Category: 8. Health

Patients hoping to treat weight-related medical conditions need more than just antiobesity medications that are effective, but that also pose challenges for successful use.

That means food counseling should be part of a comprehensive treatment plan for obesity, according to experts who summarized the state of the research on the issue.

A group of 18 researchers came together to publish “Nutritional priorities to support GLP-1 therapy for obesity: a joint Advisory from the American College of Lifestyle Medicine, the American Society for Nutrition, the Obesity Medicine Association, and The Obesity Society.” It came out this month in the organizations’ respective journals.

The 24-page guide acknowledges that for some patients, the new glucagon-like peptide-1 receptor agonist drugs (GLP-1s) amount to weight loss via injection. But treatment success depends on a patient-centered approach involving more than a prescription.

Patients need counseling — and then must integrate into their lives — elements ranging from management of gastrointestinal side effects, to prevention of nutrient deficiencies, to preservation of muscle and bone mass.

“Despite the efficacy and growing utilization of these medications, real-world challenges are increasingly evident,” the paper said.

“All these challenges may be partially mitigated by an evidence-based, structured lifestyle program, particularly around food, when prescribing GLP-1s for obesity,” the advisory said. “However, practical guidance for clinicians to implement such an approach is limited.”

Medical effects

Studies have produced results showing GLP-1s have helped patients reduce their weight. But real-world efficacy generally has been lower, and weight regain is common when patients discontinue use of the medications, the advisory said. Research also has demonstrated clinical benefits for conditions ranging from heart failure to sleep apnea to chronic kidney disease to substance use disorders.

Gastrointestinal irritation is common, but not likely to lead to discontinuation. With a loss of appetite and lower energy intake, patients may develop vitamin and mineral deficiencies and symptoms such as fatigue, hair loss, skin flakiness, muscle weakness, poor wound healing and bruising, the advisory said. Muscle mass and bone density also may decrease.

Financial effects

Adherence to the drugs is relatively low for reasons that are unclear, although cost may be a factor. Based on current list prices, the drugs may cost up to $16,000 a year. Prices are lower with manufacturers’ rebates, dropping to $7,000 to $8,000 annually, and lower still with compounded versions, that still cost up to $3,000 a year.

While patients may experience improved quality of life, the GLP-1s have not provided a long-term financial return for health care overall. Several studies “have found that GLP-1 treatment costs exceed health care savings,” and one found patients using GLP-1 drugs had significantly higher health care costs than patients with obesity, but not using the drugs.

“Considering cost-effectiveness, i.e., health gained per dollar spent, most studies find that GLP-1s, even at currently discounted prices, do not meet accepted thresholds for cost-effective therapy,” the study said.

All those factors indicate something more is needed.

“These high costs, lower adherence in practice, and frequent weight regain after discontinuation, each highlight the importance of complementary nutritional and lifestyle counseling to help maximize overall efficacy and cost-effectiveness,” the advisory said.

Barriers to care

The researchers cited a number of difficulties in current practice:

• Visits with primary care physicians and non-obesity medicine specialists are usually short and centered on acute illness or needs, screening discussions, and medication management.
• Access is limited to lifestyle medicine approaches for obesity and its comorbidities. “For example, the Diabetes Prevention Program is known to reduce the risk of progression to diabetes and is covered by major payers, but has not been meaningfully scaled due to regulatory and implementation barriers,” the advisory said.
• There is no American Medical Association approval of category I Current Procedural Terminology codes for health coaching, so that remains a barrier to reimbursement.
• Private and public payer coverage for medical nutrition therapy for obesity remains limited, preventing broad utilization in practice.

“These pressures, alongside a frequent lack of practitioner education about integrating lifestyle management in medicine, have created a dearth of implemented behavioral and lifestyle counseling, accessible and effective referral programs, and integration into existing care delivery systems,” the authors said.

Getting started

The researchers suggested using a 5As Framework — assess, advise, agree, assist, and arrange — to guide physician-patient interaction toward a successful long-term plan. There also will be at least eight elements or nutritional priorities to support GLP-1 therapy for obesity.

