CHEST Physician

Bicycling has always been part of who I am because it offered me the freedom to explore as a preteen. As an adult I have always been a bicycle commuter and a very visible part of the community as I pedal around town to do my errands. But, I didn’t always wear a helmet ... because well, I just didn’t. I saw the helmet as a nuisance with very little benefit to myself. Eventually, when bike races required helmets I bought one just for the competitions. Until one day about 30 years ago when the mother of a child I was seeing in the office said, “Dr. Wilkoff, you know as an influential member of this community, particularly its children, you should be wearing a helmet.” My wife had been badgering me for years but this woman’s courage to speak up embarrassed me into changing my ways.

For some, maybe many, people, wearing a mask during the COVID-19 pandemic is a nuisance and an assault on their independence just as I viewed a bicycle helmet. Initially there was some information being circulated that any mask less robust than a N-95 had very little if any effect, either as protection or as way to decrease spread. I certainly had my doubts about the value of mask other than as a statement of solidarity. However, we are now learning that masks can serve an important role along with social distancing in a comprehensive community effort to minimize contagion.

In light of this new information, why are there are still people who won’t wear a mask? It may be that they are receiving their news filtered through a lens that discredits science. But, it is more likely the result of the same mindset that permeates the anti-vaccine faction that the common good is less important than personal freedom to follow their beliefs.

Do we have any tools at our disposal to increase the number of folks wearing masks? Based on our experience with attempts to convince those who are anti-vaccine, education will be ineffective in shifting the focus from personal freedom to a commitment to the welfare of the community at large. Shaming might be effective, but it runs the risk of igniting conflicts and further widening the gaps in our society. Some establishments have been effective in simply saying “no mask, no entry,” but this runs the same risk of creating friction depending on the community and the situation.

The ship may have already sailed on our best opportunity to achieve community compliance when the leaders of our national government have chosen to ignore their obligation to set an example by refusing to wear masks. I fear that the wedge has already been set and the widening of the gap between those who see their responsibility to the community at large and those who do not will continue to grow.

I am fortunate to live in a town whose residents look out for each other and have relied on local leaders to set an example in the absence of leadership on a national level.
 

Dr. Wilkoff practiced primary care pediatrics in Brunswick, Maine for nearly 40 years. He has authored several books on behavioral pediatrics, including “How to Say No to Your Toddler.” Email him at [email protected].

Bicycling has always been part of who I am because it offered me the freedom to explore as a preteen. As an adult I have always been a bicycle commuter and a very visible part of the community as I pedal around town to do my errands. But, I didn’t always wear a helmet ... because well, I just didn’t. I saw the helmet as a nuisance with very little benefit to myself. Eventually, when bike races required helmets I bought one just for the competitions. Until one day about 30 years ago when the mother of a child I was seeing in the office said, “Dr. Wilkoff, you know as an influential member of this community, particularly its children, you should be wearing a helmet.” My wife had been badgering me for years but this woman’s courage to speak up embarrassed me into changing my ways.

For some, maybe many, people, wearing a mask during the COVID-19 pandemic is a nuisance and an assault on their independence just as I viewed a bicycle helmet. Initially there was some information being circulated that any mask less robust than a N-95 had very little if any effect, either as protection or as way to decrease spread. I certainly had my doubts about the value of mask other than as a statement of solidarity. However, we are now learning that masks can serve an important role along with social distancing in a comprehensive community effort to minimize contagion.

In light of this new information, why are there are still people who won’t wear a mask? It may be that they are receiving their news filtered through a lens that discredits science. But, it is more likely the result of the same mindset that permeates the anti-vaccine faction that the common good is less important than personal freedom to follow their beliefs.

Do we have any tools at our disposal to increase the number of folks wearing masks? Based on our experience with attempts to convince those who are anti-vaccine, education will be ineffective in shifting the focus from personal freedom to a commitment to the welfare of the community at large. Shaming might be effective, but it runs the risk of igniting conflicts and further widening the gaps in our society. Some establishments have been effective in simply saying “no mask, no entry,” but this runs the same risk of creating friction depending on the community and the situation.

The ship may have already sailed on our best opportunity to achieve community compliance when the leaders of our national government have chosen to ignore their obligation to set an example by refusing to wear masks. I fear that the wedge has already been set and the widening of the gap between those who see their responsibility to the community at large and those who do not will continue to grow.

I am fortunate to live in a town whose residents look out for each other and have relied on local leaders to set an example in the absence of leadership on a national level.
 

Dr. Wilkoff practiced primary care pediatrics in Brunswick, Maine for nearly 40 years. He has authored several books on behavioral pediatrics, including “How to Say No to Your Toddler.” Email him at [email protected].

Bicycling has always been part of who I am because it offered me the freedom to explore as a preteen. As an adult I have always been a bicycle commuter and a very visible part of the community as I pedal around town to do my errands. But, I didn’t always wear a helmet ... because well, I just didn’t. I saw the helmet as a nuisance with very little benefit to myself. Eventually, when bike races required helmets I bought one just for the competitions. Until one day about 30 years ago when the mother of a child I was seeing in the office said, “Dr. Wilkoff, you know as an influential member of this community, particularly its children, you should be wearing a helmet.” My wife had been badgering me for years but this woman’s courage to speak up embarrassed me into changing my ways.

For some, maybe many, people, wearing a mask during the COVID-19 pandemic is a nuisance and an assault on their independence just as I viewed a bicycle helmet. Initially there was some information being circulated that any mask less robust than a N-95 had very little if any effect, either as protection or as way to decrease spread. I certainly had my doubts about the value of mask other than as a statement of solidarity. However, we are now learning that masks can serve an important role along with social distancing in a comprehensive community effort to minimize contagion.

In light of this new information, why are there are still people who won’t wear a mask? It may be that they are receiving their news filtered through a lens that discredits science. But, it is more likely the result of the same mindset that permeates the anti-vaccine faction that the common good is less important than personal freedom to follow their beliefs.

Do we have any tools at our disposal to increase the number of folks wearing masks? Based on our experience with attempts to convince those who are anti-vaccine, education will be ineffective in shifting the focus from personal freedom to a commitment to the welfare of the community at large. Shaming might be effective, but it runs the risk of igniting conflicts and further widening the gaps in our society. Some establishments have been effective in simply saying “no mask, no entry,” but this runs the same risk of creating friction depending on the community and the situation.

The ship may have already sailed on our best opportunity to achieve community compliance when the leaders of our national government have chosen to ignore their obligation to set an example by refusing to wear masks. I fear that the wedge has already been set and the widening of the gap between those who see their responsibility to the community at large and those who do not will continue to grow.

I am fortunate to live in a town whose residents look out for each other and have relied on local leaders to set an example in the absence of leadership on a national level.
 

Dr. Wilkoff practiced primary care pediatrics in Brunswick, Maine for nearly 40 years. He has authored several books on behavioral pediatrics, including “How to Say No to Your Toddler.” Email him at [email protected].

After careful consideration, CHEST has decided to cancel the live, in-person CHEST Annual Meeting in Chicago, Illinois, this October and replace it with a 100% virtual event. The COVID-19 pandemic has provided the opportunity to look at different approaches for delivering education, and over the past several months, CHEST has done just that.

Due to the pandemic, we moved the CHEST Congress 2020, originally scheduled to take place in Bologna, Italy, to June 2021. On June 30, in partnership with the Italian Delegation, the CHEST Virtual Congress event took place with over 3,200 people registered, spanning over 100 countries. This event featured a robust program that included an international COVID panel, additional educational sessions, over 300 recorded poster presentations, and live, interactive games that kept attendees engaged throughout the day. There was also a surprise welcome message delivered by Dr. Anthony Fauci, the Director of the National Institute of Allergy and Infectious Diseases. We are excited to use the success of this virtual event as an opportunity to expand our knowledge and expertise, and deliver a fun, memorable CHEST 2020.

This October, CHEST will bring you the premier virtual education event in pulmonary, critical care, and sleep medicine, all from the comfort and safety of your home or institution. This year’s virtual Annual Meeting will include live, interactive education, including panel and case-based discussions, virtual networking opportunities, CHEST GAMES, and the space for you to connect, learn, and recharge with your peers…virtually.

Top faculty from across the field will bring you the latest in clinical developments related to the diagnosis, treatment, and management of pulmonary diseases, critical care complications, and sleep disorders. Nonclinical topics, like cultural diversity and burnout, that feature more prominently than ever in day-to-day practice, will be given equal weight. Sessions like, Being Me: Understanding ‘Otherness’ and Issues of Diversity, will rely on audience interaction to address scenarios involving bias and racism faced by the panel of presenters and members of the audience.

Crucial and quickly evolving information on COVID-19 will be front and center, including complications with COVID-19 recovery, COVID-19 management in complex situations, and additional discussions on updated drug trials, treatment plans, and practice management changes. We will focus on other challenges the pandemic has highlighted, helping educators with sessions such as APCCMPD: Education Lessons During a Pandemic and sharing key reminders to all on the fundamentals of pandemic preparation with When the Theoretical Becomes Real: Lessons from a Pandemic.

It is more important than ever to stay up to date on developments in health and medicine, but CHEST is putting equal weight on ensuring the experience of CHEST 2020 is a respite from the mental and physical exhaustion our community is experiencing during these unprecedented times. As ever, we will ensure you meet your educational needs. But together, we will also focus on supporting you in building resilience and giving you the tools to continue to find joy in medicine, even amidst the chaos of a pandemic. Thank you for your continued trust in CHEST, and we look forward to “seeing” you at CHEST 2020 October 18-21!

After careful consideration, CHEST has decided to cancel the live, in-person CHEST Annual Meeting in Chicago, Illinois, this October and replace it with a 100% virtual event. The COVID-19 pandemic has provided the opportunity to look at different approaches for delivering education, and over the past several months, CHEST has done just that.

Due to the pandemic, we moved the CHEST Congress 2020, originally scheduled to take place in Bologna, Italy, to June 2021. On June 30, in partnership with the Italian Delegation, the CHEST Virtual Congress event took place with over 3,200 people registered, spanning over 100 countries. This event featured a robust program that included an international COVID panel, additional educational sessions, over 300 recorded poster presentations, and live, interactive games that kept attendees engaged throughout the day. There was also a surprise welcome message delivered by Dr. Anthony Fauci, the Director of the National Institute of Allergy and Infectious Diseases. We are excited to use the success of this virtual event as an opportunity to expand our knowledge and expertise, and deliver a fun, memorable CHEST 2020.

This October, CHEST will bring you the premier virtual education event in pulmonary, critical care, and sleep medicine, all from the comfort and safety of your home or institution. This year’s virtual Annual Meeting will include live, interactive education, including panel and case-based discussions, virtual networking opportunities, CHEST GAMES, and the space for you to connect, learn, and recharge with your peers…virtually.

Top faculty from across the field will bring you the latest in clinical developments related to the diagnosis, treatment, and management of pulmonary diseases, critical care complications, and sleep disorders. Nonclinical topics, like cultural diversity and burnout, that feature more prominently than ever in day-to-day practice, will be given equal weight. Sessions like, Being Me: Understanding ‘Otherness’ and Issues of Diversity, will rely on audience interaction to address scenarios involving bias and racism faced by the panel of presenters and members of the audience.

Crucial and quickly evolving information on COVID-19 will be front and center, including complications with COVID-19 recovery, COVID-19 management in complex situations, and additional discussions on updated drug trials, treatment plans, and practice management changes. We will focus on other challenges the pandemic has highlighted, helping educators with sessions such as APCCMPD: Education Lessons During a Pandemic and sharing key reminders to all on the fundamentals of pandemic preparation with When the Theoretical Becomes Real: Lessons from a Pandemic.

It is more important than ever to stay up to date on developments in health and medicine, but CHEST is putting equal weight on ensuring the experience of CHEST 2020 is a respite from the mental and physical exhaustion our community is experiencing during these unprecedented times. As ever, we will ensure you meet your educational needs. But together, we will also focus on supporting you in building resilience and giving you the tools to continue to find joy in medicine, even amidst the chaos of a pandemic. Thank you for your continued trust in CHEST, and we look forward to “seeing” you at CHEST 2020 October 18-21!

After careful consideration, CHEST has decided to cancel the live, in-person CHEST Annual Meeting in Chicago, Illinois, this October and replace it with a 100% virtual event. The COVID-19 pandemic has provided the opportunity to look at different approaches for delivering education, and over the past several months, CHEST has done just that.

Due to the pandemic, we moved the CHEST Congress 2020, originally scheduled to take place in Bologna, Italy, to June 2021. On June 30, in partnership with the Italian Delegation, the CHEST Virtual Congress event took place with over 3,200 people registered, spanning over 100 countries. This event featured a robust program that included an international COVID panel, additional educational sessions, over 300 recorded poster presentations, and live, interactive games that kept attendees engaged throughout the day. There was also a surprise welcome message delivered by Dr. Anthony Fauci, the Director of the National Institute of Allergy and Infectious Diseases. We are excited to use the success of this virtual event as an opportunity to expand our knowledge and expertise, and deliver a fun, memorable CHEST 2020.

This October, CHEST will bring you the premier virtual education event in pulmonary, critical care, and sleep medicine, all from the comfort and safety of your home or institution. This year’s virtual Annual Meeting will include live, interactive education, including panel and case-based discussions, virtual networking opportunities, CHEST GAMES, and the space for you to connect, learn, and recharge with your peers…virtually.

Top faculty from across the field will bring you the latest in clinical developments related to the diagnosis, treatment, and management of pulmonary diseases, critical care complications, and sleep disorders. Nonclinical topics, like cultural diversity and burnout, that feature more prominently than ever in day-to-day practice, will be given equal weight. Sessions like, Being Me: Understanding ‘Otherness’ and Issues of Diversity, will rely on audience interaction to address scenarios involving bias and racism faced by the panel of presenters and members of the audience.

Crucial and quickly evolving information on COVID-19 will be front and center, including complications with COVID-19 recovery, COVID-19 management in complex situations, and additional discussions on updated drug trials, treatment plans, and practice management changes. We will focus on other challenges the pandemic has highlighted, helping educators with sessions such as APCCMPD: Education Lessons During a Pandemic and sharing key reminders to all on the fundamentals of pandemic preparation with When the Theoretical Becomes Real: Lessons from a Pandemic.

