Key clinical point: Loss of bone mineral density (BMD) was lower in patients with rheumatoid arthritis (RA) who achieved remission, indicating an important role of treat-to-target therapy in RA, with female sex being a risk factor and low disease activity and bisphosphonate therapy being protective factors.

Major finding: Patients achieving remission had less yearly BMD loss in the lumbar spine (P = .036). Female sex was a risk factor (P = .016), whereas low disease activity (P = .001) and bisphosphonate treatment (P < .001) were protective factors for BMD loss in patients with RA.

Study details: The data comes from a prospective, observational cohort including 268 patients with RA.

Disclosures: This study was supported by the National Natural Science Foundation of China and Peking University Health Science Center. The authors declared no conflicts of interest.

Source: Huang H et al. Impact of treat-to-target therapy on bone mineral density loss in patients with rheumatoid arthritis: A prospective cohort study. Front Endocrinol. 2022;13:867610 (May 17). Doi: 10.3389/fendo.2022.867610

Key clinical point: Loss of bone mineral density (BMD) was lower in patients with rheumatoid arthritis (RA) who achieved remission, indicating an important role of treat-to-target therapy in RA, with female sex being a risk factor and low disease activity and bisphosphonate therapy being protective factors.

Major finding: Patients achieving remission had less yearly BMD loss in the lumbar spine (P = .036). Female sex was a risk factor (P = .016), whereas low disease activity (P = .001) and bisphosphonate treatment (P < .001) were protective factors for BMD loss in patients with RA.

Study details: The data comes from a prospective, observational cohort including 268 patients with RA.

Disclosures: This study was supported by the National Natural Science Foundation of China and Peking University Health Science Center. The authors declared no conflicts of interest.

Source: Huang H et al. Impact of treat-to-target therapy on bone mineral density loss in patients with rheumatoid arthritis: A prospective cohort study. Front Endocrinol. 2022;13:867610 (May 17). Doi: 10.3389/fendo.2022.867610

Key clinical point: Loss of bone mineral density (BMD) was lower in patients with rheumatoid arthritis (RA) who achieved remission, indicating an important role of treat-to-target therapy in RA, with female sex being a risk factor and low disease activity and bisphosphonate therapy being protective factors.

Major finding: Patients achieving remission had less yearly BMD loss in the lumbar spine (P = .036). Female sex was a risk factor (P = .016), whereas low disease activity (P = .001) and bisphosphonate treatment (P < .001) were protective factors for BMD loss in patients with RA.

Study details: The data comes from a prospective, observational cohort including 268 patients with RA.

Disclosures: This study was supported by the National Natural Science Foundation of China and Peking University Health Science Center. The authors declared no conflicts of interest.

Source: Huang H et al. Impact of treat-to-target therapy on bone mineral density loss in patients with rheumatoid arthritis: A prospective cohort study. Front Endocrinol. 2022;13:867610 (May 17). Doi: 10.3389/fendo.2022.867610

Key clinical point: Patients with anticitrullinated peptide antibody (ACPA)-positive and ACPA-negative rheumatoid arthritis (RA) show different magnetic resonance imaging-detected joint inflammation trajectories based on the sustained disease-modifying antirheumatic drug (DMARD)-free remission (SDFR) status.

Major finding: Patients with ACPA-positive RA who achieved vs. did not achieve SDFR had lower inflammation levels at disease presentation and subsequent follow-up (P = .02). However, although all patients with ACPA-negative RA had similar inflammation levels at disease presentation, those who achieved vs. did not achieve SDFR had significantly lower inflammation levels in the first year of DMARD treatment (P < .01).

Study details: This study included 198 patients with RA (ACPA-positive [n = 104] and ACPA-negative [n = 94]) treated with DMARD and 174 patients with ACPA-positive RA from the AVERT-1 trial.

Disclosures: The study was funded by the Dutch Arthritis Foundation and the European Research Council. TWJ Huizinga reported receiving research support, lecture fees, and consulting fees from various sources. Two authors reported being shareholders and employees of Bristol Myers Squibb.

Source: Verstappen M et al. ACPA-negative and ACPA-positive RA patients achieving disease resolution demonstrate distinct patterns of MRI-detected joint-inflammation. Rheumatology (Oxford). 2022 (May 18). Doi: 10.1093/rheumatology/keac294

Key clinical point: Patients with anticitrullinated peptide antibody (ACPA)-positive and ACPA-negative rheumatoid arthritis (RA) show different magnetic resonance imaging-detected joint inflammation trajectories based on the sustained disease-modifying antirheumatic drug (DMARD)-free remission (SDFR) status.

Major finding: Patients with ACPA-positive RA who achieved vs. did not achieve SDFR had lower inflammation levels at disease presentation and subsequent follow-up (P = .02). However, although all patients with ACPA-negative RA had similar inflammation levels at disease presentation, those who achieved vs. did not achieve SDFR had significantly lower inflammation levels in the first year of DMARD treatment (P < .01).

Study details: This study included 198 patients with RA (ACPA-positive [n = 104] and ACPA-negative [n = 94]) treated with DMARD and 174 patients with ACPA-positive RA from the AVERT-1 trial.

Disclosures: The study was funded by the Dutch Arthritis Foundation and the European Research Council. TWJ Huizinga reported receiving research support, lecture fees, and consulting fees from various sources. Two authors reported being shareholders and employees of Bristol Myers Squibb.

Source: Verstappen M et al. ACPA-negative and ACPA-positive RA patients achieving disease resolution demonstrate distinct patterns of MRI-detected joint-inflammation. Rheumatology (Oxford). 2022 (May 18). Doi: 10.1093/rheumatology/keac294

Key clinical point: Patients with anticitrullinated peptide antibody (ACPA)-positive and ACPA-negative rheumatoid arthritis (RA) show different magnetic resonance imaging-detected joint inflammation trajectories based on the sustained disease-modifying antirheumatic drug (DMARD)-free remission (SDFR) status.

Major finding: Patients with ACPA-positive RA who achieved vs. did not achieve SDFR had lower inflammation levels at disease presentation and subsequent follow-up (P = .02). However, although all patients with ACPA-negative RA had similar inflammation levels at disease presentation, those who achieved vs. did not achieve SDFR had significantly lower inflammation levels in the first year of DMARD treatment (P < .01).

Study details: This study included 198 patients with RA (ACPA-positive [n = 104] and ACPA-negative [n = 94]) treated with DMARD and 174 patients with ACPA-positive RA from the AVERT-1 trial.

Disclosures: The study was funded by the Dutch Arthritis Foundation and the European Research Council. TWJ Huizinga reported receiving research support, lecture fees, and consulting fees from various sources. Two authors reported being shareholders and employees of Bristol Myers Squibb.

Source: Verstappen M et al. ACPA-negative and ACPA-positive RA patients achieving disease resolution demonstrate distinct patterns of MRI-detected joint-inflammation. Rheumatology (Oxford). 2022 (May 18). Doi: 10.1093/rheumatology/keac294

Key clinical point: Methotrexate reduced the risk for overall mortality in rheumatoid arthritis (RA), particularly mortality from RA with cardiovascular diseases and RA-associated interstitial lung diseases.

Major finding: Methotrexate significantly reduced risk for overall mortality by 41% (hazard ratio [HR] 0.59; P < .001), mortality from RA with cardiovascular disease by 28% (HR 0.72; P = .031), and mortality from RA-associated interstitial lung diseases by 56% (HR 0.44; P = .037).

Study details: Findings are from a meta-analysis of 15 cohort studies involving 69,914 participants.