• Initiation of GLP-1 therapy with a patient-centered approach.
• Completion of baseline nutritional assessment and screening.
• Management of gastrointestinal side effects.
• Navigation of dietary preferences and intake.
• Prevention and mitigation of nutrient deficiencies.
• Preservation of muscle and bone mass.
• Maximization of weight reduction efficacy.
• Promotion of other supportive lifestyle measures.

Under “arrange,” the experts noted physicians likely won’t go it alone with patients. Registered dietitian nutritionists, behavioral therapists, social workers and case managers all may be part of a team.

Along with medications, food counseling and a new menu, the authors emphasized the need for patients to take up resistance training and other physical activities. Good sleep, stress management and substance use cessation all will be part of the treatment plan.

More research is needed

The GLP-1 drugs still prompt questions and need more research. The researchers note physicians, other clinicians and patients refer to GLP-1s, but there is no widely accepted terminology to describe the medications. There also is room for research on measuring obesity and adopting definitions and treatments for clinical and preclinical obesity.

“In conclusion, although GLP-1s alone can produce significant weight reduction and related health benefits, several challenges limit its long-term success for individuals and populations,” the advisory said.

“Careful attention to evidence-based nutritional and behavior modification can help mitigate the adverse effects of these challenges,” the authors said. “Thus, all clinicians prescribing GLP-1s for obesity management should establish a thoughtful plan of care that includes thorough nutritional and lifestyle counseling before, during, and after the weight reduction period.”

Fungi have a reputation for appearing where humans don’t want them: on crops, in basements and cold storage rooms, and in the human body. Worse, fungi are getting better at resisting conventional defenses, meaning we need to either use even more fungicides—which would exacerbate the resistance problem—or innovate our tools.

Researchers have now developed a spray that can keep fungi at bay. The nontoxic solution forms an extremely hydrophobic surface coating that makes it harder for fungi to latch on to a surface and kills them if they do take root.

Boaz Pokroy, a materials scientist at Technion—Israel Institute of Technology, and his colleagues decided to leverage their previous work with antibacterial fatty acids to develop a novel “dual mode” agent that is very difficult for the fungi to become resistant to. First, stearic acid, with its inherent hydrophobicity, keeps fungi from sticking to the surface. This alone reduced the growth of gray mold, Botrytis cinerea, by more than 60% on filter paper.

Second, the addition of a shorter-chain fatty acid, such as caprylic acid, provides fungicidal power against any fungi that manage to anchor themselves. With the combined fatty acids, the researchers were able to achieve total inhibition of the mold.

Pokroy and his team explain that after spraying, stearic acid forms crystal nuclei, which caprylic acid adsorbs onto. As the spray’s solvent evaporates, stearic acid crystals assemble into clusters, thus producing a rough surface imbued with adsorbed liquid layers of caprylic acid, which is primed to kill fungi. The caprylic acid leached out of the coating after about a week, thereby diminishing the potency of the coating.

Pokroy points to ventilation ducts as a prime location to use the new spray. Air ducts often become breeding grounds for fungi due to their damp, dark, and cold interiors. These fungi release fungal spores into the air. In hospital settings, those spores raise the risk of infection for already vulnerable people. Since conventional fungicides are toxic to humans and the environment, stringent limits exist on the site, quantity, and duration of their use.

Jonathan C. Barnes, a chemistry professor at Washington University in St. Louis who wasn’t involved in the study, commended the work and found the technology “very scalable,” as the same fatty acids are common ingredients of food and cosmetics.

“The fact that the dual-purpose coating was successfully applied to both glass slides and cellulose filter substrates is an indication that the technology could be used on a variety of surfaces and thus in many different applications,” he says. One potential application he saw was spraying this coating on medical implants, where a quick burst release of the medium-chain fatty acids may prevent infections during surgery.

Patients with polycythemia vera (PV) require treatment to reduce hematocrit and maintain quality of life over a significant span of time living with the disease. In a recent in-person Community Case Forum event in Santa Monica, California, Mojtaba Akhtari, MD, professor of medicine at Loma Linda University, discussed the trials in high-risk disease that not only looked at response to treatment but showed promise in reducing thrombotic events that represent the greatest risk to patients’ survival. Trials that have been ongoing for several years are now producing longer-term data that provides guidance on how to manage treating patients with PV most effectively and what trends indicate worse outcomes.