It is more important than ever to stay up to date on developments in health and medicine, but CHEST is putting equal weight on ensuring the experience of CHEST 2020 is a respite from the mental and physical exhaustion our community is experiencing during these unprecedented times. As ever, we will ensure you meet your educational needs. But together, we will also focus on supporting you in building resilience and giving you the tools to continue to find joy in medicine, even amidst the chaos of a pandemic. Thank you for your continued trust in CHEST, and we look forward to “seeing” you at CHEST 2020 October 18-21!

Young adult smokers who stop smoking in the first year after an initial myocardial infarction are far less likely to die over the next 10 years than their peers who continue to smoke. Yet nearly two-thirds keep smoking after the event, according to new data from the Partners YOUNG-MI Registry.

“Smoking is one of the most common risk factors for developing an MI at a young age. ... This reinforces the need to have more young individuals avoid, or quit, the use of tobacco,” Ron Blankstein, MD, Brigham and Women’s Hospital and Harvard Medical School, Boston, said in an interview.

Yet, the finding that 62% of young adults continue to smoke 1 year after MI points to an “enormous need for better smoking cessation efforts following a heart attack,” he said.
 

“Powerful” message for clinicians

“This study joins an incredibly powerful body of evidence that says if you quit smoking, you’re going to live longer,” said Michael Fiore, MD, MPH, MBA, director of the University of Wisconsin Center for Tobacco Research and Intervention, Madison, who wasn’t involved in the study.

“As physicians, there is nothing we can do that will have a greater impact for our patients than quitting smoking. The study is a powerful call for clinicians to intervene with their patients that smoke – both if you have an MI or if you don’t,” Dr. Fiore told this news organization.

The study involved 2,072 individuals 50 years or younger (median age, 45 years; 81% male) who were hospitalized for an initial MI at two large academic medical centers in Boston. Of these, 33.9% were never-smokers, 13.6% were former smokers, and 52.5% were smokers at the time of their MI.

During a median follow-up of 10.2 years, those who quit smoking had a significantly lower rate of death from any cause (unadjusted hazard ratio, 0.35; 95% confidence interval, 0.19-0.63; P < .001) and a cardiovascular cause (HR, 0.29; 95% CI, 0.11-0.79; P = .02), relative to those who continued to smoke.

The results remained statistically significant in a propensity-matched analysis for both all-cause (HR, 0.30; 95% CI, 0.16-0.56; P < .001) and CV mortality (HR, 0.19; 95% CI, 0.06-0.56; P = .003).

“Although patients who quit smoking were similar to those who continued to smoke with respect to their baseline characteristics, smoking cessation was associated with an approximate 70%-80% reduction in all-cause and CV mortality,” the authors note in their article, published online July 8 in JAMA Network Open.

They say it’s also noteworthy that long-term death rates of never-smokers and former smokers who quit before the MI were nearly identical.

‘A failure of our health care system’

The bottom line, said Dr. Blankstein, is that it is “never too late to quit, and those who experience an MI should do so right away. Our health care system must help promote such efforts, as there is immense room for improvement.”

Dr. Fiore said: “When I see an article like this, it just reminds me that, if you’re really thinking about staying healthy, there is nothing better you can do to improve the quality and longevity of your life than quitting smoking.”

The observation that many patients continue to smoke after MI is a “failure of our health care system, and it’s an individual failure in that these individuals are not able to overcome their powerful nicotine dependence. It’s an unfortunate occurrence that’s resulting in unnecessary deaths,” said Dr. Fiore.

There is no “magic bullet” to overcome nicotine addiction, but there are approved treatments that can “substantially boost quit rates,” he noted.

The two most effective smoking-cessation treatments are varenicline (Chantix) and combination nicotine replacement therapy, a patch combined ideally with nicotine mini lozenges, particularly when combined with some brief counseling, said Fiore.

He encourages cardiologists to get their patients to commit to quitting and then link them to resources such as 1-800-QUIT-NOW or SmokeFree.gov.

Funding for the study was provided by grants from the National Heart, Lung, and Blood Institute. Dr. Blankstein reported receiving research support from Amgen and Astellas. Dr. Fiore had no relevant disclosures.

A version of this article originally appeared on Medscape.com.

Young adult smokers who stop smoking in the first year after an initial myocardial infarction are far less likely to die over the next 10 years than their peers who continue to smoke. Yet nearly two-thirds keep smoking after the event, according to new data from the Partners YOUNG-MI Registry.

“Smoking is one of the most common risk factors for developing an MI at a young age. ... This reinforces the need to have more young individuals avoid, or quit, the use of tobacco,” Ron Blankstein, MD, Brigham and Women’s Hospital and Harvard Medical School, Boston, said in an interview.

Yet, the finding that 62% of young adults continue to smoke 1 year after MI points to an “enormous need for better smoking cessation efforts following a heart attack,” he said.
 

“Powerful” message for clinicians

“This study joins an incredibly powerful body of evidence that says if you quit smoking, you’re going to live longer,” said Michael Fiore, MD, MPH, MBA, director of the University of Wisconsin Center for Tobacco Research and Intervention, Madison, who wasn’t involved in the study.

“As physicians, there is nothing we can do that will have a greater impact for our patients than quitting smoking. The study is a powerful call for clinicians to intervene with their patients that smoke – both if you have an MI or if you don’t,” Dr. Fiore told this news organization.

The study involved 2,072 individuals 50 years or younger (median age, 45 years; 81% male) who were hospitalized for an initial MI at two large academic medical centers in Boston. Of these, 33.9% were never-smokers, 13.6% were former smokers, and 52.5% were smokers at the time of their MI.

During a median follow-up of 10.2 years, those who quit smoking had a significantly lower rate of death from any cause (unadjusted hazard ratio, 0.35; 95% confidence interval, 0.19-0.63; P < .001) and a cardiovascular cause (HR, 0.29; 95% CI, 0.11-0.79; P = .02), relative to those who continued to smoke.

The results remained statistically significant in a propensity-matched analysis for both all-cause (HR, 0.30; 95% CI, 0.16-0.56; P < .001) and CV mortality (HR, 0.19; 95% CI, 0.06-0.56; P = .003).

“Although patients who quit smoking were similar to those who continued to smoke with respect to their baseline characteristics, smoking cessation was associated with an approximate 70%-80% reduction in all-cause and CV mortality,” the authors note in their article, published online July 8 in JAMA Network Open.

They say it’s also noteworthy that long-term death rates of never-smokers and former smokers who quit before the MI were nearly identical.

‘A failure of our health care system’

The bottom line, said Dr. Blankstein, is that it is “never too late to quit, and those who experience an MI should do so right away. Our health care system must help promote such efforts, as there is immense room for improvement.”

Dr. Fiore said: “When I see an article like this, it just reminds me that, if you’re really thinking about staying healthy, there is nothing better you can do to improve the quality and longevity of your life than quitting smoking.”

The observation that many patients continue to smoke after MI is a “failure of our health care system, and it’s an individual failure in that these individuals are not able to overcome their powerful nicotine dependence. It’s an unfortunate occurrence that’s resulting in unnecessary deaths,” said Dr. Fiore.

There is no “magic bullet” to overcome nicotine addiction, but there are approved treatments that can “substantially boost quit rates,” he noted.

The two most effective smoking-cessation treatments are varenicline (Chantix) and combination nicotine replacement therapy, a patch combined ideally with nicotine mini lozenges, particularly when combined with some brief counseling, said Fiore.

He encourages cardiologists to get their patients to commit to quitting and then link them to resources such as 1-800-QUIT-NOW or SmokeFree.gov.

Funding for the study was provided by grants from the National Heart, Lung, and Blood Institute. Dr. Blankstein reported receiving research support from Amgen and Astellas. Dr. Fiore had no relevant disclosures.

A version of this article originally appeared on Medscape.com.

Young adult smokers who stop smoking in the first year after an initial myocardial infarction are far less likely to die over the next 10 years than their peers who continue to smoke. Yet nearly two-thirds keep smoking after the event, according to new data from the Partners YOUNG-MI Registry.

“Smoking is one of the most common risk factors for developing an MI at a young age. ... This reinforces the need to have more young individuals avoid, or quit, the use of tobacco,” Ron Blankstein, MD, Brigham and Women’s Hospital and Harvard Medical School, Boston, said in an interview.

Yet, the finding that 62% of young adults continue to smoke 1 year after MI points to an “enormous need for better smoking cessation efforts following a heart attack,” he said.
 

“Powerful” message for clinicians

“This study joins an incredibly powerful body of evidence that says if you quit smoking, you’re going to live longer,” said Michael Fiore, MD, MPH, MBA, director of the University of Wisconsin Center for Tobacco Research and Intervention, Madison, who wasn’t involved in the study.

“As physicians, there is nothing we can do that will have a greater impact for our patients than quitting smoking. The study is a powerful call for clinicians to intervene with their patients that smoke – both if you have an MI or if you don’t,” Dr. Fiore told this news organization.

The study involved 2,072 individuals 50 years or younger (median age, 45 years; 81% male) who were hospitalized for an initial MI at two large academic medical centers in Boston. Of these, 33.9% were never-smokers, 13.6% were former smokers, and 52.5% were smokers at the time of their MI.

During a median follow-up of 10.2 years, those who quit smoking had a significantly lower rate of death from any cause (unadjusted hazard ratio, 0.35; 95% confidence interval, 0.19-0.63; P < .001) and a cardiovascular cause (HR, 0.29; 95% CI, 0.11-0.79; P = .02), relative to those who continued to smoke.

The results remained statistically significant in a propensity-matched analysis for both all-cause (HR, 0.30; 95% CI, 0.16-0.56; P < .001) and CV mortality (HR, 0.19; 95% CI, 0.06-0.56; P = .003).

“Although patients who quit smoking were similar to those who continued to smoke with respect to their baseline characteristics, smoking cessation was associated with an approximate 70%-80% reduction in all-cause and CV mortality,” the authors note in their article, published online July 8 in JAMA Network Open.

They say it’s also noteworthy that long-term death rates of never-smokers and former smokers who quit before the MI were nearly identical.

‘A failure of our health care system’

The bottom line, said Dr. Blankstein, is that it is “never too late to quit, and those who experience an MI should do so right away. Our health care system must help promote such efforts, as there is immense room for improvement.”

Dr. Fiore said: “When I see an article like this, it just reminds me that, if you’re really thinking about staying healthy, there is nothing better you can do to improve the quality and longevity of your life than quitting smoking.”

The observation that many patients continue to smoke after MI is a “failure of our health care system, and it’s an individual failure in that these individuals are not able to overcome their powerful nicotine dependence. It’s an unfortunate occurrence that’s resulting in unnecessary deaths,” said Dr. Fiore.

There is no “magic bullet” to overcome nicotine addiction, but there are approved treatments that can “substantially boost quit rates,” he noted.

The two most effective smoking-cessation treatments are varenicline (Chantix) and combination nicotine replacement therapy, a patch combined ideally with nicotine mini lozenges, particularly when combined with some brief counseling, said Fiore.

He encourages cardiologists to get their patients to commit to quitting and then link them to resources such as 1-800-QUIT-NOW or SmokeFree.gov.

Funding for the study was provided by grants from the National Heart, Lung, and Blood Institute. Dr. Blankstein reported receiving research support from Amgen and Astellas. Dr. Fiore had no relevant disclosures.

A version of this article originally appeared on Medscape.com.

Greetings. I hope that you are well and are enjoying the summer as best you can during these challenging times. Since the “CHEST year” has drawn to a close recently, I would like to offer my reflections, which were recently shared with the Board of Regents, as well as a glimpse of what is ahead for CHEST. There is just so much great work I want to share.

This past year has posed a number of challenges. COVID-19 has caused us to interact differently on both a social and a business level. CHEST Headquarters has been closed, and we have not had a live-learning course for more than 4 months. But our work has not faltered. We have been extremely productive during this period and have once again demonstrated our resiliency and innovative spirit; in our vernacular, we “Crushed It.”

While COVID-19 has presented us with a number of obstacles, it has presented us with a number of opportunities, and we have taken advantage of them. During this pandemic, CHEST has truly demonstrated its ability to provide a connection at a critical time, giving this phrase new meaning and urgency. We have created a new resource center for clinicians, developed patient education and awareness campaigns to support the public through this crisis, launched a webinar series, developed scientific guidance statements, and more. At the same time, we have invested in our technology and educational infrastructure to grow our capabilities and position CHEST for long-term success.

Prior to COVID-19, we spent a significant amount of time among the CHEST staff, Presidents, and Boards drafting and reviewing a concise strategy statement for CHEST to provide focus and clarity to its efforts and derive and tie together future strategies specific to learning, technology, and more. From this statement, we derived four key areas requiring our continued and explicit focus to achieve this goal:

• People: Ensure we attract, retain, and incentivize the right people (staff, leaders, and volunteers).

• Products: Foster an environment of innovation and product development resulting in overall revenue growth, as well as revenue from new products and services.

• Education: Ensure that CHEST education products and services are robust, differentiated, and scalable..

• Growth: Meet or exceed revenue and margin targets.

As long as the mission and strategy of the organization does not deviate, these goals should not change. However, how we go about executing on achieving these goals each year will depend on the context of our environment and be shaped by the specific initiatives planned affecting our People, Products, Education, and building toward Growth. This consistency is important to sustain a vibrant, aligned, and productive organization.

Beyond this groundwork, I also would like to list a series of things that, together, CHEST accomplished over the last year.

• Reviewed existing contracts and, where appropriate, renegotiated major contracts to ensure terms more favorable for CHEST.
• Hired and on-boarded a Chief Learning Officer to place greater emphasis on expanding CHEST educational programs. Analyzed current educational products and have begun repositioning our educational efforts to better serve our learners.
• Refined the one CHEST concept, realigned responsibilities throughout the organization in general, and the CHEST Foundation, in particular, to enhance resource readiness and productivity. Clarified relationship with industry by continuing to implement our Industry Partnership Guidelines and streamline efforts with our partners.
• Continued rollout and execution of our international event strategy. Successfully developed and held a program for CHEST Congress 2020 Italy with our CHEST Italian Delegation, in a virtual format, due to COVID, while enabling us to build momentum for a rescheduled meeting in 2021. We had over 2,000 virtual registrants from over 100 countries, and there was a thank you given to all attendees by Dr. Anthony Fauci, Director of the National Institute of Allergy and Infectious Diseases, to start off the program – what a success!
• Accelerated our digital transformation with an educational focus on virtual Board Review, CHEST 2020 Annual Meeting, online simulation.
• Forecasting strong financial outlook and improving financial reporting for FY19-20. Successful 2019 annual meeting:

o Total attendance 8,593—the largest attendance to date.

o Simulation Session Registration 979

o Exhibiting companies 160 SOLD OUT

o CHEST Annual Meeting 2019 delivered largest number of APPs and fellows attending in the last 5 years.

• Reintroduced CHEST into the advocacy and health policy arena through the successful acquisition of NAMDRC.

CHEST’s operating financial performance is solid, and well thought out efforts have kept CHEST on a growth trajectory over the last 7 years. During this same period (since 2011/12), our staff headcount has grown from 85 to a projected 121 this year; the new expertise and capabilities we have brought on board, combined with our highly talented and committed staff team, have contributed to this tremendous growth.

Our future is bright. These 2 two years have been very exciting for me both professionally and personally. I am grateful for the opportunity to work with all of you and serve as your CEO/EVP because together, we truly are making a significant difference in moving CHEST forward and crushing lung disease.

I know you are as proud of CHEST’s efforts this year as I am.

Thank you.

Greetings. I hope that you are well and are enjoying the summer as best you can during these challenging times. Since the “CHEST year” has drawn to a close recently, I would like to offer my reflections, which were recently shared with the Board of Regents, as well as a glimpse of what is ahead for CHEST. There is just so much great work I want to share.

This past year has posed a number of challenges. COVID-19 has caused us to interact differently on both a social and a business level. CHEST Headquarters has been closed, and we have not had a live-learning course for more than 4 months. But our work has not faltered. We have been extremely productive during this period and have once again demonstrated our resiliency and innovative spirit; in our vernacular, we “Crushed It.”

While COVID-19 has presented us with a number of obstacles, it has presented us with a number of opportunities, and we have taken advantage of them. During this pandemic, CHEST has truly demonstrated its ability to provide a connection at a critical time, giving this phrase new meaning and urgency. We have created a new resource center for clinicians, developed patient education and awareness campaigns to support the public through this crisis, launched a webinar series, developed scientific guidance statements, and more. At the same time, we have invested in our technology and educational infrastructure to grow our capabilities and position CHEST for long-term success.

Prior to COVID-19, we spent a significant amount of time among the CHEST staff, Presidents, and Boards drafting and reviewing a concise strategy statement for CHEST to provide focus and clarity to its efforts and derive and tie together future strategies specific to learning, technology, and more. From this statement, we derived four key areas requiring our continued and explicit focus to achieve this goal:

• People: Ensure we attract, retain, and incentivize the right people (staff, leaders, and volunteers).

• Products: Foster an environment of innovation and product development resulting in overall revenue growth, as well as revenue from new products and services.

• Education: Ensure that CHEST education products and services are robust, differentiated, and scalable..

• Growth: Meet or exceed revenue and margin targets.

As long as the mission and strategy of the organization does not deviate, these goals should not change. However, how we go about executing on achieving these goals each year will depend on the context of our environment and be shaped by the specific initiatives planned affecting our People, Products, Education, and building toward Growth. This consistency is important to sustain a vibrant, aligned, and productive organization.

Beyond this groundwork, I also would like to list a series of things that, together, CHEST accomplished over the last year.

• Reviewed existing contracts and, where appropriate, renegotiated major contracts to ensure terms more favorable for CHEST.
• Hired and on-boarded a Chief Learning Officer to place greater emphasis on expanding CHEST educational programs. Analyzed current educational products and have begun repositioning our educational efforts to better serve our learners.
• Refined the one CHEST concept, realigned responsibilities throughout the organization in general, and the CHEST Foundation, in particular, to enhance resource readiness and productivity. Clarified relationship with industry by continuing to implement our Industry Partnership Guidelines and streamline efforts with our partners.
• Continued rollout and execution of our international event strategy. Successfully developed and held a program for CHEST Congress 2020 Italy with our CHEST Italian Delegation, in a virtual format, due to COVID, while enabling us to build momentum for a rescheduled meeting in 2021. We had over 2,000 virtual registrants from over 100 countries, and there was a thank you given to all attendees by Dr. Anthony Fauci, Director of the National Institute of Allergy and Infectious Diseases, to start off the program – what a success!
• Accelerated our digital transformation with an educational focus on virtual Board Review, CHEST 2020 Annual Meeting, online simulation.
• Forecasting strong financial outlook and improving financial reporting for FY19-20. Successful 2019 annual meeting:

o Total attendance 8,593—the largest attendance to date.

o Simulation Session Registration 979

o Exhibiting companies 160 SOLD OUT

o CHEST Annual Meeting 2019 delivered largest number of APPs and fellows attending in the last 5 years.

• Reintroduced CHEST into the advocacy and health policy arena through the successful acquisition of NAMDRC.

CHEST’s operating financial performance is solid, and well thought out efforts have kept CHEST on a growth trajectory over the last 7 years. During this same period (since 2011/12), our staff headcount has grown from 85 to a projected 121 this year; the new expertise and capabilities we have brought on board, combined with our highly talented and committed staff team, have contributed to this tremendous growth.

Our future is bright. These 2 two years have been very exciting for me both professionally and personally. I am grateful for the opportunity to work with all of you and serve as your CEO/EVP because together, we truly are making a significant difference in moving CHEST forward and crushing lung disease.

I know you are as proud of CHEST’s efforts this year as I am.

Thank you.

Greetings. I hope that you are well and are enjoying the summer as best you can during these challenging times. Since the “CHEST year” has drawn to a close recently, I would like to offer my reflections, which were recently shared with the Board of Regents, as well as a glimpse of what is ahead for CHEST. There is just so much great work I want to share.

This past year has posed a number of challenges. COVID-19 has caused us to interact differently on both a social and a business level. CHEST Headquarters has been closed, and we have not had a live-learning course for more than 4 months. But our work has not faltered. We have been extremely productive during this period and have once again demonstrated our resiliency and innovative spirit; in our vernacular, we “Crushed It.”

While COVID-19 has presented us with a number of obstacles, it has presented us with a number of opportunities, and we have taken advantage of them. During this pandemic, CHEST has truly demonstrated its ability to provide a connection at a critical time, giving this phrase new meaning and urgency. We have created a new resource center for clinicians, developed patient education and awareness campaigns to support the public through this crisis, launched a webinar series, developed scientific guidance statements, and more. At the same time, we have invested in our technology and educational infrastructure to grow our capabilities and position CHEST for long-term success.

Prior to COVID-19, we spent a significant amount of time among the CHEST staff, Presidents, and Boards drafting and reviewing a concise strategy statement for CHEST to provide focus and clarity to its efforts and derive and tie together future strategies specific to learning, technology, and more. From this statement, we derived four key areas requiring our continued and explicit focus to achieve this goal:

• People: Ensure we attract, retain, and incentivize the right people (staff, leaders, and volunteers).

• Products: Foster an environment of innovation and product development resulting in overall revenue growth, as well as revenue from new products and services.

• Education: Ensure that CHEST education products and services are robust, differentiated, and scalable..

• Growth: Meet or exceed revenue and margin targets.

As long as the mission and strategy of the organization does not deviate, these goals should not change. However, how we go about executing on achieving these goals each year will depend on the context of our environment and be shaped by the specific initiatives planned affecting our People, Products, Education, and building toward Growth. This consistency is important to sustain a vibrant, aligned, and productive organization.

Beyond this groundwork, I also would like to list a series of things that, together, CHEST accomplished over the last year.

• Reviewed existing contracts and, where appropriate, renegotiated major contracts to ensure terms more favorable for CHEST.
• Hired and on-boarded a Chief Learning Officer to place greater emphasis on expanding CHEST educational programs. Analyzed current educational products and have begun repositioning our educational efforts to better serve our learners.
• Refined the one CHEST concept, realigned responsibilities throughout the organization in general, and the CHEST Foundation, in particular, to enhance resource readiness and productivity. Clarified relationship with industry by continuing to implement our Industry Partnership Guidelines and streamline efforts with our partners.
• Continued rollout and execution of our international event strategy. Successfully developed and held a program for CHEST Congress 2020 Italy with our CHEST Italian Delegation, in a virtual format, due to COVID, while enabling us to build momentum for a rescheduled meeting in 2021. We had over 2,000 virtual registrants from over 100 countries, and there was a thank you given to all attendees by Dr. Anthony Fauci, Director of the National Institute of Allergy and Infectious Diseases, to start off the program – what a success!
• Accelerated our digital transformation with an educational focus on virtual Board Review, CHEST 2020 Annual Meeting, online simulation.
• Forecasting strong financial outlook and improving financial reporting for FY19-20. Successful 2019 annual meeting:

o Total attendance 8,593—the largest attendance to date.

o Simulation Session Registration 979

o Exhibiting companies 160 SOLD OUT

o CHEST Annual Meeting 2019 delivered largest number of APPs and fellows attending in the last 5 years.

• Reintroduced CHEST into the advocacy and health policy arena through the successful acquisition of NAMDRC.

CHEST’s operating financial performance is solid, and well thought out efforts have kept CHEST on a growth trajectory over the last 7 years. During this same period (since 2011/12), our staff headcount has grown from 85 to a projected 121 this year; the new expertise and capabilities we have brought on board, combined with our highly talented and committed staff team, have contributed to this tremendous growth.

Our future is bright. These 2 two years have been very exciting for me both professionally and personally. I am grateful for the opportunity to work with all of you and serve as your CEO/EVP because together, we truly are making a significant difference in moving CHEST forward and crushing lung disease.

I know you are as proud of CHEST’s efforts this year as I am.

Thank you.

Dear Colleagues,

We are now near 6 months into living with COVID-19. In Texas, we are experiencing the surge that much of the Northeast saw in March and April. The COVID-19 Task Force led by Dr. Steve Simpson (CHEST President-Elect) and with representation from the Critical Care, Chest Infections, and Disaster Response and Global Health NetWorks continues to meet regularly to keep our members updated on the latest research and rapidly changing clinical management of COVID-19 illness and the sequelae. COVID-19 has put our medical profession and our subspecialty under considerable stress, and CHEST has launched a new longitudinal Wellness Center led by Dr. Alex Niven, from Mayo Clinic, Rochester. These new resources will feature a wellness webinar series focused on mental health and wellness for clinicians during COVID-19 and beyond. CHEST received overwhelming positive feedback from members and attendees to the Women & Pulmonary Virtual Happy Hour that focused on sharing stories and building community. Many leaders have suggested other such topics and efforts that may be useful to the CHEST community. The CHEST Wellness Center will launch on July 15.

In addition to COVID-19 activities, our nation and the world have compelled a new powerful look at race relations, disparities, and diversity. I represented CHEST at a “White Coats for Black Lives” event in San Antonio. Following our nation’s call for racial equality, CHEST released a Statement of Equity that received overwhelmingly positive feedback and response from members via email and on social media. This statement clearly resonated with the CHEST community. We are asking our leadership and members to consider ways in which CHEST might continue to raise awareness and continue with efforts related to diversity and equity. CHEST also hosted an excellent webinar moderated by Dr. Demondes Haynes and Dr. Nneka Sederstrom in late June that offered a direct and meaningful dialogue on issues facing clinicians and patients of color, and the responsibility of those in leadership positions. CHEST leadership stand firm that racism and inequality are public health issues and are working to define how we further our efforts in this arena.

On June 17, CHEST held a 1-day Virtual CHEST Congress in conjunction with our the CHEST Italian Delegation, as COVID-19 prevented us from safely holding the live Congress in Bologna. We had 3,250 registered attendees. I was so impressed at what a virtual platform can deliver, complete with great educational sessions, including much on COVID-19, as well as capturing the CHEST experience with games, bocce, jeopardy etc! This gave CHEST an opportunity to explore further virtual-based education to reach our wider global audience. CHEST will still be holding an in-person Congress in Bologna, June 24-26, 2021.

CHEST will host three entirely virtual Board Review Courses this August in the areas of Pulmonary, Critical Care, and Pediatric Pulmonary Medicine. These courses will include a combination of pre-recorded lectures and live, interactive sessions. Audience response systems and SEEK questions will still be utilized. There’s still time to register, so don’t miss it! With time being a major commodity at present, all attendees will receive year-long access to all material!

I know you have been wondering about CHEST 2020, and as you have heard by now, CHEST 2020 in Chicago will be a virtual meeting. I am sure that this announcement came as no big surprise, but is certainly disappointing. As you can imagine this was a difficult decision, but one that was necessary based upon our new reality. It was compounded by limitations on the convention center venue under the Illinois reopening plan, and the fact that a large number of our faculty, as well as our attendees, are under a travel ban for the remainder of 2020 that will not allow them to travel to Chicago. The abstract and case report deadline closed June 1, and despite these circumstances, we saw our highest number of submissions to date! Late abstracts were due on July 17. We will be presenting standalone and complementary online offerings to ensure seamless delivery of critical education in formats that cater easily to our newly formed habits.

Thanks to our dedicated Scientific Program Committee Chair, Dr. Victor Test, and staff, we had already begun preparing for virtual CHEST Annual Meeting 2020. Here’s what you can expect:

• A memorable experience

• A highly interactive education program that includes audience Q&A, discussion threads, and audience response systems

• Opportunities for one-on-one discussions, networking, and access to faculty

• Industry-sponsored programs and a virtual exhibit hall

• Access to hundreds of narrated poster presentations, case reports, and research abstracts

• Competitive educational gaming where attendees can participate, win, or watch

• Dedicated COVID-19 update sessions

• CME and MOC credits

If you have already registered for CHEST 2020, you will have the option to transfer your registration to this new model. Our main focus is delivering the virtual program with the highest level of service that you have come to expect from CHEST and respect for our member’s time and current situation. I know Dr. Victor Test and the program committee will deliver a superb educational experience in a virtual meeting setting. Thank you for your support and understanding as we continue to evolve our events to meet the needs of our members while adapting to the best delivery methods.

Since so many fellows were unable to hold their live graduation events, and celebrations, we decided to send them off with a virtual event! On June 30 we held a Joint CHEST/ATS Respiratory Community Graduation Ceremony–for graduating fellows, and to welcome new fellows to our profession. The ceremony consisted of a combination of live and recorded messages from key leaders from both organizations. In addition, there was a keynote address from Dr. Rana Awdish, a critical care physician at Henry Ford Hospital in Detroit, who authored the bestselling book “In Shock: My Journey from Death to Recovery and the Redemptive Power of Hope.” I encourage you to watch the video on the Early Career Professionals page on our Chestnet.org website.

