VTEs and Their Effects on Patients with AE-COPD
Clinical question: How common are venous thromboembolisms (VTEs) in patients presenting with acute exacerbation of chronic obstructive pulmonary disease (AE-COPD) and what is the effect on prognosis, hospital length of stay (LOS), and one-year mortality?
Background: Worldwide, COPD is a leading cause of mortality, and many COPD patients will suffer from exacerbations. Many times, infections or environmental triggers are to blame, but the etiology remains elusive in up to one-third of patients. It is known that COPD patients are twice as likely to develop VTE compared to those without, and prior studies have shown variable ...
Source: The Hospitalist - April 1, 2024 Category: Hospital Management Authors: Ronda Whitaker Tags: In the Literature Source Type: research
Risk and Benefit of Secondary Prevention with Aspirin Versus P2Y12 Inhibitor in CAD Patients
Clinical question: In patients with coronary artery disease (CAD), what is the difference in risk and benefit between secondary prevention with aspirin (ASA) versus a P2Y12 inhibitor?
Background: Lifelong ASA is the mainstay of care for patients with CAD who require secondary prevention. This is predicated on studies from several decades ago. Subsequent studies examining P2Y12 monotherapy versus ASA have had inconsistent results.
Study design: Systematic review and meta-analysis
Setting: Seven randomized clinical trials from 1996 to 2021 were found to meet the criteria for analysis.
Synopsis: 24,325 patients were included ...
Source: The Hospitalist - April 1, 2024 Category: Hospital Management Authors: Ronda Whitaker Tags: Cardiology In the Literature Source Type: research
Cefepime Versus Piperacillin-tazobactam in Adults Hospitalized with Acute Infection
This study analyzed 2,511 patients over the age of 18 prescribed antipseudomonal antibiotics from November 10, 2021, to October 7, 2022, in the emergency department, medical inpatient unit, or ICU at Vanderbilt University Medical Center in Nashville, Tenn. The patient population had a median age of 58 years with 42.7% being female. The primary outcome was acute kidney injury (AKI) or death within 14 days. Secondary outcomes were major adverse kidney events and number of days alive free of delirium or coma within the 14 days. After the patients were randomized to a 1:1 ratio, the patient was provided the antibiotic and the ...
Source: The Hospitalist - April 1, 2024 Category: Hospital Management Authors: Ronda Whitaker Tags: In the Literature Pharmacology Source Type: research
Time to Benefit of SGLT-2 Inhibitors Among Patients with HF
Clinical question: What is the time to benefit for patients with heart failure (HF) and prescribed a sodium-glucose cotransporter-2 (SGLT-2) inhibitor?
Background: SGLT-2 inhibitors are an effective medication for patients with heart failure and preserved (HFpEF) or reduced ejection fraction (HRrEF).
Study design: Comparative effectiveness study
Setting: The authors conducted a systematic review of the literature up to the date of September 5, 2022. 636 articles were identified, and 449 papers were excluded due to meeting the exclusion criteria of a meta-analysis, review, nonhuman research study, correspondence, or editori...
Source: The Hospitalist - April 1, 2024 Category: Hospital Management Authors: Ronda Whitaker Tags: Cardiology In the Literature Source Type: research
Reliability of Admission Procalcitonin Testing for Capturing Bacteremia Across the Sepsis Spectrum
This study wanted to look at the performance of procalcitonin for detecting bloodstream infections on admission in a real-world setting.
Study design: Retrospective, observational, cohort study
Setting: Cerner HealthFacts database, electronic health record data from 65 U.S. hospitals
Synopsis: This study looked at 74,958 patients at 65 U.S. hospitals, analyzing real-world data on the utilization of procalcitonin in patients admitted with potential bloodstream infections. They included patients 18 years or older who had blood cultures and procalcitonin ordered within 24 hours of admission. The procalcitonin cutoff used was ...
