UpToDate(R) and The Nurse Practitioner are collaborating to present select "What's New" content. UpToDate is an evidence-based, clinical support resource used worldwide by healthcare practitioners to make decisions at the point of care. For complete, current "What's New" content, or to become a subscriber for full content access, visit http://go.uptodate.com/np. "What's New" is free for all medical professionals.
Cardiovascular Medicine-Congenital Heart Disease, Adult
Long-term risk of ventricular septal defect (January 2023)
Limited data are available on long-term outcomes in adults with congenital ventricular septal defects (VSDs). In a population-based cohort study comparing 8,000 patients with VSDs with over 80,000 matched controls for a median of more than 20 years, the risks of heart failure, arrhythmia, infectious endocarditis, and pulmonary hypertension were elevated in patients with unrepaired or surgically repaired VSDs.2 Among patients with unrepaired VSDs, the risk of morbidity accelerated after age 40 years, and at a younger age in patients with repaired VSDs. These findings underscore the importance of long-term clinical follow-up in adults with VSDs.
Family Medicine-Adult Endocrinology and Diabetes
ADA guidelines for hypertension treatment in individuals with diabetes (January 2023)
Hypertension management is a cornerstone of cardiovascular risk reduction in patients with diabetes, but society guidelines have been discordant in their recommended treatment targets for medical therapy. In its recently published guidelines, the American Diabetes Association (ADA) recommends treatment targets for systolic and diastolic blood pressures of <130 mmHg and <80 mmHg, respectively, for most patients with diabetes.3 These treatment targets should be implemented only if they can be achieved safely, and treatment goals should be individualized based on cardiovascular risk, patient preferences, and possible adverse effects of therapy. These ADA guidelines are now consistent with those of the American College of Cardiology/American Heart Association.
Family Medicine-Adult General Internal Medicine
Removal of X-waiver requirement to prescribe buprenorphine for opioid use disorder (February 2023)
Previously, in order to prescribe buprenorphine for opioid use disorder (OUD) in the United States, clinicians had to apply for a federally required DATA Waiver (X-Waiver). In January 2023, the Consolidated Appropriations Act of 2023 removed this requirement and allowed clinicians with schedule III authority on their Drug Enforcement Administration (DEA) registration to prescribe buprenorphine for OUD treatment if permitted by applicable state law.4
Pulmonary and Critical Care Medicine-COPD
New GOLD strategy for initial COPD pharmacologic management (January 2023)
The Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2023 report identifies key changes for patients with COPD1, specifically more aggressive initial bronchodilator therapy:
* Single-agent long-acting bronchodilator therapy for less severe symptoms and low exacerbation risk (Group A).
* Dual long-acting bronchodilator therapy for more severe symptoms and low exacerbation risk (Group B).
* Dual long-acting bronchodilator therapy for high exacerbation risk, regardless of symptoms (Group E, replacing previous Groups C and D categories).
It also redefines a COPD exacerbation as an event characterized by dyspnea and/or cough and sputum that worsens over <=14 days with possible tachypnea and/or tachycardia caused by airway infection, pollution, or other insult to the airways. This new definition decouples exacerbations from their treatment, which had confounded earlier approaches. A new classification for severity of exacerbations was also outlined.
1. Global Initiative for Chronic Obstructive Lung Disease (GOLD). Global Strategy for the Diagnosis, Management and Prevention of Chronic Obstructive Pulmonary Disease: 2023 Report. http://www.goldcopd.org (Accessed on December 13, 2022). [Context Link]
2. Eckerstrom F, Nyboe C, Redington A, Hjortdal VE. Lifetime Burden of Morbidity in Patients With Isolated Congenital Ventricular Septal Defect. J Am Heart Assoc. 2023;12(1):e027477. [Context Link]
3. ElSayed NA, Aleppo G, Aroda VR, et al 10. Cardiovascular Disease and Risk Management: Standards of Care in Diabetes-2023. Diabetes Care. 2023;46(Suppl 1):S158. [Context Link]
4. Substance Abuse and Mental Health Services Administration. Removal of DATA Waiver (X-Waiver) Requirement. https://www.samhsa.gov/medications-substance-use-disorders/removal-data-waiver-r (Accessed on February 07, 2023). [Context Link]
Disclaimer: This content is provided for reference purposes only and represents a portion of the UpToDate topic. Readers should not rely on the content or any information cited here as being applicable to specific patient circumstances. All topics are updated as new evidence becomes available and our peer review process is complete.