30 days was associated with reduced 30-day readmissions, but the association varied by patient age and disease type, indicating a need for targeted rather than universal follow-up.

PMID:41186947 | DOI:10.1001/jamanetworkopen.2025.41272

JAMA Netw Open. 2025 Nov 3;8(11):e2541336. doi: 10.1001/jamanetworkopen.2025.41336.

ABSTRACT

IMPORTANCE: There are disparities in blood pressure (BP) levels by race in the US.

OBJECTIVE: To estimate the number of cardiovascular disease (CVD) events and deaths that could be prevented among non-Hispanic Black adults by achieving the same mean systolic BP (SBP) as non-Hispanic White adults 45 years or older.

DESIGN, SETTING, AND PARTICIPANTS: In this modeling study, the difference in mean SBP between non-Hispanic Black and non-Hispanic White US adults was calculated from the 2015-2020 cycles of the National Health and Nutrition Examination Survey (NHANES). The 10-year cumulative incidence of CVD, including stroke, coronary heart disease, and heart failure, and CVD mortality for non-Hispanic Black adults were calculated using data from the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study. The relative risk reduction for CVD events and mortality with initiation and intensification of antihypertensive medication treatment was applied from the Blood Pressure Lowering Treatment Trialists Collaboration (BPLTTC), calibrated to reflect the SBP reduction for non-Hispanic Black adults to have the same SBP as non-Hispanic White adults. Data were analyzed from June 22, 2022, to August 13, 2025.

EXPOSURE: Systolic blood pressure.

MAIN OUTCOMES AND MEASURES: Number of CVD events and deaths. Using data from NHANES, REGARDS, and BPLTCC, the cumulative incidence of CVD events and deaths expected over the next 10 years with current SBP levels and with SBP equity was estimated.

RESULTS: Among 82.3 million US adults included in the study, 37.2 million (45.3%) were men, 45.0 million (54.7%) were women, 10.1 million (12.2%) were non-Hispanic Black, and 72.2 million (87.8%) were non-Hispanic White. The mean (SD) age was 60.8 (0.3) years. The mean SBP was 130.7 (95% CI, 129.0-132.5) mm Hg among non-Hispanic Black adults and 124.2 (95% CI, 123.1-125.3) mm Hg among non-Hispanic White adults for those not taking antihypertensive medication (difference, 6.5 [95% CI, 4.5-8.5] mm Hg), and 137.8 (95% CI, 135.8-139.8) mm Hg among non-Hispanic Black adults and 131.2 (95% CI, 129.7-132.7) mm Hg among non-Hispanic White adults for those taking antihypertensive medication (difference, 6.5 [95% CI, 4.0-9.1] mm Hg). Achieving equity in SBP between non-Hispanic Black and White adults was projected to reduce the number of CVD events during 10 years by 50 434 (95% CI, 33 985-71 137) among non-Hispanic Black US adults not taking antihypertensive medication and 122 881 (95% CI, 83 220-176 826) among non-Hispanic Black adults taking antihypertensive medication. Achieving equity in SBP between non-Hispanic Black and White adults was projected to reduce the number of CVD deaths during 10 years by 21 703 (95% CI, 7313-40 278) among non-Hispanic Black US adults not taking antihypertensive medication and 55 055 (95% CI, 19 823-99 693) among non-Hispanic Black adults taking antihypertensive medication. The largest proportion of CVD events and deaths prevented were among those aged 45 to 64 years. For example, more than half of CVD events prevented among non-Hispanic Black adults not taking antihypertensive medication (55%) were in that age group.

CONCLUSIONS AND RELEVANCE: The findings of this modeling study suggest that achieving SBP equity between non-Hispanic Black and White adults could substantially reduce the number of CVD events and deaths experienced by non-Hispanic Black US adults. Initiatives to maintain normal BP and achieve BP control for individuals with hypertension could have a substantial impact on health equity in the US.