Source: The Hospitalist - April 1, 2024 Category: Hospital Management Authors: Ronda Whitaker Tags: In the Literature Infectious Diseases Source Type: research
Pitavastatin to Prevent Cardiovascular Disease in HIV Infection
This study highlights that pitavastatin use can decrease MACEs in patients with HIV who are on antiretroviral therapy.
Study design: Multicenter, randomized, placebo-controlled trial (REPRIEVE)
Setting: 7,769 people aged 40 to 75 years with low to moderate CV risk with HIV on ART were recruited from 145 sites in 12 different countries
Synopsis: This trial was a multinational, randomized, placebo-controlled, efficacy study where patients were randomized to receive pitavastatin or placebo. The participants were between the ages of 40 and 75 years and on ART therapy, with a low-to-moderate risk of ASCVD. Patients with known A...
Source: The Hospitalist - April 1, 2024 Category: Hospital Management Authors: Ronda Whitaker Tags: In the Literature Infectious Diseases Source Type: research
Getting Another Degree While Working … Or Not?
The monthly(-ish) #JHMChat on X, formerly Twitter, is a time to discuss interesting articles in the Journal of Hospital Medicine [The Hospitalist’s sister publication], meet new people, and learn from each other. Our chat this past November was based on this article by Drs. Jennifer Spicer and Samuel Lai about deciding to get a degree while working, and it did not disappoint. We had Dr. Spicer, who received another degree while working, as our guest expert. Among our participants who finished secondary degrees, those actively obtaining their secondary degree, and those who have chosen not to pursue an additional degr...
Source: The Hospitalist - March 12, 2024 Category: Hospital Management Authors: Lisa Casinger Tags: Career Education Source Type: research
A Clinician ’ s Romance with Uncertainty
It all started as a fling; harmless, unburdened. My tryst with uncertainty found its roots in those educational conferences where every case started as a mystery and was resolved with a definitive answer.
Out on the wards, there was a thrill in the chase. I was exhilarated by those opportunities to solve the mysterious fever; ensnared by the curious constellation of symptoms. Although I did feel the twinges of vulnerability that accompany any new relationship, I always took solace in the safety nets that stripped me of ultimate accountability for the patient mysteries I couldn’t solve.
These safety nets also allowed me t...
Source: The Hospitalist - March 4, 2024 Category: Hospital Management Authors: Lisa Casinger Tags: Essay Source Type: research
Time to Rethink AF Treatment: Prolonged Benefits of Cryoballoon Ablation
Clinical question: Does initial therapy with catheter cryoballoon ablation reduce progression to persistent atrial fibrillation (AF) in patients with symptomatic, paroxysmal AF when compared to antiarrhythmic therapy?
Background: Atrial fibrillation can progress from a paroxysmal to a persistent form due to electrical and structural remodeling of the heart. The Early Aggressive Invasive Intervention for Atrial Fibrillation (Early-AF) trial concluded that initial treatment of symptomatic, paroxysmal AF with cryoballoon ablation resulted in lower recurrence of arrhythmias compared to antiarrhythmic drug therapy alone during ...
Source: The Hospitalist - March 1, 2024 Category: Hospital Management Authors: Ronda Whitaker Tags: Cardiology In the Literature Source Type: research
Longer-term Outcomes in Critically Ill Patients with COVID-19 in the REMAP-CAP Trial
Clinical question: What is the longer-term (180-day) mortality effect of common therapies on critically ill patients with COVID-19?
Background: Most randomized clinical trials for patients with COVID-19 focus on short-term outcomes such as 28-day mortality or organ failure. Trials evaluating longer-term outcomes of therapeutic interventions are needed.
Study design: Randomized adaptive-platform trial
Setting: International multicenter trial (197 sites in 14 countries)
Synopsis: 4,869 critically ill patients were enrolled from March 2020 through June 2021. Patients were randomized to one of six treatment arms (immune modula...
Source: The Hospitalist - March 1, 2024 Category: Hospital Management Authors: Ronda Whitaker Tags: COVID-19 In the Literature Source Type: research
Main Causes of Costly Inappropriate Hospital Admissions are Premature Admission and the Potential for Outpatient Management
Clinical question: How prevalent and costly are inappropriate hospital admissions and are patients’ intrinsic risk factors (IRFs) or comorbidities associated with inappropriate hospital admissions?
