Sodium-glucose cotransporter 2 (SGLT2) inhibitors are established therapies across the cardiovascular–renal continuum. Although the excess risk of external genital infection is well recognized, the association between SGLT2 inhibition and urinary tract infection (UTI), particularly serious/complicated urinary infection, remains uncertain. We conducted a systematic review and meta-analysis of randomized placebo-controlled trials of empagliflozin, dapagliflozin, canagliflozin, ertugliflozin, and bexagliflozin in adults with type 2 diabetes, chronic kidney disease, or heart failure. Co-primary urinary safety outcomes were any UTI and serious/complicated urinary infection, the latter defined using directly reported serious UTI endpoints or the closest reported severe urinary phenotype. Sensitivity analysis, subgroup analyses by drug and population, leave-one-out analyses, and exploratory meta-regression were performed. A total of 14 studies were included. For the primary any-UTI analysis, 11 studies contributed data, comprising 62,542 participants and 4,685 events. SGLT2 inhibitors were associated with a pooled RR of 1.14 (95
Background Rezūm water vapor therapy has emerged as an effective minimally invasive surgical treatment for lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH). However, large contemporary studies evaluating the durability of functional outcomes beyond the immediate postoperative period remain limited. Objective To evaluate symptom improvement, urinary function, durability, and predictors of long-term outcomes following Rezūm therapy. Design, Setting, and Participants A retrospective cohort study was conducted among 1,238 consecutive patients who underwent outpatient Rezūm therapy between April 2022 and May 2025 at a high-volume ambulatory surgical center. ( Outcome Measurements and Statistical Analysis Changes in International Prostate Symptom Score (IPSS), quality of life (QoL), peak urinary flow rate (Qmax), post-void residual urine volume (PVR), retreatment-free survival, and patient satisfaction were assessed through 24 months. Longitudinal mixed-effects models, Kaplan-Meier analyses, multivariable regression, receiver operating characteristic analysis, calibration assessment, and decision curve analysis were performed. Results Mean baseline IPSS improved from 23.1 to 8.4 at 24 months (p<0.001). Mean QoL score improved from 4.8 to 1.8 (p<0.001), Qmax increased from 8.7 to 16.0 mL/s (p<0.001), and mean PVR decreased from 146 to 56 mL (p<0.001). Improvements were evident by 3 months and remained stable throughout follow-up (Figure 1). Twenty-four-month retreatment-free survival exceeded 95% (Figure 2). Multivariable analyses demonstrated that elevated baseline PVR and prior urinary retention were associated with less favorable long-term outcomes (Figure 3). Predictive models demonstrated good discrimination and calibration, with area-under-the-curve values approaching 0.80 (Figure 4). Conclusions Rezūm therapy provides durable improvements in urinary symptoms, quality of life, urinary flow, and bladder emptying for up to 24 months. Clinical durability remains high, with low retreatment rates and excellent patient satisfaction. Baseline bladder dysfunction appears to be the principal determinant of long-term outcome. Patient Summary In more than 1,200 men treated with Rezūm therapy, urinary symptoms improved substantially and remained durable for at least two years. Most patients avoided additional procedures and reported high satisfaction. The author is indebted to Gabriella Carroll for her assistance in developing this manuscript. Rezūm therapy produces durable improvements in urinary symptoms through 24 months.
Cardiovascular disease is the leading cause of morbidity and mortality globally. Despite effective treatments, poor adherence limits their long-term benefits. Digital health solutions can enhance clinicians’ ability to optimise guideline-based therapies, improving patient outcomes. Digital tools for remote consultations, monitoring, cardiac device interrogation and clinical decision support systems are now widely available. Digital health monitoring improves care quality, providing value to patients, healthcare professionals, hospitals and governments. This transformation is fostering a future where ‘health’ takes precedence over ‘reactive care’, driven by empowered patients and advanced technologies. Success in this transformation requires not only technology, but also new strategic operational models, optimised workflows and workforce redesign. Health systems that form partnerships with other stakeholders, such as peers, payers, start-ups, life sciences organisations, industries, will be better positioned to improve patient experiences and outcomes. This review examines digital solutions that optimise medical therapy prescriptions, promote patient engagement and address therapeutic inertia in AF, heart failure and coronary artery disease.
Small airway dysfunction (SAD) is a pivotal feature of chronic obstructive pulmonary disease (COPD), yet spirometry has limited sensitivity for peripheral airway impairment. Oscillometry offers effort-independent assessment of respiratory mechanics during tidal breathing. We systematically reviewed longitudinal studies reporting the association between baseline oscillometry and subsequent moderate-to-severe acute exacerbations (AE) in COPD, and compared its predictive accuracy with spirometric indices. Effect estimates (OR, HR, IRR) were pooled using a random-effects model (DerSimonian–Laird). Eight studies (4,175 independent patients; follow-up 1–6 years) met inclusion criteria, five contributing to the meta-analysis. Patients with oscillometry-defined SAD had a 2.18-fold higher risk of moderate-to-severe AE (95% CI 1.49–3.20; I² = 49.8%; P < 0.001). In four studies reporting both indices, oscillometry and FEV₁ showed comparable discrimination for AE (AUC 0.775 vs 0.777), whereas a combined model achieved superior discrimination (AUC 0.860). Patients with GOLD stage 1 COPD and abnormal oscillometry had exacerbation risk comparable to GOLD stage 2, indicating that oscillometry identifies at-risk patients missed by spirometry alone. Oscillometry-defined SAD independently predicts COPD exacerbations and provides incremental prognostic value over spirometry, supporting its integration into a precision-medicine approach. Further studies should validate oscillometric cut-offs for risk stratification.
Recent Italian real-world data show that more than 30% of patients hospitalised for a documented acute atherothrombotic event are readmitted to hospital in the year following discharge. Adherence to guideline recommendations for secondary prevention strategies appears to be largely inadequate. To try to narrow the gap between what is recommended and what is implemented in clinical practice, we designed a national implementation science project, BRING-UP Prevention, based on educational programmes and patient data collection. BRING-UP Prevention is a nationwide, observational, prospective, multicentre study enrolling patients with a documented prior atherothrombotic event. The study consists of two 3-month enrolment phases followed by a 6-month follow-up with end-point evaluation, with each enrolment phase preceded by an educational intervention to discuss guideline recommendations. The first phase was recently completed. These data relate to the primary endpoint, which was the percentage of patients achieving the target of LDL cholesterol <55 mg/dL. The first phase has recently been completed. These data refer to the primary endpoint, which was the percentage of patients achieving the target LDL cholesterol level of <55 mg/dL. 189 cardiology centres collected data on 4790 patients, 2500 discharged from hospital and 2290 managed as outpatients. Follow-up data at 6 months were available for 4643 patients (96.9%). The rate of patients with LDL cholesterol <55 mg/dL increased from 33% to 58.1%, with absolute and relative increases of 25.1 and 76.0%, respectively. Overall, the proportion of patients with LDL cholesterol ≤70 mg/dL increased from 53.5% to 82.2%. At discharge/end of visit, 96% of patients were on statins and 94.7% were still on statins at 6 months. Atorvastatin and rosuvastatin were the most commonly prescribed statins, in more than 75% of cases at high doses. Ezetimibe was prescribed in 84% of cases. The figure shows LDL cholesterol levels at baseline and after 6 months of follow-up. PCSK9Is were prescribed in 7.7% and inclisiran in 2.3% of patients. Pts with partial or total intolerance to statins were 4.5%. Data from the first phase of the BRING-UP Prevention study show that: 1) the rate of pts with a LDL cholesterol increased consistently over the 6-month follow-up period; 2) this result was achieved with high intensity statins, very often in combination with ezetimibe, while the use of new lipid-lowering drugs remained limited. These data show that it is possible to significantly increase the percentage of patients achieving guideline-recommended LDL cholesterol levels with a very favourable cost-benefit approach using a high-intensity statin and ezetimibe. The need to use more potent and costly lipid-lowering approaches is limited to a relatively small proportion of patients.