Disclosures: The study was supported by grants from the National Natural Science Foundation of China and others. The authors declared no conflicts of interest.

Source: Xu J et al. Methotrexate use reduces mortality risk in rheumatoid arthritis: A systematic review and meta-analysis of cohort studies. Semin Arthritis Rheum. 2022;55:152031 (Jun 4). Doi: 10.1016/j.semarthrit.2022.152031

Key clinical point: Methotrexate reduced the risk for overall mortality in rheumatoid arthritis (RA), particularly mortality from RA with cardiovascular diseases and RA-associated interstitial lung diseases.

Major finding: Methotrexate significantly reduced risk for overall mortality by 41% (hazard ratio [HR] 0.59; P < .001), mortality from RA with cardiovascular disease by 28% (HR 0.72; P = .031), and mortality from RA-associated interstitial lung diseases by 56% (HR 0.44; P = .037).

Study details: Findings are from a meta-analysis of 15 cohort studies involving 69,914 participants.

Disclosures: The study was supported by grants from the National Natural Science Foundation of China and others. The authors declared no conflicts of interest.

Source: Xu J et al. Methotrexate use reduces mortality risk in rheumatoid arthritis: A systematic review and meta-analysis of cohort studies. Semin Arthritis Rheum. 2022;55:152031 (Jun 4). Doi: 10.1016/j.semarthrit.2022.152031

Key clinical point: Methotrexate reduced the risk for overall mortality in rheumatoid arthritis (RA), particularly mortality from RA with cardiovascular diseases and RA-associated interstitial lung diseases.

Major finding: Methotrexate significantly reduced risk for overall mortality by 41% (hazard ratio [HR] 0.59; P < .001), mortality from RA with cardiovascular disease by 28% (HR 0.72; P = .031), and mortality from RA-associated interstitial lung diseases by 56% (HR 0.44; P = .037).

Study details: Findings are from a meta-analysis of 15 cohort studies involving 69,914 participants.

Disclosures: The study was supported by grants from the National Natural Science Foundation of China and others. The authors declared no conflicts of interest.

Source: Xu J et al. Methotrexate use reduces mortality risk in rheumatoid arthritis: A systematic review and meta-analysis of cohort studies. Semin Arthritis Rheum. 2022;55:152031 (Jun 4). Doi: 10.1016/j.semarthrit.2022.152031

Key clinical point: Genetic liability to rheumatoid arthritis (RA) was positively associated with the risk for coronary artery disease (CAD) and intracerebral hemorrhage (IA), with the high levels of C-reactive protein (CRP) appearing to mediate the association with CAD.

Major finding: Each unit increase in log odds of RA increased the risk for CAD (combined odds ratio [cOR] 1.02; P = .003) and IA (cOR 1.05; P = .001), with the levels of genetically predicted CRP influencing the risk association between RA and CAD (adjusted cOR 1.01; P = .268).

Study details: This was a two-sample Mendelian randomization study that selected 70 single nucleotide polymorphisms strongly associated with RA from a genome-wide association meta-analysis including 14,361 patients with RA and 43,923 control individuals.

Disclosures: The study was supported by research grants from Swedish Heart-Lung Foundation, the Swedish Research Council for Health, and others. The authors declared no conflicts of interest.

Source: Yuan S et al. Genetic liability to rheumatoid arthritis in relation to coronary artery disease and stroke risk. Arthritis Rheumatol. 2022 (May 18). Doi: 10.1002/art.42239

Key clinical point: Genetic liability to rheumatoid arthritis (RA) was positively associated with the risk for coronary artery disease (CAD) and intracerebral hemorrhage (IA), with the high levels of C-reactive protein (CRP) appearing to mediate the association with CAD.

Major finding: Each unit increase in log odds of RA increased the risk for CAD (combined odds ratio [cOR] 1.02; P = .003) and IA (cOR 1.05; P = .001), with the levels of genetically predicted CRP influencing the risk association between RA and CAD (adjusted cOR 1.01; P = .268).

Study details: This was a two-sample Mendelian randomization study that selected 70 single nucleotide polymorphisms strongly associated with RA from a genome-wide association meta-analysis including 14,361 patients with RA and 43,923 control individuals.

Disclosures: The study was supported by research grants from Swedish Heart-Lung Foundation, the Swedish Research Council for Health, and others. The authors declared no conflicts of interest.

Source: Yuan S et al. Genetic liability to rheumatoid arthritis in relation to coronary artery disease and stroke risk. Arthritis Rheumatol. 2022 (May 18). Doi: 10.1002/art.42239

Key clinical point: Genetic liability to rheumatoid arthritis (RA) was positively associated with the risk for coronary artery disease (CAD) and intracerebral hemorrhage (IA), with the high levels of C-reactive protein (CRP) appearing to mediate the association with CAD.

Major finding: Each unit increase in log odds of RA increased the risk for CAD (combined odds ratio [cOR] 1.02; P = .003) and IA (cOR 1.05; P = .001), with the levels of genetically predicted CRP influencing the risk association between RA and CAD (adjusted cOR 1.01; P = .268).

Study details: This was a two-sample Mendelian randomization study that selected 70 single nucleotide polymorphisms strongly associated with RA from a genome-wide association meta-analysis including 14,361 patients with RA and 43,923 control individuals.

Disclosures: The study was supported by research grants from Swedish Heart-Lung Foundation, the Swedish Research Council for Health, and others. The authors declared no conflicts of interest.

Source: Yuan S et al. Genetic liability to rheumatoid arthritis in relation to coronary artery disease and stroke risk. Arthritis Rheumatol. 2022 (May 18). Doi: 10.1002/art.42239

Key clinical point: This real-world study found no evidence of increased risk for malignancy in patients with rheumatoid arthritis (RA) who initiated tofacitinib vs. tumor necrosis factor inhibitors (TNFi).

Major finding: The risk for cumulative malignancies in patients who initiated tofacitinib vs. TNFi was not higher in the real-world evidence (RWE) cohort (pooled weighted hazard ratio [pwHR] 1.01; 95% CI 0.83-1.22), but was numerically higher in the randomized controlled trial (RCT)-duplicate cohort of patients aged ≥50 years with at least one cardiovascular risk factor (pwHR 1.17; 95% CI 0.85-1.62).

Study details: This was a population-based observational, STAR-RA, study including 83,295 patients in the RWE cohort and 27,035 patients in the RCT-duplicate cohort who initiated tofacitinib or TNFi.

Disclosures: The study was supported by the Brigham and Women’s Hospital & Harvard Medical School (BWHHMS). SC Kim and RJ Desai reported receiving research grants to BWHHMS from various sources.

Source: Khosrow-Khavar F et al. Tofacitinib and risk of malignancy: Results from the Safety of TofAcitinib in Routine care patients with Rheumatoid Arthritis (STAR-RA) Study. Arthritis Rheumatol. 2022 (May 29). Doi: 10.1002/art.42250

Key clinical point: This real-world study found no evidence of increased risk for malignancy in patients with rheumatoid arthritis (RA) who initiated tofacitinib vs. tumor necrosis factor inhibitors (TNFi).

Major finding: The risk for cumulative malignancies in patients who initiated tofacitinib vs. TNFi was not higher in the real-world evidence (RWE) cohort (pooled weighted hazard ratio [pwHR] 1.01; 95% CI 0.83-1.22), but was numerically higher in the randomized controlled trial (RCT)-duplicate cohort of patients aged ≥50 years with at least one cardiovascular risk factor (pwHR 1.17; 95% CI 0.85-1.62).

