Objective To characterize racial disparities in glaucoma management by evaluating treatment modality utilization patterns between Asian American and non-Asian American patients with primary open-angle glaucoma (POAG). Patients and Methods This retrospective cohort study utilized the TriNetX US Collaborative Network, a large-scale, multi-institutional electronic medical record database, with data from January 1, 2004, to June 16, 2025. Asian American and non-Asian American patients with POAG were identified via ICD-10 codes and stratified by disease severity (mild-to-moderate vs severe). Cohorts were balanced using 1:1 propensity score matching for demographic characteristics, systemic comorbidities, family history, and smoking status. The primary outcome was the relative utilization of topical medications, laser procedures, traditional surgery, and microinvasive glaucoma surgery. Results After propensity score matching, the study evaluated 12,526 patients with mild-to-moderate POAG (6263 per group) and 3410 patients with severe POAG (1705 per group). In the mild-to-moderate cohort, Asian Americans had a higher likelihood of receiving topical medications (odds ratio [OR], 1.041; 95% confidence interval [CI], 1.016-1.068). Conversely, Asian Americans with severe POAG were less likely to receive topical medications (OR, 0.950; 95% CI, 0.906-0.996) or laser procedures (OR, 0.769; 95% CI, 0.630-0.939). No significant differences were observed in surgical or microinvasive glaucoma surgery utilization. Conclusion Significant differences exist in POAG treatment utilization for Asian Americans, particularly a relative underutilization of adjunctive medical and laser therapies in severe disease. These findings suggest that current practice patterns may diverge from traditional treatment algorithms for this rapidly growing demographic, highlighting a need for increased awareness of potential systemic or provider-level barriers to equitable care.
Objective To determine the ultraviolet-C (UV-C) irradiation doses required to inactivate Pseudomonas aeruginosa and Aspergillus flavus contamination on polycarbonate surfaces using a triangular emitter configuration. Patients and Methods In this laboratory experiment, polycarbonate test carriers inoculated with >108 colony-forming units of P aeruginosa (MYA-15442) or A flavus (American Type Culture Collection 9643) were positioned 2.74 m from 3 linear UV-C emitters to determine minimally effective doses. Ten independent irradiation doses were evaluated for P aeruginosa (25-250 mJ/cm2) and A flavus (50-2000 mJ/cm2). Larger carriers were additionally evaluated for A flavus to model reduced cell clumping, simulating prior surface disinfection. Residual colony-forming units were quantified and compared with untreated controls to calculate log reductions. Finally, the efficacy of delivering these minimally effective doses through a triangular UV-C emitter configuration was assessed. Results For P aeruginosa, no growth was detected at any dose, including 25 mJ/cm2. For A flavus on standard carriers, inactivation occurred at 725 mJ/cm2, though no growth conditions were not achieved at any tested dose. However, on larger carriers (reduced clumping), no growth conditions for A flavus were achieved at 650 mJ/cm2. Delivery of 25 mJ/cm2 for P aeruginosa and 650 mJ/cm2 for A flavus through the triangular configuration resulted in undetectable growth. Conclusion A UV-C dose of 25 mJ/cm2 is sufficient to attenuate P aeruginosa surface contamination. Conversely, A flavus inactivation will likely require manual high-level surface disinfection augmented with 650 mJ/cm2 of UV-C irradiation.
