Below please find summaries of new articles that will be published in the next issue of Annals of Internal Medicine. The summaries are not intended to substitute for the full articles as a source of information. This information is under strict embargo and by taking it into possession, media representatives are committing to the terms of the embargo not only on their own behalf, but also on behalf of the organization they represent.
1. Rapid screening, face masks may prevent SARS-CoV-2 transmission at indoor mass-gathering events
Abstract: https://www.acpjournals.org/doi/10.7326/M21-2278
URL goes live when the embargo lifts
An observational study in Barcelona, Spain found that implementation of same-day rapid screening, use of face masks, and improved ventilation was associated with very low rates of SARS-CoV-2 transmission at an indoor mass-gathering live concert without physical distancing. The brief research report is published in Annals of Internal Medicine.
Indoor mass-gathering events have been banned since the beginning of the COVID-19 pandemic because of the high risk for the spread of SARS-CoV-2. Protocols are needed to prevent virus transmission during such events.
Researchers from Germans Trias i Pujol Hospital, Barcelona, Spain studied electronic health records to determine if previously tested containment measures could prevent high rates of transmission during an indoor live music concert with 5,000 attendees. On-site nurses screened all attendees with an antigen-detecting rapid diagnostic test (Ag-RDT) and filtering facepiece 2 masks were required to be worn during the entire event. Singing and dancing were allowed, and no physical distancing was required. An analysis of 4,584 attendees found 6 cases of COVID-19 within the 2 weeks after the concert. Of those 6 persons, 3 were identified in contact-tracing studies of known index cases who had not attended the concert; therefore, their contagion was unlikely to occur during the event. One woman may have had COVID-19 and attended the event during the incubation period. The transmission source of the 2 remaining cases could not be identified.
The authors note that the study was conducted in a community with low vaccination rates and a moderate infection rate. Nonetheless, they conclude that their findings have implications for informing safety measures at similar mass-gathering indoor events.
Media contacts: For an embargoed PDF, please contact Angela Collom at acollom@acponline.org. To speak with the corresponding author, Josep M. Llibre, MD, PhD, please contact Nacho Creus at icreus@flsida.org.
2. Antibody-based multitarget FIT test shows better diagnostic accuracy for colorectal cancer compared with standard FIT
Abstract: https://www.acpjournals.org/doi/10.7326/M20-8270
Editorial: https://www.acpjournals.org/doi/10.7326/M21-2748
URL goes live when the embargo lifts
A diagnostic test accuracy study found that an antibody-based multitarget fecal immunochemical test (mtFIT) for colorectal cancer (CRC) showed better diagnostic accuracy in detecting advanced neoplasia compared with the standard FIT test because of its ability to better detect advanced adenomas, without compromising specificity. These findings support further development of mtFIT technology as a future test for population-based CRC screening. The study is published in Annals of Internal Medicine.
FIT detects human hemoglobin in feces and has been proven effective for reducing CRC incidence and death. Although the sensitivity of FIT in one round of screening is high for CRC, the sensitivity for relevant precursor lesions, advanced adenomas and advanced serrated polyps is much lower. This underlines the clinical need for a noninvasive screening test that has higher sensitivity for precursor lesions without increasing false-positive test results.
Researchers from the Netherlands Cancer Institute, Amsterdam, in collaboration with researchers from Amsterdam UMC and Erasmus MC in Rotterdam, used biobanked residual FIT kit buffer from 1,284 patients to assess if the addition of protein biomarker quantification in stool could be used to improve the sensitivity of FIT without sacrificing specificity. The patients were classified by their most advanced lesion - CRC, advanced adenomas, advanced serrated polyps, nonadvanced adenomas, and nonadvanced serrated polyps--and then classification and regression tree (CART) analysis were applied to biomarker concentrations to identify the optimal combination for detecting advanced neoplasia. Performance of this combination, the mtFIT, was cross-validated using a leave-one-out approach and compared with FIT at equal specificity. The researchers found that the combination of 3 biomarkers (hemoglobin, calprotectin, and serpin family F member 2; subsequently referred to as the multi-target (mt) FIT) had significantly higher sensitivity than FIT for advanced neoplasia (i.e. CRC and advanced precursor lesions) with equal specificity to FIT. The improvement was seen in the advanced adenomas, for which sensitivity was increased by 35%, while sensitivity for CRC and advanced serrated polyps did not change. The improved sensitivity for advanced adenomas may prove critical to improving FIT's performance as a cancer prevention test. The authors estimate that when performed biennially and compared to traditional biennial FIT, mtFIT would reduce CRC incidence and mortality by 12% and 8%, respectively, assuming 73% adherence. Finally, the mFIT was also deemed cost-effective. A prospective screening trial to further validate mtFIT within the context of the Dutch CRC screening program is in preparation.
Media contacts: For an embargoed PDF, please contact Angela Collom at acollom@acponline.org. To speak with the corresponding author, Meike de Wit, PhD, please email directly at m.d.wit@nki.nl.
3. Apixiban associated with lower rates of adverse events in frail patients with atrial fibrillation compared to warfarin
Abstract: https://www.acpjournals.org/doi/10.7326/M20-7141
URL goes live when the embargo lifts
A retrospective observational study comparing direct oral anticoagulants (DAOCs) and warfarin found that for older adults with atrial fibrillation, apixaban was associated with lower rates of adverse events in patients at all levels of frailty. Dabigatran and rivaroxaban were associated with lower event rates than warfarin only among patients without frailty. The findings are published in Annals of Internal Medicine.
DOACs are at least as effective as warfarin in patients with atrial fibrillation with generally lower rates of major bleeding, fewer drug-drug or drug-food interactions. This may be particularly important to older adults with frailty, who are at high risk for falls and drug-related adverse events. Still, the role of differing levels of frailty in the choice of oral anticoagulants for older adults with atrial fibrillation is unclear.
Researchers from Bigham and Women's Hospital, Hebrew SeniorLife, and Harvard Medical School studied claims data for Medicare beneficiaries with atrial fibrillation who initiated use of dabigatran, rivaroxaban, apixaban, or warfarin to compare outcomes by frailty levels. The data showed that only apixaban was consistently associated with lower rates of the composite end point of death, ischemic stroke, and major bleeding than warfarin across all frailty levels. According to the authors, these findings provide evidence to guide the choice of a DOAC versus warfarin for older adults with atrial fibrillation.
Media contacts: For an embargoed PDF, please contact Angela Collom at acollom@acponline.org. To speak with the corresponding author, Dae Hyun Kim, MD, MPH, ScD, please email directly at dkim12@bwh.harvard.edu.
Also new in this issue:
Lipid Lowering Therapy in Patients of Advanced Age
Caputo
Annals Consult Guys
Abstract: https://www.acpjournals.org/doi/10.7326/W20-0023
COPD: What Clinicians Need to Know - Part 1
Centor
Annals On Call
Abstract: https://www.acpjournals.org/doi/10.7326/A20-0017
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Journal
Annals of Internal Medicine