Yusuke Tsugawa

Percutaneous microaxial ventricular assist devices (pVAD) have the potential to reduce mortality of patients with cardiogenic shock (CS). However, the association between the distribution of pVAD-performing centers and outcomes of CS has not been explored.

This observational study included Medicare fee-for-service beneficiaries aged 65–99 years treated with pVAD for CS from 2016 to 2020 and examined the associations between patient outcomes and two exposure variables: hospitals’ procedure volumes of pVAD and patient-hospital distances.

Researchers developed Cox proportional hazard regression for 180-day mortality and heart failure (HF) readmission rates and multivariable logistic regression for in-hospital outcomes, adjusting for patient demographics, comorbidities, concomitant treatments, and hospital characteristics, including CS volume, teaching status, and the ability to perform extracorporeal membrane oxygenation.

Findings: A total of 6,637 patients with CS underwent pVAD at 1,041 hospitals, with the annualized hospital volume ranging widely from 0.3 to 55.6 cases/year. Patients treated at higher-volume centers experienced lower 180-day mortality compared with patients treated at lower-volume centers. The study found no evidence that patient-hospital distances were associated with mortality.

Researchers found no evidence that the hospital volume and patient-hospital distances were associated with in-hospital bleeding, intracranial hemorrhage, or renal replacement therapy initiation. Hospital volume was more strongly associated with mortality than patient-hospital distances, suggesting that rational distribution of pVAD-performing centers while ensuring adequate procedure volumes may optimize patient mortality.
 

Authors investigate health insurance-generated improvements in cardiovascular risk factors (blood pressure and hemoglobin levels) for identifiable subpopulations and use machine learning to identify characteristics of people predicted to most benefit.

The researchers studied Medicaid insurance coverage in 2008 for adults on low incomes (defined as lower than the federal-defined poverty line) in Oregon who were uninsured, including 12,134 participants from the Oregon Health Insurance Experiment with in-person data for health outcomes for both treatment and control groups.

Findings: Although Medicaid coverage did not improve cardiovascular risk factors on average, substantial heterogeneity was noted in the effects within that population. Individuals with high predicted benefits were more likely to have no or low prior health care charges. Findings suggest that Medicaid coverage leads to improved cardiovascular risk factors for some, particularly for blood pressure, although those benefits may be diluted by individuals who did not experience benefits.

A recent analysis of health insurance effects in the U.S. reveals that while average health improvements are inconsistent, certain subgroups experience significant benefits. Although the Affordable Care Act reduced the uninsured rate from 46.5 million in 2010 to 25.6 million in 2022, many still face access challenges. The Oregon Health Insurance Experiment showed that while Medicaid improved access and reduced financial risk, its impact on physical health was mixed.

A better understanding of the range of effects of policy changes can help tailor health care interventions to meet diverse patient needs and can allow policymakers to design programs that make the most of limited resources.

 

The pharynx is one of the few areas in the body where blood vessels and immune tissues can readily be observed from outside the body noninvasively. Although prior studies have found that sex could be identified from retinal images using artificial intelligence, it remains unknown as to whether individuals’ sex could also be identified using pharyngeal images. Demographic information and pharyngeal images were collected from patients who visited 64 primary care clinics in Japan for influenza-like symptoms. Authors trained a deep learning-based classification model to predict reported sex, which incorporated a multiple instance convolutional neural network, on 20,319 images from 51 clinics.

Findings: The study demonstrated the potential utility of pharyngeal images as a new modality in medical imaging by identifying reported sex from pharyngeal images using deep learning. Authors discovered that the algorithm focuses on the posterior pharyngeal wall and the uvula. This approach allowed authors to provide quantitative insights into the differences between males and females in the uvula and posterior wall.