Preventive Medicine

System-level, multi-component interventions increase uptake of breast cancer preventive medications

This systematic review of 15 studies found educational and decision-aid interventions improved knowledge but produced only modest uptake increases for SERMs and AIs. Combining education with personalized risk assessment (for example, polygenic risk scores) tended to yield greater uptake than education alone. A holistic, system-level intervention that integrated clinician counseling and proactive prescribing achieved substantial uptake and adherence. Apply multi-level, tailored strategies rather than single-component patient education when aiming to increase preventive-medication use. 1

Guideline handbooks rarely advise on incorporating prediction models

Scoping review of 84 guideline development documents found only eight (10.5%) mention prediction model guidance. Existing guidance addressed searching, selection, and critical appraisal but provided no criteria for model performance or choosing between models. Guideline developers currently lack standardized methods for integrating prediction models into recommendations. Be cautious adopting model-based guidance; guideline methodology groups should require transparent model performance and comparison metrics. 2

ICM-based, nurse-managed diuretic strategy safe but did not improve 60-day HF outcomes

The ALLEVIATE-HF randomized trial (n=711) showed no significant difference in the 60-day composite primary outcome (win ratio 0.79; P=0.06). Serious adverse events were rare (0.32%), supporting the safety of the tested implementation. Cumulative cardiovascular events were numerically higher in the intervention arm (HR 1.43; P=0.091), though not statistically definitive. Do not adopt ICM-triggered, centrally managed diuretic protocols for short-term HF outcome improvement without further supportive evidence. 3