Smartwatches have been gaining popularity, and smartwatch-based patient-activated recordings have been widely used for screening atrial fibrillation (AF) and sleep-disordered breathing. We encountered a 79-year-old man who routinely activated a smartwatch ECG in the morning. He had documented paroxysms of AF while working as a businessman a decade ago. Thereafter, the paroxysms were not documented after he retired from work; therefore, pulsed field ablation was deferred. However, the smartwatch repeatedly detected AF paroxysms the following morning, only after the smartwatch had issued a breathing-disturbance notification during sleep. Smartwatch ECG cannot completely substitute for conventional ECG, and smartwatch-detected breathing disturbance is not equivalent to polysomnography (PSG)-detected obstructive sleep apnea (OSA). However, this case suggests that nocturnal respiratory disturbance may be associated with daily AF paroxysms and that this possibility may be detected using a single smartwatch. Accumulation of similar cases with simultaneous polysomnographic and ECG monitoring may help clarify the mechanistic relationship between nocturnal hypoxemia and AF paroxysms.
BACKGROUND & AIMS:Direct-acting antiviral agents (DAA)-mediated HCV cure correlates with better outcomes, but there are insufficient data on detailed mortality-related risk factors after cure. This study sought to clarify mortality and associated risk factors post-HCV cure. METHODS:The study included HCV patients with sustained virological response following DAA (DAA-SVR) from 39 REAL-C centres in North America, Europe and Asia-Pacific. The primary outcome was all-cause mortality in DAA-SVR patients. Mortality rate per 1000 patient-years (PY) was calculated as the number of deaths divided by total PY multiplied by 1000. RESULTS:A total of 10 034 DAA-SVR patients (stratified by cirrhosis status: 5611 non-cirrhosis, 4153 compensated, 270 decompensated) were included. With a median follow-up of 4.76 PY, 4.9% (491) died. The all-cause mortality rates were 6.2, 13.1, 60.0 and 10.4 per 1000 PY for patients without cirrhosis, compensated and decompensated cirrhosis, and overall patients, respectively. The 5-year cumulative survival was 95.1% (94.5%-95.6%) overall, with the lowest rate of 73.9% (67.0%-79.5%) in decompensated cirrhosis. Non-liver-related death was the main cause in non-cirrhosis (non-liver-related vs. liver: 5.2 vs. 0.8 per 1000 PY)/compensated cirrhosis (8.2 vs. 4.8 per 1000 PY), while liver-related death was dominant in decompensated cirrhosis (24.7 vs. 33.8 per 1000 PY). Risk factors for higher mortality included age > 65 (3.2-fold), male (1.5-fold), cirrhosis (decompensated 7.6-fold) and baseline DM (1.5-fold). CONCLUSION:This study showed significant age, sex, fibrosis stage and DM differences in mortality and causes among DAA-SVR patients. It provided granular subgroup data for precision medicine to support individualised care, future modelling studies and public health planning.
Objective: To evaluate the efficacy and safety of imeglimin for elderly patients with type 2 diabetes mellitus (T2DM) in real-world clinical practice. Methods: This retrospective study included 65 consecutive patients with T2DM who initiated imeglimin 2,000 mg/ day between September 2021 and August 2025. Patients were classified as elderly (≥65 years, n=38) or younger (<65 years, n=27). Efficacy was assessed for 45 patients who continued treatment for at least 6 months and safety for all 65. Results: The median age was 70 years (IQR: 61-79), and 38.5% were female. Compared with younger patients, the elderly had lower body mass index (BMI) and estimated glomerular filtration rate (eGFR). In the elderly group, HbA1c had decreased significantly, by 0.72%, at 6 months (P < 0.001), whereas the younger group showed a non-significant reduction of 0.22%. The discontinuation rate within 6 months was lower in the elderly group (13.2% vs. 22.2%, P = 0.53). No significant changes in BMI or eGFR were observed in either group. An improvement of liver function was observed among patients with baseline alanine aminotransferase (ALT) 30-50 U/L. No severe adverse events occurred. Conclusion: Imeglimin effectively lowered the HbA1c of these elderly T2DM patients, with good tolerability and without adverse effects on weight or renal function.
BACKGROUND:Mitochondrial DNA copy number (mtDNA-CN) in peripheral blood leukocytes has emerged as a surrogate marker of mitochondrial function. This study examined associations between leukocyte mtDNA-CN, physical performance, and lipid metabolism in community-dwelling older adults. METHODS:We conducted a cross-sectional analysis of 594 adults aged ≥ 50 years (median 71 years; 351 women, 243 men) who were independent in activities of daily living. Physical performance was assessed using handgrip strength and gait parameters measured with a triaxial accelerometer. Frailty status was evaluated using the Japanese version of the Cardiovascular Health Study (J-CHS) criteria. Blood samples were collected after fasting for mtDNA-CN and other blood chemical measurements. RESULTS:Median values of mtDNA-CN were 124 in women and 114 in men. According to the J-CHS criteria, 6.1% of women and 6.3% of men were classified as frail, while 48.9% of women and 53.6% of men were pre-frail. Participants with higher mtDNA-CN levels demonstrated superior physical performance. After multivariable adjustment, mtDNA-CN correlated positively with gate ability in women and handgrip strength in men. In addition, mtDNA-CN correlated positively with iron in women and high-density lipoprotein cholesterol (HDL-C) in men, and negatively with uric acid and C-reactive protein in men. In the multivariate regression analyses, mtDNA-CN still showed positive associations with handgrip strength and HDL-C, a negative association with uric acid in men, and a positive association with iron in women and men. CONCLUSION:Leukocyte mtDNA-CN was associated with physical performance, suggesting its potential utility as a biomarker for frailty assessment in older adults.
BRASH syndrome is defined as a clinical condition in which bradycardia, renal failure, atrioventricular (AV) nodal blockade, shock, and hyperkalemia interact to form a self-perpetuating negative spiral. Geriatric practitioners are increasingly likely to encounter elderly patients with this syndrome who are taking AV nodal blocking agents, such as calcium channel blockers (CCBs) or β-blockers. However, it remains unclear how the heart failure (HF) pandemic and coronavirus disease 2019 (COVID-19) have influenced the incidence, triggers, management, and clinical course of BRASH syndrome. Therefore, open-access databases were searched for publications from 1980 to 2025, identifying 41 eligible articles reporting a total of 54 patients with BRASH syndrome. The mean age of affected patients was 69.0 ± 15.1 years. Hypertension (HTN, 74%), chronic kidney disease (CKD, 61%), and diabetes (54%) were the most common comorbidities. More than half of the patients (52%) were prescribed angiotensin-suppressing agents (angiotensin-converting enzyme inhibitors (ACEi), angiotensin receptor blockers (ARB), or angiotensin receptor-neprilysin inhibitors (ARNI)) for HTN or HF. Two elderly patients were diagnosed with BRASH syndrome triggered by COVID-19. This literature review clarifies that BRASH syndrome commonly occurs in elderly patients with HTN or CKD and is often associated with everyday clinical events such as anorexia, vomiting, diarrhea, bleeding, and infection, including COVID-19. Our database search supports recognizing BRASH syndrome as an important clinical entity in geriatric emergency medicine. Geriatric practitioners should be aware of this condition to enable early diagnosis and appropriate management in the modern HF and post-COVID-19 era.
