In this installment of Med-Op-Ed: a device you might want on you in an avalanche; why heart failure with preserved ejection fraction might be seen as a diagnostic placeholder; and how to curate treatment options for a patient.

Device for Surviving Avalanche Burial?

If you ever find yourself completely buried in snow, a shovel would be nice — but a source of oxygen is even more important. An artificial air pocket device may significantly extend survival time by maintaining oxygen levels and preventing carbon dioxide buildup. One experiment convincingly demonstrated the life-saving potential of this technology, wrote Daniel S. Martin, MBChB, PhD, and Helen T. McKenna, MBBS, PhD, in JAMA.

The Context 

• To evaluate the effectiveness of the Safeback SBX ­device, which incorporates a fan into a backpack, researchers conducted a controlled trial in which they buried male and female volunteers in at least 50 cm (about 20 inches) of snow — creating “the most realistic environment possible within the parameters of what is ethical and safe,” the editorial noted.
• Among participants with the device, levels of oxygen and carbon dioxide remained consistent during a 35-minute burial, and 11 of 12 participants completed the protocol.
• In the control group, however, only one volunteer stayed buried for the duration; seven participants were removed from the snow once their oxygen saturation hit 80%.

In Their Own Words

“Despite it being a small trial (n = 24), the results leave little doubt as to which intervention one would choose if buried by an avalanche.” 

Read it: A Breath of Fresh Air — Improving Survival After Avalanche Burial

HFpEF: A Placeholder Term That Leads to Overtreatment? 

Heart failure with preserved ejection fraction (HFpEF) lacks evidence as a distinct clinical entity and functions more as a diagnostic placeholder than a clearly defined syndrome, argues Maria Giulia Bellicini, MD, from the Cardiology Unit at Spedali Civili of Brescia, Italy, in JACC: Case Reports.

The Context

• Many HFpEF trials have included patients without objective evidence of elevated filling pressure.
• Meanwhile, patients with severe valvular disease may not be systematically excluded from trials due to inconsistent echocardiography practices.
• A recent cohort study by Bellicini found that most patients with left ventricular ejection fraction greater than 40% who were hospitalized for acute heart failure had severe valvular dysfunction, with tricuspid and mitral regurgitation being the most common lesions.

In Their Own Words

“The consequences are not benign. Misdiagnosing patients as having HFpEF may lead to inappropriate treatment with diuretics, unnecessary fluid restrictions, long-term follow-up in heart failure clinics, and the psychological weight of an ill-defined chronic condition.”

Read it: HFpEF Diagnosis: A Controversial Construct in Modern Cardiology

When Less Information Helps More 

When it comes to recommending treatment options to patients, clinicians should think curation over menu. This advice comes from Neal W. Dickert, MD, PhD, and David Wendler, PhD, in the Journal of General Internal Medicine. They argue that offering too many choices can overwhelm patients and undermine, not help, the shared decision-making process. 

The Context

• Existing guidance on disclosing treatment options is insufficient. Clinicians who disclose all theoretical possibilities may leave an unwieldy number of choices on the table.
• When strategically deciding which treatment options to disclose, clinicians should consider patient-specific factors, such as preferences, contraindications, insurance coverage, and financial circumstances, while avoiding uninformed assumptions.
• Withholding certain options may have benefits at the societal level. Not disclosing antibiotics for respiratory infections, for example, could combat antibiotic resistance. Bypassing expensive treatments of questionable benefit might be economically sound.

In Their Own Words

“If the clinician believes two of the pharmacologic options make the most sense, she might explain: ‘There are a number of treatment options, including surgery, physical therapy, and different medications. Let’s first discuss the two options I think make most sense for you. We can then discuss the other options if you would like to hear more about them.’”

Read it: Setting the Table: Determining Which Options Clinicians Should Disclose to Patients

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.