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1. High ambient temperatures were associated with increased Emergency Department visits for mental health conditions including substance use disorders, anxiety, mood disorders, schizophrenia, and childhood-onset behavioral disorders.
Evidence Rating Level: 2 (Good)
Exposure to high ambient temperatures and its association with excess morbidity and mortality has been well-documented. Ambient temperature has been previously associated with exacerbation of symptoms for many mental health conditions, but this has been less documented compared to physical health outcomes. With climate change and increased frequency of temperature extremes, the burden of ambient heat on mental health outcomes is expected to increase. In this case-crossover study, 3 496 762 medical claims for Emergency Department visits among adults during warm-season months from 2010 through 2019 with Medicare Advantage health insurance in the United States were identified. Days with extreme heat temperatures were associated with increased rates of ED visits for any mental health condition (IRR 1.08, 95% CI 1.07-1.09) compared to days with ideal ambient temperatures. This association was more evident in specific mental health conditions including substance use disorders, anxiety, mood disorders, schizophrenia, and childhood-onset behavioral disorders. As this study focuses on more severe exacerbations of mental health conditions due to emphasis on ED visits, it does not represent the incidence of less severe outcomes during high ambient temperatures. Additionally, the impact of other variables such as race, socio-economic status, occupation, and length of exposure to heat was not discussed. Nevertheless, these findings may warrant increasing mental health service capacity during periods of extreme temperatures and improving public health measures prior to anticipated temperature extremes to reduce ER visits and hospital burden.
1. Patients with low eGFR, as an indicator for reduced kidney function, had an increased bleeding risk while on rivaroxaban antithrombotic therapy compared to patients with high eGFR
Evidence Rating Level: 2 (Good)
The efficacy of antithrombotic therapies is often assessed based on thrombotic and bleeding events. Factors such as kidney function can influence bleeding risk during antithrombotic therapy; for instance, patients with atrial fibrillation and chronic kidney disease have an elevated risk of bleeding complications. However, nuances underlying the association between kidney function and bleeding risk, such as the relationship between estimated glomerular filtration rate (eGFR) are less understood. In this post-hoc subgroup analysis of the Atrial Fibrillation and Ischemic Events with Rivaroxaban in Patients with Stable Coronary Artery Disease (AFIRE) trial, 2092 patients were divided into high and low eGFR groups using 50 mL/min as the cut-off point and were followed-up over 36 months to study the incidence of bleeding events, ischemic cardiovascular events, and mortality. The cumulative incidence of bleeding per 100 patients by the end of the first year was higher in the low eGFR group compared to the high eGFR group (6.2 and 5.4, respectively). The cumulative number of ischemic cardiovascular events per 100 patients was also elevated in the low eGFR group compared to the high eGFR group (7.8 and 6.4, respectively). Additionally, the bleeding rate per 100 person-years was 15.3 in the low eGFR group and 11.3 in the high eGFR group (rate ratio 0.738, 95% CI 0.615-0.860, p = 0.0009). As such, low eGFR (eGFR < 50 mL/min) was associated with a higher outcome incidence compared to the high eGFR group. However, given that this study only focused on rivaroxaban therapy, there may be reduced generalizability for other antithrombic therapies. As well, the use of 50 mL/min as a cut-off for eGFR to delineate poor and high kidney function may yield imprecise results. Nonetheless, these findings still support healthcare practitioners to have increased discussions regarding bleeding outcomes in patients with reduced eGFR given the increased risks present in this population.
1. Black adults with high depressive symptoms had a 43% increased risk of heart failure compared to Black adults with low depressive symptoms.