The National Association for Medical Direction of Respiratory Care (NAMDRC) merger with CHEST was finalized at the end of May. Look for more advocacy-related actions coming from CHEST. The newly formed Health Policy and Advocacy Committee is helping to set CHEST’s advocacy agendas in the legislative and regulatory arenas, engaging with policymakers and educating CHEST members on governmental affairs relevant to CHEST’s mission. Did you see the inaugural CHEST published, on-line issue of Washington Watchline, a newsletter that aims to keep CHEST members informed about governmental activities that affect physicians who provide clinical care in respiratory, critical care, and sleep medicine? Follow Washington Watchline to learn more about CHEST’s advocacy around regulatory, legislative, and payment issues that relate to the delivery of health care in support of CHEST’s mission. One of the features was Telemedicine, which many of us are now using and is likely to be a part of many of our practices going forward.

With new COVID-19 surges throughout many parts of the United States, CHEST has continued our volunteer matching program for areas of need, including to the Navaho Nations, where CHEST matched 20 volunteers and has had more than a half-dozen inquiries from our members. In addition, in conjunction with the Foundation, CHEST has partnered with American Mask Rally and started a campaign to distribute masks to frontline essential workers in underserved communities. CHEST received a generous donation from AstraZeneca and Glaxo Smith Kline to help in the global fight against COVID-19 to provide current and accurate information and education to frontline clinicians to allow them to provide the best patient outcomes. CHEST also partnered with the American Thoracic Society to launch a joint PSA/ media campaign entitled For My Lung Health Campaign, to provide credible resources for underserved Black and Latino communities, as these communities are disproportionally affected by COVID-19. At the time of this writing, over a million people have seen the related video, featuring tips for taking control of one’s health in these difficult and uncertain times.

So, in closing, thank you all for what you do in these challenging times. 2020 will certainly be a year to remember! Stay safe and stay well!

Stephanie




 

Dear Colleagues,

We are now near 6 months into living with COVID-19. In Texas, we are experiencing the surge that much of the Northeast saw in March and April. The COVID-19 Task Force led by Dr. Steve Simpson (CHEST President-Elect) and with representation from the Critical Care, Chest Infections, and Disaster Response and Global Health NetWorks continues to meet regularly to keep our members updated on the latest research and rapidly changing clinical management of COVID-19 illness and the sequelae. COVID-19 has put our medical profession and our subspecialty under considerable stress, and CHEST has launched a new longitudinal Wellness Center led by Dr. Alex Niven, from Mayo Clinic, Rochester. These new resources will feature a wellness webinar series focused on mental health and wellness for clinicians during COVID-19 and beyond. CHEST received overwhelming positive feedback from members and attendees to the Women & Pulmonary Virtual Happy Hour that focused on sharing stories and building community. Many leaders have suggested other such topics and efforts that may be useful to the CHEST community. The CHEST Wellness Center will launch on July 15.

In addition to COVID-19 activities, our nation and the world have compelled a new powerful look at race relations, disparities, and diversity. I represented CHEST at a “White Coats for Black Lives” event in San Antonio. Following our nation’s call for racial equality, CHEST released a Statement of Equity that received overwhelmingly positive feedback and response from members via email and on social media. This statement clearly resonated with the CHEST community. We are asking our leadership and members to consider ways in which CHEST might continue to raise awareness and continue with efforts related to diversity and equity. CHEST also hosted an excellent webinar moderated by Dr. Demondes Haynes and Dr. Nneka Sederstrom in late June that offered a direct and meaningful dialogue on issues facing clinicians and patients of color, and the responsibility of those in leadership positions. CHEST leadership stand firm that racism and inequality are public health issues and are working to define how we further our efforts in this arena.

On June 17, CHEST held a 1-day Virtual CHEST Congress in conjunction with our the CHEST Italian Delegation, as COVID-19 prevented us from safely holding the live Congress in Bologna. We had 3,250 registered attendees. I was so impressed at what a virtual platform can deliver, complete with great educational sessions, including much on COVID-19, as well as capturing the CHEST experience with games, bocce, jeopardy etc! This gave CHEST an opportunity to explore further virtual-based education to reach our wider global audience. CHEST will still be holding an in-person Congress in Bologna, June 24-26, 2021.

CHEST will host three entirely virtual Board Review Courses this August in the areas of Pulmonary, Critical Care, and Pediatric Pulmonary Medicine. These courses will include a combination of pre-recorded lectures and live, interactive sessions. Audience response systems and SEEK questions will still be utilized. There’s still time to register, so don’t miss it! With time being a major commodity at present, all attendees will receive year-long access to all material!

I know you have been wondering about CHEST 2020, and as you have heard by now, CHEST 2020 in Chicago will be a virtual meeting. I am sure that this announcement came as no big surprise, but is certainly disappointing. As you can imagine this was a difficult decision, but one that was necessary based upon our new reality. It was compounded by limitations on the convention center venue under the Illinois reopening plan, and the fact that a large number of our faculty, as well as our attendees, are under a travel ban for the remainder of 2020 that will not allow them to travel to Chicago. The abstract and case report deadline closed June 1, and despite these circumstances, we saw our highest number of submissions to date! Late abstracts were due on July 17. We will be presenting standalone and complementary online offerings to ensure seamless delivery of critical education in formats that cater easily to our newly formed habits.

Thanks to our dedicated Scientific Program Committee Chair, Dr. Victor Test, and staff, we had already begun preparing for virtual CHEST Annual Meeting 2020. Here’s what you can expect:

• A memorable experience

• A highly interactive education program that includes audience Q&A, discussion threads, and audience response systems

• Opportunities for one-on-one discussions, networking, and access to faculty

• Industry-sponsored programs and a virtual exhibit hall

• Access to hundreds of narrated poster presentations, case reports, and research abstracts

• Competitive educational gaming where attendees can participate, win, or watch

• Dedicated COVID-19 update sessions

• CME and MOC credits

If you have already registered for CHEST 2020, you will have the option to transfer your registration to this new model. Our main focus is delivering the virtual program with the highest level of service that you have come to expect from CHEST and respect for our member’s time and current situation. I know Dr. Victor Test and the program committee will deliver a superb educational experience in a virtual meeting setting. Thank you for your support and understanding as we continue to evolve our events to meet the needs of our members while adapting to the best delivery methods.

Since so many fellows were unable to hold their live graduation events, and celebrations, we decided to send them off with a virtual event! On June 30 we held a Joint CHEST/ATS Respiratory Community Graduation Ceremony–for graduating fellows, and to welcome new fellows to our profession. The ceremony consisted of a combination of live and recorded messages from key leaders from both organizations. In addition, there was a keynote address from Dr. Rana Awdish, a critical care physician at Henry Ford Hospital in Detroit, who authored the bestselling book “In Shock: My Journey from Death to Recovery and the Redemptive Power of Hope.” I encourage you to watch the video on the Early Career Professionals page on our Chestnet.org website.

The National Association for Medical Direction of Respiratory Care (NAMDRC) merger with CHEST was finalized at the end of May. Look for more advocacy-related actions coming from CHEST. The newly formed Health Policy and Advocacy Committee is helping to set CHEST’s advocacy agendas in the legislative and regulatory arenas, engaging with policymakers and educating CHEST members on governmental affairs relevant to CHEST’s mission. Did you see the inaugural CHEST published, on-line issue of Washington Watchline, a newsletter that aims to keep CHEST members informed about governmental activities that affect physicians who provide clinical care in respiratory, critical care, and sleep medicine? Follow Washington Watchline to learn more about CHEST’s advocacy around regulatory, legislative, and payment issues that relate to the delivery of health care in support of CHEST’s mission. One of the features was Telemedicine, which many of us are now using and is likely to be a part of many of our practices going forward.

With new COVID-19 surges throughout many parts of the United States, CHEST has continued our volunteer matching program for areas of need, including to the Navaho Nations, where CHEST matched 20 volunteers and has had more than a half-dozen inquiries from our members. In addition, in conjunction with the Foundation, CHEST has partnered with American Mask Rally and started a campaign to distribute masks to frontline essential workers in underserved communities. CHEST received a generous donation from AstraZeneca and Glaxo Smith Kline to help in the global fight against COVID-19 to provide current and accurate information and education to frontline clinicians to allow them to provide the best patient outcomes. CHEST also partnered with the American Thoracic Society to launch a joint PSA/ media campaign entitled For My Lung Health Campaign, to provide credible resources for underserved Black and Latino communities, as these communities are disproportionally affected by COVID-19. At the time of this writing, over a million people have seen the related video, featuring tips for taking control of one’s health in these difficult and uncertain times.

So, in closing, thank you all for what you do in these challenging times. 2020 will certainly be a year to remember! Stay safe and stay well!

Stephanie




 

Dear Colleagues,

We are now near 6 months into living with COVID-19. In Texas, we are experiencing the surge that much of the Northeast saw in March and April. The COVID-19 Task Force led by Dr. Steve Simpson (CHEST President-Elect) and with representation from the Critical Care, Chest Infections, and Disaster Response and Global Health NetWorks continues to meet regularly to keep our members updated on the latest research and rapidly changing clinical management of COVID-19 illness and the sequelae. COVID-19 has put our medical profession and our subspecialty under considerable stress, and CHEST has launched a new longitudinal Wellness Center led by Dr. Alex Niven, from Mayo Clinic, Rochester. These new resources will feature a wellness webinar series focused on mental health and wellness for clinicians during COVID-19 and beyond. CHEST received overwhelming positive feedback from members and attendees to the Women & Pulmonary Virtual Happy Hour that focused on sharing stories and building community. Many leaders have suggested other such topics and efforts that may be useful to the CHEST community. The CHEST Wellness Center will launch on July 15.

In addition to COVID-19 activities, our nation and the world have compelled a new powerful look at race relations, disparities, and diversity. I represented CHEST at a “White Coats for Black Lives” event in San Antonio. Following our nation’s call for racial equality, CHEST released a Statement of Equity that received overwhelmingly positive feedback and response from members via email and on social media. This statement clearly resonated with the CHEST community. We are asking our leadership and members to consider ways in which CHEST might continue to raise awareness and continue with efforts related to diversity and equity. CHEST also hosted an excellent webinar moderated by Dr. Demondes Haynes and Dr. Nneka Sederstrom in late June that offered a direct and meaningful dialogue on issues facing clinicians and patients of color, and the responsibility of those in leadership positions. CHEST leadership stand firm that racism and inequality are public health issues and are working to define how we further our efforts in this arena.

On June 17, CHEST held a 1-day Virtual CHEST Congress in conjunction with our the CHEST Italian Delegation, as COVID-19 prevented us from safely holding the live Congress in Bologna. We had 3,250 registered attendees. I was so impressed at what a virtual platform can deliver, complete with great educational sessions, including much on COVID-19, as well as capturing the CHEST experience with games, bocce, jeopardy etc! This gave CHEST an opportunity to explore further virtual-based education to reach our wider global audience. CHEST will still be holding an in-person Congress in Bologna, June 24-26, 2021.

CHEST will host three entirely virtual Board Review Courses this August in the areas of Pulmonary, Critical Care, and Pediatric Pulmonary Medicine. These courses will include a combination of pre-recorded lectures and live, interactive sessions. Audience response systems and SEEK questions will still be utilized. There’s still time to register, so don’t miss it! With time being a major commodity at present, all attendees will receive year-long access to all material!

I know you have been wondering about CHEST 2020, and as you have heard by now, CHEST 2020 in Chicago will be a virtual meeting. I am sure that this announcement came as no big surprise, but is certainly disappointing. As you can imagine this was a difficult decision, but one that was necessary based upon our new reality. It was compounded by limitations on the convention center venue under the Illinois reopening plan, and the fact that a large number of our faculty, as well as our attendees, are under a travel ban for the remainder of 2020 that will not allow them to travel to Chicago. The abstract and case report deadline closed June 1, and despite these circumstances, we saw our highest number of submissions to date! Late abstracts were due on July 17. We will be presenting standalone and complementary online offerings to ensure seamless delivery of critical education in formats that cater easily to our newly formed habits.

Thanks to our dedicated Scientific Program Committee Chair, Dr. Victor Test, and staff, we had already begun preparing for virtual CHEST Annual Meeting 2020. Here’s what you can expect:

• A memorable experience

• A highly interactive education program that includes audience Q&A, discussion threads, and audience response systems

• Opportunities for one-on-one discussions, networking, and access to faculty

• Industry-sponsored programs and a virtual exhibit hall

• Access to hundreds of narrated poster presentations, case reports, and research abstracts

• Competitive educational gaming where attendees can participate, win, or watch

• Dedicated COVID-19 update sessions

• CME and MOC credits

If you have already registered for CHEST 2020, you will have the option to transfer your registration to this new model. Our main focus is delivering the virtual program with the highest level of service that you have come to expect from CHEST and respect for our member’s time and current situation. I know Dr. Victor Test and the program committee will deliver a superb educational experience in a virtual meeting setting. Thank you for your support and understanding as we continue to evolve our events to meet the needs of our members while adapting to the best delivery methods.

Since so many fellows were unable to hold their live graduation events, and celebrations, we decided to send them off with a virtual event! On June 30 we held a Joint CHEST/ATS Respiratory Community Graduation Ceremony–for graduating fellows, and to welcome new fellows to our profession. The ceremony consisted of a combination of live and recorded messages from key leaders from both organizations. In addition, there was a keynote address from Dr. Rana Awdish, a critical care physician at Henry Ford Hospital in Detroit, who authored the bestselling book “In Shock: My Journey from Death to Recovery and the Redemptive Power of Hope.” I encourage you to watch the video on the Early Career Professionals page on our Chestnet.org website.

The National Association for Medical Direction of Respiratory Care (NAMDRC) merger with CHEST was finalized at the end of May. Look for more advocacy-related actions coming from CHEST. The newly formed Health Policy and Advocacy Committee is helping to set CHEST’s advocacy agendas in the legislative and regulatory arenas, engaging with policymakers and educating CHEST members on governmental affairs relevant to CHEST’s mission. Did you see the inaugural CHEST published, on-line issue of Washington Watchline, a newsletter that aims to keep CHEST members informed about governmental activities that affect physicians who provide clinical care in respiratory, critical care, and sleep medicine? Follow Washington Watchline to learn more about CHEST’s advocacy around regulatory, legislative, and payment issues that relate to the delivery of health care in support of CHEST’s mission. One of the features was Telemedicine, which many of us are now using and is likely to be a part of many of our practices going forward.