Study details: This was a population-based observational, STAR-RA, study including 83,295 patients in the RWE cohort and 27,035 patients in the RCT-duplicate cohort who initiated tofacitinib or TNFi.

Disclosures: The study was supported by the Brigham and Women’s Hospital & Harvard Medical School (BWHHMS). SC Kim and RJ Desai reported receiving research grants to BWHHMS from various sources.

Source: Khosrow-Khavar F et al. Tofacitinib and risk of malignancy: Results from the Safety of TofAcitinib in Routine care patients with Rheumatoid Arthritis (STAR-RA) Study. Arthritis Rheumatol. 2022 (May 29). Doi: 10.1002/art.42250

Key clinical point: This real-world study found no evidence of increased risk for malignancy in patients with rheumatoid arthritis (RA) who initiated tofacitinib vs. tumor necrosis factor inhibitors (TNFi).

Major finding: The risk for cumulative malignancies in patients who initiated tofacitinib vs. TNFi was not higher in the real-world evidence (RWE) cohort (pooled weighted hazard ratio [pwHR] 1.01; 95% CI 0.83-1.22), but was numerically higher in the randomized controlled trial (RCT)-duplicate cohort of patients aged ≥50 years with at least one cardiovascular risk factor (pwHR 1.17; 95% CI 0.85-1.62).

Study details: This was a population-based observational, STAR-RA, study including 83,295 patients in the RWE cohort and 27,035 patients in the RCT-duplicate cohort who initiated tofacitinib or TNFi.

Disclosures: The study was supported by the Brigham and Women’s Hospital & Harvard Medical School (BWHHMS). SC Kim and RJ Desai reported receiving research grants to BWHHMS from various sources.

Source: Khosrow-Khavar F et al. Tofacitinib and risk of malignancy: Results from the Safety of TofAcitinib in Routine care patients with Rheumatoid Arthritis (STAR-RA) Study. Arthritis Rheumatol. 2022 (May 29). Doi: 10.1002/art.42250

Key clinical point: Reduced doses of rituximab can be considered in patients with rheumatoid arthritis (RA) who have had treatment failure with multiple biologic disease-modifying antirheumatic drugs (bDMARD), significant comorbidities, and an initial sustained clinical response.

Major finding: Over a 60-month follow-up, only 7.5% and 5.9% of patients relapsed on low-dose and standard-dose rituximab, respectively (P = .6), with patients on low-dose vs. standard-dose rituximab having significantly lower rates of serious adverse events (incidence rate: 0.77 vs. 1.57 per 1000 person-years; P < .0001) and drug discontinuation due to treatment failure (37.9% vs. 63.6%; P < .0001).

Study details: This was a prospective, observational study including 361 patients with established RA and prior failure using bDMARD who received low-dose (n = 81) or standard-dose (n  =280) rituximab.

Disclosures: The study was partly supported by the Pancretan Health Association. The authors declared no conflicts of interest.

Source: Bertsias A et al. Rheumatoid arthritis patients initiating rituximab with low number of previous bDMARDs failures may effectively reduce rituximab dose and experience fewer serious adverse events than patients on full dose: A 5-year cohort study. Arthritis Res Ther. 2022;24:132 (Jun 2). Doi: 10.1186/s13075-022-02826-6

Key clinical point: Reduced doses of rituximab can be considered in patients with rheumatoid arthritis (RA) who have had treatment failure with multiple biologic disease-modifying antirheumatic drugs (bDMARD), significant comorbidities, and an initial sustained clinical response.

Major finding: Over a 60-month follow-up, only 7.5% and 5.9% of patients relapsed on low-dose and standard-dose rituximab, respectively (P = .6), with patients on low-dose vs. standard-dose rituximab having significantly lower rates of serious adverse events (incidence rate: 0.77 vs. 1.57 per 1000 person-years; P < .0001) and drug discontinuation due to treatment failure (37.9% vs. 63.6%; P < .0001).

Study details: This was a prospective, observational study including 361 patients with established RA and prior failure using bDMARD who received low-dose (n = 81) or standard-dose (n  =280) rituximab.

Disclosures: The study was partly supported by the Pancretan Health Association. The authors declared no conflicts of interest.

Source: Bertsias A et al. Rheumatoid arthritis patients initiating rituximab with low number of previous bDMARDs failures may effectively reduce rituximab dose and experience fewer serious adverse events than patients on full dose: A 5-year cohort study. Arthritis Res Ther. 2022;24:132 (Jun 2). Doi: 10.1186/s13075-022-02826-6

Key clinical point: Reduced doses of rituximab can be considered in patients with rheumatoid arthritis (RA) who have had treatment failure with multiple biologic disease-modifying antirheumatic drugs (bDMARD), significant comorbidities, and an initial sustained clinical response.

Major finding: Over a 60-month follow-up, only 7.5% and 5.9% of patients relapsed on low-dose and standard-dose rituximab, respectively (P = .6), with patients on low-dose vs. standard-dose rituximab having significantly lower rates of serious adverse events (incidence rate: 0.77 vs. 1.57 per 1000 person-years; P < .0001) and drug discontinuation due to treatment failure (37.9% vs. 63.6%; P < .0001).

Study details: This was a prospective, observational study including 361 patients with established RA and prior failure using bDMARD who received low-dose (n = 81) or standard-dose (n  =280) rituximab.

Disclosures: The study was partly supported by the Pancretan Health Association. The authors declared no conflicts of interest.

Source: Bertsias A et al. Rheumatoid arthritis patients initiating rituximab with low number of previous bDMARDs failures may effectively reduce rituximab dose and experience fewer serious adverse events than patients on full dose: A 5-year cohort study. Arthritis Res Ther. 2022;24:132 (Jun 2). Doi: 10.1186/s13075-022-02826-6

Key clinical point: Obefazimod (ABX464) at a dose of 50 mg showed promising efficacy and was safe and well-tolerated in patients with moderate-to-severely active rheumatoid arthritis (RA).

Major finding: A dose of 50 mg ABX464 vs. placebo was associated with numerically more severe adverse events (14.3% vs. 5%) but with no malignancies, opportunistic infections, or deaths, and a significant reduction in the Disease Activity Score 28-C reactive protein (−1.41 vs. −0.60; P = .043) and Clinical Disease Activity Index Score (−15.8 vs. −6.9; P = .020) at week 12.

Study details: This was a phase 2 trial including 60 patients with moderate-to-severely active RA and inadequate response to methotrexate or anti-tumor necrosis factor alpha therapy who were randomly assigned to ABX464 or placebo in combination with methotrexate for 12 weeks.

Disclosures: The study was supported by Abivax. C Daien reported receiving consulting fees, punctual links, or research grants from Abivax and other sources. Ten authors reported being current/former employees or investigators contracted by Abivax.

Source: Daien C et al. Safety and efficacy of the miR-124 upregulator ABX464 (obefazimod, 50 and 100 mg per day) in patients with active rheumatoid arthritis and inadequate response to methotrexate and/or anti-TNFα therapy: A placebo-controlled phase II study. Ann Rheum Dis. 2022 (May 31). Doi: 10.1136/annrheumdis-2022-222228

Key clinical point: Obefazimod (ABX464) at a dose of 50 mg showed promising efficacy and was safe and well-tolerated in patients with moderate-to-severely active rheumatoid arthritis (RA).

