Evaluation of GPT-4 for 10-year cardiovascular risk prediction: Insights from the UK Biobank and KoGES data.

Cardiovascular disease (CVD) remains a pressing global health concern. While traditional risk prediction methods such as the Framingham and American College of Cardiology/American Heart Association (ACC/AHA) risk scores have been widely used in the practice, artificial intelligence (AI), especially GPT-4, offers new opportunities. Utilizing large scale of multi-center data from 47,468 UK Biobank participants and 5,718 KoGES participants, this study quantitatively evaluated the predictive capabilities of GPT-4 in comparison with traditional models. Our results suggest that the GPT-based score showed commendably comparable performance in CVD prediction when compared to traditional models (AUROC on UKB: 0.725 for GPT-4, 0.733 for ACC/AHA, 0.728 for Framingham; KoGES: 0.664 for GPT-4, 0.674 for ACC/AHA, 0.675 for Framingham). Even with omission of certain variables, GPT-4's performance was robust, demonstrating its adaptability to data-scarce situations. In conclusion, this study emphasizes the promising role of GPT-4 in predicting CVD risks across varied ethnic datasets, pointing toward its expansive future applications in the medical practice.

International cohort study indicates no association between alpha-1 blockers and susceptibility to COVID-19 in benign prostatic hyperplasia patients.

Purpose: Alpha-1 blockers, often used to treat benign prostatic hyperplasia (BPH), have been hypothesized to prevent COVID-19 complications by minimising cytokine storm release. The proposed treatment based on this hypothesis currently lacks support from reliable real-world evidence, however. We leverage an international network of large-scale healthcare databases to generate comprehensive evidence in a transparent and reproducible manner. Methods: In this international cohort study, we deployed electronic health records from Spain (SIDIAP) and the United States (Department of Veterans Affairs, Columbia University Irving Medical Center, IQVIA OpenClaims, Optum DOD, Optum EHR). We assessed association between alpha-1 blocker use and risks of three COVID-19 outcomes-diagnosis, hospitalization, and hospitalization requiring intensive services-using a prevalent-user active-comparator design. We estimated hazard ratios using state-of-the-art techniques to minimize potential confounding, including large-scale propensity score matching/stratification and negative control calibration. We pooled database-specific estimates through random effects meta-analysis. Results: Our study overall included 2.6 and 0.46 million users of alpha-1 blockers and of alternative BPH medications. We observed no significant difference in their risks for any of the COVID-19 outcomes, with our meta-analytic HR estimates being 1.02 (95% CI: 0.92-1.13) for diagnosis, 1.00 (95% CI: 0.89-1.13) for hospitalization, and 1.15 (95% CI: 0.71-1.88) for hospitalization requiring intensive services. Conclusion: We found no evidence of the hypothesized reduction in risks of the COVID-19 outcomes from the prevalent-use of alpha-1 blockers-further research is needed to identify effective therapies for this novel disease.

Effectiveness of Maintenance and Reliever Therapy Using Inhaled Corticosteroid-Formoterol in Asthmatics.

BACKGROUND: Real-world evidence on the effectiveness of maintenance and reliever therapy (MART) using inhaled corticosteroids plus long-acting beta-2 agonist (ICS-LABA) is sparse. OBJECTIVE: This study aimed to evaluate the clinical effectiveness of MART (ICS-formoterol) by comparing its effectiveness with that of ICS-LABA plus as-needed short-acting beta-2 agonist (SABA) in adult asthmatics. METHODS: We retrospectively retrieved data from the medical records of the Ajou University Medical Center, Korea, to compare clinical outcomes between patients treated with MART (the MART group) and those treated with ICS-LABA plus SABA (the non-MART group). Propensity score matching was performed and hazard ratios (HRs) with 95% confidence intervals were calculated using the Cox proportional hazards model. Severe asthma exacerbation (SAEx) was the primary end point, and asthma exacerbation (AEx), hospitalization, and pneumonia were secondary end points. Corticosteroid requirement was also analyzed. RESULTS: After propensity score matching, the MART and the non-MART groups included 231 and 512 adult asthmatics, respectively. The risk of SAEx and AEx was significantly lower in the MART group than in the non-MART group (HR [95% CI] 0.39 [0.18-0.77] and 0.61 [0.37-0.99], respectively). There was no significant difference in hospitalization and pneumonia risk between the 2 groups (HR [95% CI] 0.88 [0.55-1.37] and 0.63 [0.03-4.51], respectively). Corticosteroid requirements were lower in the MART group than in the non-MART group (median [interquartile range], 190.0 [97.9-420.0] and 411.0 [143.0-833.0] mg/person-year, respectively; P < .01). CONCLUSIONS: The MART strategy of ICS-formoterol was associated with lower risk of AEx and reduced corticosteroid requirement.

Characteristics and outcomes of COVID-19 patients with COPD from the United States, South Korea, and Europe.

Background: Characterization studies of COVID-19 patients with chronic obstructive pulmonary disease (COPD) are limited in size and scope. The aim of the study is to provide a large-scale characterization of COVID-19 patients with COPD. Methods: We included thirteen databases contributing data from January-June 2020 from North America (US), Europe and Asia. We defined two cohorts of patients with COVID-19 namely a 'diagnosed' and 'hospitalized' cohort. We followed patients from COVID-19 index date to 30 days or death. We performed descriptive analysis and reported the frequency of characteristics and outcomes among COPD patients with COVID-19. Results: The study included 934,778 patients in the diagnosed COVID-19 cohort and 177,201 in the hospitalized COVID-19 cohort. Observed COPD prevalence in the diagnosed cohort ranged from 3.8% (95%CI 3.5-4.1%) in French data to 22.7% (95%CI 22.4-23.0) in US data, and from 1.9% (95%CI 1.6-2.2) in South Korean to 44.0% (95%CI 43.1-45.0) in US data, in the hospitalized cohorts. COPD patients in the hospitalized cohort had greater comorbidity than those in the diagnosed cohort, including hypertension, heart disease, diabetes and obesity. Mortality was higher in COPD patients in the hospitalized cohort and ranged from 7.6% (95%CI 6.9-8.4) to 32.2% (95%CI 28.0-36.7) across databases. ARDS, acute renal failure, cardiac arrhythmia and sepsis were the most common outcomes among hospitalized COPD patients.   Conclusion: COPD patients with COVID-19 have high levels of COVID-19-associated comorbidities and poor COVID-19 outcomes. Further research is required to identify patients with COPD at high risk of worse outcomes.

Comprehensive Comparative Effectiveness and Safety of First-Line ß-Blocker Monotherapy in Hypertensive Patients: A Large-Scale Multicenter Observational Study.

[Figure: see text].