Tobacco Abstinence

Providers can offer a helpful impact to patients in their journey to quit tobacco use, according to a recent randomized trial. The study found that a best practice advisory message to providers through the electronic health record to curb tobacco use was more than twice as effective at leading to patient smoking cessation engagement as simply reminding patients to quit during a visit or trying to send messages to patients directly.

In the same study, “Advanced practice providers did a better job initiating tobacco use treatment than physicians,” expounded Daniel Croft, MD, MPH, ATSF, assistant professor of pulmonary diseases and critical care, and environmental medicine at the University of Rochester Medical Center. “Physicians have some catching up to do.”

Researchers also found that adaptive trial design is nearly three times more effective in achieving patient smoking cessation than conventional trials designed for biochemically verified 30-day smoking abstinence over 12 weeks.

Another study’s results found that cytisinicline could be an effective treatment to help patients achieve tobacco abstinence. Both 12- and 6-week regimens of cytisinicline led to higher rates of smoking abstinence than placebo. Cytisinicline is currently sold over the counter for smoking cessation in Europe.

Extracorporeal Membrane Oxygenation

Extracorporeal membrane oxygenation (ECMO) does not decrease mortality in patients with planned percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) revascularization with cardiogenic shock.

“Extracorporeal life support (ECLS) did not decrease the risk of death from any cause within 30 days,” said Tai Pham, MD PhD, MPH, professor of respiratory medicine at Hôpitau Universitaires Paris-Saclay, Paris, France. “But we did see more complications in the ECLS group.”

Other data showed that extracorporeal CPR was no better than standard CPR in decreasing mortality following out-of-hospital cardiac arrest. Patients’ survival rates with favorable neurologic outcomes were also similar between extracorporeal and standard CPR.

The PRONECMO trial studying patients with severe acute respiratory distress syndrome (ARDS) found that prone positioning did not improve ECMO outcomes compared with supine positioning. Both groups showed 44 percent successful ECMO weaning by 60 days.

The ECMObesity trial quelled concerns that obesity may be a contraindication to ECMO. Patients with obesity (BMI>30) exhibited lower mortality rates than patients without obesity. Additional sensitivity analyses confirmed this conclusion.

Pulmonary Vascular Disease

Multiple guidelines recommend utilizing multi-component risk scores to guide therapy, which suggests that risk scores could serve as pragmatic surrogate endpoints in pulmonary arterial hypertension (PAH) trials. However, a meta-analysis of three FDA trials and over 2,500 patients showed weak to moderate evidence supporting their use as surrogate endpoints.

“These scores remain useful to predict long-term survival,” said Silvia Ulrich, MD, PhD, professor of internal and respiratory medicine, and director of pulmonology at the University Hospital Zurich, Zurich, Switzerland. “But the data questions their use as an endpoint in future clinical trials.”

Sotatercept, an activin signaling inhibitor, showed high efficacy in improving six-minute walk distance and other health outcomes in PAH but did not improve overall cardiac output. A post hoc analysis of the STELLAR study found that sotatercept reduced pulmonary artery pressure and right heart size while improving right ventricle function and hemodynamics.

Sleep Medicine

The ADVENT-HF trial found that adaptive servo-ventilation is not better than guideline-based medical treatment for patients with heart failure with reduced ejection fraction (HFrEF).

“There was a modest improvement in quality of life for both obstructive and central sleep apnea, but there was no difference in mortality or morbidity.,” said Alejandra C. Lastra, MD, associate professor of pulmonary and critical care at the University of Chicago Sleep Center.

MARIPOSA showed benefits for using aroxybutynin and atomoxetine to treat obstructive sleep apnea (OSA). Presenters noted that long-term data are still pending.

Another recent sleep medicine study found that CPAP can reduce the risk of cardiovascular events, but only if patients use their device. A subgroup of patients who regularly used their CPAP as intended had a 45 percent reduction in cardiovascular risk.

Clinicians can expect patients to ask about tirzepatide, part of a growing class of GLP-1 receptor agonists, for OSA. Topline data released by the manufacturer showed a 63 percent reduction in Apnea-Hypopnea Index (AHI) levels, but peer-reviewed trial results have not been published.