This article is part 2 of a 2-part series from a Community Case Forum event.

Targeted Oncology: Could you describe the design of the MAJIC-PV study [ISRCTN61925716]in patients with higher-risk PV?

Mojtaba Akhtari, MD: The MAJIC-PV study was done in the United Kingdom; Claire N. Harrison, MD, of St. Thomas’ Hospital in South London, did the MAJIC-PV study for patients with PV with a 1:1 randomization of 190 patients: one group received ruxolitinib [Jakafi] and the other group received best available treatment. They looked for complete or partial response, and if they had complete or partial response, they continued ruxolitinib as long as they had a partial response for up to 5 years, and in the other arm they were allowed to change the treatment.

A complete remission was getting hematocrit below 45%, white blood cell [WBC] count below 10,000/μL, platelet count less than 400,000/μL, no phlebotomy, and normalization of spleen size. Looking at those given ruxolitinib, they did better [HR, 0.38; 95% CI, 0.24-0.61; P < .001].¹ Looking at the event-free survival [EFS], they did better [HR, 0.58; 95% CI, 0.35-0.94; P = .03]. The patients on ruxolitinib had fewer thrombotic events. This is the first time that an intervention has shown it reduces the risk of thrombosis.

What data support the long-term use of ropeginterferon alfa-2b (Besremi) in high-risk PV?

The PROUD-PV and CONTINUATION-PV studies [NCT01949805; NCT02218047] enrolled adult patients with PV who were [either] naive patients in need of cytoreductive [therapy] or some patients pretreated with hydroxyurea with a 1:1 randomization. One arm received ropeginterferon, the other one received hydroxyurea, and patients were able to continue through 12 months, and then for up to 3 to 5 years, they continued with either ropeginterferon or best available treatment.

For ropeginterferon alfa-2b, the rate of complete hematologic response and normal spleen size at 12 months was 21% [vs 28% in the control group].² The rate of complete hematologic response only at 12 months was 43% [vs 46%], and molecular response at 12 months was 34% [vs 42%].

Hydroxyurea is very like old-fashioned chemotherapy. Interferon is more like targeted treatment that works through the immune system. We are not treating patients with chronic myeloid leukemia with hydroxyurea anymore, unless you want to control severe leukocytosis…so I’m not sure why we should give hydroxyurea to patients with PV, but it’s good to have discussions. Patients can have adverse events, but it’s usually well tolerated; the discontinuation rate is low.

In the long term, in year 6 of treatment for ropeginterferon, 81.4% were keeping the hematocrit below 45%; in the control arm, it was 60%.³ EFS was better for ropeginterferon, so patients would have fewer complications if they were on ropeginterferon.

What did the REVEAL study (NCT02252159) show about disease outcomes of PV?

This is the largest prospective observational study of PV in the United States. More than 2500 patients were enrolled, and 2200 patients were eligible. A total of 142 thrombotic events were observed: 100 were venous thrombotic events and 42 were arterial traumatic events.⁴

If we look at what the [lower-risk] patients were given as treatment, 54.3% only had phlebotomy, 18.1% had hydroxyurea only, 15.7% had phlebotomy and hydroxyurea, 7% other, and 5% watchful waiting. I don’t think I have patients with PV on watchful waiting because they need phlebotomy or they need to be on aspirin.

Looking at cumulative incidence of thrombotic events for these patients, high-risk patients had more thrombotic events vs low-risk patients [5.2% vs 2.78%]. Heart attack and stroke were what killed these patients. They looked at blood values to see which patients could get more blood clots. Patients whose hematocrit was more than 45% had more trouble. Patients whose WBC count was more than 11,000/μL and patients whose platelet count was more than 400,000/μL did worse. This is another study showing that leukocytosis and thrombocytosis matter in patients with PV.