Major finding: A dose of 50 mg ABX464 vs. placebo was associated with numerically more severe adverse events (14.3% vs. 5%) but with no malignancies, opportunistic infections, or deaths, and a significant reduction in the Disease Activity Score 28-C reactive protein (−1.41 vs. −0.60; P = .043) and Clinical Disease Activity Index Score (−15.8 vs. −6.9; P = .020) at week 12.

Study details: This was a phase 2 trial including 60 patients with moderate-to-severely active RA and inadequate response to methotrexate or anti-tumor necrosis factor alpha therapy who were randomly assigned to ABX464 or placebo in combination with methotrexate for 12 weeks.

Disclosures: The study was supported by Abivax. C Daien reported receiving consulting fees, punctual links, or research grants from Abivax and other sources. Ten authors reported being current/former employees or investigators contracted by Abivax.

Source: Daien C et al. Safety and efficacy of the miR-124 upregulator ABX464 (obefazimod, 50 and 100 mg per day) in patients with active rheumatoid arthritis and inadequate response to methotrexate and/or anti-TNFα therapy: A placebo-controlled phase II study. Ann Rheum Dis. 2022 (May 31). Doi: 10.1136/annrheumdis-2022-222228

Key clinical point: Obefazimod (ABX464) at a dose of 50 mg showed promising efficacy and was safe and well-tolerated in patients with moderate-to-severely active rheumatoid arthritis (RA).

Major finding: A dose of 50 mg ABX464 vs. placebo was associated with numerically more severe adverse events (14.3% vs. 5%) but with no malignancies, opportunistic infections, or deaths, and a significant reduction in the Disease Activity Score 28-C reactive protein (−1.41 vs. −0.60; P = .043) and Clinical Disease Activity Index Score (−15.8 vs. −6.9; P = .020) at week 12.

Study details: This was a phase 2 trial including 60 patients with moderate-to-severely active RA and inadequate response to methotrexate or anti-tumor necrosis factor alpha therapy who were randomly assigned to ABX464 or placebo in combination with methotrexate for 12 weeks.

Disclosures: The study was supported by Abivax. C Daien reported receiving consulting fees, punctual links, or research grants from Abivax and other sources. Ten authors reported being current/former employees or investigators contracted by Abivax.

Source: Daien C et al. Safety and efficacy of the miR-124 upregulator ABX464 (obefazimod, 50 and 100 mg per day) in patients with active rheumatoid arthritis and inadequate response to methotrexate and/or anti-TNFα therapy: A placebo-controlled phase II study. Ann Rheum Dis. 2022 (May 31). Doi: 10.1136/annrheumdis-2022-222228

Key clinical point: A dose of 5 or 10 mg tofacitinib twice daily improved clinical efficacy outcomes compared with placebo in patients with moderate-to-severe rheumatoid arthritis (RA) regardless of baseline body mass index (BMI).

Major finding: The American College of Rheumatology 20/50/70 response rates at 6 months were significantly higher in patients who received 5 or 10 mg tofacitinib vs. placebo (P < .05) and were comparable across baseline BMI (<25, 25 to <30, and ≥30 kg/m²) categories.

Study details: This was a post hoc analysis of six phase 3 trials including 3880 patients with moderate-to-severe RA who were randomly assigned to receive tofacitinib (5 or 10 mg), placebo, or active controls (methotrexate or adalimumab).

Disclosures: The study was sponsored by Pfizer Inc. Several authors reported being on speaker’s bureaus or receiving grants, consulting fees, or other remuneration from various sources, including Pfizer. Five authors reported being employees or shareholders of Pfizer or companies contracting with Pfizer.

Source: Dikranian AH et al. Efficacy of tofacitinib in patients with rheumatoid arthritis stratified by baseline body mass index: An analysis of pooled data from phase 3 studies. RMD Open. 2022;8:e002103 (May 16). Doi: 10.1136/rmdopen-2021-002103

Key clinical point: A dose of 5 or 10 mg tofacitinib twice daily improved clinical efficacy outcomes compared with placebo in patients with moderate-to-severe rheumatoid arthritis (RA) regardless of baseline body mass index (BMI).

Major finding: The American College of Rheumatology 20/50/70 response rates at 6 months were significantly higher in patients who received 5 or 10 mg tofacitinib vs. placebo (P < .05) and were comparable across baseline BMI (<25, 25 to <30, and ≥30 kg/m²) categories.

Study details: This was a post hoc analysis of six phase 3 trials including 3880 patients with moderate-to-severe RA who were randomly assigned to receive tofacitinib (5 or 10 mg), placebo, or active controls (methotrexate or adalimumab).

Disclosures: The study was sponsored by Pfizer Inc. Several authors reported being on speaker’s bureaus or receiving grants, consulting fees, or other remuneration from various sources, including Pfizer. Five authors reported being employees or shareholders of Pfizer or companies contracting with Pfizer.

Source: Dikranian AH et al. Efficacy of tofacitinib in patients with rheumatoid arthritis stratified by baseline body mass index: An analysis of pooled data from phase 3 studies. RMD Open. 2022;8:e002103 (May 16). Doi: 10.1136/rmdopen-2021-002103

Key clinical point: A dose of 5 or 10 mg tofacitinib twice daily improved clinical efficacy outcomes compared with placebo in patients with moderate-to-severe rheumatoid arthritis (RA) regardless of baseline body mass index (BMI).

Major finding: The American College of Rheumatology 20/50/70 response rates at 6 months were significantly higher in patients who received 5 or 10 mg tofacitinib vs. placebo (P < .05) and were comparable across baseline BMI (<25, 25 to <30, and ≥30 kg/m²) categories.

Study details: This was a post hoc analysis of six phase 3 trials including 3880 patients with moderate-to-severe RA who were randomly assigned to receive tofacitinib (5 or 10 mg), placebo, or active controls (methotrexate or adalimumab).

Disclosures: The study was sponsored by Pfizer Inc. Several authors reported being on speaker’s bureaus or receiving grants, consulting fees, or other remuneration from various sources, including Pfizer. Five authors reported being employees or shareholders of Pfizer or companies contracting with Pfizer.

Source: Dikranian AH et al. Efficacy of tofacitinib in patients with rheumatoid arthritis stratified by baseline body mass index: An analysis of pooled data from phase 3 studies. RMD Open. 2022;8:e002103 (May 16). Doi: 10.1136/rmdopen-2021-002103

The World Health Organization declared COVID-19 a pandemic on March 11, 2020, just 4 months before the start of a new residency cycle. Referred to as “COVID interns,” PGY-1 residents transitioning out of medical school in 2020 faced an unprecedented challenge of doctoring within a confused and ill-prepared health care system, while senior residents scrambled to adjust to their rapidly changing training programs. Each subsequent week brought more sobering news of increasing hospitalizations, intensive care unit admissions, and deaths; hospitals across the country resorted to the redeployment of residents across all specialties to buffer the growing need within their internal medicine and critical care units.¹ And while the news and social media blurred into a collage of ventilator shortages, politicization of science, and “#healthcareheroes,” one study showed53.7% of medical interns (N=108) were struggling with mild to extremely severe depression, while 63.9% reported mild to severe anxiety.²

Many shortcomings of our health care system—ill preparedness, racial disparity, health illiteracy—were highlighted during the COVID-19 pandemic, and providers’ mental health was no exception.³ Classic psychosocial risk factors, such as high demands, lack of control, lack of institutional support, and absence of reward defined the workplace, leading Theorell⁴ to call it “a randomized trial for maximal worsening of the work environment.” Stress and burnout during residency are not novel concepts. A 2002 survey including 415 medical residency programs with a response from more than 4000 residents found depressive symptoms in 35% of respondents, paired with feelings of increased cynicism and decreased humanism despite major curricular reforms and duty hour limitations.⁵ Unfortunately, the statistics in the coming years hardly budged and, in the wake of the pandemic, culminated to more than 50% to 76% of physicians worldwide reporting burnout in 2020.^6-8