PMID:41186946 | DOI:10.1001/jamanetworkopen.2025.41336

JAMA Netw Open. 2025 Nov 3;8(11):e2541401. doi: 10.1001/jamanetworkopen.2025.41401.

ABSTRACT

IMPORTANCE: Advance care planning (ACP) engagement is poorly understood among people with serious illness.

OBJECTIVE: Determine whether diagnosis of and worries about serious illness are associated with ACP engagement.

DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study was based on a nationally representative survey administered April to May 2021 online or by telephone. Eligible participants were adults and English or Spanish language. Data were analyzed May 2023 to February 2025).

EXPOSURE: Having a serious illness.

MAIN OUTCOMES AND MEASURES: Three domains of ACP engagement: discussion with people close to participants, discussion with clinicians, and documentation in writing. Barriers to ACP documentation and worries about serious illness were also assessed. Survey responses were weighted to reflect the US Census population. χ2 tests and multivariable logistic regression models were adjusted for covariables to assess associations between serious illness and each ACP outcome.

RESULTS: Among 1854 participants (468 [weighted percentage, 25.2%] aged 65 years or older; 955 women [weighted percentage, 51.9%]; 193 Black [weighted percentage, 12.0%], 288 Hispanic [weighted percentage, 16.7%], 1218 White [weighted percentage, 61.2%]), 367 (weighted percentage, 20%) had serious illness. Overall, 1254 (weighted percentage, 65.9%) had engaged in ACP (283 of 367 [weighted percentage, 76.5%] serious illness vs 971 of 1487 [weighted percentage, 62.6%] without serious illness; P < .001); 1071 (weighted percentage, 55.3%) discussed ACP with people close to them, 462 (weighted percentage, 22.5%) discussed with clinicians, and 650 (weighted percentage, 32.8%) documented a surrogate. People with serious illness had higher odds than those without having discussed choices for surrogates and medical wishes with people close to them (aOR, 1.57 [95% CI, 1.19-2.07] and 1.66 [95% CI, 1.26-2.19]) and with clinicians (aOR, 2.16 [95% CI, 1.63-2.88] and 2.22 [95% CI, 1.67-2.94]). Serious illness status was not associated with ACP documentation. The most common barriers to documentation were not having thought about it (489 of 1171 [weighted percentage, 43.1%]) and assuming surrogates would know what they want (369 of 1171 [weighted percentage, 32.2%]). Participants who were worried (vs not worried) about being able to afford care, surrogates making the best or right decisions, having access to the best treatments, or having high stress or symptoms had significantly higher rates of ACP engagement.

CONCLUSIONS AND RELEVANCE: In this survey study of adults in the US, we found that ACP discussions with someone close to them were high, yet discussions with clinicians and documentation were low, even among people with serious illness. Our findings offer insights into how people’s worries about serious illness care may affect their engagement in ACP, and how to leverage these insights to tailor patient-facing messaging about ACP.

PMID:41186945 | DOI:10.1001/jamanetworkopen.2025.41401

J Cardiovasc Surg (Torino). 2025 Nov 4. doi: 10.23736/S0021-9509.25.13370-3. Online ahead of print.

ABSTRACT

BACKGROUND: The aim of this paper was to compare the patient characteristics, procedural details, 30-day postoperative outcomes of carotid artery stenting (CAS) performed through radial access versus femoral access.

METHODS: This is a single-center, retrospective, non-randomized study conducted on 613 consecutive patients who underwent elective CAS between January 2015 and January 2025. Patients were divided into two groups based on access route: radial (N.=167) and femoral (N.=446). The following were considered as the primary endpoints: 1) the occurrence of one of TIA/stroke/death; and 2) the overall perioperative complications rate. Secondary endpoints included access-site complications, procedure duration, and single complication rate.