With new COVID-19 surges throughout many parts of the United States, CHEST has continued our volunteer matching program for areas of need, including to the Navaho Nations, where CHEST matched 20 volunteers and has had more than a half-dozen inquiries from our members. In addition, in conjunction with the Foundation, CHEST has partnered with American Mask Rally and started a campaign to distribute masks to frontline essential workers in underserved communities. CHEST received a generous donation from AstraZeneca and Glaxo Smith Kline to help in the global fight against COVID-19 to provide current and accurate information and education to frontline clinicians to allow them to provide the best patient outcomes. CHEST also partnered with the American Thoracic Society to launch a joint PSA/ media campaign entitled For My Lung Health Campaign, to provide credible resources for underserved Black and Latino communities, as these communities are disproportionally affected by COVID-19. At the time of this writing, over a million people have seen the related video, featuring tips for taking control of one’s health in these difficult and uncertain times.

So, in closing, thank you all for what you do in these challenging times. 2020 will certainly be a year to remember! Stay safe and stay well!

Stephanie




 

The benefits of continuous positive airway pressure therapy for patients with obstructive sleep apnea are well documented, but it only works if patients can adhere to the therapy.

A large national study of older Medicare patients with obstructive sleep apnea (OSA) has identified lower socioeconomic status and comorbidities as independent risk factors for nonadherence to continuous positive airway pressure (CPAP) therapy.

“[The] present results represent the largest study to date of rates and predictors of CPAP adherence among older adults in the United States. In our national sample of Medicare beneficiaries, adherence rates were generally lower than previously reported in smaller, clinic-based studies,” Emerson M. Wickwire, PhD, of the Sleep Disorders Center and division of pulmonary and critical care medicine at the University of Maryland, Baltimore, and colleagues wrote in Sleep.

Dr. Wickwire and colleagues estimated CPAP machine adherence using a 5% sample of Medicare claims data, identifying 3,229 Medicare beneficiaries with OSA who began CPAP therapy between 2009 and 2011. Individuals in the sample were aged at least 65 years with a new diagnosis of OSA, 88.1% of beneficiaries were white, and 52.3% were male.

The researchers applied objective adherence criteria set by the Centers for Medicare & Medicaid Services, which defines CPAP adherence as a patient using CPAP for at least 4 hours on 70% of nights, or CPAP use for 21 of 30 consecutive days within 90 days after beginning therapy.

Using CPAP machine charges as a measure of who adhered to therapy, they found 1,420 of 3,229 individuals (44%) achieved adherence under these criteria, which included making 13 monthly payments during their CPAP machine’s “rent-to-own” period. Partial adherence was found in 997 individuals (30.9%) who made between 4-12 payments on their CPAP machine, while 812 individuals (25.2%) made 4 payments or fewer on their CPAP machines, which the researchers classified as nonadherence. Nonadherers tended to be slightly younger (mean, 72.5 years vs. 79.2 years; P < .001) and had a higher number of comorbidities (35.2% vs. 30.4%; P = .002), compared with individuals with high adherence. Anxiety (odds ratio, 1.34; 95% confidence interval, 1.12-1.61), anemia (OR, 1.16; 95% CI, 1.02-1.32), fibromyalgia (OR, 1.19; 95% CI, 1.03-1.38), traumatic brain injury (OR, 1.58; 95% CI, 1.21-2.07), and Medicaid eligibility (OR, 1.48; 95% CI, 1.24-1.75) were all independently associated with lower CPAP adherence. Medicaid eligibility was considered an indicator of lower socioeconomic status.

Krishna M. Sundar, MD, FCCP, director at the Sleep-Wake Center in the University of Utah pulmonary division in Salt Lake City and CHEST Physician editorial board member, said in an interview that studies have shown early signs of adherence within the first few weeks are an important indicator of overall adherence to CPAP therapy. However, the use of CPAP machine payments in the study by Dr. Wickwire and colleagues was a novel way to track adherence.

Some of the issues with nonadherence may be related to challenges in using the technology, but it is the clinician’s role to communicate with patients about the effectiveness of CPAP and identifying reasons for nonadherence while also attempting to tease out the subtle socioeconomic factors related to nonadherence, Dr. Sundar noted. “We need to alter our practice to make sure that we communicate with these patients and better understand what are the social factors in getting the CPAP or utilizing CPAP, and also following these patients more closely, especially in the first month of starting CPAP therapy.

“Just because somebody has severe sleep apnea and other comorbid conditions does not mean that they’re going to wear the CPAP,” he said. “So, the fact that socioeconomic factors play an equal if not more important role in terms of predicting CPAP adherence. That is an important takeaway.”

Octavian C. Ioachimescu, MD, FCCP, of Emory University, Atlanta, and the Atlanta Veteran Affairs Administration and CHEST Physician editorial board member, said in an interview that the study raises a major question of what is next. “What can we offer to these patients, and what is the real-world compliance to that ‘next-best’ modality?” Dr. Ioachimescu said. “What are the outcomes of these individuals in the point-of-care environment, or ‘real world?’ ”

The analysis by the authors adds the perspective of a “real-world depiction of clinical care for patients with OSA,” Dr. Ioachimescu said. “One major lesson of such an analysis is that the health care goal setting that is referential to initial, randomized, well-controlled studies on highly selected patient populations need to be reassessed periodically from the point of view of actual results in the clinics.”

Clinicians may need to borrow ideas from other therapeutic fields to help improve patient adherence, he said. “[W]e may be able to develop and implement in the future peer involvement, behavioral and cognitive approaches, motivational enhancement interventions, as well as elements of acceptance and commitment techniques, all in the larger context of more integrated and in the same time individualized approaches to therapy.”

The investigators concluded that, “relative to Medicare-only beneficiaries, those eligible for both Medicare and Medicaid were significantly less likely to adhere to CPAP. Future research should seek to develop a deeper understanding of the mechanisms through which [socioeconomic status] and other social determinants impact patient experience throughout the OSA diagnostic and treatment process, including receiving, acclimating, and adhering to CPAP therapy.”

Dr. Sundar concurred with this assessment and said more research is needed on factors impacting adherence such as poverty, homelessness, and home support systems. “It’s not just coordinating with the patient. Clearly, more work is needed in understanding the social aspects of CPAP adherence.”

This study was funded in part by an investigator-initiated grant provided by ResMed to Dr. Wickmire’s institution, the University of Maryland, Baltimore. Dr. Wickmire reported being a scientific consultant to DayZz, Eisai, Merck, and Purdue and holds shares in WellTap. Dr. Oldstone is a ResMed employee and shareholder. Dr. Sundar reported being a cofounder of Hypnoscure, which creates software for population management of sleep apnea, and an investigator in trials where ResMed and Respironics devices were used. Dr. Ioachimescu reported no relevant financial disclosures.

SOURCE: Wickwire EM et al. Sleep. 2020 Jun 23. doi: 10.1093/sleep/zsaa122.

The benefits of continuous positive airway pressure therapy for patients with obstructive sleep apnea are well documented, but it only works if patients can adhere to the therapy.

A large national study of older Medicare patients with obstructive sleep apnea (OSA) has identified lower socioeconomic status and comorbidities as independent risk factors for nonadherence to continuous positive airway pressure (CPAP) therapy.

“[The] present results represent the largest study to date of rates and predictors of CPAP adherence among older adults in the United States. In our national sample of Medicare beneficiaries, adherence rates were generally lower than previously reported in smaller, clinic-based studies,” Emerson M. Wickwire, PhD, of the Sleep Disorders Center and division of pulmonary and critical care medicine at the University of Maryland, Baltimore, and colleagues wrote in Sleep.

Dr. Wickwire and colleagues estimated CPAP machine adherence using a 5% sample of Medicare claims data, identifying 3,229 Medicare beneficiaries with OSA who began CPAP therapy between 2009 and 2011. Individuals in the sample were aged at least 65 years with a new diagnosis of OSA, 88.1% of beneficiaries were white, and 52.3% were male.

The researchers applied objective adherence criteria set by the Centers for Medicare & Medicaid Services, which defines CPAP adherence as a patient using CPAP for at least 4 hours on 70% of nights, or CPAP use for 21 of 30 consecutive days within 90 days after beginning therapy.

Using CPAP machine charges as a measure of who adhered to therapy, they found 1,420 of 3,229 individuals (44%) achieved adherence under these criteria, which included making 13 monthly payments during their CPAP machine’s “rent-to-own” period. Partial adherence was found in 997 individuals (30.9%) who made between 4-12 payments on their CPAP machine, while 812 individuals (25.2%) made 4 payments or fewer on their CPAP machines, which the researchers classified as nonadherence. Nonadherers tended to be slightly younger (mean, 72.5 years vs. 79.2 years; P < .001) and had a higher number of comorbidities (35.2% vs. 30.4%; P = .002), compared with individuals with high adherence. Anxiety (odds ratio, 1.34; 95% confidence interval, 1.12-1.61), anemia (OR, 1.16; 95% CI, 1.02-1.32), fibromyalgia (OR, 1.19; 95% CI, 1.03-1.38), traumatic brain injury (OR, 1.58; 95% CI, 1.21-2.07), and Medicaid eligibility (OR, 1.48; 95% CI, 1.24-1.75) were all independently associated with lower CPAP adherence. Medicaid eligibility was considered an indicator of lower socioeconomic status.

Krishna M. Sundar, MD, FCCP, director at the Sleep-Wake Center in the University of Utah pulmonary division in Salt Lake City and CHEST Physician editorial board member, said in an interview that studies have shown early signs of adherence within the first few weeks are an important indicator of overall adherence to CPAP therapy. However, the use of CPAP machine payments in the study by Dr. Wickwire and colleagues was a novel way to track adherence.

Some of the issues with nonadherence may be related to challenges in using the technology, but it is the clinician’s role to communicate with patients about the effectiveness of CPAP and identifying reasons for nonadherence while also attempting to tease out the subtle socioeconomic factors related to nonadherence, Dr. Sundar noted. “We need to alter our practice to make sure that we communicate with these patients and better understand what are the social factors in getting the CPAP or utilizing CPAP, and also following these patients more closely, especially in the first month of starting CPAP therapy.

“Just because somebody has severe sleep apnea and other comorbid conditions does not mean that they’re going to wear the CPAP,” he said. “So, the fact that socioeconomic factors play an equal if not more important role in terms of predicting CPAP adherence. That is an important takeaway.”

Octavian C. Ioachimescu, MD, FCCP, of Emory University, Atlanta, and the Atlanta Veteran Affairs Administration and CHEST Physician editorial board member, said in an interview that the study raises a major question of what is next. “What can we offer to these patients, and what is the real-world compliance to that ‘next-best’ modality?” Dr. Ioachimescu said. “What are the outcomes of these individuals in the point-of-care environment, or ‘real world?’ ”

The analysis by the authors adds the perspective of a “real-world depiction of clinical care for patients with OSA,” Dr. Ioachimescu said. “One major lesson of such an analysis is that the health care goal setting that is referential to initial, randomized, well-controlled studies on highly selected patient populations need to be reassessed periodically from the point of view of actual results in the clinics.”

Clinicians may need to borrow ideas from other therapeutic fields to help improve patient adherence, he said. “[W]e may be able to develop and implement in the future peer involvement, behavioral and cognitive approaches, motivational enhancement interventions, as well as elements of acceptance and commitment techniques, all in the larger context of more integrated and in the same time individualized approaches to therapy.”

The investigators concluded that, “relative to Medicare-only beneficiaries, those eligible for both Medicare and Medicaid were significantly less likely to adhere to CPAP. Future research should seek to develop a deeper understanding of the mechanisms through which [socioeconomic status] and other social determinants impact patient experience throughout the OSA diagnostic and treatment process, including receiving, acclimating, and adhering to CPAP therapy.”

Dr. Sundar concurred with this assessment and said more research is needed on factors impacting adherence such as poverty, homelessness, and home support systems. “It’s not just coordinating with the patient. Clearly, more work is needed in understanding the social aspects of CPAP adherence.”

This study was funded in part by an investigator-initiated grant provided by ResMed to Dr. Wickmire’s institution, the University of Maryland, Baltimore. Dr. Wickmire reported being a scientific consultant to DayZz, Eisai, Merck, and Purdue and holds shares in WellTap. Dr. Oldstone is a ResMed employee and shareholder. Dr. Sundar reported being a cofounder of Hypnoscure, which creates software for population management of sleep apnea, and an investigator in trials where ResMed and Respironics devices were used. Dr. Ioachimescu reported no relevant financial disclosures.

SOURCE: Wickwire EM et al. Sleep. 2020 Jun 23. doi: 10.1093/sleep/zsaa122.

The benefits of continuous positive airway pressure therapy for patients with obstructive sleep apnea are well documented, but it only works if patients can adhere to the therapy.

A large national study of older Medicare patients with obstructive sleep apnea (OSA) has identified lower socioeconomic status and comorbidities as independent risk factors for nonadherence to continuous positive airway pressure (CPAP) therapy.

“[The] present results represent the largest study to date of rates and predictors of CPAP adherence among older adults in the United States. In our national sample of Medicare beneficiaries, adherence rates were generally lower than previously reported in smaller, clinic-based studies,” Emerson M. Wickwire, PhD, of the Sleep Disorders Center and division of pulmonary and critical care medicine at the University of Maryland, Baltimore, and colleagues wrote in Sleep.

Dr. Wickwire and colleagues estimated CPAP machine adherence using a 5% sample of Medicare claims data, identifying 3,229 Medicare beneficiaries with OSA who began CPAP therapy between 2009 and 2011. Individuals in the sample were aged at least 65 years with a new diagnosis of OSA, 88.1% of beneficiaries were white, and 52.3% were male.

The researchers applied objective adherence criteria set by the Centers for Medicare & Medicaid Services, which defines CPAP adherence as a patient using CPAP for at least 4 hours on 70% of nights, or CPAP use for 21 of 30 consecutive days within 90 days after beginning therapy.