As a COVID intern at Brigham and Women’s Hospital (Boston, Massachusetts), I also experienced the demanding workload and witnessed the struggle of my colleagues firsthand. Brigham and Women’s Hospital, similar to many of its peer institutions, implemented frequent mental health check-ins within its curriculum. Known as the Intern Humanistic Curriculum, these check-ins essentially were an echo chamber to unload the psychological burdens of our workdays, and we eagerly shared what made us angry, sad, hopeful, and hopeless. During one such session, I learned about moral injury, a term originating in the military defined as the psychological stress resulting from actions—or the lack of actions—that violates one’s moral or ethical code.⁹ With the onslaught of patient deaths for which most of us felt unprepared, we had all endured varying degrees of moral injury. Greenberg et al⁹ described 2 potential outcomes after moral injury: (1) the development of mental health disorders such as depression and posttraumatic stress disorder, or (2) posttraumatic growth, which is the bolstering of psychological resilience. Notably, the outcome is based on the way someone is supported before, during, and after the challenging incident.⁹

With the aim of psychological growth and developing resilience, residents should prioritize mental health throughout their training. To this end, several resources are readily available, many of which I actively use or frequently revisit, which are reviewed here.

Mindfulness Meditation App

Calm (https://www.calm.com/) is one of several popular mobile applications (apps) that delivers mindfulness mediation—the practice of attending to experiences, thoughts, and emotions without bias or judgment. With more than 100 million downloads, Calm includes meditation tutorials, breathing exercises, nature scenes and sounds, and audio programs taught by mindfulness experts for $69.99 a year or $14.99 a month. Systemic reviews have demonstrated reduced sleep disturbance, decreased ruminative thoughts and emotional reactivity, and increased awareness and acceptance in those practicing mindfulness meditation. Calm users have reported these benefits, with many able to forego the time- and cost-intensive cognitive behavioral therapy that requires highly trained therapists.^10-12

Exercise to Relieve Stress

Both aerobic and anaerobic exercises are antidepressive and anxiolytic and also lower one’s overall sensitivity to stress. Whether it is governed by neurotransmitters such as the activation of the opioid systems or the release of endogenous endorphins or time spent focusing on a different task at hand, the benefits of exercise against mental stressors have been extensively studied and established.¹³ Consider obtaining a new gym membership at the start of residency or joining an intramural team. Both have the added benefit of expanding your social circle.

Socialize With Others

Social isolation and perceived loneliness are key stressors linked to neuroendocrine disturbances that underlie depression, anxiety, and even schizophrenia.^14,15 Throughout residency there will be several social events and opportunities to gather with colleagues—inside or outside of the work environment—and residents should attend as time allows. Even virtual social interactions were found to reduce stress and help in the treatment of social anxiety disorder.¹⁴

 

 

Communicate About Stressors

Open up to your co-residents, friends, and family about any struggles that may be invisible on the outside. Even attendings can empathize with the struggles of residency, and the mentors in place are actively trained to prioritize resident wellness. If verbal communication is not your strength, try journaling. Writing helps to untangle and better define underlying stressors and is itself meditative.^16,17 However, ensure that your journaling is focused on positive emotional responses and aims to determine the positive benefits within any stressful event; those solely expressing negative emotions were found to have higher levels of stress and anxiety afterward than they had before.¹⁷

Seek a Mental Health Specialist

As with all other human ailments, severe mental health disorders require specialists and proper medication. Unfortunately, substantial stigma accompanying mental health continues to permeate medicine, creating considerable barriers for residents in need of care.¹⁸ A 2016 survey of more than 2000 physicians found that those with mental illnesses did not seek treatment due to limited time, fear of being reported to a medical licensing board, concern over obtaining licensure, and shame or embarrassment at the diagnosis.¹⁹ Besides urging residents to seek care, more effort should be invested in addressing the stigma and ensuring confidentiality. In 2021, the internal medicine and medicine-pediatrics residency at the University of Colorado Anschutz Medical Campus (Aurora, Colorado) developed a confidential opt-out, rather than opt-in, mental health program, and appointments were made for all 80 interns in advance. In doing so, they found increased participation and self-reported wellness at a relatively low cost and simple implementation.²⁰ For trainees without such access, online or mobile therapy platforms offering electronic mental health treatment or telepsychiatry also have been employed.^21,22 The onus ultimately is still on the individual to seek the care they need. Although only an anecdotal piece of evidence, I have found the prevalence of physicians taking selective serotonin reuptake inhibitors such as escitalopram, sertraline, or fluoxetine to be strikingly common and quite beneficial.

Final Thoughts

Residency remains rife with financial, emotional, and physical stressors; even as the dust settles on the COVID-19 pandemic, the light shed on the importance of trainee mental health must remain illuminated. For the aforementioned resources to have an impact, residents need to be empowered to openly discuss mental health issues and to seek help if necessary. Finally, in 2018, the Journal of Graduate Medical Education published a 10-year prospective cohort study that found that emotional distress during residency persists in professional practice even 10 years after residency and is associated with future burnout.²³ Trainees should consider prioritizing their mental health to not only improve their quality of life in the present but also as an investment for their future.

The World Health Organization declared COVID-19 a pandemic on March 11, 2020, just 4 months before the start of a new residency cycle. Referred to as “COVID interns,” PGY-1 residents transitioning out of medical school in 2020 faced an unprecedented challenge of doctoring within a confused and ill-prepared health care system, while senior residents scrambled to adjust to their rapidly changing training programs. Each subsequent week brought more sobering news of increasing hospitalizations, intensive care unit admissions, and deaths; hospitals across the country resorted to the redeployment of residents across all specialties to buffer the growing need within their internal medicine and critical care units.¹ And while the news and social media blurred into a collage of ventilator shortages, politicization of science, and “#healthcareheroes,” one study showed53.7% of medical interns (N=108) were struggling with mild to extremely severe depression, while 63.9% reported mild to severe anxiety.²

Many shortcomings of our health care system—ill preparedness, racial disparity, health illiteracy—were highlighted during the COVID-19 pandemic, and providers’ mental health was no exception.³ Classic psychosocial risk factors, such as high demands, lack of control, lack of institutional support, and absence of reward defined the workplace, leading Theorell⁴ to call it “a randomized trial for maximal worsening of the work environment.” Stress and burnout during residency are not novel concepts. A 2002 survey including 415 medical residency programs with a response from more than 4000 residents found depressive symptoms in 35% of respondents, paired with feelings of increased cynicism and decreased humanism despite major curricular reforms and duty hour limitations.⁵ Unfortunately, the statistics in the coming years hardly budged and, in the wake of the pandemic, culminated to more than 50% to 76% of physicians worldwide reporting burnout in 2020.^6-8

As a COVID intern at Brigham and Women’s Hospital (Boston, Massachusetts), I also experienced the demanding workload and witnessed the struggle of my colleagues firsthand. Brigham and Women’s Hospital, similar to many of its peer institutions, implemented frequent mental health check-ins within its curriculum. Known as the Intern Humanistic Curriculum, these check-ins essentially were an echo chamber to unload the psychological burdens of our workdays, and we eagerly shared what made us angry, sad, hopeful, and hopeless. During one such session, I learned about moral injury, a term originating in the military defined as the psychological stress resulting from actions—or the lack of actions—that violates one’s moral or ethical code.⁹ With the onslaught of patient deaths for which most of us felt unprepared, we had all endured varying degrees of moral injury. Greenberg et al⁹ described 2 potential outcomes after moral injury: (1) the development of mental health disorders such as depression and posttraumatic stress disorder, or (2) posttraumatic growth, which is the bolstering of psychological resilience. Notably, the outcome is based on the way someone is supported before, during, and after the challenging incident.⁹

With the aim of psychological growth and developing resilience, residents should prioritize mental health throughout their training. To this end, several resources are readily available, many of which I actively use or frequently revisit, which are reviewed here.

