Addressing the Missing Links in Cardiovascular Aging [Corrigendum]

Dinetz E, Zeballos-Palacios C, Martinez CA. Clin Interv Aging. 2024;19:873–882. Page 874, The Microbiome and Cardiovascular Aging, sixth sentence, the text “Specifically, aging and age- related pathology including CAD appears to be linked to the relative abundance of the phyla Firmicutes, which increases with age, and a decrease in Bactericides” should read “Specifically, aging and age- related pathology including CAD appears to be linked to the relative abundance of the phyla Firmicutes and Bacteroidetes”. The authors apologize for this error

Effect of Shared Decision-Making for Stroke Prevention on Treatment Adherence and Safety Outcomes in Patients With Atrial Fibrillation: A Randomized Clinical Trial

BACKGROUND Guidelines promote shared decision-making (SDM) for anticoagulation in patients with atrial fibrillation. We recently showed that adding a within-encounter SDM tool to usual care (UC) increases patient involvement in decision-making and clinician satisfaction, without affecting encounter length. We aimed to estimate the extent to which use of an SDM tool changed adherence to the decided care plan and clinical safety end points.METHODS AND RESULTS We conducted a multicenter, encounter-level, randomized trial assessing the efficacy of UC with versus without an SDM conversation tool for use during the clinical encounter (Anticoagulation Choice) in patients with nonvalvular atrial fibrillation considering starting or reviewing anticoagulation treatment. We conducted a chart and pharmacy review, blinded to randomization status, at 10 months after enrollment to assess primary adherence (proportion of patients who were prescribed an anticoagulant who filled their first prescription) and secondary adherence (estimated using the proportion of days for which treatment was supplied and filled for direct oral anticoagulant, and as time in therapeutic range for warfarin). We also noted any strokes, transient ischemic attacks, major bleeding, or deaths as safety end points. We enrolled 922 evaluable patient encounters (Anticoagulation Choice=463, and UC=459), of which 814 (88%) had pharmacy and clinical follow-up. We found no differences between arms in either primary adherence (78% of patients in the SDM arm filled their first prescription versus 81% in UC arm) or secondary adherence to anticoagulation (percentage days covered of the direct oral anticoagulant was 74.1% in SDM versus 71.6% in UC; time in therapeutic range for warfarin was 66.6% in SDM versus 64.4% in UC). Safety outcomes, mostly bleeds, occurred in 13% of participants in the SDM arm and 14% in the UC arm.CONCLUSIONS In this large, randomized trial comparing UC with a tool to promote SDM against UC alone, we found no significant differences between arms in primary or secondary adherence to anticoagulation or in clinical safety outcomes

The Efficacy of Resiliency Training Programs: A Systematic Review and Meta-Analysis of Randomized Trials

<div><p>Importance</p><p>Poor mental health places a burden on individuals and populations. Resilient persons are able to adapt to life’s challenges and maintain high quality of life and function. Finding effective strategies to bolster resilience in individuals and populations is of interest to many stakeholders.</p><p>Objectives</p><p>To synthesize the evidence for resiliency training programs in improving mental health and capacity in 1) diverse adult populations and 2) persons with chronic diseases.</p><p>Data Sources</p><p>Electronic databases, clinical trial registries, and bibliographies. We also contacted study authors and field experts.</p><p>Study Selection</p><p>Randomized trials assessing the efficacy of any program intended to enhance resilience in adults and published after 1990. No restrictions were made based on outcome measured or comparator used.</p><p>Data Extraction and Synthesis</p><p>Reviewers worked independently and in duplicate to extract study characteristics and data. These were confirmed with authors. We conducted a random effects meta-analysis on available data and tested for interaction in planned subgroups.</p><p>Main Outcomes</p><p>The standardized mean difference (SMD) effect of resiliency training programs on 1) resilience/hardiness, 2) quality of life/well-being, 3) self-efficacy/activation, 4) depression, 5) stress, and 6) anxiety.</p><p>Results</p><p>We found 25 small trials at moderate to high risk of bias. Interventions varied in format and theoretical approach. Random effects meta-analysis showed a moderate effect of generalized stress-directed programs on enhancing resilience [pooled SMD 0.37 (95% CI 0.18, 0.57) p = .0002; I² = 41%] within 3 months of follow up. Improvement in other outcomes was favorable to the interventions and reached statistical significance after removing two studies at high risk of bias. Trauma-induced stress-directed programs significantly improved stress [−0.53 (−1.04, −0.03) p = .03; I² = 73%] and depression [−0.51 (−0.92, −0.10) p = .04; I² = 61%].</p><p>Conclusions</p><p>We found evidence warranting low confidence that resiliency training programs have a small to moderate effect at improving resilience and other mental health outcomes. Further study is needed to better define the resilience construct and to design interventions specific to it.</p><p>Registration Number</p><p>PROSPERO #<a href="http://www.crd.york.ac.uk/PROSPERO/display_record.asp?ID=CRD42014007185.VDLPvykbBiY" target="_blank">CRD42014007185</a></p></div

Summary of Included Study Characteristics and Findings.

<p>Summary of Included Study Characteristics and Findings.</p

Summarized Effects of Resiliency Training in Meta-analysis.

<p>Summarized Effects of Resiliency Training in Meta-analysis.</p

Study flow diagram.

<p>Study flow diagram.</p

Resiliency training program operational framework.

<p>Resiliency training program operational framework.</p

Forest plot of generalized stress-directed resiliency training programs’ effect (SMD) on resilience, divided into subgroups based on whether a well-matched attention control was used.

<p>Forest plot of generalized stress-directed resiliency training programs’ effect (SMD) on resilience, divided into subgroups based on whether a well-matched attention control was used.</p