Using CPAP machine charges as a measure of who adhered to therapy, they found 1,420 of 3,229 individuals (44%) achieved adherence under these criteria, which included making 13 monthly payments during their CPAP machine’s “rent-to-own” period. Partial adherence was found in 997 individuals (30.9%) who made between 4-12 payments on their CPAP machine, while 812 individuals (25.2%) made 4 payments or fewer on their CPAP machines, which the researchers classified as nonadherence. Nonadherers tended to be slightly younger (mean, 72.5 years vs. 79.2 years; P < .001) and had a higher number of comorbidities (35.2% vs. 30.4%; P = .002), compared with individuals with high adherence. Anxiety (odds ratio, 1.34; 95% confidence interval, 1.12-1.61), anemia (OR, 1.16; 95% CI, 1.02-1.32), fibromyalgia (OR, 1.19; 95% CI, 1.03-1.38), traumatic brain injury (OR, 1.58; 95% CI, 1.21-2.07), and Medicaid eligibility (OR, 1.48; 95% CI, 1.24-1.75) were all independently associated with lower CPAP adherence. Medicaid eligibility was considered an indicator of lower socioeconomic status.

Krishna M. Sundar, MD, FCCP, director at the Sleep-Wake Center in the University of Utah pulmonary division in Salt Lake City and CHEST Physician editorial board member, said in an interview that studies have shown early signs of adherence within the first few weeks are an important indicator of overall adherence to CPAP therapy. However, the use of CPAP machine payments in the study by Dr. Wickwire and colleagues was a novel way to track adherence.

Some of the issues with nonadherence may be related to challenges in using the technology, but it is the clinician’s role to communicate with patients about the effectiveness of CPAP and identifying reasons for nonadherence while also attempting to tease out the subtle socioeconomic factors related to nonadherence, Dr. Sundar noted. “We need to alter our practice to make sure that we communicate with these patients and better understand what are the social factors in getting the CPAP or utilizing CPAP, and also following these patients more closely, especially in the first month of starting CPAP therapy.

“Just because somebody has severe sleep apnea and other comorbid conditions does not mean that they’re going to wear the CPAP,” he said. “So, the fact that socioeconomic factors play an equal if not more important role in terms of predicting CPAP adherence. That is an important takeaway.”

Octavian C. Ioachimescu, MD, FCCP, of Emory University, Atlanta, and the Atlanta Veteran Affairs Administration and CHEST Physician editorial board member, said in an interview that the study raises a major question of what is next. “What can we offer to these patients, and what is the real-world compliance to that ‘next-best’ modality?” Dr. Ioachimescu said. “What are the outcomes of these individuals in the point-of-care environment, or ‘real world?’ ”

The analysis by the authors adds the perspective of a “real-world depiction of clinical care for patients with OSA,” Dr. Ioachimescu said. “One major lesson of such an analysis is that the health care goal setting that is referential to initial, randomized, well-controlled studies on highly selected patient populations need to be reassessed periodically from the point of view of actual results in the clinics.”

Clinicians may need to borrow ideas from other therapeutic fields to help improve patient adherence, he said. “[W]e may be able to develop and implement in the future peer involvement, behavioral and cognitive approaches, motivational enhancement interventions, as well as elements of acceptance and commitment techniques, all in the larger context of more integrated and in the same time individualized approaches to therapy.”

The investigators concluded that, “relative to Medicare-only beneficiaries, those eligible for both Medicare and Medicaid were significantly less likely to adhere to CPAP. Future research should seek to develop a deeper understanding of the mechanisms through which [socioeconomic status] and other social determinants impact patient experience throughout the OSA diagnostic and treatment process, including receiving, acclimating, and adhering to CPAP therapy.”

Dr. Sundar concurred with this assessment and said more research is needed on factors impacting adherence such as poverty, homelessness, and home support systems. “It’s not just coordinating with the patient. Clearly, more work is needed in understanding the social aspects of CPAP adherence.”

This study was funded in part by an investigator-initiated grant provided by ResMed to Dr. Wickmire’s institution, the University of Maryland, Baltimore. Dr. Wickmire reported being a scientific consultant to DayZz, Eisai, Merck, and Purdue and holds shares in WellTap. Dr. Oldstone is a ResMed employee and shareholder. Dr. Sundar reported being a cofounder of Hypnoscure, which creates software for population management of sleep apnea, and an investigator in trials where ResMed and Respironics devices were used. Dr. Ioachimescu reported no relevant financial disclosures.

SOURCE: Wickwire EM et al. Sleep. 2020 Jun 23. doi: 10.1093/sleep/zsaa122.

The first order of business in the long-awaited, recently released Centers for Medicare & Medicaid Services (CMS) proposed national coverage decision (NCD) for transcatheter mitral valve repair (TMVR) was to get rid of its familiar moniker.

The document tosses the term TMVR in favor of transcatheter edge-to-edge repair (TEER) “to more precisely define the treatment addressed in this NCD” and differentiate it from other therapies that repair or replace the mitral valve.

(In an off-the-cuff Twitter poll launched right after the CMS document’s release, 80.3% of respondents answered that they “hate” the new acronym and the remainder said they “love” it; those two were the poll’s only choices.)

The NCD proposal goes on to say that CMS coverage of TEER would expand to include treatment of symptomatic moderate-to-severe or severe functional mitral regurgitation (MR) when used with maximally tolerated guideline-directed medical therapy.

The proposed NCD has been expected since March 2019 when the US Food and Drug Administration (FDA) approved the MitraClip (Abbott Vascular) for secondary functional MR. Medicare has covered MitraClip for primary degenerative MR since 2014.

Abbott announced in October 2019 that it would ramp up production of the MitraClip, which is currently the only FDA-approved TEER device.

Further specifications

Even as the new proposed NCD would add CMS coverage for functional MR, it would also decline a coverage statement for degenerative MR. Instead, it proposes to leave such coverage decisions to local Medical Administrative Contractors (MACs), given a relatively low incidence of clip intervention for degenerative MR. Less than 1% of the Medicare population undergo TEER of the mitral valve for that indication, the document says.

“The MACs are structured to be able to take into account local patient, physician, and institutional factors, which are especially important when overall prevalence is very low.”

The proposal also emphasizes that patients undergoing such covered TEER procedures be “under the care of a heart failure physician specialist experienced in the care and treatment of mitral valve disease,» with additional care provided by a heart team that includes a cardiac surgeon, interventional cardiologist, interventional echocardiographer.

The new document is generally consistent with a Consensus Statement from the American Association for Thoracic Surgery, the American College of Cardiology (ACC), the Society for Cardiovascular Angiography and Interventions, and the Society of Thoracic Surgeons published in December 2019 and covered then by theheart.org / Medscape Cardiology.

In anticipation the CMS coverage proposal, the ACC earlier this year published a Focused Update of the 2017 Expert Consensus Decision Pathway on the Management of Mitral Regurgitation to reflect new evidence in the field, mainly the recent clinical trial data on functional MR from the MITRA-FR and COAPT trials.

“The proposed criteria are nicely guided by the multisociety consensus document, which sought to foster optimal patient outcomes while also maintaining access to TEER,” Sammy Elmariah, MD, MPH, from Massachusetts General Hospital in Boston, commented by email.

“These criteria, in conjunction with results of the COAPT trial, establish TEER as the standard of care for patients with symptomatic functional MR despite guideline-directed medical therapy who do not possess an alternative indication for cardiac surgery,” said Elmariah, a coauthor on both the Consensus Statement and the Focused Update.

The proposed NCD seems “reasonable,” cardiothoracic surgeon Michael J. Reardon, MD, Houston Methodist Hospital, said by email. But he thought there might be some objections to the requirement for TEER centers to have a surgery program with a minimum annual volume for mitral-valve surgeries.

The proposed NCD says a hospital must have “a surgical program that performs ≥25 total mitral valve surgical procedures for severe MR per year, of which at least 10 must be mitral valve repairs.”

“There is a very definite relationship between mitral valve surgery volume and surgical outcomes and between TEER volume and TEER outcomes, but no real relationship between mitral valve surgery volumes and TEER outcomes,” Reardon said. “A mitral valve surgery program is important, but how many cases do you need to be able to start and run a TEER program?”

Edwards Lifesciences is currently testing its own device for TEER: the PASCAL transcatheter mitral valve repair system. Early findings from the company’s ongoing CLASP IID trial, a head-to-head comparison of Pascal and MitraClip, are expected in December 2023.

CMS is seeking comments on the proposed national coverage determination, and will render a final decision within 60 days of the end of the 30-day public comment period.

Elmariah discloses receiving research grants from the American Heart Association, the National Institutes of Health, Edwards Lifesciences, Svelte Medical, and Medtronic, and consulting fees from AstraZeneca. Reardon recently reported no relevant conflicts of interest.

This article first appeared on Medscape.com.

The first order of business in the long-awaited, recently released Centers for Medicare & Medicaid Services (CMS) proposed national coverage decision (NCD) for transcatheter mitral valve repair (TMVR) was to get rid of its familiar moniker.

The document tosses the term TMVR in favor of transcatheter edge-to-edge repair (TEER) “to more precisely define the treatment addressed in this NCD” and differentiate it from other therapies that repair or replace the mitral valve.

(In an off-the-cuff Twitter poll launched right after the CMS document’s release, 80.3% of respondents answered that they “hate” the new acronym and the remainder said they “love” it; those two were the poll’s only choices.)

The NCD proposal goes on to say that CMS coverage of TEER would expand to include treatment of symptomatic moderate-to-severe or severe functional mitral regurgitation (MR) when used with maximally tolerated guideline-directed medical therapy.

The proposed NCD has been expected since March 2019 when the US Food and Drug Administration (FDA) approved the MitraClip (Abbott Vascular) for secondary functional MR. Medicare has covered MitraClip for primary degenerative MR since 2014.

Abbott announced in October 2019 that it would ramp up production of the MitraClip, which is currently the only FDA-approved TEER device.

Further specifications

Even as the new proposed NCD would add CMS coverage for functional MR, it would also decline a coverage statement for degenerative MR. Instead, it proposes to leave such coverage decisions to local Medical Administrative Contractors (MACs), given a relatively low incidence of clip intervention for degenerative MR. Less than 1% of the Medicare population undergo TEER of the mitral valve for that indication, the document says.

“The MACs are structured to be able to take into account local patient, physician, and institutional factors, which are especially important when overall prevalence is very low.”

The proposal also emphasizes that patients undergoing such covered TEER procedures be “under the care of a heart failure physician specialist experienced in the care and treatment of mitral valve disease,» with additional care provided by a heart team that includes a cardiac surgeon, interventional cardiologist, interventional echocardiographer.

The new document is generally consistent with a Consensus Statement from the American Association for Thoracic Surgery, the American College of Cardiology (ACC), the Society for Cardiovascular Angiography and Interventions, and the Society of Thoracic Surgeons published in December 2019 and covered then by theheart.org / Medscape Cardiology.

In anticipation the CMS coverage proposal, the ACC earlier this year published a Focused Update of the 2017 Expert Consensus Decision Pathway on the Management of Mitral Regurgitation to reflect new evidence in the field, mainly the recent clinical trial data on functional MR from the MITRA-FR and COAPT trials.

“The proposed criteria are nicely guided by the multisociety consensus document, which sought to foster optimal patient outcomes while also maintaining access to TEER,” Sammy Elmariah, MD, MPH, from Massachusetts General Hospital in Boston, commented by email.

“These criteria, in conjunction with results of the COAPT trial, establish TEER as the standard of care for patients with symptomatic functional MR despite guideline-directed medical therapy who do not possess an alternative indication for cardiac surgery,” said Elmariah, a coauthor on both the Consensus Statement and the Focused Update.

The proposed NCD seems “reasonable,” cardiothoracic surgeon Michael J. Reardon, MD, Houston Methodist Hospital, said by email. But he thought there might be some objections to the requirement for TEER centers to have a surgery program with a minimum annual volume for mitral-valve surgeries.

The proposed NCD says a hospital must have “a surgical program that performs ≥25 total mitral valve surgical procedures for severe MR per year, of which at least 10 must be mitral valve repairs.”

“There is a very definite relationship between mitral valve surgery volume and surgical outcomes and between TEER volume and TEER outcomes, but no real relationship between mitral valve surgery volumes and TEER outcomes,” Reardon said. “A mitral valve surgery program is important, but how many cases do you need to be able to start and run a TEER program?”

Edwards Lifesciences is currently testing its own device for TEER: the PASCAL transcatheter mitral valve repair system. Early findings from the company’s ongoing CLASP IID trial, a head-to-head comparison of Pascal and MitraClip, are expected in December 2023.

CMS is seeking comments on the proposed national coverage determination, and will render a final decision within 60 days of the end of the 30-day public comment period.

Elmariah discloses receiving research grants from the American Heart Association, the National Institutes of Health, Edwards Lifesciences, Svelte Medical, and Medtronic, and consulting fees from AstraZeneca. Reardon recently reported no relevant conflicts of interest.

This article first appeared on Medscape.com.

The first order of business in the long-awaited, recently released Centers for Medicare & Medicaid Services (CMS) proposed national coverage decision (NCD) for transcatheter mitral valve repair (TMVR) was to get rid of its familiar moniker.

The document tosses the term TMVR in favor of transcatheter edge-to-edge repair (TEER) “to more precisely define the treatment addressed in this NCD” and differentiate it from other therapies that repair or replace the mitral valve.

(In an off-the-cuff Twitter poll launched right after the CMS document’s release, 80.3% of respondents answered that they “hate” the new acronym and the remainder said they “love” it; those two were the poll’s only choices.)

The NCD proposal goes on to say that CMS coverage of TEER would expand to include treatment of symptomatic moderate-to-severe or severe functional mitral regurgitation (MR) when used with maximally tolerated guideline-directed medical therapy.

The proposed NCD has been expected since March 2019 when the US Food and Drug Administration (FDA) approved the MitraClip (Abbott Vascular) for secondary functional MR. Medicare has covered MitraClip for primary degenerative MR since 2014.

Abbott announced in October 2019 that it would ramp up production of the MitraClip, which is currently the only FDA-approved TEER device.

Further specifications

Even as the new proposed NCD would add CMS coverage for functional MR, it would also decline a coverage statement for degenerative MR. Instead, it proposes to leave such coverage decisions to local Medical Administrative Contractors (MACs), given a relatively low incidence of clip intervention for degenerative MR. Less than 1% of the Medicare population undergo TEER of the mitral valve for that indication, the document says.

