Stopping statins in older adults raises events in STREAM; machine learning delirium model holds up at second hospital; Medicare cuts 2027 pay

• Research Nov 7, 2026
  Stopping statins at 70 and older meets noninferiority, but hazard ratio for events is 1.38 in STREAM trial of 1,880
  The open-label STREAM trial randomized 1,880 adults 70 or older with at least two chronic conditions and no known cardiovascular disease to stop or continue statins. Two-year restricted mean event-free survival was 96.5 weeks with stopping versus 98.5 weeks with continuing, within the prespecified 5.2-week margin. Over a median 103 weeks, nonfatal heart attack, nonfatal ischemic stroke or death occurred in 12.7% versus 9.2% (hazard ratio 1.38, 95% CI 1.05 to 1.81), and the investigators estimated one additional event for every 40 people who stopped. Mean 12-month LDL cholesterol was 176.0 versus 99.4 mg/dL in a 235-person subsample.
  Sources: NEJM, Crossref, HCPLive
• AI Nov 2, 2026
  Machine learning delirium model reaches area under the curve of 0.91 at a second Mount Sinai hospital without retraining
  In a quality improvement study of 33,095 non-intensive care admissions of patients 60 or older at Mount Sinai Hospital and Mount Sinai Morningside, a machine learning delirium risk model had an area under the receiver operating characteristic curve of 0.94 and 0.91. After deployment at Morningside, the mean monthly delirium detection rate rose from 9.23% to 19.59%. Positive predictive value was 25.9% at Morningside, and the authors reported a high false positive rate, according to the JAMA Network Open study published Nov. 2.
  Sources: JAMA Network Open, PubMed
• Payment Nov 4, 2026
  Medicare cuts 2027 conversion factor 2.31% to $32.63 and delays remote monitoring staffing limit to 2029
  The Centers for Medicare & Medicaid Services (CMS) set the 2027 conversion factor at $32.63 for most clinicians, a 2.31% decrease, and $32.95 for qualifying advanced payment model participants, a 1.83% decrease. CMS delayed to Jan. 1, 2029, a rule that would pay for remote patient monitoring only when practice-employed clinical staff provide it. The final rule pays 20% less for the lower-paid service when a visit and a 0-day global procedure fall on the same day, according to Medical Economics, which said Congress extended Medicare telehealth flexibilities through Dec. 31, 2027, in the Consolidated Appropriations Act, 2026.
  Sources: CMS, Medical Economics
• Research Nov 7, 2026
  Systolic target under 120 mm Hg after stroke cuts cardiovascular events versus under 140 in 4,368-patient OPTIMAL-STROKE trial
  In the open-label OPTIMAL-STROKE trial at 30 sites in Brazil, 4,368 patients with high blood pressure and a prior ischemic stroke or transient ischemic attack were randomized to a systolic target under 120 or under 140 mm Hg. Over a median 3.9 years, the primary composite of cardiovascular death, nonfatal myocardial infarction, nonfatal stroke or hospitalization for unstable angina or heart failure occurred in 10.9% versus 13.5% (hazard ratio 0.79; 95% CI 0.67 to 0.94; P = .007). Renal outcomes were more common with intensive treatment (3.9% versus 2.2%). The trial was presented at the American Heart Association Scientific Sessions.
  Sources: New England Journal of Medicine, Healio
• Research Nov 7, 2026
  Systolic target below 120 mm Hg does not significantly cut cardiovascular events in OPTIMAL-DIABETES trial of 9,476 adults
  In the trial at 33 sites in Brazil, adults 50 and older with type 2 diabetes and elevated systolic blood pressure were treated to below 120 mm Hg or below 140 mm Hg. Major cardiovascular events occurred in 6.0% of the intensive group and 6.7% of the standard group, and the results were not statistically significant, according to the American Heart Association (AHA). Kidney events, mainly declines in function, occurred in 5.7% versus 3.7%, while end-stage renal disease was similar. The trial was presented Nov. 7 at the AHA Scientific Sessions and published in the New England Journal of Medicine.
  Source: American Heart Association
• Research Nov 7, 2026
  Pelacarsen lowers lipoprotein(a) 78% but does not reduce cardiovascular events in full Lp(a)HORIZON results
  The phase 3 trial enrolled more than 8,300 adults with established cardiovascular disease and lipoprotein(a) of at least 70 mg/dL, according to the American Heart Association, which reported the results Nov. 7. The primary end point occurred in 12.3% of the pelacarsen group and 12.1% of the placebo group (hazard ratio 1.02; 95% CI 0.9 to 1.15; P = .76), Healio reported. Extended NEJM Evidence analyses by treatment exposure also found no reduction. Developers Ionis and Novartis announced the primary result in September, Healio reported. Dr. Steven Nissen, the senior author, said "it didn't work."
  Sources: American Heart Association, Healio, NEJM Evidence
• Research Nov 4, 2026
  COVID-19 vaccine tied to more shoulder injuries than influenza vaccine, 1.84 versus 1.15 per 10,000, in 1,366,362 adults
  In a population-based cohort of 1,366,362 adults at Kaiser Permanente Southern California published Nov. 4 in JAMA Internal Medicine, shoulder injury related to vaccine administration occurred at 1.84 per 10,000 COVID-19 vaccinations versus 1.15 per 10,000 influenza vaccinations (adjusted relative risk 1.63, 95% CI 1.16 to 2.28). The authors said COVID-19 vaccination was associated with about seven additional cases per 100,000 vaccinations.
  Sources: JAMA Internal Medicine, PubMed

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