Objective To evaluate the effectiveness of Tofersen in patients with superoxide dismutase 1 gene (SOD1-ALS) patients in France in a real-world setting, using disease progression within patient comparisons and with a historical cohort. Patients and Methods Patients with SOD1-ALS were included from across 19 French FILSLAN network centers. Baseline was defined as the treatment initiation date. Main endpoints were the ALSFRS-R progression rate and plasmatic neurofilament light chain (NfL) levels at baseline and 12 months after baseline. Results In the Tofersen Cohort (N=46), within-group comparisons showed that the mean ALS functional rating scale revised (ALSFRS-R) progression rate slowed from 0.53 ± 0.5 at baseline to 0.22 ± 0.3 point/month at 12 months (P=.006). NfL levels significantly decreased from 89.0 ± 9.0 pg/ml at baseline to 29.2 ± 19.5.5 at 12 months (P=.004). Exploratory comparisons with a propensity score (PS) matched historical cohort (39 matched pairs) using a mixed-effects model, ALSFRS-R progression rate at baseline, 6 months, and 12 months after baseline, showed no statistically significant differences between groups P=.30, whereas longitudinal ALSFRS-R scores differed significantly between groups (time-treatment interaction P=.006). The mean survival of the PS matched population was longer in the Tofersen Cohort (42.6 months) than the Historical Cohort (31.8 months) P=.004. Time-dependent adjusted cox analysis showed that Tofersen was associated with a reduction in mortality risk (adjusted HR=0.34; 95% CI, 0.12-0.91; P=.03). Conclusion Tofersen seems to be associated with slower functional decline and reduced NfL levels. While limitations of retrospective design and ALSFRS-R sensitivity must be acknowledged, these findings provide real-world evidence suggesting a clinical benefit of Tofersen.
Objective To evaluate the association of estimated cardiorespiratory fitness (eCRF) with incident cardiometabolic multimorbidity (CMM) and its potential contribution to CMM risk prediction in an older adult population. Patients and Methods The analysis included 3326 participants from the English Longitudinal Study of Aging (mean age 63 years; 1820 (54.7%) women) who were free of hypertension, cardiovascular disease, diabetes, and stroke at baseline (wave 4; 2008-2009). Estimated CRF was derived using validated nonexercise prediction equations (heart rate-based, body mass index-based, and Nord-Trøndelag Health Study-based eCRF). Incident CMM was defined at wave 10 (2021-2023) as the presence of ≥2 of the following: hypertension, cardiovascular disease, diabetes, or stroke. Multivariable-adjusted odds ratios (ORs) (95% CIs) and discrimination indices were calculated. Results During 12-15 years of follow-up, 197 (5.9%) participants developed CMM. Each eCRF measure reported an inverse linear association with CMM risk. Higher heart rate-based eCRF was associated with lower odds of CMM (per 1- metabolic equivalents (MET) increment: OR=0.78; 95% CI, 0.70-0.87; highest vs lowest tertile: OR=0.42; 95% CI, 0.25-0.69). Similar associations were observed for body mass index-based eCRF (per 1-MET increment: OR=0.78; 95% CI, 0.68-0.89; highest vs lowest tertile: OR=0.42; 95% CI, 0.25-0.70) and Nord-Trøndelag Health Study-based eCRF (per 1-MET increment: OR=0.73; 95% CI, 0.65-0.82; highest vs lowest tertile: OR=0.36; 95% CI, 0.22-0.58). Incorporation of each eCRF measure into a conventional risk prediction model modestly improved discrimination. Conclusion Estimated CRF derived from validated nonexercise equations was similarly and inversely associated with incident CMM in older adults, with all models reporting comparable modest predictive utility.
Objective To assess the work-related quality of life (WRQoL) of anesthesiologists and various health issues that may have an impact on it. Patients and Methods We conducted a cross-sectional, anonymous electronic survey of active American Society of Anesthesiologists (ASA) members to evaluate sex-specific health conditions and WRQoL. The WRQoL included validated domains of job satisfaction, stress at work, home-work interface, control at work, and working conditions, along with demographic and professional characteristics. Descriptive statistics and multivariable analyses were used to identify factors independently associated with lower WRQoL scores. Results The survey was distributed to approximately 37,000 ASA members from September 2024 to December 2024, yielding 2292 responses. About 45.9% of respondents were women, slightly overrepresenting female anesthesiologists compared with the ASA population. Occupational and psychosocial exposures were common: 78.8% reported lifetime exposure to occupational hazards, 49.7% to harassment, and 74.6% to burnout, all of which significantly correlated with lower WRQoL (P<.001). Multivariable analysis identified occupational hazards, harassment, and burnout as independent predictors of lower WRQoL. Female anesthesiologists had higher odds of burnout and occupational hazard exposure impacting their quality of life, whereas older physicians reported lower burnout risk. Commonly endorsed workplace improvements included consistent schedules, reduced call burden, and flexible leave policies. Conclusion This national survey represents the first large-scale assessment of WRQoL among US anesthesiologists. Findings highlight the multidimensional nature of professional well-being and underscore the importance of organizational culture, workload management, and targeted strategies to support high-risk subgroups. Addressing these factors may improve workforce sustainability.
Objective To enhance the multifunctional efficacy and cost efficiency of lumbar puncture (LP) services for optimal patient outcomes. Patients and Methods In January 2023, the neurosciences intensive care unit (NeuroICU) created a day team (Team 2) to offload time-sensitive tasks from the 24-hour service team (Team 1). We hypothesized that a multifunction service would improve operational efficiency and generate meaningful cost savings. We performed a single-center, retrospective review of Team 2 activities from January 21, 2023, to April 21, 2025, at Jacksonville campus of Mayo Clinic Florida, encompassing 400 consult encounters across 7 multifunction service domains. We determined cost savings using a time-driven, activity-based costing method, which estimated bed-day savings using a $2500/day cost and average 2-day hospital length-of-stay reduction with earlier intervention. Results During the study period, a total 200 LPs were performed, creating an estimated cost savings of $1 million. Team 2 completed around 100 LPs/year vs 23/year with the previous model, reducing length of stay by 2 days per LP (∼$5000/patient; ∼$500,000/year). This led to earlier postoperative discharges, as early as the day of the LP in some cases. These collective functions similarly streamlined care pathways, fostering bed availability, and led to earlier discharge of patients needing LP consult and those in the primary postoperative NeuroICU using an early discharge process. Conclusion A multifunctional NeuroICU day team yielded measurable throughput gains and substantial direct cost savings, as well as added team operational resilience.
Objective To address the limited recognition of structural causes of lower-limb pain and the lack of real-world data on entheseal pathology, we evaluated ultrasound-detected entheseal and tendinous abnormalities in an unselected outpatient population, highlighting the underuse of musculoskeletal ultrasound (MSK US) in early diagnostic assessment despite the frequent misclassification of these conditions as nonspecific soft-tissue or degenerative disorders. Patients and Methods We conducted a retrospective analysis of 667 consecutive adults undergoing standardized MSK US for lower-limb pain in a general ambulatory orthopedic clinic. Fourteen predefined entheseal and tendinous sites across the hip, knee, and ankle–foot regions were evaluated using Outcome Measures in Rheumatology criteria. Prevalence, anatomical distribution, bilaterality, and clinical predictors were assessed using descriptive statistics and multivariable logistic regression. Results Ultrasound-confirmed enthesopathy or tendinopathy was present in 152 of 667 patients (22.8%). Lesions most frequently involved the gluteus medius tendon and plantar fascia (5.5% each, n=37), followed by the semimembranosus (2.8%, n=19), patellar (2.6%, n=17), and Achilles tendons (4.2%, n=28). Abnormalities were predominantly unilateral (<10% bilateral). Increasing age was the only independent predictor of entheseal pathology (adjusted OR 1.26 per 10-year increase; 95% CI, 1.08-1.47). Sex, body mass index, diabetes, and rheumatologic disease were not relatively associated with pathology. Conclusion Entheseal and tendinous abnormalities are common among symptomatic adults in everyday outpatient practice. Systematic integration of MSK US as a first-line assessment tool could improve diagnostic precision and enable targeted management strategies. These findings provide population-relevant evidence to inform musculoskeletal care pathways and health system decision-making.