Background: Health care resource overuse (inappropriate hospital admissions) has a significant economic impact on U.S. health care spending. While previous studies have focused on the frequency and non-clinical patient factors linked to improper hospital admissions, this article explores the economic consequences of such admissions and the connection between IRFs or comorbidities and inappropriate hospital admissions using the...
Source: The Hospitalist - March 1, 2024 Category: Hospital Management Authors: Ronda Whitaker Tags: Business of Medicine In the Literature Source Type: research
Use of Amiodarone with Apixaban or Rivaroxaban Increases Risk for Bleeding-related Hospitalizations
This study was observational, and the Medicare data lacked information on several potential confounding factors, thereby limiting the ability to establish a causal relationship. However, hospitalists who are initiating antiarrhythmic drugs for atrial fibrillation should consider the potential increased risk for bleeding-related hospitalization in patients concurrently taking apixaban or rivaroxaban.
Bottom line: Amiodarone, when used in conjunction with apixaban or rivaroxaban, increases the risk of bleeding-related hospitalization when compared to the use of flecainide or sotalol.
Citation: Ray WA, et al. Risk for bleedin...
Source: The Hospitalist - March 1, 2024 Category: Hospital Management Authors: Ronda Whitaker Tags: Hematology (blood) In the Literature Source Type: research
Initial Aggressive Diuresis in Patients Hospitalized with Acute HF
Clinical question: For patients admitted with acute heart failure, is early and aggressive diuresis associated with improved dyspnea without an associated worsening in renal function?
Background: Acute heart failure is one of the leading causes of hospitalization in the U.S. and intravenous loop diuretics are considered the mainstay of therapy. Data and guidelines regarding diuretic goals and the safety of early aggressive diuresis are lacking.
Study design: Retrospective, pooled-cohort analysis
Setting: Merged data from the DOSE, ROSE, and ATHENA-HF trials
Synopsis: A pooled cohort of 807 patients admitted with acute hear...
Source: The Hospitalist - March 1, 2024 Category: Hospital Management Authors: Ronda Whitaker Tags: Cardiology In the Literature Source Type: research
Periprocedural Management of Patients with AF Receiving a DOAC Undergoing a Digestive Endoscopy
This study established a standardized periprocedural DOAC management strategy based on medication pharmacokinetics, including creatinine clearance and procedure risk. The authors analyzed outcomes for 556 adult patients with AF who were treated with DOACs, undergoing an elective digestive endoscopy, and who were able to adhere to the defined DOAC interruption protocol. The mean duration of DOAC interruption was 3.9 ±1.6 days. There were low rates of thromboembolism (0.7%) and GI bleeding (2.5%).
Procedure details were unavailable for those with bleeding complications and most complications occurred around 10 days post-pro...
Source: The Hospitalist - March 1, 2024 Category: Hospital Management Authors: Ronda Whitaker Tags: Cardiology Gastroenterology In the Literature Source Type: research
DOACs Versus LMWH and Recurrent VTE in Patients with Cancer
Clinical question: Are direct oral anticoagulants (DOACs) acceptable compared to low-molecular-weight heparin (LMWH) for preventing venous thromboembolism (VTE) with a safe bleeding risk in cancer patients?
Background: LMWH has long been the standard of care in cancer patients with VTE and for future VTE prevention. Are DOACs now a viable option?
Study design: Randomized clinical trial
Setting: 67 U.S. member centers of the Alliance for Clinical Trials in Oncology research network
Synopsis: 671 participants were randomized to either the DOAC or LMWH group. Rates of VTE were 6.1% in the DOAC group and 8.8% in the LMWH group...
Source: The Hospitalist - March 1, 2024 Category: Hospital Management Authors: Ronda Whitaker Tags: In the Literature Oncology Pulmonology Source Type: research