Looking at the thrombotic events in the high-risk patients, those with erythrocytosis or hematocrit of more than 45%, leukocytosis with WBC count more than 11,000/μL, or thrombocytosis with platelet count than 400,000/μL were associated with worse outcomes.

_{DISCLOSURES: Akhtari previously reported consulting or advisory roles with Abbvie, BMS, Incyte, Karyopharm Therapeutics, Pfizer, and Takeda; and speakers’ bureau with Incyte, Jazz Pharmaceuticals, and Novartis.}

_References:

_{1. Harrison CN, Nangalia J, Boucher R, et al. Ruxolitinib versus best available therapy for polycythemia vera intolerant or resistant to hydroxycarbamide in a randomized trial. J Clin Oncol. 2023;41(19):3534-3544. doi:10.1200/JCO.22.01935}

_{2. Gisslinger H, Klade C, Georgiev P, et al. Ropeginterferon alfa-2b versus standard therapy for polycythaemia vera (PROUD-PV and CONTINUATION-PV): a randomised, non-inferiority, phase 3 trial and its extension study. Lancet Haematol. 2020;7(3):e196-e208. doi:10.1016/S2352-3026(19)30236-4}

_{3. Gisslinger H, Klade C, Georgiev P, et al. Ropeginterferon alfa-2b achieves patient-specific treatment goals in polycythemia vera: final results from the PROUD-PV/CONTINUATION-PV studies. HemaSphere. 2022;6:97-98. doi:10.1097/01.hs9.0000843676.80508.b5}

_{4. Gerds AT, Mesa R, Burke JM, et al. Association between elevated white blood cell counts and thrombotic events in polycythemia vera: analysis from REVEAL. Blood. 2024;143(16):1646-1655. doi:10.1182/blood.2023020232}

There is much to commend about Australia’s lung cancer screening program, which started on July 1.

The program is based on gold-standard trial evidence showing this type of screening is likely to reduce lung cancer deaths.

Some people will have their life prolonged due to this screening, which involves taking low-dose CT scans to look for lung cancer in people with a significant smoking history.

In some of these people, cancer will be detected at an early stage, and they can be treated. Without screening, these people may have died of cancer because it would have been detected at a later, incurable stage.

However, for some people, screening could also harm.

How can screening harm?

Screening for disease, including cancer, can cause harm – during screening, diagnosis and treatment.

With lung cancer screening, a positive scan can prompt an invasive lung biopsy. This is where a sample of lung tissue is obtained with a special needle guided by imaging, or through surgery under anaesthesia.

If, after examination under the microscope, the pathologist thinks there is lung cancer, then more extensive surgery and other treatments will likely follow, all of which have a risk of side effects.

The diagnostic label “lung cancer” itself is distressing, and the stigma attached to the diagnosis may worsen this distress.

These harms and risks may be considered acceptable if the treatment prevents the person’s cancer from progressing.

However, as with other cancers, screening is likely to also cause overdiagnosis and overtreatment. That is, some of the lesions picked up through screening and diagnosed as cancer, would have never caused any trouble if they’d been left alone. If these lesions were left undetected (and untreated), they would never have caused symptoms or shortened the person’s life.

But all patients with a cancer diagnosis will be offered treatment – including surgery, radiotherapy and cancer drugs. Yet patients who really have an indolent (non-lethal) lesion have the same risk of harm from diagnosis and treatment as others, but without potentially benefiting from treatment.

A related issue is that of “incidental findings”. Reports from lung cancer screening programs overseas show there is a large potential to find things other than cancer on the CT scan.

For instance, some people have lung “nodules” (small spots on the scan) that fall short of being suspicious for cancer, but nonetheless need close monitoring with repeat scans for a while. For these people, we need to make sure health-care workers follow protocols that prevent unnecessary intervention in a nodule that is not growing.

The scans can also pick up other conditions. These include calcium in coronary arteries, small aneurysms of the aorta (bulges in the body’s largest artery), or abnormalities in abdominal organs such as the liver.

Some of these “incidental findings” may lead to early detection of disease that can be treated. However, in many cases the findings would not have caused any issues if they’d been left undetected, another example of overdiagnosis. These patients experience risks from further cascades of interventions triggered by the incidental finding, but without these interventions improving their health.