Mindfulness Meditation App

Calm (https://www.calm.com/) is one of several popular mobile applications (apps) that delivers mindfulness mediation—the practice of attending to experiences, thoughts, and emotions without bias or judgment. With more than 100 million downloads, Calm includes meditation tutorials, breathing exercises, nature scenes and sounds, and audio programs taught by mindfulness experts for $69.99 a year or $14.99 a month. Systemic reviews have demonstrated reduced sleep disturbance, decreased ruminative thoughts and emotional reactivity, and increased awareness and acceptance in those practicing mindfulness meditation. Calm users have reported these benefits, with many able to forego the time- and cost-intensive cognitive behavioral therapy that requires highly trained therapists.^10-12

Exercise to Relieve Stress

Both aerobic and anaerobic exercises are antidepressive and anxiolytic and also lower one’s overall sensitivity to stress. Whether it is governed by neurotransmitters such as the activation of the opioid systems or the release of endogenous endorphins or time spent focusing on a different task at hand, the benefits of exercise against mental stressors have been extensively studied and established.¹³ Consider obtaining a new gym membership at the start of residency or joining an intramural team. Both have the added benefit of expanding your social circle.

Socialize With Others

Social isolation and perceived loneliness are key stressors linked to neuroendocrine disturbances that underlie depression, anxiety, and even schizophrenia.^14,15 Throughout residency there will be several social events and opportunities to gather with colleagues—inside or outside of the work environment—and residents should attend as time allows. Even virtual social interactions were found to reduce stress and help in the treatment of social anxiety disorder.¹⁴

 

 

Communicate About Stressors

Open up to your co-residents, friends, and family about any struggles that may be invisible on the outside. Even attendings can empathize with the struggles of residency, and the mentors in place are actively trained to prioritize resident wellness. If verbal communication is not your strength, try journaling. Writing helps to untangle and better define underlying stressors and is itself meditative.^16,17 However, ensure that your journaling is focused on positive emotional responses and aims to determine the positive benefits within any stressful event; those solely expressing negative emotions were found to have higher levels of stress and anxiety afterward than they had before.¹⁷

Seek a Mental Health Specialist

As with all other human ailments, severe mental health disorders require specialists and proper medication. Unfortunately, substantial stigma accompanying mental health continues to permeate medicine, creating considerable barriers for residents in need of care.¹⁸ A 2016 survey of more than 2000 physicians found that those with mental illnesses did not seek treatment due to limited time, fear of being reported to a medical licensing board, concern over obtaining licensure, and shame or embarrassment at the diagnosis.¹⁹ Besides urging residents to seek care, more effort should be invested in addressing the stigma and ensuring confidentiality. In 2021, the internal medicine and medicine-pediatrics residency at the University of Colorado Anschutz Medical Campus (Aurora, Colorado) developed a confidential opt-out, rather than opt-in, mental health program, and appointments were made for all 80 interns in advance. In doing so, they found increased participation and self-reported wellness at a relatively low cost and simple implementation.²⁰ For trainees without such access, online or mobile therapy platforms offering electronic mental health treatment or telepsychiatry also have been employed.^21,22 The onus ultimately is still on the individual to seek the care they need. Although only an anecdotal piece of evidence, I have found the prevalence of physicians taking selective serotonin reuptake inhibitors such as escitalopram, sertraline, or fluoxetine to be strikingly common and quite beneficial.

Final Thoughts

Residency remains rife with financial, emotional, and physical stressors; even as the dust settles on the COVID-19 pandemic, the light shed on the importance of trainee mental health must remain illuminated. For the aforementioned resources to have an impact, residents need to be empowered to openly discuss mental health issues and to seek help if necessary. Finally, in 2018, the Journal of Graduate Medical Education published a 10-year prospective cohort study that found that emotional distress during residency persists in professional practice even 10 years after residency and is associated with future burnout.²³ Trainees should consider prioritizing their mental health to not only improve their quality of life in the present but also as an investment for their future.

The World Health Organization declared COVID-19 a pandemic on March 11, 2020, just 4 months before the start of a new residency cycle. Referred to as “COVID interns,” PGY-1 residents transitioning out of medical school in 2020 faced an unprecedented challenge of doctoring within a confused and ill-prepared health care system, while senior residents scrambled to adjust to their rapidly changing training programs. Each subsequent week brought more sobering news of increasing hospitalizations, intensive care unit admissions, and deaths; hospitals across the country resorted to the redeployment of residents across all specialties to buffer the growing need within their internal medicine and critical care units.¹ And while the news and social media blurred into a collage of ventilator shortages, politicization of science, and “#healthcareheroes,” one study showed53.7% of medical interns (N=108) were struggling with mild to extremely severe depression, while 63.9% reported mild to severe anxiety.²

Many shortcomings of our health care system—ill preparedness, racial disparity, health illiteracy—were highlighted during the COVID-19 pandemic, and providers’ mental health was no exception.³ Classic psychosocial risk factors, such as high demands, lack of control, lack of institutional support, and absence of reward defined the workplace, leading Theorell⁴ to call it “a randomized trial for maximal worsening of the work environment.” Stress and burnout during residency are not novel concepts. A 2002 survey including 415 medical residency programs with a response from more than 4000 residents found depressive symptoms in 35% of respondents, paired with feelings of increased cynicism and decreased humanism despite major curricular reforms and duty hour limitations.⁵ Unfortunately, the statistics in the coming years hardly budged and, in the wake of the pandemic, culminated to more than 50% to 76% of physicians worldwide reporting burnout in 2020.^6-8

As a COVID intern at Brigham and Women’s Hospital (Boston, Massachusetts), I also experienced the demanding workload and witnessed the struggle of my colleagues firsthand. Brigham and Women’s Hospital, similar to many of its peer institutions, implemented frequent mental health check-ins within its curriculum. Known as the Intern Humanistic Curriculum, these check-ins essentially were an echo chamber to unload the psychological burdens of our workdays, and we eagerly shared what made us angry, sad, hopeful, and hopeless. During one such session, I learned about moral injury, a term originating in the military defined as the psychological stress resulting from actions—or the lack of actions—that violates one’s moral or ethical code.⁹ With the onslaught of patient deaths for which most of us felt unprepared, we had all endured varying degrees of moral injury. Greenberg et al⁹ described 2 potential outcomes after moral injury: (1) the development of mental health disorders such as depression and posttraumatic stress disorder, or (2) posttraumatic growth, which is the bolstering of psychological resilience. Notably, the outcome is based on the way someone is supported before, during, and after the challenging incident.⁹

With the aim of psychological growth and developing resilience, residents should prioritize mental health throughout their training. To this end, several resources are readily available, many of which I actively use or frequently revisit, which are reviewed here.