Objective To implement a quality improvement project to promote cefazolin for surgical antimicrobial prophylaxis (SAP) among patients with penicillin allergy labels (PwPAL) as updated guidelines suggest shifting SAP to preferred antibiotics (cefazolin) in PwPAL, including penicillin-associated anaphylaxis. Patients and Methods An interdisciplinary quality improvement project was conducted in a large, multiregion health care system in the United States to promote cefazolin for SAP among PwPAL. Interventions occurred January 1, 2023 through November 30, 2023 and were applied to adult and pediatric PwPAL undergoing operation. Broad system-based changes were implemented, including electronic health record allergy module enhancements, algorithm development, and point-of-care guidance to surgical clinicians through modifications to the electronic health record allergy-antibiotic flag at order entry and to surgical order sets. A dashboard was created to capture all SAP data, and education modules and communication articles were disseminated. Practice representative input was obtained, and frequent updates were provided through departmental meetings. Results Use of cefazolin for SAP in PwPAL improved 38% across all regions within our health care organization, increasing from 63.4% (8349/13,164) to 89.1% (12,988/14,569), P≤.001. No difference in use of medications for hypersensitivity or tryptase testing was noted between the preintervention cohort and postintervention cohort. Reductions in clindamycin, from 9.1% (1198/13,164) to 0.7% (100/14,569), P≤.001), and vancomycin, from 16.7% (2194/13,164) to 4.7% (691/14,569), P<.001) were also noted. Conclusion A successful increase in the use of cefazolin for SAP in PwPAL was achieved through broad quality improvement project implementation of system-based interventions without a corresponding increase in hypersensitivity surrogate markers.
Objectives To describe reasons why patients declined to participate in the Tapestry whole exome sequencing study and examine demographic trends in responses. Patients and Methods The Tapestry study enrolled patients 18 years of age and over, beginning July 1, 2020, through May 31, 2024. This study includes 12,705 recruited subjects who declined to participate before February 14, 2022, but provided reasons for declination (RPs). RPs were selected from 5 discrete reasons for declination and had the opportunity to add a free-text comment. Comments were classified into 7 theme-based categories by the reviewers for analysis. Demographics of the subjects, including age, race, ethnicity, having a primary care provider, and rural–urban commuting area, were compared based on consent status and their reasons for declination. Results RPs had a mean age of 61 years, were 90.1% White, and were 57.4% female. The most common reasons for declination were concerns about storing genetic data in electronic health records, the complexity of the process, and discomfort with genetic research. Significant differences in reasons for declination were found by sex, age, race, ethnicity, primary care provider status, and rural–urban commuting area. Conclusion Our study highlights demographic and structural factors influencing genomic study non-participation. Distinct barriers were identified among active decliners, including privacy concerns, logistical issues, and mistrust. These findings emphasize the need for targeted education and provider engagement to support informed decision-making, reduce post-genomic sequencing regret, and promote equity in participation in large-scale personalized medicine initiatives.
Objective: To investigate alcohol withdrawal syndrome prevalence among women and to study age and sex differences in clinical manifestations and hospital course. Patients and Methods: This cohort study included all hospitalized patients from June 1, 2019 to June 1, 2022, where the Clinical Institute Withdrawal Assessment for Alcohol Scale, revised, protocol for alcohol withdrawal syndrome was implemented. Results: A total of 16,190 hospitalizations (10,092 patients aged ≥21 years), with 30.2% women, were included in the study and divided into the following 4 age groups: 21 to 39 years (n=2453 [24.3%]), 40-64 years (n=5128 [50.8%]), 65-74 years (n=1705 [16.9%]), and 75 years or older (n=806 [8%]). We considered the age group (40-64 years) with the highest number of patients as the reference group. Older patients presented with lower blood alcohol concentration and took longer to reach peak withdrawal manifestations than younger patients. Compared with women, men in the youngest age group reached a peak withdrawal earlier (mean, 18.5 hours [95% CI, 17.2-19.8] vs 19.4 hours [95% CI, 17.5-21.3]; P<.001), and there was no sex difference in other age groups. Men required higher benzodiazepine doses during hospitalization in the youngest (mean, 20.1 mg [95% CI, 17.1-23.1] vs 13.6 mg [95% CI, 11.4-15.8]; P=.013) and the reference (mean, 18.0 mg [95% CI, 16.5-19.4] vs 12.7 mg [95% CI, 11.4-14]; P<.001) age groups; there was no sex difference among older adults. The benzodiazepine dose during the first 24 hours of hospitalization dose decreased significantly as age increased (21-39 years: mean, 6.64 mg [95% CI, 6.3-7.0]; 40-64 years: mean, 5.8 mg [95% CI, 5.5-6.0]; 65-74 years: mean, 3.76 mg [95% CI, 3.4-4.1]; ≥75 years: mean, 2.79 mg [95% CI, 2.4-3.2]; P<.001 for all groups). There was no sex difference in the all-cause mortality rate, including posthospitalization mortality, among any age group. Conclusion: The results of this study show a narrowing of the traditional sex gap in alcohol withdrawal.
Objective To define the timing and intensity of cardiovascular risk after severe acute respiratory syndrome coronavirus 2 infection across the pre-Delta, Delta, and Omicron eras. Patients and Methods We conducted a population-based retrospective cohort study of 162,471 adults with severe acute respiratory syndrome coronavirus 2 infection from March 1, 2020 to December 31, 2023 using the Rochester Epidemiology Project, a medical records-linkage system covering a 27-county region in Minnesota and Wisconsin. Outcomes included major adverse cardiovascular events, thrombotic events, and dysrhythmias, identified using validated International Classification of Diseases, 10th Revision codes. Cumulative incidence accounted for the competing risk of death, and multivariable Cox regression assessed age- and variant-specific risk. Results Over a median follow-up of 1.9 years (interquartile range, 1.2-2.4 years), 4922 individuals experienced major adverse cardiovascular events. Risk was highest within 30 days after infection and declined thereafter (P<.0001). During this early hazard window, adults aged ≥80 years had substantially higher adjusted risk in the pre-Delta and Delta eras compared with Omicron (pre-Delta hazard ratio, 3.89 [95% CI, 3.17-4.77]; Delta hazard ratio, 2.91 [95% CI, 2.28-3.71]). Thrombotic events showed a similar early, age-dependent pattern, peaking during the pre-Delta and Delta eras. Early dysrhythmia rates rose steeply with age and peaked during the Delta era, exceeding 60 events per 1000 person-months among adults aged ≥80 years. Late dysrhythmia incidence was stable across eras, reflecting persistent age-related risk. Conclusion Cardiovascular events after corona virus disease 2019 infection clustered within the first 30 days, with variation by age and variant era. This early concentration, most pronounced among older adults during the pre-Delta and Delta eras, is supportive of a clinically relevant hazard window while distinguishing observed patterns from causal inference. These findings support targeted, time-sensitive cardiovascular monitoring in higher-risk populations.
Artificial intelligence (AI) and automation are rapidly transforming health care, yet their integration into clinical workflows often falls short owing to technical, ethical, and organizational challenges. Lack of trust emerges as the central hurdle, encompassing both patient and provider confidence in AI systems. Patients raise concerns over safety, transparency, and the physician-patient relationship, whereas providers express apprehension toward algorithmic opacity, data quality and, legal ambiguity. To address these concerns, the understand, transform, and sustain (UTS) framework offers a behavior-based, systems-level approach to AI deployment. Developed by Mayo Clinic’s Quality Academy, UTS integrates process improvement principles across 3 phases, emphasizing stakeholder engagement, transparency and patient safety throughout the AI lifecycle. The understand phase identifies inefficiencies by mapping workflows, collecting data, and recognizing areas for improvement, ensuring developers create tools that address appropriate priorities. In the transform phase, interventions are designed, implemented and tested through improvement cycles and feedback loops. Data to build algorithms is carefully evaluated to avoid biases, and AI output is assessed for opacity risk to maintain transparency and explainability. The sustain phase monitors outcomes and standardizes practices for long-term value. Data audits and automated extraction tools are applied for fidelity and harmonization, promoting scalability and collaboration among organizations. By keeping human intelligence central, UTS represents a catalyst for responsible innovation by aligning technological advancement with clinical priorities. Previous frameworks are more prescriptive in terms of tools and actions; UTS builds on this, targeting the underlying decision-making teams needed for sustainable process improvement, critical for successful health care transformation.
