Internal Medicine

PREVENT CVD equations perform well in large EHR cohort, even with missing data

In >400,000 adults without baseline CVD, PREVENT equations showed strong 5-year discrimination in both complete and missing-data EHR cohorts (C-index ~0.75–0.77). Allowing missing laboratory and vital signs with race-sex median imputation did not materially degrade discrimination compared with complete-case data. Calibration ratios suggested greater risk underestimation in patients with complete data, indicating potential need for local recalibration in some settings. Locally retrained Cox and machine-learning models were compared with recalibrated PREVENT, supporting system-level choices about adopting vs adapting PREVENT scores. 1

GLP-1 RA and SGLT2 inhibitor use rose sharply with persistent inequities and higher costs

From 2017 to 2023, national GLP-1 RA/SGLT2 inhibitor use rose more than tenfold overall and among adults with approved indications. Blacks, Hispanics, lower-income and less-educated adults, publicly insured and uninsured patients were significantly less likely to receive these agents. Per-prescription spending increased by nearly 50%, suggesting growing financial barriers despite expanding indications and use. Off-label use declined from 27% to 12%, but remained more common among women and less common among racial and educationally disadvantaged groups. 2

Hepatologist-delivered primary palliative care is noninferior to specialist care in ESLD

In 935 patients with decompensated cirrhosis or hepatocellular carcinoma, structured palliative care improved QoL at 3 months in both trial arms. Hepatologists received primary palliative care training and delivered four checklist-based visits, compared with traditional specialist palliative care consultation. QoL gains were similar between groups, and noninferiority of hepatologist-delivered care versus specialist care was met on the FACT-Hep score. Symptom burden, distress, depression, satisfaction, and mortality changes were comparable, supporting integration of primary palliative care within hepatology practices. 3

Higher ischemic stroke severity predicts steeper cognitive decline and greater dementia risk

Across 42,342 adults followed a median 11.1 years, incident ischemic stroke substantially increased dementia risk versus no stroke. Dementia hazard rose progressively with baseline NIHSS severity, from nearly doubled risk with minor stroke to >5-fold risk with NIHSS ≥11. Higher stroke severity was associated with dose-dependent, steeper declines in global cognition, memory, and executive function compared with no stroke. These findings underscore the importance of aggressive vascular risk control and long-term cognitive monitoring after stroke, especially for more severe events. 4