“The MACs are structured to be able to take into account local patient, physician, and institutional factors, which are especially important when overall prevalence is very low.”

The proposal also emphasizes that patients undergoing such covered TEER procedures be “under the care of a heart failure physician specialist experienced in the care and treatment of mitral valve disease,» with additional care provided by a heart team that includes a cardiac surgeon, interventional cardiologist, interventional echocardiographer.

The new document is generally consistent with a Consensus Statement from the American Association for Thoracic Surgery, the American College of Cardiology (ACC), the Society for Cardiovascular Angiography and Interventions, and the Society of Thoracic Surgeons published in December 2019 and covered then by theheart.org / Medscape Cardiology.

In anticipation the CMS coverage proposal, the ACC earlier this year published a Focused Update of the 2017 Expert Consensus Decision Pathway on the Management of Mitral Regurgitation to reflect new evidence in the field, mainly the recent clinical trial data on functional MR from the MITRA-FR and COAPT trials.

“The proposed criteria are nicely guided by the multisociety consensus document, which sought to foster optimal patient outcomes while also maintaining access to TEER,” Sammy Elmariah, MD, MPH, from Massachusetts General Hospital in Boston, commented by email.

“These criteria, in conjunction with results of the COAPT trial, establish TEER as the standard of care for patients with symptomatic functional MR despite guideline-directed medical therapy who do not possess an alternative indication for cardiac surgery,” said Elmariah, a coauthor on both the Consensus Statement and the Focused Update.

The proposed NCD seems “reasonable,” cardiothoracic surgeon Michael J. Reardon, MD, Houston Methodist Hospital, said by email. But he thought there might be some objections to the requirement for TEER centers to have a surgery program with a minimum annual volume for mitral-valve surgeries.

The proposed NCD says a hospital must have “a surgical program that performs ≥25 total mitral valve surgical procedures for severe MR per year, of which at least 10 must be mitral valve repairs.”

“There is a very definite relationship between mitral valve surgery volume and surgical outcomes and between TEER volume and TEER outcomes, but no real relationship between mitral valve surgery volumes and TEER outcomes,” Reardon said. “A mitral valve surgery program is important, but how many cases do you need to be able to start and run a TEER program?”

Edwards Lifesciences is currently testing its own device for TEER: the PASCAL transcatheter mitral valve repair system. Early findings from the company’s ongoing CLASP IID trial, a head-to-head comparison of Pascal and MitraClip, are expected in December 2023.

CMS is seeking comments on the proposed national coverage determination, and will render a final decision within 60 days of the end of the 30-day public comment period.

Elmariah discloses receiving research grants from the American Heart Association, the National Institutes of Health, Edwards Lifesciences, Svelte Medical, and Medtronic, and consulting fees from AstraZeneca. Reardon recently reported no relevant conflicts of interest.

This article first appeared on Medscape.com.

A phase 1/2 trial of a vaccine against SARS-CoV-2 being developed by the University of Oxford has found that the vaccine is safe, causes few side effects, and induces strong immune responses.

The early stage results, published in The Lancet, found that the candidate vaccine, known as ChAdOx1 nCoV-19, provoked a T-cell response peaking 14 days after vaccination, and an antibody response within 28 days.

Andrew Pollard, chief investigator on the study, and professor of pediatric infection and immunity at Oxford University, described the results as “encouraging”. He told a briefing convened by the Science Media Centre on Monday that it was “a really important milestone on the path to the development of the vaccine”.

In the Commons, the Health Secretary, Matt Hancock, hailed the results for taking us “one step closer to finding a vaccine that can potentially save lives, all around the world”.

The trial, which has so far involved 1,077 healthy adults, caused minor side effects when compared with a control group given a meningitis vaccine. Fatigue and headache were the most commonly reported reactions.

However, there were no serious adverse events from the vaccine, the researchers said.
 

‘Still a long way to go’

Sarah Gilbert, lead researcher of the vaccine development program, and professor of vaccinology at Oxford, cautioned that there was still a long way to go before the team could confirm that the vaccine could protect against developing COVID-19.

“The difficulty that we have, and that all vaccine developers have in trying to make a vaccine against this particular virus, is that we don’t know how strong that immune response needs to be,” she said.

“So, we can’t say just by looking at immune responses whether this is going to protect people or not. And the only way we’re going to find out is by doing the large phase 3 trials and wait for people to be infected as part of that trial before we know if the vaccine can work.”

The authors noted some limitations to their findings. They said more research was needed to confirm their results in different groups of people – including older age groups, those with other health conditions, and in ethnically and geographically diverse populations.

A notable result of the trial was that participants given a second dose of the vaccine appeared to display a stronger immune response, a finding that had influenced plans to “look at two dose regimes as well as one dose regimes in the phase 3 trial”, Prof Adrian Hill, director of Oxford’s Jenner Institute, confirmed.

ChAdOx1 nCoV-19 is made from a weakened version of an adenovirus that causes infections in chimpanzees. The virus has been genetically modified so that it cannot grow in humans.

On Monday, the government announced that it had struck a deal with AstraZeneca for access to 100 million doses of the Oxford vaccine, in addition to millions of doses of other promising candidate vaccines.
 

Expert reaction to the findings

The Medical Research Council helped to fund the trial. Executive Chair Professor Fiona Watt commented: “It is truly remarkable how fast this vaccine has progressed, with our support, through early clinical trials, and it is very encouraging that it shows no safety concerns and evokes strong immune responses.

“There is a lot that we don’t yet know about immunity to the virus that causes COVID-19. However, it seems that both antibody and T cell immunity are important, and this vaccine triggers both responses. The much anticipated next milestone will be the results of the larger trials that are happening now to find out if the vaccine will protect people from the virus.”

Jonathan Ball, professor of molecular virology at the University of Nottingham, told the SMC: “The results of the Oxford chimp adenovirus vaccine candidate show that the vaccine is able to generate antibodies and T cells in humans and these persisted for several weeks. Whilst encouraging there is still a long way to go before we can herald the arrival of a successful coronavirus vaccine.

“It is unclear whether the levels of immunity can protect against infection – that’s what the larger ongoing phase III trials are designed to test. Nor do we know if this vaccine can protect those most vulnerable to severe COVID-19 disease.”

Stephen Evans, professor of pharmacoepidemiology at the London School of Hygiene and Tropical Medicine, commented: “For the vaccine to be really useful, we not only need the larger studies conducted where COVID-19 is still occurring at a high rate, but we need to be reasonably sure that the protection lasts for a considerable time.”

He said it was also vital that people older than 55 were included in later trials.

Richard Torbett, chief executive of the Association of the British Pharmaceutical Industry, said: “Developing a vaccine is an incredibly difficult challenge; the fact that there are multiple candidates in development is hopefully a sign that the hard work will ultimately pay off.

“But we must be patient. Proving that a vaccine is safe and effective is a long process and we could still be many months away.”

This article first appeared on Medscape.com.

A phase 1/2 trial of a vaccine against SARS-CoV-2 being developed by the University of Oxford has found that the vaccine is safe, causes few side effects, and induces strong immune responses.

The early stage results, published in The Lancet, found that the candidate vaccine, known as ChAdOx1 nCoV-19, provoked a T-cell response peaking 14 days after vaccination, and an antibody response within 28 days.

Andrew Pollard, chief investigator on the study, and professor of pediatric infection and immunity at Oxford University, described the results as “encouraging”. He told a briefing convened by the Science Media Centre on Monday that it was “a really important milestone on the path to the development of the vaccine”.

In the Commons, the Health Secretary, Matt Hancock, hailed the results for taking us “one step closer to finding a vaccine that can potentially save lives, all around the world”.

The trial, which has so far involved 1,077 healthy adults, caused minor side effects when compared with a control group given a meningitis vaccine. Fatigue and headache were the most commonly reported reactions.

However, there were no serious adverse events from the vaccine, the researchers said.
 

‘Still a long way to go’

Sarah Gilbert, lead researcher of the vaccine development program, and professor of vaccinology at Oxford, cautioned that there was still a long way to go before the team could confirm that the vaccine could protect against developing COVID-19.

“The difficulty that we have, and that all vaccine developers have in trying to make a vaccine against this particular virus, is that we don’t know how strong that immune response needs to be,” she said.

“So, we can’t say just by looking at immune responses whether this is going to protect people or not. And the only way we’re going to find out is by doing the large phase 3 trials and wait for people to be infected as part of that trial before we know if the vaccine can work.”

The authors noted some limitations to their findings. They said more research was needed to confirm their results in different groups of people – including older age groups, those with other health conditions, and in ethnically and geographically diverse populations.

A notable result of the trial was that participants given a second dose of the vaccine appeared to display a stronger immune response, a finding that had influenced plans to “look at two dose regimes as well as one dose regimes in the phase 3 trial”, Prof Adrian Hill, director of Oxford’s Jenner Institute, confirmed.

ChAdOx1 nCoV-19 is made from a weakened version of an adenovirus that causes infections in chimpanzees. The virus has been genetically modified so that it cannot grow in humans.

On Monday, the government announced that it had struck a deal with AstraZeneca for access to 100 million doses of the Oxford vaccine, in addition to millions of doses of other promising candidate vaccines.
 

Expert reaction to the findings

The Medical Research Council helped to fund the trial. Executive Chair Professor Fiona Watt commented: “It is truly remarkable how fast this vaccine has progressed, with our support, through early clinical trials, and it is very encouraging that it shows no safety concerns and evokes strong immune responses.

“There is a lot that we don’t yet know about immunity to the virus that causes COVID-19. However, it seems that both antibody and T cell immunity are important, and this vaccine triggers both responses. The much anticipated next milestone will be the results of the larger trials that are happening now to find out if the vaccine will protect people from the virus.”

Jonathan Ball, professor of molecular virology at the University of Nottingham, told the SMC: “The results of the Oxford chimp adenovirus vaccine candidate show that the vaccine is able to generate antibodies and T cells in humans and these persisted for several weeks. Whilst encouraging there is still a long way to go before we can herald the arrival of a successful coronavirus vaccine.

“It is unclear whether the levels of immunity can protect against infection – that’s what the larger ongoing phase III trials are designed to test. Nor do we know if this vaccine can protect those most vulnerable to severe COVID-19 disease.”

Stephen Evans, professor of pharmacoepidemiology at the London School of Hygiene and Tropical Medicine, commented: “For the vaccine to be really useful, we not only need the larger studies conducted where COVID-19 is still occurring at a high rate, but we need to be reasonably sure that the protection lasts for a considerable time.”

He said it was also vital that people older than 55 were included in later trials.

Richard Torbett, chief executive of the Association of the British Pharmaceutical Industry, said: “Developing a vaccine is an incredibly difficult challenge; the fact that there are multiple candidates in development is hopefully a sign that the hard work will ultimately pay off.

“But we must be patient. Proving that a vaccine is safe and effective is a long process and we could still be many months away.”

This article first appeared on Medscape.com.

A phase 1/2 trial of a vaccine against SARS-CoV-2 being developed by the University of Oxford has found that the vaccine is safe, causes few side effects, and induces strong immune responses.

The early stage results, published in The Lancet, found that the candidate vaccine, known as ChAdOx1 nCoV-19, provoked a T-cell response peaking 14 days after vaccination, and an antibody response within 28 days.

Andrew Pollard, chief investigator on the study, and professor of pediatric infection and immunity at Oxford University, described the results as “encouraging”. He told a briefing convened by the Science Media Centre on Monday that it was “a really important milestone on the path to the development of the vaccine”.

In the Commons, the Health Secretary, Matt Hancock, hailed the results for taking us “one step closer to finding a vaccine that can potentially save lives, all around the world”.

The trial, which has so far involved 1,077 healthy adults, caused minor side effects when compared with a control group given a meningitis vaccine. Fatigue and headache were the most commonly reported reactions.

However, there were no serious adverse events from the vaccine, the researchers said.
 

‘Still a long way to go’

Sarah Gilbert, lead researcher of the vaccine development program, and professor of vaccinology at Oxford, cautioned that there was still a long way to go before the team could confirm that the vaccine could protect against developing COVID-19.

“The difficulty that we have, and that all vaccine developers have in trying to make a vaccine against this particular virus, is that we don’t know how strong that immune response needs to be,” she said.

“So, we can’t say just by looking at immune responses whether this is going to protect people or not. And the only way we’re going to find out is by doing the large phase 3 trials and wait for people to be infected as part of that trial before we know if the vaccine can work.”

The authors noted some limitations to their findings. They said more research was needed to confirm their results in different groups of people – including older age groups, those with other health conditions, and in ethnically and geographically diverse populations.

A notable result of the trial was that participants given a second dose of the vaccine appeared to display a stronger immune response, a finding that had influenced plans to “look at two dose regimes as well as one dose regimes in the phase 3 trial”, Prof Adrian Hill, director of Oxford’s Jenner Institute, confirmed.

ChAdOx1 nCoV-19 is made from a weakened version of an adenovirus that causes infections in chimpanzees. The virus has been genetically modified so that it cannot grow in humans.

On Monday, the government announced that it had struck a deal with AstraZeneca for access to 100 million doses of the Oxford vaccine, in addition to millions of doses of other promising candidate vaccines.
 

Expert reaction to the findings

The Medical Research Council helped to fund the trial. Executive Chair Professor Fiona Watt commented: “It is truly remarkable how fast this vaccine has progressed, with our support, through early clinical trials, and it is very encouraging that it shows no safety concerns and evokes strong immune responses.

“There is a lot that we don’t yet know about immunity to the virus that causes COVID-19. However, it seems that both antibody and T cell immunity are important, and this vaccine triggers both responses. The much anticipated next milestone will be the results of the larger trials that are happening now to find out if the vaccine will protect people from the virus.”

Jonathan Ball, professor of molecular virology at the University of Nottingham, told the SMC: “The results of the Oxford chimp adenovirus vaccine candidate show that the vaccine is able to generate antibodies and T cells in humans and these persisted for several weeks. Whilst encouraging there is still a long way to go before we can herald the arrival of a successful coronavirus vaccine.

“It is unclear whether the levels of immunity can protect against infection – that’s what the larger ongoing phase III trials are designed to test. Nor do we know if this vaccine can protect those most vulnerable to severe COVID-19 disease.”