Mindfulness Meditation App

Calm (https://www.calm.com/) is one of several popular mobile applications (apps) that delivers mindfulness mediation—the practice of attending to experiences, thoughts, and emotions without bias or judgment. With more than 100 million downloads, Calm includes meditation tutorials, breathing exercises, nature scenes and sounds, and audio programs taught by mindfulness experts for $69.99 a year or $14.99 a month. Systemic reviews have demonstrated reduced sleep disturbance, decreased ruminative thoughts and emotional reactivity, and increased awareness and acceptance in those practicing mindfulness meditation. Calm users have reported these benefits, with many able to forego the time- and cost-intensive cognitive behavioral therapy that requires highly trained therapists.^10-12

Exercise to Relieve Stress

Both aerobic and anaerobic exercises are antidepressive and anxiolytic and also lower one’s overall sensitivity to stress. Whether it is governed by neurotransmitters such as the activation of the opioid systems or the release of endogenous endorphins or time spent focusing on a different task at hand, the benefits of exercise against mental stressors have been extensively studied and established.¹³ Consider obtaining a new gym membership at the start of residency or joining an intramural team. Both have the added benefit of expanding your social circle.

Socialize With Others

Social isolation and perceived loneliness are key stressors linked to neuroendocrine disturbances that underlie depression, anxiety, and even schizophrenia.^14,15 Throughout residency there will be several social events and opportunities to gather with colleagues—inside or outside of the work environment—and residents should attend as time allows. Even virtual social interactions were found to reduce stress and help in the treatment of social anxiety disorder.¹⁴

 

 

Communicate About Stressors

Open up to your co-residents, friends, and family about any struggles that may be invisible on the outside. Even attendings can empathize with the struggles of residency, and the mentors in place are actively trained to prioritize resident wellness. If verbal communication is not your strength, try journaling. Writing helps to untangle and better define underlying stressors and is itself meditative.^16,17 However, ensure that your journaling is focused on positive emotional responses and aims to determine the positive benefits within any stressful event; those solely expressing negative emotions were found to have higher levels of stress and anxiety afterward than they had before.¹⁷

Seek a Mental Health Specialist

As with all other human ailments, severe mental health disorders require specialists and proper medication. Unfortunately, substantial stigma accompanying mental health continues to permeate medicine, creating considerable barriers for residents in need of care.¹⁸ A 2016 survey of more than 2000 physicians found that those with mental illnesses did not seek treatment due to limited time, fear of being reported to a medical licensing board, concern over obtaining licensure, and shame or embarrassment at the diagnosis.¹⁹ Besides urging residents to seek care, more effort should be invested in addressing the stigma and ensuring confidentiality. In 2021, the internal medicine and medicine-pediatrics residency at the University of Colorado Anschutz Medical Campus (Aurora, Colorado) developed a confidential opt-out, rather than opt-in, mental health program, and appointments were made for all 80 interns in advance. In doing so, they found increased participation and self-reported wellness at a relatively low cost and simple implementation.²⁰ For trainees without such access, online or mobile therapy platforms offering electronic mental health treatment or telepsychiatry also have been employed.^21,22 The onus ultimately is still on the individual to seek the care they need. Although only an anecdotal piece of evidence, I have found the prevalence of physicians taking selective serotonin reuptake inhibitors such as escitalopram, sertraline, or fluoxetine to be strikingly common and quite beneficial.

Final Thoughts

Residency remains rife with financial, emotional, and physical stressors; even as the dust settles on the COVID-19 pandemic, the light shed on the importance of trainee mental health must remain illuminated. For the aforementioned resources to have an impact, residents need to be empowered to openly discuss mental health issues and to seek help if necessary. Finally, in 2018, the Journal of Graduate Medical Education published a 10-year prospective cohort study that found that emotional distress during residency persists in professional practice even 10 years after residency and is associated with future burnout.²³ Trainees should consider prioritizing their mental health to not only improve their quality of life in the present but also as an investment for their future.

The American College of Cardiology and the American Heart Association have jointly issued a comprehensive set of data standards to help clarify definitions of the cardiovascular (CV) and non-CV complications of COVID-19.

It’s the work of the ACC/AHA Task Force on Clinical Data Standards and has been endorsed by the Heart Failure Society of America and Society for Cardiac Angiography and Interventions.

There is increased importance to understanding the acute and long-term impact of COVID-19 on CV health, the writing group notes. Until now, however, there has not been “clarity or consensus” on definitions of CV conditions related to COVID-19, with different diagnostic terminologies being used for overlapping conditions, such as “myocardial injury,” “myocarditis,” “type Il myocardial infarction,” “stress cardiomyopathy,” and “inflammatory cardiomyopathy,” they point out.

Floaria Bicher/iStock/Getty Images Plus

“We, as a research community, did some things right and some things wrong surrounding the COVID pandemic,” Sandeep Das, MD, MPH, vice chair of the writing group, noted in an interview with this news organization.

“The things that we really did right is that everybody responded with enthusiasm, kind of all hands on deck with a massive crisis response, and that was fantastic,” Dr. Das said.

“However, because of the need to hurry, we didn’t structure and organize in the way that we typically would for something that was sort of a slow burn kind of problem rather than an emergency. One of the consequences of that was fragmentation of how things are collected, reported, et cetera, and that leads to confusion,” he added.

The report was published simultaneously June 23 in the Journal of the American College of Cardiology and Circulation: Cardiovascular Quality and Outcomes.
 

A necessary but not glamorous project

The new data standards for COVID-19 will help standardize definitions and set the framework to capture and better understand how COVID-19 affects CV health.

“It wasn’t exactly a glamorous-type project but, at the same time, it’s super necessary to kind of get everybody on the same page and working together,” Dr. Das said. 

Broad agreement on common vocabulary and definitions will help with efforts to pool or compare data from electronic health records, clinical registries, administrative datasets, and other databases, and determine whether these data apply to clinical practice and research endeavors, the writing group says.

They considered data elements relevant to the full range of care provided to COVID-19 patients in all care settings. Among the key items included in the document are:

• Case definitions for confirmed, probable, and suspected acute COVID-19, as well as postacute sequelae of COVID-19.
• Definitions for acute CV complications related to COVID-19, including acute myocardial injury, heart failure, shock, arrhythmia, thromboembolic complications, and .
• Data elements related to COVID-19 vaccination status, comorbidities, and preexisting CV conditions.
• Definitions for postacute CV sequelae of SARS-CoV-2 infection and long-term CV complications of COVID-19.
• Data elements for CV mortality during acute COVID-19.
• Data elements for non-CV complications to help document severity of illness and other competing diagnoses and complications that might affect CV outcomes.
• A list of symptoms and signs related to COVID-19 and CV complications.
• Data elements for diagnostic and therapeutic strategies for COVID-19 and CV conditions.
• A discussion of advanced therapies, including , extracorporeal membrane oxygenation, and end-of-life management strategies.

These data standards will be useful for researchers, registry developers, and clinicians, and they are proposed as a framework for ICD-10 code development of COVID-19–related CV conditions, the writing group says.

The standards are also of “great importance” to patients, clinicians, investigators, scientists, administrators, public health officials, policymakers, and payers, the group says.

Dr. Das said that, although there is no formal plan in place to update the document, he could see sections that might be refined.

“For example, there’s a nice long list of all the various variants, and unfortunately, I suspect that that is going to change and evolve over time,” Dr. Das told this news organization.

“We tried very hard not to include things like specifying specific treatments so we didn’t get proscriptive. We wanted to make it descriptive, so hopefully it will stand the test of time pretty well,” he added.

This research had no commercial funding. The writing group has no relevant disclosures.

A version of this article first appeared on Medscape.com.