2. The effect of high depressive symptoms on heart failure incidence was specific to women.
Evidence Rating Level: 2 (Good)
The interaction between depression, incident heart failure, and mortality are well-documented in literature focusing on predominantly White populations. Although Black adults are more likely to develop heart failure compared to other racial groups, there is limited data discussing the associations between depression and incident heart failure in this population. In this community-based cohort from the Jackson Heart Study (JHS), 2651 participants were followed over 10 years to study the effect of clinically elevated depressive symptoms on incidence of heart failure. The cumulative incidence of heart failure was significantly higher in participants with high depressive symptoms (0.07, 95% CI 0.05-0.09) compared to participants with low depressive symptoms (0.05, 95% CI 0.04-0.06). Participants with high depressive symptoms had a 43% increased risk of heart failure in the unadjusted model. The association between high depressive symptoms and heart failure remained significant after adjusting for demographics and established heart failure risk factors, but the strength of this association was attenuated after adjusting for lifestyle factors such as smoking, obesity, and physical activity. Additionally, high depressive symptoms were associated with heart failure in women (HR 1.52, 95% CI 1.02-2.26, P=0.039) but this association did not exist in men. Future clinical practice may benefit from addressing depressive symptoms in addition to lifestyle modifications when discussing risk factors of heart failure. Further research elaborating upon sex-specific influences of depression and approaches to reducing the associated risk of heart failure on Black women may be beneficial.
Efficacy of sigmoidoscopy for evaluating disease activity in patients with ulcerative colitis
1. The high concordance of disease activity in UC between the entire colon and the rectosigmoid colon, which can be evaluated by sigmoidoscopy alone, suggests that sigmoidoscopy is sufficient in assessing disease remission and mucosal healing in follow-up.
Evidence Rating Level: 2 (Good)
Treatment goals of ulcerative colitis (UC) have been shifting from symptomatic control to complete remission of UC. As such, endoscopic evaluation to assess disease activity has become a key component in the management of UC. The efficacy of sigmoidoscopy alone when evaluating UC disease activity compared to colonoscopy examination is not well-documented in literature. This retrospective multicenter study recruited 333 Korean patients from 2012 to 2018 with UC whose disease activity was evaluated through colonoscopy using the Mayo endoscopic sub-score (MES) and Ulcerative Colitis Endoscopic Index of Severity (UCEIS). The concordance of disease activity in the rectosigmoid and proximal regions of the colon was identified to confirm the efficacy of sigmoidoscopy, as proximal regions could only be evaluated using colonoscopy. Only 7.6% of patients had a high endoscopic disease activity score that was identified in the proximal area and required colonoscopy for evaluation of the disease, instead of the sigmoidoscopy alone. As well, there was a high concordance rate between sigmoidoscopy and colonoscopy when assessing endoscopic healing in follow-up (kappa: 0.882, r(Spearman): 0.887, p < 0.001). As such, the high concordance of disease activity between the rectosigmoid area, which can be evaluated by sigmoidoscopy alone, and the entire colon suggests that sigmoidoscopy may be sufficient to evaluate disease activity following the diagnosis of UC. While the generalizability of this study to other ethnicities may be limited due to the focus on Korean populations, these findings warrant further research into sigmoidoscopic evaluation of UC given its less-invasive nature and the ease of the procedure compared to colonoscopy.
1. Social isolation in older women was significantly associated with heart failure hospitalization incidence.
Evidence Rating Level: 2 (Good)
Social isolation, defined as a lack of social ties, institutional connections, or community participation, has been strongly associated with all-cause mortality in older adults. However, the role of social isolation in heart failure incidence has not been well-elucidated in external literature. In this retrospective cohort study, 44 174 postmenopausal women from the Women’s Health Initiative (WHI) who underwent annual assessment for heart failure from baseline enrollment between 1993 and 1998 were followed through 2018 to assess for social isolation and heart failure hospitalization. The minimally adjusted risk of heart failure incidence was 56% higher in women who were socially isolated (HR 1.56, 95% CI 1.37-1.78) compared to women who were not socially isolated. This model also showed that depressive symptoms were independently associated with incident heart failure, although after adjusting for depressive symptoms, the association between social isolation and incident heart failure remained significant. This association did not differ when accounting for factors such as baseline age, race, and ethnicity. Other variables which significantly increased the risk of heart failure hospitalization included age, treated diabetes, obesity, prevalent cardiovascular disease, and incident myocardial infarction. While the findings of this study may not be generalizable to younger women and men due to the focus on older women, the association identified between social isolation and heart failure hospitalization has important implications when assessing risk factors for heart failure and identifying preventative strategies.
Image: PD
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