Geriatría HGG Journal Club

Nearly half a century ago, trials were performed that provided convincing evidence that long-term treatment with beta-blockers can improve outcomes after a myocardial infarction.

...Among patients with myocardial infarction and a preserved left ventricular ejection fraction, the findings of the REDUCE-AMI trial placed the use of beta-blockers for secondary prevention squarely on the “injured-reserve” list in April 2024.10 The results of current trials will provide additional data on whether the use of these drugs in this population may be approaching final retirement.

Neuroleptic Malignant Syndrome

• Neuroleptic malignant syndrome is characterized by fever, muscular rigidity, and dysautonomia after exposure to dopamine-blocking agents, especially antipsychotic drugs.

• Clinical criteria for diagnosis vary and may include an altered level of consciousness, but the syndrome is a rare and unpredictable complication of antipsychotic drugs.

• Neuroleptic malignant syndrome may lead to major medical complications, which clinicians can anticipate.

• Treatment, which is empirical, includes muscle relaxants and close monitoring, usually in an intensive care unit.

• There is a low risk of recurrence after reexposure, but some risk remains.

 To evaluate the effectiveness, comparative effectiveness, and harms of sodium–glucose cotransporter-2 (SGLT2) inhibitors, glucagon-like peptide-1 (GLP1) agonists, dipeptidyl peptidase-4 (DPP4) inhibitors, and long-acting insulins as monotherapy or combination therapy in adults with type 2 diabetes mellitus (T2DM).

In adults with T2DM, SGLT2 inhibitors and GLP1 agonists (but not DPP4 inhibitors, insulin, or tirzepatide) reduce all-cause mortality and MACE compared with usual care. SGLT2 inhibitors reduce CKD progression and heart failure hospitalization and GLP1 agonists reduce stroke compared with usual care. Serious adverse events and severe hypoglycemia are less frequent with SGLT2 inhibitors and GLP1 agonists than with insulin or SU. 

tDCS can significantly improve the immediate postintervention cognitive function of healthy older adults and MCI elderly individuals. Additional longitudinal extensive sample studies are required to clarify the specific effects of tDCS on different cognitive domains, and the optimal tDCS parameters need to be explored to guide clinical practice.

The next decades of health care innovation will undoubtedly be

dependent on the volume of health data generated in the daily conduct of health delivery. Coupled with the technological breakthroughs afforded by the rapid growth of AI capabilities, these health care innovations could truly revolutionize the practice of medicine as we know it. However, this potential will not be realized without a refocusing of AI technology development toward a closer alignment with the health goals that clinicians and patients understand are required to ensure widespread adoption and maximal impact to improve human health.We need clearly articulated clinical indications, well-defined risk-based clinical testing processes and evidence generation, and continuous monitoring linked to these indications.

Without this type of paradigm shift, we fear that the use of

AI technologies will struggle to gain sufficient trust among clinicians and patients, which in turn will limit its adoption and impact on health.

In this audio interview, Editor-in-Chief Eric Rubin and Deputy Editor Jane Leopold discuss research being presented at the 2024 European Society of Cardiology annual meeting. . . .

Multiple factors are associated with the persistent osteoporosis care gap.

Patient factors include lack of knowledge about osteoporosis, nonadherence to treatment recommendations, and worries about rare drug adverse effects, including atypical femur fractures and osteonecrosis of the jaw.

Clinician factors include failure to offer treatment to patients with advanced age and cognitive impairment, limited familiarity with antiosteoporosis medications, and concerns about the adverse implications of early antiresorptive therapy for fracture healing.

Health system factors include unclear jurisdiction for medical management of osteoporosis in hospitalized patients, lack of reimbursement for high-quality osteoporosis care, and a disconnect between acute andprimary care.

Background: Evidence-based practice in community-acquired pneumonia often assumes an accurate initial diagnosis. Objective: To examine the evolution of pneumonia diagnoses among patients hospitalized from the emergency department (ED).  

Conclusion: More than half of all patients hospitalized and treated for pneumonia had discordant diagnoses from initial presentation to discharge. Treatments for other diagnoses and expressions of uncertainty were common. These findings highlight the need to recognize diagnostic uncertainty and treatment ambiguity in research and practice of pneumonia-related care.

Prolonged grief disorder is a newly classified diagnosis, and information about its symptoms and treatment is not yet widely disseminated. Clinicians may not have the training to recognize prolonged grief disorder or know how to provide efficacious treatment or evidence-guided support. The coronavirus disease 2019 pandemic and the growing amount of literature about the diagnosis have increased attention on ways clinicians can identify and address grief and other bereavement-related emotional problems.

Although frailty is a geriatric syndrome that is associated with disability, hospitalization, and mortality, it can be reversible and preventable with the appropriate interventions. Additionally, as the current diagnostic criteria for frailty include only physical, psychological, cognitive, and social measurements, there is a need for promising blood-based molecular biomarkers to aid in the diagnosis of frailty.

 All five biomarkers showed statistically significant correlations with components of the frailty diagnostic criteria. We discovered several potential biomarkers for the diagnosis of frailty. Further refinement may lead to their future clinical use.