The American journal of medicine
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This study aimed to compare the demographic features and socioeconomic status of patients who underwent coronary artery calcium screening to that of their local population. ⋯ The disproportionate distribution of coronary artery calcium screening favoring educated, affluent, White English speakers indicates that higher-income and healthcare personnel are more likely to receive testing. Disparities in coronary artery calcium testing, especially in minorities and non-English speaking individuals, should be further explored.
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Machine learning algorithms are essential for predicting severe outcomes during public health crises like COVID-19. However, the dynamic nature of diseases requires continual evaluation and updating of these algorithms. This study aims to compare three update strategies for predicting severe COVID-19 outcomes post-diagnosis: 'naive' (a single initial model), 'frequent' (periodic retraining), and 'context-driven' (retraining informed by clinical insights). The goal is to determine the most effective timing and approach for adapting algorithms to evolving disease dynamics and emerging data. ⋯ A context-driven approach, guided by clinical insights, can enhance predictive performance and offer cost-effective solutions for dynamic public health challenges. These findings have significant implications for efficiently managing healthcare resources during evolving disease outbreaks.
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National heart failure guidelines recommend quadruple therapy with renin-angiotensin system inhibitors, beta-blockers, mineralocorticoid receptor antagonists, and sodium-glucose cotransporter 2 inhibitors for patients with heart failure with reduced ejection fraction (HFrEF), most of whom also receive loop diuretics. However, the guidelines are less clear about the safe approaches to discontinuing older drugs whose decreasing or residual benefit is less well understood. The objective of this study was to examine whether digoxin can be safely discontinued in patients with HFrEF receiving beta-blockers. ⋯ Digoxin can be discontinued without increasing the risk of adverse outcomes in patients with HFrEF receiving beta-blockers. Future studies need to examine the residual benefit of older heart failure drugs to ensure their safe discontinuation in patients with HFrEF receiving newer guideline-directed medical therapy.