RESULTS: No significant differences were observed between the two groups in pre/intraoperative variables, except for the rate of symptomatic carotid stenosis (radial 22% vs. femoral 15%, P=0.030) and the use of dual-layer stents (radial 87% vs. femoral 75%, P<0.001). The TIA/Stroke/death rate (radial 1.8% vs. femoral 4.4%, P=0.119), overall perioperative complication rate (radial 5.4% vs. femoral 10%, P=0.057), and access-site complications (radial 0.6% vs. femoral 2%, P=0.217) were comparable between groups. However, the mean procedure time was significantly shorter in the radial group (36±15 minutes vs. 42±18 minutes, P<0.001).

CONCLUSIONS: Percutaneous radial access in CAS procedures was more frequently performed in symptomatic patients and with the use of newer low-profile dual-layer micromesh platforms. Radial access was associated with shorter procedural times and a trend toward lower perioperative complication rates, though the latter did not reach statistical significance.

PMID:41186916 | DOI:10.23736/S0021-9509.25.13370-3

Dig Dis Sci. 2025 Nov 4. doi: 10.1007/s10620-025-09517-7. Online ahead of print.

ABSTRACT

BACKGROUND: Caustic ingestion remains a significant public health concern, particularly in low- and middle-income countries, and often results in long-term complications such as esophageal strictures. Esophagogastroduodenoscopy (EGD) is widely used for grading mucosal injury (Zargar classification) but cannot assess wall depth. Endoscopic ultrasound (EUS) allows visualization of transmural involvement, yet its prognostic role in caustic injuries is underexplored.

METHODS: This prospective cohort study included 63 adults with confirmed caustic ingestion who underwent both EGD and EUS within 24 h. Zargar grades and EUS findings were recorded, and patients were followed for 12 weeks to assess stricture formation and clinical outcomes. Statistical comparisons were made between those who developed strictures and those who did not.

RESULTS: Median age was 25 years (interquartile range [IQR] 20-40), and 75% were female. Acid ingestion predominated (60%), and most cases (89%) were intentional. Strictures developed in 41% of patients, most frequently in the esophagus. Male sex was significantly associated with stricture formation (p = 0.015). All patients with Zargar grade IIIA/IIIB or muscularis/serosal involvement on EUS developed strictures, while none with Zargar I or mucosal-only involvement did. Dysphagia was the most common post-discharge symptom, reported by 40% at 12 weeks. No EUS-related complications occurred.

CONCLUSION: EUS appears promising in providing complementary prognostic information to EGD and may improve stricture risk stratification, particularly in intermediate- and high-grade injuries. Incorporating EUS into early evaluation could guide closer monitoring and intervention. Larger multicenter studies with longer follow-up are warranted.

PMID:41186906 | DOI:10.1007/s10620-025-09517-7

Eur Arch Paediatr Dent. 2025 Nov 4. doi: 10.1007/s40368-025-01128-0. Online ahead of print.

ABSTRACT

PURPOSE: The preformed metal crown (PMC) is an extremely durable restoration for cavitated carious primary molars. Clinically, the PMC is delivered either by the conventional technique (CT) or the more conservative Hall technique (HT). The present study aimed to compare procedural time, child pain perception and behaviour, and parent acceptability, when the CT or HT were used to restore carious primary molars with PMCs.

METHODS: This was a primary care-based, two-arm parallel-group, randomised controlled trial with 80 participants randomly assigned into the CT and HT groups. To ensure standardisation, potential participants were screened and treated by a single paediatric dentist. Outcome measures evaluated included the procedural time taken; child’s pain perception (Wong-Baker FACES Pain Scale); child behaviour (Frankl scale); and parental perceptions and acceptability (5-point Likert scales).

RESULTS: Procedural time required for the CT and HT treatment groups was 17.4 ± 2.9 and 7.1 ± 2.8 min, respectively (P < 0.001). Child self-reported pain intensity perception was statistically significantly higher in the CT group (Χ² = 12.27; P = 0.03). Dentist-evaluated child behaviour was comparable for both treatment groups with 65% of the CT group children and 85% of HT group children rated as ‘Positive’ or Definitively positive’. Parental perception of child’s comfort during the treatment procedure showed no statistically significant difference between children who received the CT versus the HT (Χ² = 5.97; P = 0.20). However, parents of children who underwent the HT expressed statistically significantly better responses with regard to procedural ease (Χ² = 21.74; P < 0.001), treatment duration (Χ² = 21.58; P < 0.001), satisfaction with the treatment procedure (Χ² = 22.04; P < 0.001), and desire to choose the same treatment procedure again (Χ² = 24.47; P < 0.001).