Stephen Evans, professor of pharmacoepidemiology at the London School of Hygiene and Tropical Medicine, commented: “For the vaccine to be really useful, we not only need the larger studies conducted where COVID-19 is still occurring at a high rate, but we need to be reasonably sure that the protection lasts for a considerable time.”

He said it was also vital that people older than 55 were included in later trials.

Richard Torbett, chief executive of the Association of the British Pharmaceutical Industry, said: “Developing a vaccine is an incredibly difficult challenge; the fact that there are multiple candidates in development is hopefully a sign that the hard work will ultimately pay off.

“But we must be patient. Proving that a vaccine is safe and effective is a long process and we could still be many months away.”

This article first appeared on Medscape.com.

Every person who received Moderna’s COVID-19 vaccine, mRNA-1273, developed an immune response to the virus that causes it, the company says in a news release.

Researchers also reported some side effects in the 45 people in the phase I study, but no significant safety issues, the news release says.

The vaccine is among hundreds being tested worldwide in an effort to halt the pandemic that has killed nearly 600,000 worldwide.

A researcher testing the vaccine called the results encouraging but cautioned more study is needed. “Importantly, the vaccine resulted in a robust immune response,” Evan Anderson, MD, principal investigator for the trial at Emory University, says in a news release. Emory and Kaiser Permanente Washington Health Research Institute were the two sites for the study.

The company is already testing the vaccine in a larger group of people, known as a phase II trial. It plans to begin phase III trials in late July. Phase III trials involve testing the vaccine on an even larger group and are the final step before FDA approval.

The study results are published in The New England Journal of Medicine. The study was led by the National Institute of Allergy and Infectious Diseases of the National Institutes of Health.

Moderna’s vaccine uses messenger RNA, also called mRNA. It carries the instruction for making the spike protein, a key protein on the surface of the virus that allows it to enter cells when a person is infected. After it’s injected, it goes to the immune cells and instructs them to make copies of the spike protein, acting as if the cells have been infected with the actual coronavirus. This allows other immune cells to develop immunity.

In the study, participants were divided into three groups of 15 people each. All groups received two vaccinations 28 days apart. Each group received a different strength of the vaccine – either 25, 100, or 250 micrograms.

Every person in the study developed antibodies that can block the infection. Most commonly reported side effects after the second vaccination in the 100-microgram group were fatigue, chills, headache, and muscle pains, ranging from mild to moderately severe.

The phase II study has 300 heathy adults ages 18-55, along with another 300 ages 55 and older

Moderna says it hopes to include about 30,000 participants at the 100-microgram dose level in the U.S. for the phase III trial. The estimated start date is July 27.

This article first appeared on WebMD.com.

Every person who received Moderna’s COVID-19 vaccine, mRNA-1273, developed an immune response to the virus that causes it, the company says in a news release.

Researchers also reported some side effects in the 45 people in the phase I study, but no significant safety issues, the news release says.

The vaccine is among hundreds being tested worldwide in an effort to halt the pandemic that has killed nearly 600,000 worldwide.

A researcher testing the vaccine called the results encouraging but cautioned more study is needed. “Importantly, the vaccine resulted in a robust immune response,” Evan Anderson, MD, principal investigator for the trial at Emory University, says in a news release. Emory and Kaiser Permanente Washington Health Research Institute were the two sites for the study.

The company is already testing the vaccine in a larger group of people, known as a phase II trial. It plans to begin phase III trials in late July. Phase III trials involve testing the vaccine on an even larger group and are the final step before FDA approval.

The study results are published in The New England Journal of Medicine. The study was led by the National Institute of Allergy and Infectious Diseases of the National Institutes of Health.

Moderna’s vaccine uses messenger RNA, also called mRNA. It carries the instruction for making the spike protein, a key protein on the surface of the virus that allows it to enter cells when a person is infected. After it’s injected, it goes to the immune cells and instructs them to make copies of the spike protein, acting as if the cells have been infected with the actual coronavirus. This allows other immune cells to develop immunity.

In the study, participants were divided into three groups of 15 people each. All groups received two vaccinations 28 days apart. Each group received a different strength of the vaccine – either 25, 100, or 250 micrograms.

Every person in the study developed antibodies that can block the infection. Most commonly reported side effects after the second vaccination in the 100-microgram group were fatigue, chills, headache, and muscle pains, ranging from mild to moderately severe.

The phase II study has 300 heathy adults ages 18-55, along with another 300 ages 55 and older

Moderna says it hopes to include about 30,000 participants at the 100-microgram dose level in the U.S. for the phase III trial. The estimated start date is July 27.

This article first appeared on WebMD.com.

Every person who received Moderna’s COVID-19 vaccine, mRNA-1273, developed an immune response to the virus that causes it, the company says in a news release.

Researchers also reported some side effects in the 45 people in the phase I study, but no significant safety issues, the news release says.

The vaccine is among hundreds being tested worldwide in an effort to halt the pandemic that has killed nearly 600,000 worldwide.

A researcher testing the vaccine called the results encouraging but cautioned more study is needed. “Importantly, the vaccine resulted in a robust immune response,” Evan Anderson, MD, principal investigator for the trial at Emory University, says in a news release. Emory and Kaiser Permanente Washington Health Research Institute were the two sites for the study.

The company is already testing the vaccine in a larger group of people, known as a phase II trial. It plans to begin phase III trials in late July. Phase III trials involve testing the vaccine on an even larger group and are the final step before FDA approval.

The study results are published in The New England Journal of Medicine. The study was led by the National Institute of Allergy and Infectious Diseases of the National Institutes of Health.

Moderna’s vaccine uses messenger RNA, also called mRNA. It carries the instruction for making the spike protein, a key protein on the surface of the virus that allows it to enter cells when a person is infected. After it’s injected, it goes to the immune cells and instructs them to make copies of the spike protein, acting as if the cells have been infected with the actual coronavirus. This allows other immune cells to develop immunity.

In the study, participants were divided into three groups of 15 people each. All groups received two vaccinations 28 days apart. Each group received a different strength of the vaccine – either 25, 100, or 250 micrograms.

Every person in the study developed antibodies that can block the infection. Most commonly reported side effects after the second vaccination in the 100-microgram group were fatigue, chills, headache, and muscle pains, ranging from mild to moderately severe.

The phase II study has 300 heathy adults ages 18-55, along with another 300 ages 55 and older

Moderna says it hopes to include about 30,000 participants at the 100-microgram dose level in the U.S. for the phase III trial. The estimated start date is July 27.

This article first appeared on WebMD.com.

People with a body mass index of 30 kg/m² or above are at significantly increased risk for severe COVID-19, while a BMI of 35 and higher dramatically increases the risk for death, new research suggests.

The data, from nearly 500 patients hospitalized with COVID-19 in March and April 2020, were published in the European Journal of Endocrinology by Matteo Rottoli, MD, of the Alma Mater Studiorum, University of Bologna (Italy), and colleagues.

The data support the recent change by the Centers for Disease Control and Prevention to lower the cutoff for categorizing a person at increased risk from COVID-19 from a BMI of 40 down to 30. However, in the United Kingdom, the National Health Service still lists only a BMI of 40 or above as placing a person at “moderate risk (clinically vulnerable).”

“This finding calls for prevention and treatment strategies to reduce the risk of infection and hospitalization in patients with relevant degrees of obesity, supporting a revision of the BMI cutoff of 40 kg/m², which was proposed as an independent risk factor for an adverse outcome of COVID-19 in the ... guidelines for social distancing in the United Kingdom: It may be appropriate to include patients with BMI >30 among those at higher risk for COVID-19 severe progression,” the authors wrote.

The study included 482 adults admitted with confirmed COVID-19 to a single Italian hospital between March 1 and April 20, 2020. Of those, 41.9% had a BMI of less than 25 (normal weight), 36.5% had a BMI of 25-29.9 (overweight), and 21.6% had BMI of at least 30 (obese). Of the obese group, 20 (4.1%) had BMIs of at least 35, while 18 patients (3.7%) had BMIs of less than 20 (underweight).

Among those with obesity, 51.9% experienced respiratory failure, 36.4% were admitted to the ICU, 25% required mechanical ventilation, and 29.8% died within 30 days of symptom onset.

Patients with BMIs of at least 30 had significantly increased risks for respiratory failure (odds ratio, 2.48; P = .001), ICU admission (OR, 5.28; P < .001), and death (2.35, P = .017), compared with those with lower BMIs. Within the group classified as obese, the risks of respiratory failure and ICU admission were higher, with BMIs of 30-34.9 (OR, 2.32; P = .004 and OR, 4.96; P < .001, respectively) and for BMIs of at least 35 (OR, 3.24; P = .019 and OR, 6.58; P < .001, respectively).

The risk of death was significantly higher among patients with a BMI of at least 35 (OR, 12.1; P < .001).

Every 1-unit increase in BMI was significantly associated with all outcomes, but there was no significant difference in any outcome between the 25-29.9 BMI category and normal weight. In all models, the BMI cutoff for increased risk was 30.

The authors reported no disclosures.

SOURCE: Rottoli M et al. Eur J Endocrinol. 2020 Jul 1. doi: 10.1530/EJE-20-054.

People with a body mass index of 30 kg/m² or above are at significantly increased risk for severe COVID-19, while a BMI of 35 and higher dramatically increases the risk for death, new research suggests.

The data, from nearly 500 patients hospitalized with COVID-19 in March and April 2020, were published in the European Journal of Endocrinology by Matteo Rottoli, MD, of the Alma Mater Studiorum, University of Bologna (Italy), and colleagues.

The data support the recent change by the Centers for Disease Control and Prevention to lower the cutoff for categorizing a person at increased risk from COVID-19 from a BMI of 40 down to 30. However, in the United Kingdom, the National Health Service still lists only a BMI of 40 or above as placing a person at “moderate risk (clinically vulnerable).”

“This finding calls for prevention and treatment strategies to reduce the risk of infection and hospitalization in patients with relevant degrees of obesity, supporting a revision of the BMI cutoff of 40 kg/m², which was proposed as an independent risk factor for an adverse outcome of COVID-19 in the ... guidelines for social distancing in the United Kingdom: It may be appropriate to include patients with BMI >30 among those at higher risk for COVID-19 severe progression,” the authors wrote.

The study included 482 adults admitted with confirmed COVID-19 to a single Italian hospital between March 1 and April 20, 2020. Of those, 41.9% had a BMI of less than 25 (normal weight), 36.5% had a BMI of 25-29.9 (overweight), and 21.6% had BMI of at least 30 (obese). Of the obese group, 20 (4.1%) had BMIs of at least 35, while 18 patients (3.7%) had BMIs of less than 20 (underweight).

Among those with obesity, 51.9% experienced respiratory failure, 36.4% were admitted to the ICU, 25% required mechanical ventilation, and 29.8% died within 30 days of symptom onset.

Patients with BMIs of at least 30 had significantly increased risks for respiratory failure (odds ratio, 2.48; P = .001), ICU admission (OR, 5.28; P < .001), and death (2.35, P = .017), compared with those with lower BMIs. Within the group classified as obese, the risks of respiratory failure and ICU admission were higher, with BMIs of 30-34.9 (OR, 2.32; P = .004 and OR, 4.96; P < .001, respectively) and for BMIs of at least 35 (OR, 3.24; P = .019 and OR, 6.58; P < .001, respectively).

The risk of death was significantly higher among patients with a BMI of at least 35 (OR, 12.1; P < .001).

Every 1-unit increase in BMI was significantly associated with all outcomes, but there was no significant difference in any outcome between the 25-29.9 BMI category and normal weight. In all models, the BMI cutoff for increased risk was 30.

The authors reported no disclosures.

SOURCE: Rottoli M et al. Eur J Endocrinol. 2020 Jul 1. doi: 10.1530/EJE-20-054.

People with a body mass index of 30 kg/m² or above are at significantly increased risk for severe COVID-19, while a BMI of 35 and higher dramatically increases the risk for death, new research suggests.

The data, from nearly 500 patients hospitalized with COVID-19 in March and April 2020, were published in the European Journal of Endocrinology by Matteo Rottoli, MD, of the Alma Mater Studiorum, University of Bologna (Italy), and colleagues.

The data support the recent change by the Centers for Disease Control and Prevention to lower the cutoff for categorizing a person at increased risk from COVID-19 from a BMI of 40 down to 30. However, in the United Kingdom, the National Health Service still lists only a BMI of 40 or above as placing a person at “moderate risk (clinically vulnerable).”

“This finding calls for prevention and treatment strategies to reduce the risk of infection and hospitalization in patients with relevant degrees of obesity, supporting a revision of the BMI cutoff of 40 kg/m², which was proposed as an independent risk factor for an adverse outcome of COVID-19 in the ... guidelines for social distancing in the United Kingdom: It may be appropriate to include patients with BMI >30 among those at higher risk for COVID-19 severe progression,” the authors wrote.

The study included 482 adults admitted with confirmed COVID-19 to a single Italian hospital between March 1 and April 20, 2020. Of those, 41.9% had a BMI of less than 25 (normal weight), 36.5% had a BMI of 25-29.9 (overweight), and 21.6% had BMI of at least 30 (obese). Of the obese group, 20 (4.1%) had BMIs of at least 35, while 18 patients (3.7%) had BMIs of less than 20 (underweight).

Among those with obesity, 51.9% experienced respiratory failure, 36.4% were admitted to the ICU, 25% required mechanical ventilation, and 29.8% died within 30 days of symptom onset.

Patients with BMIs of at least 30 had significantly increased risks for respiratory failure (odds ratio, 2.48; P = .001), ICU admission (OR, 5.28; P < .001), and death (2.35, P = .017), compared with those with lower BMIs. Within the group classified as obese, the risks of respiratory failure and ICU admission were higher, with BMIs of 30-34.9 (OR, 2.32; P = .004 and OR, 4.96; P < .001, respectively) and for BMIs of at least 35 (OR, 3.24; P = .019 and OR, 6.58; P < .001, respectively).

The risk of death was significantly higher among patients with a BMI of at least 35 (OR, 12.1; P < .001).

Every 1-unit increase in BMI was significantly associated with all outcomes, but there was no significant difference in any outcome between the 25-29.9 BMI category and normal weight. In all models, the BMI cutoff for increased risk was 30.

The authors reported no disclosures.

SOURCE: Rottoli M et al. Eur J Endocrinol. 2020 Jul 1. doi: 10.1530/EJE-20-054.