Aleda E. Lutz VA Medical Center

Background: Cardiomyopathy and liver diseases are recognized as interrelated conditions due to their shared mechanisms, including systemic inflammation, neurohormonal dysregulation, and metabolic disturbances. While their mortality trends have been studied, there is a lack of national-level data on the intersection of these two conditions. Understanding the evolution of mortality patterns when both conditions coexist is crucial for identifying high-risk populations. Research Question: We aimed to investigate national mortality trends and demographic disparities among U.S. adults with both cardiomyopathy and liver disease listed on their death certificates from 1999 to 2020. Methods: We queried the CDC WONDER multiple cause-of-death database (1999–2020) for adults aged ≥25 years with ICD-10 codes for Cardiomyopathy (I42.x) and Liver Diseases (K70–K76). Age-adjusted mortality rates (AAMRs) were calculated using the 2000 U.S. standard population. Joinpoint regression identified inflection years and annual percent changes (APCs). Negative binomial regression estimated incidence rate ratios (IRRs), adjusting for age, sex, and race. Results: A total of 104,684 deaths involved both conditions. AAMRs declined from 2.39 in 1999 to 1.64 in 2018 (APC −1.9%, p<0.05), then rose to 2.31 in 2020 (APC +19.5%, p<0.01). Males had higher AAMRs than females, but the mortality trend reversed for both males (−1.01%/y to +6.00%/y) and females (−0.82% to +2.06%) in 2018. By race, Native Americans had the highest AAMR in 2020 (4.84), followed by Black (2.65), White (2.12), and Asian/Pacific Islander (0.93) groups. Disparities widened after 2018. Adjusted IRRs confirmed an elevated risk among American Indian/Alaska Native (1.65, 95% CI: 1.52–1.79) and Black individuals (1.37, 95% CI: 1.30–1.44), with a lower risk in Asian/Pacific Islanders (0.42, 95% CI: 0.38–0.46). Each year showed a 1.1% decline in risk (IRR 0.989, p < 0.001) before the reversal. Conclusion: After two decades of decline, mortality involving both cardiomyopathy and liver disease rose sharply after 2018, especially among males and Native American and Black populations. This concerning trend may reflect increases in alcohol-related and metabolic liver disease, widening disparities in care, and pandemic-related disruptions. Targeted public health efforts are needed to address this dual burden and mitigate emerging cardiometabolic disparities.

Background: Patients with traumatic brain injury (TBI) are at elevated risk for forming venous thromboembolism (VTE), warranting initiation of VTE chemoprophylaxis as early as possible, though the timing of initiation is unclear, particularly when intracranial hemorrhage (ICH) is also present. The purpose of this study is to evaluate the safety of early initiation of chemoprophylaxis in the TBI patient population with ICH on initial imaging.Methods: A 2-year retrospective cohort study was conducted on eligible trauma patients admitted to MyMichigan Medical Center Saginaw who sustained ICH and received subcutaneous heparin (SQH) prophylaxis within 24 h of the first stable head computed tomography (CTH). The primary outcome of interest was the change in hemorrhage size on subsequent CTHs following SQH initiation.Results: 63 patients met the inclusion criteria. On the first imaging post-SQ heparin initiation, 26 of the 63 patients (41%) had improved ICH, 37 patients (59%) had stable ICH, and none had worsening ICH.Conclusion: In TBI patients with ICH, administration of SQH chemoprophylaxis within the first 24 h of stable imaging appears to be safe, without the risk of worsening hemorrhage.

Abstract Stable chest pain is a common presentation requiring accurate diagnostic strategies to identify coronary artery disease (CAD) while minimizing risks. This systematic review compares the utility of coronary computed tomography angiography (CCTA) versus functional stress testing (e.g., exercise electrocardiography, stress echocardiography, nuclear perfusion imaging) in patients with stable chest pain. Following PRISMA guidelines, we searched PubMed, EMBASE, and Cochrane databases for randomized controlled trials (RCTs) and meta-analyses published through July 2025. Included studies evaluated diagnostic accuracy, clinical outcomes (e.g., myocardial infarction [MI], death, revascularization), and resource utilization. From 1,280 screened records, 18 studies (including 6 RCTs and 5 meta-analyses) involving over 30,000 patients were analyzed. CCTA demonstrated superior sensitivity (94.6%; 95% CI, 92.7-96.0) and specificity (76.3%; 95% CI, 72.2-80.0) for obstructive CAD compared with functional testing (sensitivity, 54.9-72.9%; specificity, 44.9-60.9%). CCTA was associated with reduced MI incidence (RR, 0.69; 95% CI, 0.49-0.98) but increased initial invasive procedures. Guidelines endorse CCTA as first-line for intermediate-risk patients. CCTA offers better prognostic value and efficiency compared with functional testing.

Patients requiring cholecystectomy or appendectomy may present with concomitant COVID infection in both the inpatient and outpatient scenarios. It is unclear whether these patients benefit more from operative or nonoperative management in the setting of active COVID infection. These guidelines seek to address urgent and elective clinical scenarios. A systematic review was conducted to address these questions. These results were then presented to an interdisciplinary panel that formulated recommendations based on the best available evidence or utilized expert opinion when the evidence base was lacking. Conditional recommendations were made in favor of (1) either operative or nonoperative management of COVID-positive patients with appendicitis or cholecystitis and (2) delaying operations by more than six weeks in patients who test positive for COVID in the elective setting. These recommendations should provide guidance regarding the management of surgical patients with concomitant COVID infection. This guideline also identifies important areas where future research should focus to strengthen the evidence base.

The Veterans Health Administration (VHA) does not routinely collect and document sexual orientation and gender identity (SOGI) data despite research on health disparities among sexual and gender minority (SGM) veterans. Due to the legacy of previous Department of Defense policies that prohibited disclosure of sexual or gender minority identities among active-duty personnel, minority veterans may be reluctant to respond to SOGI questions on confidential VHA surveys and in discussions with their VHA providers. Veterans may generally find SOGI questions uncomfortable and may not appreciate their relevance to health care. The purpose of this research was to examine veterans' comfort in reporting identity characteristics on confidential VHA surveys and in discussion with their VHA providers and whether comfort differed by sociodemographic characteristics. The project involves the secondary analysis of quantitative data from a quality improvement survey project. A total of 806 veterans were surveyed. Overall, 7.15% endorsed sexual or gender minority identity which is a higher rate than the 4.5% noted in the general US population. Cisgender and heterosexual veterans were more comfortable reporting identity characteristics both on VHA confidential surveys and in discussion with VHA providers compared with SGM veterans. These data suggest that the majority of veterans feel comfortable reporting their identities both on surveys and in the context of health care. Understanding these perceptions can assist VHA programs in implementing SOGI data collection and disclosure in clinical care, creating a welcoming environment of care for SGM veterans that does not make veterans from other backgrounds feel uncomfortable.