The SGLT2 inhibitors are now officially not ‘diabetes’ medications, but also drugs capable of risk reduction for people with heart failure and reduced systolic function. And more than one option. All good news for patients. Now to ensure access. #ESCCongress#ESC2020@TheLancet
@TheLancet The key thing about the meta-analysis of the SGLT2 inhibitors is that the primary endpoint was The primary endpoint was time to all-cause death. Not a composite. Not something needing adjudication. 13% reduction in allcause death (pooled HR 0·87, 95% CI 0·77–0·98; p=0·018).
@TheLancet The absolute difference in deaths was 1-2% range; but when you look across other outcomes, including hospitalizations, it is substantial. For adverse effects, interestingly, severe hypoglycaemic events was low, with
no increase in the active treatment groups in both trials.
Reproducibility means a lot to me. Too often we are not testing reproducibility-or class effects. The authors note: 'striking consistency of the findings of CV and renal benefits w/empagliflozin & dapagliflozin in patients with HFrEF
across the two trials.’ #ESCCongress#ESC2020
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What we do now is write a paper...& then preprint @medrxivpreprint ...then we take reviews from the journal & the world & work to make the research better. So, Internal tremors & vibrations in long COVID: a cross-sectional study is open for public comment. https://t.co/xh7dXqPcSGmedrxiv.org/content/10.110…
@medrxivpreprint Our objective: 'We compared demographics, socioeconomic characteristics, pre-pandemic comorbidities, & new-onset conditions between people with internal tremors and vibrations as part of their #LongCovid symptoms & people with long COVID but without these symptoms.' #LISTENstudy
@medrxivpreprint Our finding: Among people with long COVID, those with internal tremors and vibrations have more associated symptoms and worse health status, suggesting it may be associated with a severe phenotype of the condition. @YaleCII @YaleMed @YaleCardiology
We have been doing a series of studies, led by @jeb1426, on sex differences in symptom complexity & phenotypes in acute myocardial infarction (AMI) and their impact on diagnosis & treatment. Some imp findings. #Cardiology#MedTwitter@YaleMed@YaleCardiology@yuan_lu1
One of most important articles I’ve done… showing the noise in clinic BP measurement is large & makes it impossible to track Rx effects; almost useless in evaluating change from 2 clinic visits. Let me explain… ahajournals.org/doi/abs/10.116…@YaleMed@YaleCardiology@CircOutcomes
@yuan_lu1@CircOutcomes@SpatzErica@YaleMed@YaleCardiology@AHAScience@amjmed We wrote that persistent hypertension was a condition of repetitive measures of above-goal elevated blood pressure over a period of time (eg, 6 mos), and drug resistance was just one of many causes. And many causes were related to missed opportunities in the care pathways.
Sleep as medicine... On behalf of hospitalized patients, what is we simply stopped ordering routine lab draws before 7am. What is we wrote an order, do not disturb before 7am except for an urgent need. Or an order for 7 hrs of peace and quiet. @FutureDocsnam12.safelinks.protection.outlook.com/?url=https%3A%…
@FutureDocs I strongly believe that rest and sleep are essential to recovery from acute illness...and yet everything we do in the hospital seems to ignore the role of sleep in treatment. We need to put people in a position to help their bodies heal and recovery... not make it more difficult.
@FutureDocs In our study we found it was normal operating procedures to draw bloods from 4-6am on hospitalized patients...the unintended effect, in my view, is to slow recovery and add stress... and impede healing. Shouldn't the hospital be where people can be treated, healed and recover?
@JAMA_current@jeremyfaust@YaleMed@harvardmed@YaleCardiology@EMRES_MGHBWH We believe excess mortality is the best metric of the burden of the pandemic… how many excess deaths compared with a pre-pandemic steady state period. And so not about labeling deaths… but a broader view of mortality.