The potential for overdiagnosis and overtreatment is greater if screening extends beyond the high-risk group with a history of heavy smoking. Some people who don’t meet the eligibility criteria may still want to be screened. For example, lung cancer awareness campaigns may lead to people who don’t smoke requesting screening. If screening staff decide to refer them for imaging, this may result in unofficial “leakage” of the screening program to include people at lower risk of cancer.

For example in the United States, an estimated 45% of scans done in its screening program are for people who do not meet eligibility criteria. In China, about 64% of those screened may be technically ineligible.

We see the results of this in a number of Asian countries with widespread, non-targeted screening, including of people who do not smoke. This has resulted in high rates of cancer diagnosis – much higher than we would expect in this low-risk group – and even higher rates of lung surgeries.

These surgeries, which involve cutting into the chest wall to remove lung tissue, carry significant operative risks. They may also cause longer-term impacts by removing normal lung tissue.

Regular independent evaluation needed

In Australia, for the eligible population with a significant smoking history, we anticipate net benefit, on balance, from the screening program.

However, if unintended consequences from screening are higher in real life than in the trials, then this could tip it the other way into net harm.

So, regular independent re-evaluation of the program is needed to ensure anticipated benefits are realised and harms are kept to a minimum.

This should include analysis of data across the population to look for signs of benefit, such as decreases in rates of advanced-stage lung cancer and deaths.

These data should also be scrutinised for signs of harm from overdiagnosis and overtreatment – including of both cancer and non-cancer conditions.

There is much excitement about the potential for lung cancer screening to prevent some Australians from dying from this devastating disease. We too have cautious optimism the program could make a real difference.

But we can’t let this optimism blind us to the potential for harm.

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This is the next article in our ‘Finding lung cancer’ series, which explores Australia’s first new cancer screening program in almost 20 years. Read other articles in the series.

More information about the program is available. If you need support to quit smoking, call Quitline on 13 78 48.

Seven in 10 respondents to a 2024 US survey said they would still reach for a home COVID-19 test if they thought they were infected, UMass Chan Medical School researchers report in JAMA Network Open.

The team used the Ipsos KnowledgePanel to ask 2009 adults whether they would test and, if not, the reasons for not testing, from October 31 to November 7, 2024. The average participant age was 51.5 years, 51.2% were women, 60.7% were White, 18.0% were Hispanic, and 12.1% were Black. 

The investigators noted that COVID-19 remains a threat, with the Centers for Disease Control and Prevention (CDC) estimating 28,000 to 46,000 related US deaths and 230,000 to 390,000 hospitalizations from October 2024 to April 2025.

“Early identification of infection enables prompt care and steps to reduce spread,” they wrote. “Timely initiation of oral antiviral medications is associated with lower hospitalizations, deaths, and long-COVID incidence among adults at high risk.” 

Older, healthy respondents more likely to test

Most participants (70.0%) said they would test if they suspected a COVID-19 infection. Factors tied to intent to test were age older than 60 years, excellent health status, trust in the healthcare system, reliance on data to make health decisions, previous completion of a home test, and Black, Hispanic, or mixed race.

Test hesitancy may delay oral antiviral initiation and could result in missed opportunities to limit transmission.

The proportion endorsing each reason for not testing were perceived lack of a reason to test (53.6%), a belief that a positive test result wouldn’t be useful (30.1%), lack of trust in tests (20.7%), forgetting that testing is an option (19.4%), preference of not knowing the results (9.1%), lack of awareness of where to procure a test (5.8%), inability to pay for testing (4.9%), and other reasons (8.3%).

The authors called for raising awareness of the value of testing. “Nearly one-third of US adults would not or might not test for suspected COVID-19, largely because they do not see value in testing,” they wrote. “Test hesitancy may delay oral antiviral initiation and could result in missed opportunities to limit transmission.”

Uterine cancer rates in the United States are expected to climb significantly over the next 25 years, with Black women projected to face the highest burden, according to a new study.

