Mobile and tablet apps, ubiquitous and pervasive computing, wearable computing and domotics for health.

Treatment for pulmonary arterial hypertension (PAH) has evolved over the past decade, including approval of new medications and growing evidence to support earlier use of combination therapy. Despite these changes, few studies have assessed real‐world treatment patterns, healthcare resource utilization (HCRU), and costs among people with PAH using recent data. We conducted a retrospective cohort study using administrative claims from the HealthCore Integrated Research Database®. Adult members with claims for a PAH diagnosis, right heart catheterization, and who initiated PAH treatment (index date) between October 1, 2015 and November 30, 2020 were identified. Members had to be continuously enrolled in the health plan for 6 months before the index date (baseline) and ≥30 days after. Treatment patterns, HCRU, and costs were described. A total of 843 members with PAH (mean age 62.3 years, 64.2% female) were included. Only 21.0% of members received combination therapy as their first‐line treatment, while most members (54.6%) received combination therapy as second‐line treatment. All‐cause HCRU remained high after treatment initiation with 58.0% of members having ≥1 hospitalization and 41.3% with ≥1 emergency room visit. Total all‐cause costs declined from $15,117 per patient per month at baseline to $14,201 after treatment initiation, with decreased medical costs ($14,208 vs. $6,349) more than offsetting increased pharmacy costs ($909 vs. $7,852). In summary, despite growing evidence supporting combination therapy, most members with PAH initiated treatment with monotherapy. Total costs decreased following treatment, driven by a reduction in medical costs even with increases in pharmacy costs.

Objective: To assess the risk of select safety outcomes including endometrial cancer, endometrial hyperplasia, and breast cancer among women using conjugated estrogens/bazedoxifene (CE/BZA) as compared with estrogen/progestin combination hormone therapy (EP). Methods: We conducted a new-user cohort study in five US healthcare claims databases representing more than 92 million women. We included CE/BZA or EP new users from May 1, 2014, to August 30, 2019. EP users were propensity score (PS) matched to users of CE/BZA. Incidence of endometrial cancer, endometrial hyperplasia, breast cancer, and eight additional cancer and cardiovascular outcomes were ascertained using claims-based algorithms. Rate ratios (RR) and differences pooled across databases were estimated using random-effects models. Results: The study population included 10,596 CE/BZA and 33,818 PS-matched EP new users. Rates of endometrial cancer and endometrial hyperplasia were slightly higher among CE/BZA users (1.6 and 0.4 additional cases per 10,000 person-years), although precision was limited because of small numbers of cases (endometrial cancer: RR, 1.50 [95% confidence interval {CI}, 0.79-2.88]; endometrial hyperplasia: RR, 1.69 [95% CI, 0.51-5.61]). Breast cancer incidence was lower in CE/BZA users (9.1 fewer cases per 10,000 person-years; RR, 0.79; 95% CI, 0.58-1.05). Rates of other outcomes were slightly higher among CE/BZA users, but with confidence intervals compatible with a wider range of possible associations. Conclusions: CE/BZA users might experience slightly higher rates of endometrial cancer and endometrial hyperplasia, and a lower rate of breast cancer, than EP users in the first years of use.

Background: 25% of all breast cancer patients have HER-2 overexpression. Breast Cancer patients with HER-2 overexpression are typically treated with HER-2 inhibitors such as Trastuzumab. Trastuzumab is known to cause a decrease in left ventricular ejection fraction. The aim of this study is to create a cardiac risk prediction tool among women with Her-2 positive breast cancer to predict cardiotoxicity. Method: Using a split sample design, we created a risk prediction tool using patient level data from electronic medical records. The study included women 18 years of age and older diagnosed with HER-2 positive breast cancer who received Trastuzumab. Outcome measure was defined as a drop in LVEF by more than 10% to less than 53% at any time in the 1-year study period. Logistic regression was used to test predictors. Results: The cumulative incidence of cardiac dysfunction in our study was 9.4%. The sensitivity and specificity of the model are 46% and 84%, respectively. Given a cumulative incidence of cardiotoxicity of 9%, the negative predictive value of the test was 94%. This suggests that in a low-risk population, the interval of screening for cardiotoxicity may be performed less frequently. Conclusion: Cardiac risk prediction tool can be used to identify Her-2 positive breast cancer patients at risk of developing cardiac dysfunction. Also, test characteristics in addition to disease prevalence may inform a rational strategy in performing cardiac ultrasound in Her-2 breast cancer patients. We have developed a cardiac risk prediction model with high NPV in a low-risk population which has an appealing cost-effectiveness profile.

IMPORTANCE: Obese subjects with obstructive sleep apnea (OSA) are at risk of pulmonary hypertension (PH) and mortality. Positive airway pressure (PAP) treatment lowers pulmonary artery pressures and mortality risk. Glucagon-like peptide-1 receptor agonists (GLP-1RAs) reduces body weight and cardiovascular risk, but their effectiveness in OSA remains unexplored. OBJECTIVE: To assess whether GLP-1 RAs is associated with lower incident PH and all-cause mortality at 1 and 3 years in obese patients with OSA treated with PAP. DESIGN: Retrospective cohort study. SETTING: US Collaborative TriNetX Global Database analysis performed on January 5, 2026 encompassing data from 56 centers during December 1, 2017 and December 25, 2025. PARTICIPANTS: Obese patients diagnosed with OSA and treated with PAP (n=288,587). EXPOSURE: Propensity score-matched comparisons of PAP vs PAP+semaglutide, PAP vs PAP+tirzepatide, PAP+semaglutide vs PAP+tirzepatide. MAIN OUTCOMES AND MEASURES: Incident PH and all-cause mortality at 1 and 3 years. Risk ratios (RRs) with 95% CIs were estimated using the delta method; number needed to treat (NNT) was calculated from the absolute risk difference. RESULTS: Compared with PAP, PAP+semaglutide was associated with lower incident PH at 1 year (RR:0.45; 95% CI:0.44–0.56, NNT=38) and at 3years (RR:0.50; 95% CI:0.45–0.54, NNT=23), and lower mortality at 1 year (RR:0.35; 95% CI:0.33–0.37, NNT=12) and 3 years (RR:0.37; 95% CI:0.35–0.39, NNT=8); PAP+tirzepatide was associated with lower incident PH at 1 year (RR:0.27; 95% CI:0.22–0.34, NNT=28) and 3 years (RR:0.22; 95% CI:0.18–0.27, NNT=15) and lower mortality at 1 year (RR:0.14; 95% CI:0.12–0.17, NNT=9) and 3 years (RR:0.12; 95% CI:0.10–0.14, NNT=6). Compared to PAP+semaglutide, PAP+tirzepatide showed lower incident PH at 1 year (RR:0.51; 95% CI:0.40–0.65, NNT=77) and 3 years (RR:0.42; 95% CI:0.34–0.51, NNT=39) and lower all-cause mortality at 1 year (RR:0.41; 95% CI:0.34–0.49, NNT=40) and 3 years (RR:0.33; 95% CI:0.28–0.39, NNT=22); all p-values<0.001. CONCLUSIONS AND RELEVANCE: Obese-OSA patients treated with PAP taking GLP-1RAs exhibited significantly lower 1-year and 3-year incident PH and all-cause mortality versus PAP. Tirzepatide exhibited further lowering of incident PH and all-cause mortality versus semaglutide, showing increased and sustained benefits over time. KEY POINTS: Question: Among patients with obesity and obstructive sleep apnea (OSA) treated with positive airway pressure (PAP), is use of glucagon-like peptide-1 receptor agonists (GLP-1 RAs) associated with lower incident pulmonary hypertension (PH) and all-cause mortality at 1 and 3 years? Findings: In a cohort study of 288,587 patients, PAP plus semaglutide or tirzepatide was associated with significantly lower incident PH and all-cause mortality versus PAP alone at 1 and 3 years. Tirzepatide was associated with lower risks than semaglutide. Meaning: GLP-1 RAs may provide additional clinical benefit in obese patients with OSA treated with PAP.

Essien E, et al. J Cardiovasc Interv. 2025 Aug;5:e2. https://doi.org/10.54912/jci.2025.0029