JAMA editors highlight top 2023 Clinical Reviews podcasts, including cirrhosis management, heart failure treatments, worsening US maternal death rates, and addressing obstetric racism.
Cirrhosis symptoms can be managed with pickle juice, taurine, bile acid binders, naltrexone, sleep hygiene, hydroxylsine, melatonin, and prescription therapies for sexual dysfunction.
SGLT2 inhibitors like dapagliflozin and empagliflozin show promise in reducing heart failure hospitalizations and improving quality of life in patients with heart failure with preserved ejection fraction (HFpEF), but there are contraindications for their use.
Deep dives
Latest Developments in the Treatment of Cirrhosis
Cirrhosis, affecting millions of adults in the U.S., has several common symptoms like muscle cramps, itching, sleep dysfunction, and sexual dysfunction. Treatment options for these symptoms include pickle juice and taurine to relieve muscle cramps, bile acid binders and naltrexone for itching, sleep hygiene and medications like hydroxylsine and melatonin for sleep dysfunction, and prescription therapies for sexual dysfunction. Furthermore, complications of cirrhosis like hepatic encephalopathy, ascites, and varicial bleeding have evidence-based treatments such as lactulose and refaxamine for hepatic encephalopathy, aldosterone antagonists combined with diuretics for ascites, and non-selective beta blockers for varicial bleeding.
SGLT2 Inhibitors for Heart Failure with Preserved Ejection Fraction
Heart failure with preserved ejection fraction (HFpEF) is the most common form of heart failure in the U.S. Sodium glucose co-transporter 2 inhibitors (SGLT2 inhibitors) like dapagliflozin and empagliflozin have proven to be beneficial in reducing heart failure hospitalizations in patients with HFpEF. These medications also show promise in improving six-minute walk distance and quality of life. However, there are contraindications for their use in type 1 diabetes and severe renal function impairment. Non-pharmacologic strategies like educating patients in heart failure self-care and aerobic exercise training can also be effective in managing HFpEF.
Challenges and Disparities in Maternal Mortality
Maternal mortality in the U.S. is alarmingly high, with rates more than 10 times higher than other high-income countries. Black women face even higher mortality rates compared to white women, and Hispanic women's rates are also increasing. Additionally, there has been a 40% increase in maternal deaths in the U.S. overall. It is crucial to acknowledge that these deaths are preventable, with a particular emphasis on addressing obstetric racism as an adverse event. Improved data collection, standardized care, and addressing societal and structural factors are key steps in reducing maternal mortality rates.
JAMA Editor in Chief Kirsten Bibbins-Domingo, PhD, MD, MAS, JAMA Executive Editor Gregory Curfman, MD, and JAMA Deputy Editor Linda Brubaker, MD, highlight their selections of top JAMA 2023 Clinical Reviews podcasts. Related Content: