2 Minute Medicine Rewind September 1, 2025

β-Blocker Use and Health Status Among Patients With Heart Failure With Preserved Ejection Fraction 1. In patients with heart failure with preserved ejection fraction (HFpEF), β-blocker use was not associated with concurrent baseline health status or modification of the health status benefit achieved with spironolactone use at 4 months. Evidence Rating Level: 2 (Good) β-blockers have traditionally been used in the management of HFpEF, yet recent studies have suggested that the use of β-blockers in this patient population may be associated with adverse outcomes such as increased risk of heart failure hospitalization. However, the association between β-blockers and patient health status, including symptoms and quality of life, is not well known. This cohort study therefore sought to investigate the association between β-blockers and heart failure-related health status among patients with HFpEF. 1726 patients (mean[SD] age, 71.6[9.7] years; 50.1% male) from the multinational TOPCAT randomized clinical trial were included in this study. Health status was assessed using the Kansas City Cardiomyopathy Questionnaire overall summary score (KCCQ-OS) including various dimensions such as symptoms, quality of life and physical and social functioning. β-blockers at baseline were not significantly associated with concurrent KCCQ-OS (mean difference, −1.1 points [95% CI, −3.7 to 1.4 points]; P = .38), and was not significantly associated with KCCQ-OS at 4 months (mean difference, −2.0 points [95% CI, −4.8 to 0.8 points]; P = .16). Patients receiving spironolactone who were also receiving concurrent β-blockers experienced greater health status improvement compared to those not taking concurrent β-blockers, yet the difference was not statistically significant (P = .20 for interaction). Overall, this study found that the use of β-blockers in the management of HFpEF was not associated with a better or worse baseline health status, nor was it associated with any modification of the health status benefit achieved with the use of spironolactone after 4 months. Computed Tomographic Angiography and Yield for Gastrointestinal Bleeding in the Emergency Department 1. Between the years 2017 and 2023, the proportion of total computed tomographic angiography (CTA) examinations related to gastrointestinal bleeding (GIB) increased from 0.09% to 0.7%, yet the diagnostic yield dropped dramatically. Evidence Rating Level: 2 (Good) Current guidelines suggest the use of CTA as a first-line diagnostic imaging modality for unstable patients with suspected GIB. However, the use of CTA also creates a significant increase in the radiologist’s workload owing to the complexity of this imaging modality. As such, this cohort study sought to investigate whether the increasing use of CTA is effective in increasing GIB detection or if it is being overused. 954 patients (mean[SD] age, 66.7[6.3] years; 44.8% female) from a quaternary care hospital in the United States were included in this study. The primary outcome of the study was annual GIB-related CTA examination volume. Between 2017 and 2023, the number of GIB-related CTA examinations increased annually by 0.09% (95% CI, 0.07% to 0.12%; P < .001). In this same time period, the test-positive proportion decreased from 20.0% to 6.3% with an annual decrease of -1.60% (95% CI, –2.41% to –0.79%; P = .001). Overall, this study found that the proportion of GIB-related CTA examinations increased dramatically between 2017 and 2023 with an associated drop in diagnostic yield. Long-term Outcomes of Patients with Crohn’s Disease Treated with Risankizumab 1. In adult patients with Crohn’s disease (CD) treated with risankizumab, only 13% of patients experienced treatment failure while 23% of patients required treatment escalation. 2. Treatment failure with risankizumab was associated with penetrating CD Evidence Rating Level: 2 (Good) Risankizumab is a newer therapeutic option approved for the management of CD, with a previous randomized clinical trial demonstrating superior efficacy compared to ustekinumab with regards to endoscopic remission at 48 weeks. However, there is a lack of data from real-world studies regarding the effectiveness of risankizumab. This retrospective cohort study therefore sought to investigate the real-world effectiveness of risankizumab in the management of CD. 106 patients (median[QR] age, 25.5[19-38] years; 50% male) from a single tertiary centre in the United States were included in this study. 