As interest in arts in health care contexts grows, arts practitioners and scholars are pointing to the need for more strategic and sustainable approaches that will enable the continued growth of programming in the future. It is critical not only to identify factors necessary for developing new programming but also to consider how to fully embed services within an institution or system. This case study examines the provision of music services for patients by the Dolores Jean Lavins Center for Humanities in Medicine at Mayo Clinic, Rochester, Minnesota, as one example of how arts programming for patients can be embedded into an institution. Although this case offers a useful example of how programming can be enhanced by aligning with existing structures and refining processes, it also draws attention to the tension between an ideal framework for embedding programming and the challenges that can come from limited resources.
Objective To assess whether simple measures of lifestyle and physical health improve mortality risk prediction in healthy adults and those living with health conditions when added to or substituted for traditional risk factors. Patients and Methods Data were from the UK Biobank (N=407,569; median age, 58 years; May 1, 2006 to September 30, 2022), stratified by sex and health status. The base model included the following: age, smoking status, body mass index, systolic blood pressure (SBP), total cholesterol-to-high-density lipoprotein cholesterol ratio (CHR), and material deprivation. Five simple physical measures (leisure time physical activity; sleep duration; resting heart rate; maximum handgrip strength; and walking pace [WP]) were added to or substituted for traditional risk factors (ie, SBP and CHR), both individually and combined. Model performance was assessed using the C-index and net reclassification index (NRI). Results Replacing both CHR and SBP with all physical measures improved C-index of 0.022 (95% CI, 0.018-0.026) and NRI by 9.6% (95% CI, 6.5%-12.8%) in women living with a health condition. Corresponding values for men were as follows: C-index: 0.024 (95% CI, 0.020-0.027); NRI: 19.0% (95% CI, 16.6%-21.4%). The improvement of C-index was smaller in healthy women (0.006; 95% CI, 0.004-0.007) and men (0.007; 95% CI, 0.006-0.009). WP alone improved risk prediction and classification when replacing CHR and SBP in individuals with a health condition, with a C-index improvement of 0.015 (95% CI, 0.012-0.019) and an NRI of 11.0% (95% CI, 7.4%-14.6%) in women and 0.014 (95% CI, 0.012-0.017) and 14.0% (95% CI, 11.5%-16.5%) in men, respectively. Conclusion Measures of lifestyle and physical health improve mortality prediction and classification and could be used as potential substitutes for traditional clinical factors, particularly in populations with prevalent illness. WP was the strongest individual predictor.
Objective:To investigate the association between sodium-glucose cotransporter-2 inhibitor (SGLT2i) use and the risk of progression to chronic dialysis in nondiabetic adults with autosomal-dominant polycystic kidney disease (ADPKD). Patients and Methods:This retrospective cohort study used the TriNetX Global Collaborative Network to identify nondiabetic adults newly diagnosed with ADPKD since 2018. We performed 1:1 propensity score matching to balance 21 baseline covariates between SGLT2i users and controls. Secondary analyses compared tolvaptan users with matched controls and performed a direct comparison between SGLT2i and tolvaptan. The primary outcome was chronic dialysis initiation, analyzed via Kaplan-Meier and Cox proportional hazards models. Results:After matching, 187 patients were included in each cohort. Dialysis initiation occurred in 19 (10.16%) SGLT2i users vs 43 (22.99%) controls (P<.001). SGLT2i use was associated with a significantly lower risk of progression to dialysis (hazard ratio [HR], 0.35; 95% CI, 0.21-0.61). However, longitudinal data on total kidney volume and genetic markers were unavailable in the data set. Conclusion:Sodium-glucose cotransporter-2 inhibitor therapy was associated with a substantially reduced risk of progressing to dialysis in this real-world nondiabetic ADPKD cohort. Although these findings are promising, prospective randomized trials are essential to confirm these results and to evaluate the longitudinal impact of SGLT2i on cyst growth and total kidney volume.