CONCLUSIONS: Compared to the CT, the HT of delivering PMCs to restore carious primary molars required shorter procedural time, elicited lower child pain perception, and better parent acceptability.

PMID:41186901 | DOI:10.1007/s40368-025-01128-0

Intern Emerg Med. 2025 Nov 4. doi: 10.1007/s11739-025-04182-0. Online ahead of print.

ABSTRACT

Hemodialysis patients have an increased risk of bleeding related to platelet dysfunction and uremia leading to acquired defects in primary hemostasis. Frequently, these patients have multiple medical comorbidities requiring treatment with antiplatelet agents and anticoagulants, further increasing their bleeding risk. This presents added challenges when they present to the emergency department (ED) with arteriovenous fistula or arteriovenous graft (AVF/AVG) bleeding. This retrospective cohort study aims to characterize patient characteristics, mortality outcomes, hemorrhage outcomes, infectious outcomes, repeat ED visits, non-invasive procedures, and invasive procedures associated with ED encounters for AVF/AVG bleeding. This is a retrospective cohort study evaluating ED encounters for patients on hemodialysis with a chief complaint of a bleeding AVF/AVG. Descriptive statistics as well as logistic regression were used to find correlations between patient and encounter factors and the risk of requiring an advanced procedure to prevent further AVF/AVG bleeding. The primary outcome was the need for a formal intervention to revascularize or perform angioplasty on the patient’s AVF or AVG. This occurred in 173 (50.7%) encounters. A history of any bleeding event was associated with the primary outcome while a higher initial platelet count or the use of antiplatelets were inversely associated with the primary outcome. This multi-center retrospective cohort study evaluated patient and clinical characteristics in encounters involving AVF/AVG bleeding. Correlating factors between ED encounters involving AVF/AVG bleeding and the need for advanced AVF/AVG interventions are described. Further research with a larger, more diverse patient base is needed to confirm these findings before these characteristics can be considered indications for more rapid interventional radiology or vascular surgery follow up in cases of AVF/AVG bleeding.

PMID:41186888 | DOI:10.1007/s11739-025-04182-0

Neth Heart J. 2025 Nov 4. doi: 10.1007/s12471-025-02000-y. Online ahead of print.

ABSTRACT

BACKGROUND: Diagnosing heart failure with preserved ejection fraction (HFpEF) remains challenging. While diagnostic algorithms support clinical evaluation, their performance across sexes is understudied, despite HFpEF being more prevalent in females, which may result in sex-specific underdiagnosis.

PURPOSE: To assess the diagnostic accuracy of three HFpEF algorithms-HFA-PEFF, H₂FPEF, and the ESC HF 2016 criteria-and to evaluate sex-related differences in performance.

METHODS: Two prospective cohorts with unexplained dyspnoea were analysed. The Amsterdam cohort (2014-2020; n = 135) had HFpEF confirmed or excluded via (exercise) right heart catheterization (RHC). The Maastricht cohort (2015-2021; n = 659) had HFpEF confirmed or excluded based on expert consensus with utilisation of HFpEF scores, and RHC when needed. Sex-specific diagnostic performance of three HFpEF algorithms was assessed using ROC curves, AUC, and a panel of metrics with cut-offs determined by the rule-in/rule-out strategies.