13% of patients (14/106) experienced treatment failure, with penetrating CD being found during multivariate analysis to be associated with treatment failure (HR, 5.2; 95% CI, 1.6-17.2; P = .007). 23% of patients (24/106) required treatment escalation, with perianal fistulizing CD (HR, 3.3; 95% CI, 1.2-9.4; P = .023) and prior exposure to more than 2 biologics (HR, 5.8; 95% CI, 1.3-26.3; P = .022) as variables associated with treatment escalation under multivariate analysis. Overall, this study found that risankizumab is an effective treatment option in the management of CD, with few patients experiencing treatment failure. Menin inhibition with revumenib for NPM1-mutated relapsed or refractory acute myeloid leukemia: the AUGMENT-101 study 1. In pretreated patients with nucleophosmin 1-mutated (NPM1m) acute myeloid leukemia (AML), nearly half of patients treated with revumenib showed a clinically meaningful response with an overall response rate (ORR) of 46.9%. Evidence Rating Level: 1 (Excellent) NPM1 is the most common mutation found in adult AML, yet no targeted therapies for paatients with NPM1m AML currently exist. In patients with refractory or relapsed (R/R) NPM1m AML, there is no standard of care and the prognosis of patients in this setting remains poor. Revumenib is a novel agent that was recently approved for the treatment of R/R lysine methyltransferase 2A (KMT2A)-translocated acute leukemia based on data from the phase ½ AUGMENT-101 trial. This study therefore provides primary efficacy data for revumenib in R/R NPM1m AML in the AUGMENT-101 trial. Between October 2021 and September 2024, the first 64 adult patients (median[range] age, 19-84 years; 59.4% female) enrolled in the study were included in the efficacy-evaluable group while 84 patients (median[range] age, 63[11-84] years; 59.5% female) who received at least 1 dose of revumenib and not included in the efficacy-evaluable group comprised the safety population. Patients in the study were heavily pre-treated with 34.5% having received at least 3 previous lines of therapy. The primary efficacy end point was met with the proportion of patients achieving composite complete remission (CRc) being 29.7% (95% CI, 18.9-42.4) and the ORR being 46.9% (95% CI, 34.3-59.8). Four patients (4.8%) required treatment discontinuation due to a treatment-related adverse event. Overall, this study found that among patients with R/R NPM1m AML, revumenib demonstrated a promising efficacy and safetyle profile. Association between serum albumin to creatinine ratio and non-alcoholic fatty liver disease: a longitudinal cohort study in non-obese Chinese individuals 1. In a group of Chinese patients with normal low-density lipoprotein cholesterol (LDL-c), serum albumin to creatinine (sACR) showed an inverse and non-linear relationship with the risk of non-alcoholic fatty liver disease (NAFLD). Evidence Rating Level: 2 (Good) NAFLD has been historically considered to result from obesity, yet the prevalence of this disease among non-obese patients is rising. Serum albumin levels are an important index for clinical assessment of liver function, with previous studies showing that reduced serum albumin levels are associated with a greater severity of NAFLD. Additionally, recent studies have shown associations between NAFLD and the incidence and severity of chronic kidney disease, yet investigations into the utility of sACR as a predictive factor for NAFLD development remain limited. This cohort study therefore sought to investigate the relationship between sACR and NAFLD incidence in Chinese patients with normal LDL-c levels. 14,698 Chinese patients (mean[SD] age, 43.47 ± 15.01 years; 52.29% male) with normal LDL-c levels from a single centre were included in this study. When adjusting for demographic factors and other variables, multivariate analysis using 2 different models showed that for every 1-unit increase in sACR, there was a reduction in the risk of NAFLD by 2.9% (HR = 0.971, 95%CI 0.967–0.975) and 3.3% (HR = 0.967, 95%CI 0.963–0.972) for models 1 and 2 respectively. This relationship was found to be nonlinear, with recursive algorithm analysis identifying an inflection point corresponding to an sACR value of 44.675 indicating a greater protective association beyond this value. Overall, this study found that among Chinese patients with a normal LDL-c level, sACR showed an inverse and non-linear relationship with NAFLD occurrence. Image: PD