Objective: To compare the performance of the patient-reported outcomes measurement information system computer adaptive testing-physical function (PROMIS CAT-PF) to the Duke Activity Status Index (DASI) as a potential alternative physical function domain assessment to assist with preoperative risk assessment. Patients and Methods: Patients consisted of a retrospective convenience sample of all adults who had a DASI or PROMIS CAT-PF score obtained from January 1, 2021 to December 31, 2022, within 90 days prior to elective surgery. DASI and PROMIS CAT-PF obtained within one month before a stress test was used to assess the correlation between actual metabolic equivalents attained and the 2 patient-facing questionnaires. To assess the ability to predict adverse outcomes, we used a composite outcome of either death or myocardial injury within 30 days of the surgery. Results: In comparing DASI and PROMIS CAT-PF correlation to actual metabolic equivalents achieved on stress testing, the DASI Spearman’s coefficient of 0.46 (95% CI, 0.32-0.58) was numerically better than the PROMIS CAT-PF Spearman’s coefficient of 0.39 (95% CI, 0.21-0.52); however, the difference was not statistically significant. Using a composite outcome of either death or myocardial injury, DASI (area under the curve of 0.712) and PROMIS CAT-PF (area under the curve of 0.773) reported fair predictive utility. The 2 patient-reported physical function domain scores showed weak correlation (κ=0.509). Conclusion: PROMIS CAT-PF performs as well as DASI, demonstrating a small incremental benefit in predicting adverse postoperative outcomes, and could be an alternative physical function domain assessment used in the preoperative evaluation of patients.
Mavacamten has emerged as an effective therapy for obstructive hypertrophic cardiomyopathy (oHCM); however, interindividual variability in maintenance dosing remains a practical challenge in clinical practice. We conducted a multicenter retrospective study of adults with oHCM treated with mavacamten across 3 tertiary sites to identify baseline predictors of higher maintenance dose requirements. Patients with at least 1-year follow-up and stable dosing for 6 months or more were included and categorized into low-dose (2.5-5 mg) and high-dose (10-15 mg) maintenance groups. Among 77 patients (mean age, 60 years; 50.6% men), 28 required high-dose maintenance therapy. Baseline medial ratio of early diastolic mitral inflow velocity to early diastolic mitral annular velocity (E/e′) was significantly higher in the high-dose group than that in the low-dose group (20.0 vs 16.1; P=.018). On multivariable logistic regression adjusting for left ventricular outflow tract gradient, left ventricular ejection fraction, and global longitudinal strain, medial E/e′ remained independently associated with higher maintenance dose requirement (odds ratio, 1.20; 95% CI, 1.10-1.30; P=.04), whereas other echocardiographic, biomarker, and electrocardiographic parameters were not predictive. These findings suggest that baseline diastolic dysfunction, as reflected by medial E/e′, plays a central role in mavacamten dose trajectory and may help inform individualized titration strategies in patients with oHCM.
Objective: To describe the clinical outcomes of refractory chronic cough (RCC) diagnosis and management at a tertiary care chronic cough clinic. Patients and Methods: This is a prospective study of all eligible patients referred to the Mayo Clinic Chronic Cough Clinic between October 6, 2020 and April 9, 2021. All adult patients aged 18 years or older with cough persisting beyond 8 weeks in accordance with the American College of Chest Physicians definition were screened. Only participants with research authorization and consent were included in this study. Results: A total of 278 patients were screened; 100 patients were enrolled in this study. On the initial visit, 56 patients who were considered to have RCC were invited for a 3-month follow-up survey. Of those 56 patients, electronic health record review clarified that 35 (62%) had etiology-confirmed chronic cough 21 (37%) patients had unexplained chronic cough. Conclusion: This study shows that RCC needs further attentiveness toward diagnosis and trials of therapy to truly ascertain those who have unexplained chronic cough such as at specialized chronic cough centers.