RESULTS: HFpEF prevalence was high in both cohorts (84.4% and 82.5%), with a female majority (69.6% and 66.5%). Across all algorithms, males consistently showed lower AUC values than females, although differences were not statistically significant. The highest diagnostic performance within the Amsterdam cohort was observed with H₂FPEF (AUC 0.86 and 0.82 for females and males), while HFA-PEFF performed best within Maastricht cohort (AUC 0.85 and 0.83, respectively). Performance for ruling-in and ruling-out HFpEF was numerically lower in males than females; Amsterdam cohort HFA-PEFF and ESC 2016 specificity were 83% versus 93% and 50% versus 73%, Maastricht cohort H₂FPEF specificity was 81% versus 89%.

CONCLUSIONS: HFpEF diagnostic algorithms may perform better in females than males in referral outpatient settings. Inconsistent performance of diagnostic algorithms between different sexes warrants further optimisation to diagnose HFpEF.

PMID:41186885 | DOI:10.1007/s12471-025-02000-y

Gen Thorac Cardiovasc Surg. 2025 Nov 4. doi: 10.1007/s11748-025-02205-3. Online ahead of print.

ABSTRACT

OBJECTIVE(S): Due to the poor prognosis of dialysis patients, accurately predicting life expectancy after aortic stenosis surgery remains challenging, leading to potential misselection of treatment options. This study aimed to develop a prognostic model specific to dialysis patients to facilitate individualized treatment selection.

METHODS: A total of 171 dialysis patients with aortic stenosis who underwent initial isolated surgical aortic valve replacement at seven cardiovascular centers in Japan between 2011 and 2021 were enrolled. The cohort was randomly divided into the training and validation cohorts in a 2:1 ratio. Risk factors contributing to mortality were identified from preoperative variables, and a prognostic model was developed using the Cox proportional hazards model.

RESULTS: Among the 171 patients, 88 deaths occurred during the total observation period of 488.9 person-years. The cumulative overall survival rates at 1, 3, and 5 years, estimated using the Kaplan-Meier method, were 74.7%, 59.4%, and 38.7%, respectively. An optimal risk model was developed, incorporating six factors: age, serum albumin, peripheral artery disease, sex, insulin-dependent diabetes mellitus, and atrial fibrillation. The model demonstrated strong predictive accuracy, with a 5-year C-statistic of 0.723 (95% confidence interval: 0.658-0.788) and 0.656 (95% confidence interval: 0.543-0.770) in the training and validation cohorts, respectively. Calibration plots confirmed that actual survival up to 5 years was well predicted (intraclass correlation coefficient = 0.918, 95% confidence interval: 0.703-0.981).

CONCLUSIONS: The proposed model is a reliable prognostic tool for dialysis patients who underwent surgical aortic valve replacement.

PMID:41186878 | DOI:10.1007/s11748-025-02205-3

Discov Oncol. 2025 Nov 4;16(1):2027. doi: 10.1007/s12672-025-03853-w.

ABSTRACT

PURPOSE: Several studies have already proven a significant correlation between the microbiota and lung cancer. In this study, we explore the potential relative oral and gut microbiota which influence the risk of lung cancer.

METHODS: We utilized genome-wide association study (GWAS) data from oral microbiota (2984 healthy individuals) and gut microbiota (2002 healthy individuals) and lung cancer with a two-sample Mendelian randomization (MR) analysis method. In this analysis, oral microbiota and gut microbiota were conducted as exposure. Lung cancer data obtained from GWAS including a total of 212,453 individuals. Inverse-variance weighted (IVW) method was used as the primary method.

RESULTS: IVW analysis identified that genus Pauljensenia, Capnocytophaga and Aggregatibacter in oral microbiota are potentially protective against lung cancer. On the contrary, higher abundances of bacteria within the genus Granulicatella, Streptococcus, Saccharimonadaceae TM7x and Neisseria in oral microbiota were associated with increased lung cancer risk. Among gut bacteria, species Enterococcus faecalis were positively associated with an increased risk of lung cancer.

CONCLUSION: The findings of this study suggest a potential causal relationship between distinct oral and gut microbial communities and lung cancer risk, offering valuable insights into microbial candidates that may serve as targets for future diagnostic innovations.

PMID:41186872 | DOI:10.1007/s12672-025-03853-w