Journal Wrap | Moving Obesity Science Into Clinical Practice; Wearable Biosensors For CHD
The hottest research from various peer-reviewed journals – handpicked weekly by the ACC.org Editorial Board led by Kim A. Eagle, MD, MACC.
Key Points: Moving Obesity Science Into Clinical Practice
The following are key points to remember from an American Heart Association scientific statement on the implementation of obesity science into clinical practice by Laddu, et al., and published in Circulation. The prevalence of obesity has been increasing for decades, with an estimated 40% of U.S. adults living with obesity. This has likely contributed to a slowing in the decline of cardiovascular disease.
Effective implementation of obesity science into routine clinical care for both the prevention and management of obesity is currently suboptimal.
Health care providers must have the knowledge to understand the prevention and management of obesity. Missed opportunities for provider education occur at multiple levels, including professional certification activities, which provide ongoing education. A paucity of obesity-related education at the medical school or resident trainee levels persists.
The Society for Behavioral Medicine has developed an evidence-based model for primary care obesity management based on the "5As "counseling framework: assess, advise, agree, assist, and arrange. This model may include referral to counseling programs to supplement brief office-based counseling.
Lifestyle counseling is an important component in the prevention and management of obesity. However, barriers include a lack of clinician comfort in counseling and a lack of referral resources. Approximately 50% of patients believe their providers did not understand the challenges of being overweight or obese or losing weight. And 30% of patients report their providers did not discuss resources for weight management.
A patient's social environment significantly influences weight. Sustainable clinic-community linkages are foundational for sustained prevention and management of obesity.
Newer pharmacologic therapies have demonstrated significant weight loss in populations, including those with cardiovascular disease. However, such medications continue to be underprescribed. Barriers include clinician-based knowledge gaps, concerns regarding safety, and coverage limitations.
Surgical treatments such as bariatric surgery have become safer and more effective. However, access barriers remain a challenge for many.
Knowledge gaps also exist regarding the cost-effectiveness of many obesity therapies. Additionally, the use of technologies, such as weight loss apps or telemedicine, has been understudied. These technologies may improve the reach of obesity treatment for underserved groups, including rural residents.
Public policy changes are essential to increase the provision of available evidence-based strategies to larger populations. At the same time, understanding how to implement and scale effective programs is also important.
Click here to read the full Key Points from Elizabeth A. Jackson, MD, FACC.
Wearable Biosensors For Congenital Heart Disease
The following are key points to remember from a science advisory by Tandon, et al., published in Circulation on advancing wearable biosensors (wearables) for patients with congenital heart disease (CHD).
Available wearables include medical grade devices used for at-home heart rhythm assessment, as well as nonmedical grade devices. Devices incorporating photoplethysmography can be used to diagnose arrhythmias and monitor oxygen saturation levels.
Patients with CHD may have physiologic measures outside of the normal range. Wearables have generally been tested at the typical physiologic ranges of oxygen saturation of 90-100%, and heart rate <200 bpm.
Systems will be needed to integrate data obtained through wearables into the electronic medical record for efficient evaluation by the treating care team.
The lack of standard regulation for establishing the validity of many commercial devices and the lack of clinical trials supporting their use, limit knowledge of their accuracy and efficacy.
In the future, wearables could help significantly in the management of patients with CHD. Continued improvement of the devices and vigorous testing, as well as a strong regulatory framework, will be required to secure widespread application of these technologies.
Click here to read the full Key Points from Timothy B. Cotts, MD, FACC.
Semaglutide Reduces NTproBNP, Improves Health Status in Obesity-Related HFpEF
A prespecified secondary analysis of pooled data from two double blind trials, STEP-HFpEF and STEP-HFpEF DM, presented at ESC Heart Failure 2024 and simultaneously published in JACC, has shown that semaglutide reduces N-terminal pro-brain natriuretic peptide (NTproBNP) in patients with obesity-related HF with preserved ejection fraction (HFpEF), and it may hold greater benefits for patients who start treatment with a higher baseline NTproBNP.
Clinical Topics: Arrhythmias and Clinical EP, Cardiovascular Care Team, Congenital Heart Disease and Pediatric Cardiology, Implantable Devices, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias, Congenital Heart Disease, CHD and Pediatrics and Arrhythmias, CHD and Pediatrics and Prevention
Keywords: Cardiology Magazine, ACC Publications, Obesity Management, Bariatric Surgery, Weight Loss, Public Policy, Wearable Electronic Devices, Arrhythmias, Cardiac, Heart Defects, Congenital