The American College of Cardiology and the American Heart Association have jointly issued a comprehensive set of data standards to help clarify definitions of the cardiovascular (CV) and non-CV complications of COVID-19.

It’s the work of the ACC/AHA Task Force on Clinical Data Standards and has been endorsed by the Heart Failure Society of America and Society for Cardiac Angiography and Interventions.

There is increased importance to understanding the acute and long-term impact of COVID-19 on CV health, the writing group notes. Until now, however, there has not been “clarity or consensus” on definitions of CV conditions related to COVID-19, with different diagnostic terminologies being used for overlapping conditions, such as “myocardial injury,” “myocarditis,” “type Il myocardial infarction,” “stress cardiomyopathy,” and “inflammatory cardiomyopathy,” they point out.

Floaria Bicher/iStock/Getty Images Plus

“We, as a research community, did some things right and some things wrong surrounding the COVID pandemic,” Sandeep Das, MD, MPH, vice chair of the writing group, noted in an interview with this news organization.

“The things that we really did right is that everybody responded with enthusiasm, kind of all hands on deck with a massive crisis response, and that was fantastic,” Dr. Das said.

“However, because of the need to hurry, we didn’t structure and organize in the way that we typically would for something that was sort of a slow burn kind of problem rather than an emergency. One of the consequences of that was fragmentation of how things are collected, reported, et cetera, and that leads to confusion,” he added.

The report was published simultaneously June 23 in the Journal of the American College of Cardiology and Circulation: Cardiovascular Quality and Outcomes.
 

A necessary but not glamorous project

The new data standards for COVID-19 will help standardize definitions and set the framework to capture and better understand how COVID-19 affects CV health.

“It wasn’t exactly a glamorous-type project but, at the same time, it’s super necessary to kind of get everybody on the same page and working together,” Dr. Das said. 

Broad agreement on common vocabulary and definitions will help with efforts to pool or compare data from electronic health records, clinical registries, administrative datasets, and other databases, and determine whether these data apply to clinical practice and research endeavors, the writing group says.

They considered data elements relevant to the full range of care provided to COVID-19 patients in all care settings. Among the key items included in the document are:

• Case definitions for confirmed, probable, and suspected acute COVID-19, as well as postacute sequelae of COVID-19.
• Definitions for acute CV complications related to COVID-19, including acute myocardial injury, heart failure, shock, arrhythmia, thromboembolic complications, and .
• Data elements related to COVID-19 vaccination status, comorbidities, and preexisting CV conditions.
• Definitions for postacute CV sequelae of SARS-CoV-2 infection and long-term CV complications of COVID-19.
• Data elements for CV mortality during acute COVID-19.
• Data elements for non-CV complications to help document severity of illness and other competing diagnoses and complications that might affect CV outcomes.
• A list of symptoms and signs related to COVID-19 and CV complications.
• Data elements for diagnostic and therapeutic strategies for COVID-19 and CV conditions.
• A discussion of advanced therapies, including , extracorporeal membrane oxygenation, and end-of-life management strategies.

These data standards will be useful for researchers, registry developers, and clinicians, and they are proposed as a framework for ICD-10 code development of COVID-19–related CV conditions, the writing group says.

The standards are also of “great importance” to patients, clinicians, investigators, scientists, administrators, public health officials, policymakers, and payers, the group says.

Dr. Das said that, although there is no formal plan in place to update the document, he could see sections that might be refined.

“For example, there’s a nice long list of all the various variants, and unfortunately, I suspect that that is going to change and evolve over time,” Dr. Das told this news organization.

“We tried very hard not to include things like specifying specific treatments so we didn’t get proscriptive. We wanted to make it descriptive, so hopefully it will stand the test of time pretty well,” he added.

This research had no commercial funding. The writing group has no relevant disclosures.

A version of this article first appeared on Medscape.com.

The American College of Cardiology and the American Heart Association have jointly issued a comprehensive set of data standards to help clarify definitions of the cardiovascular (CV) and non-CV complications of COVID-19.

It’s the work of the ACC/AHA Task Force on Clinical Data Standards and has been endorsed by the Heart Failure Society of America and Society for Cardiac Angiography and Interventions.

There is increased importance to understanding the acute and long-term impact of COVID-19 on CV health, the writing group notes. Until now, however, there has not been “clarity or consensus” on definitions of CV conditions related to COVID-19, with different diagnostic terminologies being used for overlapping conditions, such as “myocardial injury,” “myocarditis,” “type Il myocardial infarction,” “stress cardiomyopathy,” and “inflammatory cardiomyopathy,” they point out.

Floaria Bicher/iStock/Getty Images Plus

“We, as a research community, did some things right and some things wrong surrounding the COVID pandemic,” Sandeep Das, MD, MPH, vice chair of the writing group, noted in an interview with this news organization.

“The things that we really did right is that everybody responded with enthusiasm, kind of all hands on deck with a massive crisis response, and that was fantastic,” Dr. Das said.

“However, because of the need to hurry, we didn’t structure and organize in the way that we typically would for something that was sort of a slow burn kind of problem rather than an emergency. One of the consequences of that was fragmentation of how things are collected, reported, et cetera, and that leads to confusion,” he added.

The report was published simultaneously June 23 in the Journal of the American College of Cardiology and Circulation: Cardiovascular Quality and Outcomes.
 

A necessary but not glamorous project

The new data standards for COVID-19 will help standardize definitions and set the framework to capture and better understand how COVID-19 affects CV health.

“It wasn’t exactly a glamorous-type project but, at the same time, it’s super necessary to kind of get everybody on the same page and working together,” Dr. Das said. 

Broad agreement on common vocabulary and definitions will help with efforts to pool or compare data from electronic health records, clinical registries, administrative datasets, and other databases, and determine whether these data apply to clinical practice and research endeavors, the writing group says.

They considered data elements relevant to the full range of care provided to COVID-19 patients in all care settings. Among the key items included in the document are:

• Case definitions for confirmed, probable, and suspected acute COVID-19, as well as postacute sequelae of COVID-19.
• Definitions for acute CV complications related to COVID-19, including acute myocardial injury, heart failure, shock, arrhythmia, thromboembolic complications, and .
• Data elements related to COVID-19 vaccination status, comorbidities, and preexisting CV conditions.
• Definitions for postacute CV sequelae of SARS-CoV-2 infection and long-term CV complications of COVID-19.
• Data elements for CV mortality during acute COVID-19.
• Data elements for non-CV complications to help document severity of illness and other competing diagnoses and complications that might affect CV outcomes.
• A list of symptoms and signs related to COVID-19 and CV complications.
• Data elements for diagnostic and therapeutic strategies for COVID-19 and CV conditions.
• A discussion of advanced therapies, including , extracorporeal membrane oxygenation, and end-of-life management strategies.

These data standards will be useful for researchers, registry developers, and clinicians, and they are proposed as a framework for ICD-10 code development of COVID-19–related CV conditions, the writing group says.

The standards are also of “great importance” to patients, clinicians, investigators, scientists, administrators, public health officials, policymakers, and payers, the group says.

Dr. Das said that, although there is no formal plan in place to update the document, he could see sections that might be refined.

“For example, there’s a nice long list of all the various variants, and unfortunately, I suspect that that is going to change and evolve over time,” Dr. Das told this news organization.

“We tried very hard not to include things like specifying specific treatments so we didn’t get proscriptive. We wanted to make it descriptive, so hopefully it will stand the test of time pretty well,” he added.

This research had no commercial funding. The writing group has no relevant disclosures.

A version of this article first appeared on Medscape.com.