Researchers found that while most cancer rates in the U.S. have declined, uterine cancer incidence increased by 0.7% annually between 2013 and 2022, and death rates rose by 1.6% each year from 2014 to 2023. Black women are already twice as likely to die from uterine cancer as women of other races and ethnicities. It’s a disparity expected to widen even further.

“Overall, uterine cancer is one of the few cancers where both incidence and mortality have been increasing, and prior studies have consistently shown significant racial disparities among Black and white women,” said lead author Dr. Jason D. Wright of Columbia University.

RELATED STORY | New study finds CT scans could be a major contributor to cancer in the US

Using a model based on U.S. population data, researchers projected mortality rates to nearly triple for Black women by 2050, rising from 14.1 to 27.9 per 100,000. In comparison, White women’s rates are expected to increase from 6.1 to 11.2 per 100,000.

Wright noted that factors such as obesity, lower hysterectomy rates, later diagnoses and more aggressive tumor types contribute to the disparity. The study suggests that if effective screening were developed, it could significantly reduce the disease burden.

As brain tumors grow, they must do one of two things: push against the brain or use finger-like extensions to invade and destroy surrounding tissue.

Previous research found tumors that push — or put mechanical force on the brain — cause more neurological dysfunction than tumors that destroy tissue. But what else can these different tactics of tumor growth tell us?

Now, the same team of researchers from the University of Notre Dame, Harvard Medical School/Massachusetts General Hospital, and Boston University has developed a technique for measuring a brain tumor’s mechanical force and a new model to estimate how much brain tissue a patient has lost. Published in Clinical Cancer Research, the study explains how these measurements may help inform patient care and be adopted into surgeons’ daily workflow.

“During brain tumor removal surgery, neurosurgeons take a slice of the tumor, put it on a slide and send it to a pathologist in real-time to confirm what type of tumor it is. Tumors that originally arise in the brain, like glioblastoma, are prescribed different treatments than tumors that metastasize to the brain from other organs like lung or breast, so these differences inform post-surgical care,” said Meenal Datta, assistant professor of aerospace and mechanical engineering at Notre Dame and co-lead author of the study.

“By adding a two-minute step to a surgeon’s procedure, we were able to distinguish between a glioblastoma tumor versus a metastatic tumor based on mechanical force alone.”

Datta and collaborators collected data from 30 patients’ preoperative MRIs and their craniotomies, which include exposing the brain and using Brainlab neuronavigation technology. This technology provides surgeons with real-time, 3D visualization during brain surgeries and is considered commonly available for neurological procedures. Neurosurgeons can use this technique to measure the bulge caused by brain swelling from the tumor’s mechanical forces before the tumor is resected.

Then this patient data was used to determine whether brain tissue was displaced by a tumor’s mechanical force or replaced by a tumor. The researchers found that when there is more mechanical force on the brain (displacement), the swelling will be more substantial. But when a tumor invades and destroys surrounding tissue (replacement), the swelling will be less significant.

The researchers created computational models based on a point system of measurements and biomechanical modeling that can be employed by doctors to measure a patient’s brain bulge, to determine the mechanical force that was being exerted by the tumor, and to determine the amount of brain tissue lost in each patient.

Funded by the National Institutes of Health, National Science Foundation and various cancer research foundations, this study is among the first to show how mechanics can distinguish between tumor types.

“Knowing the mechanical force of a tumor can be useful to a clinician because it could inform patient strategies to alleviate symptoms. Sometimes patients receive steroids to reduce brain swelling, or antipsychotic agents to counter neurological effects of tumors,” said Datta, an affiliate of Notre Dame’s Harper Cancer Research Institute. Datta recently showed that even affordable and widely used blood pressure medications can counter these effects. “We’re hoping this measurement becomes even more relevant and that it can help predict outcomes of chemotherapy and immunotherapy.”

To get a better idea of what else mechanical force could indicate, the research team used animal modeling of three different brain tumors: breast cancer metastasis to the brain, glioblastoma and childhood ependymoma.

