Staying #Up2Date 🚨

1. Guideline Watch 👀

An update to the primary stroke prevention guidelines is here! The guidelines address the social determinants of health, list sex/gender specific risks, endorse the Mediterranean diet, and recommend GLP-1 receptor agonists in those with diabetes or high cardiovascular risk. There’s even a plug for the American Heart Association’s Essential 8. 

2. Chronic Painful Pancreatitis 

In this Dutch cohort study, 88 patients with painful chronic pancreatitis were randomized to early surgery vs. endoscopy. At 16 months follow-up, patients in the surgery group reported less pain and greater satisfaction compared to the endoscopy group. After the initial 18-month follow-up, 26% patients in the early surgery group underwent re-interventions vs. 44% patients in the endoscopy-first group. 

3. GLP-1 receptor agonists in HFpEF

In the SUMMIT trial, patients with heart failure preserved ejection fraction (HFpEF) and BMI 30 were assigned to tirzepatide vs. placebo. At 52 weeks, heart failure worsening or cardiovascular death was lower in the tirzepatide group (10% vs 15%, HR 0.62); the KCCQ-CSS clinical score was also lower in the trizepatide group by ~7 points. Gastrointestinal adverse events and discontinuation were more frequent with tirzepatide group.

Primary Care Crisis 🚨

How family physician shortages are overloading ERs

What happened: A report has found that 1 in 7 ER visits in Canada could have been handled at a family physician's office. 

Why it’s interesting: The study analyzed people aged 2 to 65+ and found that children under 10 accounted for 26% of ER visits – for issues like colds, sore throats, prescription refills, and antibiotics. Canadians were also found to be the least likely among 10 high-income countries to get a same- or next-day appointment with their primary care provider. The report focused on primary and virtual care access between April 2023 to March 2024. 

What’s causing it: Family medicine residency has dropped in recent years, and family doctors are seeing fewer patients than 5 years ago. Administrative burnout is a key factor – over 60% of family physicians say additional paperwork affects their mental health. The chair of BC Family Doctors said a solution needs to be found so that doctors can spend more time treating patients rather than filling out paperwork.

But: Some provinces are taking measures to increase the number of family physicians. Thanks to BC’s new family doctor payment model, the province has brought in 800 new doctors, connecting 123,000 patients to doctors between April and October of this year. BC’s Premier said the province is aiming to let doctors and nurses move between ERs throughout the province to keep more departments open. 

Bottom line: Canada needs more family physicians to ensure patients get timely care and to keep ERs available for critical patients.

Hot Off The Press

1: ⚕️ UnitedHealthcare CEO Brian Thompson, 50, was fatally shot in a targeted attack outside a Manhattan hotel on his way to an investor conference. Thompson, who led the nation’s largest health insurer, kept a low profile despite overseeing $281 billion in revenue and shaping how millions of Americans access healthcare. Luigi Mangione, 26, has been arrested in Pennsylvania in connection with the killing, while carrying a manifesto which included phrases like “These parasites had it coming.“

The news of the shooting sparked heated reactions online — for example: “If you would like to appeal the fatal gunshot, please call 1-800-555-1234 with case #123456789P to initiate a peer-to-peer within 48 hours.”

Another added, “Murder is not justice. However, if someone had to be vigilante murdered, I’m glad it wasn’t somebody else.”

2: 🏥 A new Canadian Cancer Society report reveals the significant financial burden cancer patients face — even with universal health care — estimating an average lifetime cost of nearly $33,000 per person. According to CBC, many patients struggle with out-of-pocket expenses for medications, treatments, and lost income, often relying on family for support.

3: 📗 TMU's new medical school is set to launch in just a year, but its controversial approach to admissions is raising eyebrows in the medical community. Many have urged TMU to delay the launch to ensure that high academic and admission standards are enforced. Critics are eyeing the program’s inclusion of equity-based pathways and focus on diversity and decolonization.

4: 💔 Manitoba's top doctor has signed a new directive banning the jailing of people under the Public Health Act after Geraldine Mason, a woman from God's Lake First Nation, was locked up for a month over missed tuberculosis medication. Premier Wab Kinew called the situation "terrible" and made sure it won’t happen again. This move follows a CBC investigation that sparked public outrage and highlighted problems in how First Nations are treated by the health and justice systems.

5: 🇺🇸 Donald Trump is calling for an immediate ceasefire in Ukraine and suggests the US may withdraw from NATO if allies don't meet military spending commitments. In a recent interview, he also indicated that military aid to Ukraine could be cut. His comments have raised alarms among Ukraine and NATO allies but have sparked cautious support from Russia, with President Zelensky calling for a "just and robust peace."

Notable Numbers 🔢

22.7%: how much Canada's aging population is projected to make up of the population by 2040, impacting health-care costs and driving up annual expenses to $12,000 per senior. The CSA Group suggests focusing on preventive care and addressing social factors like housing, mental health, and isolation to mitigate the financial strain.

77%: how much of obesity’s impact on Alzheimer’s risk is tied to visceral fat, according to a study from Washington University School of Medicine. Researchers found that this type of fat, mostly around the abdomen, is a major driver of amyloid buildup in the brain, making midlife interventions like weight loss crucial. Visceral fat may also reduce blood flow to the brain, adding to the risk.

Postcall Picks

☎️ Phone: plan for $8.33/month? Not a bad offer from Telus (if you don’t use much data). Unlimited talk/text and 2GB/month.

🌴 Travel: to Bali with Doctors-on-Tour this upcoming April 27 - May 13 and get 15 CME hours along the way. Full itinerary here.

📈 Invest: is 2025 the year that you finally quit those high fees from MD Financial and move to a self-managed investment portfolio? Here’s our favourite starting point: one ETF to rule them all.

🏦 Bank: another one is vying for attention from physicians: National Bank. They’re offering a free World Elite credit card with pretty good points rate and insurance policy. We haven’t tried it, though — if you have, let us know your experience!

💰 Missed: Vijay Wealth’s year-end tax workshop for physicians? Don't fret - sign up here and they'll send you all the key insights this week.**

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