No abstract

Objective An American Heart Association (AHA) Science Advisory recommends patients with coronary heart disease undergo routine screening for depressive symptoms with the two-stage Patient Health Questionnaire (PHQ). However, little is known on the prognostic impact of a positive PHQ screen on heart failure (HF) mortality. Methods We screened hospitalized patients with systolic HF (left ventricle ejection fraction≤40%) for depression with the two-item Patient Health Questionnaire (PHQ-2) and administered the follow-up nine-item Patient Health Questionnaire (PHQ-9) both immediately following the PHQ-2 and by telephone 1 month after discharge. Later, we ascertained vital status at 4-year follow-up on all patients who completed the inpatient PHQ-9 and calculated mortality incidence and risk by baseline PHQ. Results Of the 520 HF patients, we enrolled 371 screened positive for depressive symptoms on the PHQ-2. Of these, 63% scored PHQ-9≥10 versus 24% of those who completed the PHQ-9 1 month later (P<.001). PHQ-2 positive status was an independent predictor of 4-year all-cause mortality (HR: 1.50; P=.04), and mortality incidence was similar by baseline PHQ-9 score. Conclusions Among hospitalized patients with systolic HF, a positive PHQ-2 screen for depressive symptoms is an independent risk factor for increased 4-year all-cause mortality. Our findings extend the AHA's Science Advisory for depression to hospitalized patients with systolic HF.

Dry eye disease (DED) is a multifactorial disease of the ocular surface and is one of the most common reasons for patients to visit an eye care provider. Cyclosporine A (CsA) is an immune modulating drug that was approved in the US for topical use in the treatment of DED in 2003, which led to a paradigm change in our understanding and treatment of DED, turning attention to control of inflammation for treatment. This review summarizes the literature to date regarding the impact of CsA on the treatment of DED. A special focus is given to the patient and physician perspectives of CsA, including dry eye symptom improvement, medication side effects, and overall patient satisfaction. Studies evaluating CsA in DED have considerable heterogeneity making generalized conclusions about the effect of CsA difficult. However, most studies have demonstrated improvement in at least some symptoms of dry eye in CsA-treated patients. Side effects, most commonly ocular burning on administration of CsA, are common. The literature is sparse regarding long-term follow-up of patients treated with CsA, optimal duration of treatment, and identifying which patients may receive the most benefit from CsA.

Testosterone levels and erectile function are known to decline as men age, leading to hypogonadism and erectile dysfunction (ED). Men with type 2 diabetes mellitus (T2DM) have a particularly high prevalence of hypogonadism and ED. This population also has an increased risk for cardiovascular diseases, as well as exposure to other metabolic and cardiovascular risk factors, such as obesity. Several professional societies have recommended screening men with T2DM for testosterone deficiency. Hypogonadism is generally suspected when morning levels for total testosterone are < 300 ng/dL and clinical signs and symptoms typically associated with androgen deficiency are present. While hypogonadism and ED have emerged as predictors of cardiovascular disease and may respond to the lifestyle changes commonly recommended for patients with diabetes and the metabolic syndrome, the literature on whether treatment with testosterone supplementation affects outcomes beyond well-being and sexual function is still emerging. Primary care providers should be aware of this dysmetabolic cluster affecting their male patients and its importance, and, given the common occurrence of hypogonadism, ED, and T2DM, diagnosis of 1 of these conditions should elicit inquiry into the other 2 conditions.