In the breast cancer metastasis tumor, researchers used a form of chemotherapy that is known to work in reducing metastasis brain tumor size. While waiting for the tumor to respond to the chemotherapy, the team found that a reduction in mechanical force changed before the tumor size was shown to change in imaging.

“In this model, we showed that mechanical force is a more sensitive readout of chemotherapy response than tumor size,” Datta said. “Mechanics are sort of disease-agnostic in that they can matter regardless of what tumor you are looking at.”

Datta hopes that doctors employ the patient models from the study to continue to grow the field’s understanding of how mechanical force can improve patient care management.

In addition to Datta, co-lead authors include Hadi T. Nia at Boston University, Ashwin S. Kumar at Massachusetts General Hospital and Harvard Medical School, and Saeed Siri at Notre Dame. Other collaborators include Gino B. Ferraro, Sampurna Chatterjee, Jeffrey M. McHugh, Patrick R. Ng, Timothy R. West, Otto Rapalino, Bryan D. Choi, Brian V. Nahed, Lance L. Munn and Rakesh K. Jain, all at Massachusetts General Hospital and Harvard Medical School.

Datta is also affiliated with Notre Dame’s Eck Institute for Global Health, the Berthiaume Institute for Precision Health, NDnano, the Warren Center for Drug Discovery, the Lucy Family Institute for Data & Society and the Boler-Parseghian Center for Rare Diseases. She is also a concurrent faculty member in the Department of Chemical and Biomolecular Engineering and a faculty adviser for Notre Dame’s graduate programs in bioengineering and materials science and engineering.

Contact: Brandi Wampler, associate director of media relations, 574-631-2632, brandiwampler@nd.edu

 

An AI algorithm used with MRI data can predict which patients are at risk of sudden cardiac arrest, researchers have reported.

By analyzing heart imaging results, specifically cardiac MRI, electronic health records, and echocardiograms, the AI algorithm was able to “reveal previously hidden information about a patient’s heart health,” according to a statement released by Johns Hopkins University in Baltimore, at which a team led by Changxin Lai, PhD, conducted the study.

The findings could not only save lives but also avoid unnecessary medical interventions such as the implantation of defibrillators, said senior author Natalia Trayanova, PhD, in the university statement. The work was published on July 2 in Nature Cardiovascular Research.

“Currently, we have patients dying in the prime of their life because they aren’t protected and others who are putting up with defibrillators for the rest of their lives with no benefit,” Trayanova said. “We have the ability to predict with very high accuracy whether a patient is at high risk for sudden cardiac death or not.”

Hypertrophic cardiomyopathy is one of the most common inherited heart diseases, affecting one in every 200 to 500 individuals worldwide, and is a leading cause of sudden cardiac death in young people and athletes, Lai and colleagues noted. Many people with the condition live normal lives, but some are at increased risk for sudden cardiac death — and it’s difficult for doctors to identify these patients.

Clinical guidelines to find patients most at risk for fatal heart attacks have about a 50% chance of identifying the right ones — “not much better than throwing dice,” Trayanova said. In light of this statistic, the group developed a transformer-based, neural network model called Multimodal AI for ventricular Arrhythmia Risk Stratification (MAARS), using it in a development and validation cohort of 553 patients and another, external cohort of 284 patients. All patients were assessed via traditional clinical guidelines and MR imaging at Johns Hopkins Hospital and Sanger Heart & Vascular Institute in North Carolina.  

Li and colleagues found that MAARS “significantly outperformed” clinical guidelines across all demographics, showing 89% accuracy for predicting sudden cardiac death across all patients and 93% accuracy for people 40 to 60 years old, which is the population among hypertrophic cardiomyopathy patients most at risk.

“MAARS has the potential to substantially improve clinical decision-making and healthcare delivery for patients with [hypertrophic cardiomyopathy], either directly through future integration with automated data extraction systems or indirectly by serving as a valuable proof of concept for the power of multimodal AI in enhancing personalized patient care,” the investigators wrote.

Going forward, the team plans to test the new model on more patients and expand the algorithm for use with other types of heart diseases, such as cardiac sarcoidosis and arrhythmogenic right ventricular cardiomyopathy, it said.

The complete study can be found here.