Chest Pain, Multivitamin Supplements, Knee Osteoarthritis, Alzheimer Dementia, Asthma
Am Fam Physician. 2025;111(4):310
What test is recommended for intermediate-risk patients with stable chest pain?
Based on randomized controlled trials and observational studies, the American College of Cardiology/American Heart Association Joint Committee recommended coronary computed tomographic angiography (CCTA) over invasive coronary angiography for intermediate-risk patients with stable chest pain and no known coronary artery disease to rule out coronary stenosis. CCTA is noninvasive, widely available, and has high patient satisfaction and lower procedural complications.
Does regular dietary supplementation with multivitamins reduce the risk of premature mortality?
In a 2022 update, the US Preventive Services Task Force found insufficient evidence to assess the benefits and harms for use of multivitamin supplements (I statement). A government-funded cohort study with 390,124 participants followed up to 27 years found no reduction in cardiovascular, cancer, cerebrovascular, or all-cause mortality from regular multivitamin use.
How much weight loss is needed to improve pain and quality of life for patients with overweight or obesity and knee osteoarthritis?
According to a meta-analysis of randomized controlled trials, a total body weight loss of 5.1%, or 0.24% per week, results in clinically significant improvement in pain and disability in patients with overweight or obesity and knee osteoarthritis.
What are the safest and most effective cognitive enhancers for patients with different stages of Alzheimer dementia?
Cognitive enhancers are in an older category of medications intended to improve function in patients with Alzheimer dementia; these include three cholinesterase inhibitors (galantamine, donepezil, rivastigmine) and the N-methyl-d-aspartate receptor antagonist memantine. A meta-analysis evaluated their effects through increases in Mini-Mental State Examination scores. In patients with mild to moderate dementia, donepezil or transdermal rivastigmine was the best initial choice; for patients with moderate to severe dementia, the combination of donepezil and memantine was most effective.
How effective is adding or increasing treatment regimens in adolescents and adults with uncontrolled asthma who are already taking a medium-dose inhaled corticosteroid (ICS)?
A Cochrane review found that adding a long-acting beta2 agonist to a medium- or high-dose ICS likely reduces the frequency of moderate to severe asthma exacerbations compared with a medium-dose ICS alone. Adding a long-acting muscarinic antagonist possibly reduces the frequency of moderate to severe asthma exacerbations compared with a medium-dose ICS alone. A high-dose ICS alone likely does not reduce the frequency of moderate to severe asthma exacerbations.
Additional Online Only AFP Clinical Answers
What preventative health screenings should be recommended for adult cancer survivors?
Clinicians should ensure that cancer survivors are up-to-date with cancer screenings appropriate for their age and sex, and encourage lifestyle interventions that may reduce the risk of cancers, such as counseling on tobacco cessation, limiting alcohol use, and implementing a healthy diet and physical activity.
Does cognitive rehabilitation improve everyday function and well-being in patients with mild to moderate dementia?
According to a Cochrane review, cognitive rehabilitation improved participant self-ratings of goal attainment, informant ratings of goal attainment, and self-ratings of satisfaction with goal attainment at the end of treatment and at 3 to 12 months of follow-up. Cognitive rehabilitation likely has a small positive effect on caregivers' social and psychological quality of life at 3 to 12 months of follow-up.
Can wearable smart devices identify the underlying cause of palpitations?
The use of smartphone-based ambulatory cardiac-monitoring devices is highly diagnostic for atrial fibrillation, which is the most common arrhythmia causing palpitations; however, other forms of arrhythmia detection are less clear.
Tip for Using AFP at the Point of Care
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A collection of AFP Clinical Answers is available at https://www.aafp.org/afp/answers.
