Annals for Hospitalists - 15 January 2019
Authors: David H. Wesorick, Vineet Chopra
Journal: Annals of Internal Medicine (2019)

Web Exclusives15 January 2019Annals for Hospitalists - 15 January 2019FREEDavid H. Wesorick, MD* and Vineet Chopra, MD, MSc*David H. Wesorick, MD*From Michigan Medicine and VA Ann Arbor Healthcare System, Ann Arbor, Michigan (D.H.W, V.C.)Search for more papers by this author and Vineet Chopra, MD, MSc*From Michigan Medicine and VA Ann Arbor Healthcare System, Ann Arbor, Michigan (D.H.W, V.C.)Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/AFHO201901150 SectionsAboutVisual Abstract ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Inpatient NotesCaregiver Engagement in Hospital Medicine: The Next Frontier—Molly J. Horstman, MD, and Eduardo Salas, PhDWhen patients are discharged from the hospital, they often depend on care from a friend or family member. But, how well do hospitals train these caregivers to perform the necessary tasks? This month's commentary focuses on the important, but often neglected, step of engaging the caregiver in the discharge process.Highlights of Recent Articles from Annals of Internal MedicineTrends in Drug Use–Associated Infective Endocarditis and Heart Valve Surgery, 2007 to 2017: A Study of Statewide Discharge DataAnn Intern Med. 2019;170:31-40. Published 1 January 2019. doi: 10.7326/M18-2124This study analyzed a statewide discharge database in North Carolina to identify trends in drug use–associated infective endocarditis (DUA-IE) during the decade of the U.S. opioid crisis. The study found a large increase in cases of endocarditis related to drug use during this period (increasing from 0.92 to 10.95 per 100 000 persons) as well as a similar increase in the rate of surgical treatment of endocarditis related to drug use (increasing from 0.1 to 1.38 per 100 000 persons).Key points for hospitalists include:This analysis demonstrates that the U.S. opioid crisis has been accompanied by a large increase in the number of patients with DUA-IE.The demographic and microbiologic profiles of patients with DUA-IE differ from those of traditional (non-DUA) endocarditis patients. DUA-IE patients are more likely to be young (median age 33 years), be white (89%), have Medicare or no insurance (73%), and be infected with methicillin-resistant Staphylococcus aureus.An editorialist notes that the rising rates of DUA-IE highlight the urgency of treating the underlying substance use disorder in patients who are admitted with this complication.Catheter Ablation of Atrial Fibrillation in Patients with Heart Failure: A Meta-analysis of Randomized Controlled TrialsAnn Intern Med. 2019;170:41-50. Published 1 January 2019. doi:10.7326/M18-0992This meta-analysis examined 6 randomized controlled trials (RCTs) to compare catheter ablation of atrial fibrillation (AF) with medical therapy in patients with heart failure. Catheter ablation, compared with medical therapy, improved all of the following outcomes: all-cause mortality, heart failure hospitalizations, left ventricular ejection fraction, 6-minute walk distance, VO2 max, and quality of life. Serious adverse events were more common with ablation than with medical therapy, although the difference was not statistically significant.Key points for hospitalists include:This meta-analysis highlights the significant benefits of catheter ablation of AF in patients with heart failure.Hospitalists might consider electrophysiology referrals for heart failure patients with AF, especially if these patients are hospitalized frequently.The authors note that several ongoing trials are further examining this issue, so additional evidence will be forthcoming.Long-Term Outcomes Among Patients Discharged From the Hospital With Moderate Anemia: A Retrospective Cohort StudyAnn Intern Med. 2019;170:81-9. Published 15 January 2019. doi:10.7326/M17-3253This retrospective cohort study examined the records of 445 371 patients who had 801 261 hospitalizations over a 5-year period from January 2010 to December 2014 to understand the effects of anemia and the trend toward more conservative transfusion practices. The authors found that the prevalence of moderate anemia (hemoglobin levels between 7 and 10 g/dL) at hospital discharge increased from 20% to 25% between 2010 and 2014, as fewer in-hospital red blood cell transfusions were given (28% decline in transfusion rates). The proportion of patients who were still anemic 6 months after hospitalization also increased during this time. However, rehospitalization, transfusion, and mortality rates in the 6 months after hospitalization all decreased during the 5-year study period.Key points for hospitalists include:These results suggest that the trend of increasingly restrictive transfusion practices in patients with moderate anemia is associated with decreased rates of rehospitalization and transfusion over the 6 months after hospitalization and is associated with lower mortality rates.An editorialist notes that this study did not explore other important outcomes, such as quality of life, and points out that the persistence of anemia demonstrated in this study suggests a need for more aggressive treatment strategies (other than transfusion) for these patients.The Latest Highlights From ACP Journal ClubDoes an extended course of rivaroxaban after discharge reduce symptomatic and fatal venous thromboembolism events after hospitalization for medical illness?In at-risk patients, rivaroxaban after discharge did not reduce symptomatic or fatal VTE at 45 daysAnn Intern Med. 2018;169:JC64. doi: 10.7326/ACPJC-2018-169-10-064This randomized controlled trial assigned more than 12 000 adult patients who had been admitted with common medical problems to either extended prophylaxis for venous thromboembolism (VTE) with rivaroxaban or placebo for 45 days. It found no significant reduction in a combined end point of symptomatic and fatal VTE events in patients discharged from the hospital receiving prophylactic rivaroxaban. There was a small decrease in symptomatic VTE, but this was offset by a trend toward increased major bleeding events. The study does not provide strong support for direct oral anticoagulants for VTE prophylaxis after discharge for most medical patients.Are oral antibiotics effective, after a course of IV antibiotics, in treating infective endocarditis?Changing to oral antibiotics was noninferior to continuing IV antibiotics in left-sided infective endocarditisAnn Intern Med. 2018;169:JC65. doi: 10.7326/ACPJC-2018-169-10-065This study examined a population of 400 patients with-gram positive infective endocarditis and randomly assigned them to 1 of 2 following antibiotic strategies: a traditional approach comprising a full course of intravenous (IV) therapy, or an approach that involved changing to oral antibiotics after an initial period of treatment with IV therapy. Oral antibiotic treatment was noninferior to IV treatment for the primary outcome (a composite of all-cause mortality, unplanned cardiac surgery, clinically evident embolic events, or relapse of bacteremia), suggesting that this approach may emerge as a reasonable option for selected patients.Sign up here to have Annals for Hospitalists delivered to your inbox each month. Comments0 CommentsSign In to Submit A Comment Author, Article, and Disclosure InformationAffiliations: From Michigan Medicine and VA Ann Arbor Healthcare System, Ann Arbor, Michigan (D.H.W, V.C.)Disclosures:Drs. Wesorick and Chopra have disclosed no conflicts of interest. The forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M16-1400.* The authors are co-first authors and contributed equally to the article. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics 15 January 2019Volume 170, Issue 2Page: HO2KeywordsAnemiaAntibioticsCardiac ablationCathetersDrugsEndocarditisHeart failureHospitalistsHospitalizationsQuality of life ePublished: 15 January 2019 Issue Published: 15 January 2019 Copyright & PermissionsCopyright © 2019 by American College of Physicians. All Rights Reserved.Loading ...