Annals for Hospitalists - November 2021
Authors: Megan Mack, Matthew Luzum, David H. Wesorick
Journal: Annals of Internal Medicine (2021)

Web ExclusivesNovember 2021Annals for Hospitalists - November 2021FREEMegan Mack, MD*, Matthew Luzum, MD* and David H. Wesorick, MDMegan Mack, MD*From Michigan Medicine and VA Ann Arbor Healthcare System, Ann Arbor, Michigan (M.M., M.L., D.H.W.)Search for more papers by this author, Matthew Luzum, MD*From Michigan Medicine and VA Ann Arbor Healthcare System, Ann Arbor, Michigan (M.M., M.L., D.H.W.)Search for more papers by this author and David H. Wesorick, MDFrom Michigan Medicine and VA Ann Arbor Healthcare System, Ann Arbor, Michigan (M.M., M.L., D.H.W.)Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/AWHO202111160 SectionsAboutVisual Abstract ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Inpatient NotesMyocarditis After Vaccination for SARS-CoV-2—Adam L. Dorfman, MD, and Venkatesh L. Murthy, MD, PhDHospitalists should be prepared to recognize the acute complications of SARS-CoV-2 vaccination. In this article, the authors discuss the uncommon but distinctive complication of myocarditis.Highlights of Recent Articles From Annals of Internal MedicineAcute Consumption of Alcohol and Discrete Atrial Fibrillation EventsAnn Intern Med. 2021;174:1503-1509. Published 31 August 2021. doi:10.7326/M21-0228This prospective, case-crossover study investigated whether acute alcohol consumption increases the risk for atrial fibrillation (AF) episodes using ambulatory cardiac monitoring among adults with documented paroxysmal AF and moderate alcohol use. Alcohol consumption was documented by patient report (pressing a button on the monitor) and by transdermal alcohol sensors. Episodes of AF were 3 times more likely (odds ratio, 3.58 [95% CI, 1.63 to 7.89]) to be associated with consuming 2 or more drinks within the preceding 4 hours (compared with AF episodes with preceding sobriety). For every 0.1% increase in peak blood alcohol concentration, the odds of alcohol consumption preceding an episode of AF increased by 38% (odds ratio, 1.38 [CI, 1.04 to 1.83]).Key points for hospitalists include:The chronic use of alcohol is a recognized risk factor for atrial fibrillation. This study now confirms that acute alcohol intake is a risk factor for AF recurrences in patients with a history of paroxysmal AF.Even modest amounts of alcohol intake (that is, a single drink) seem to increase the risk. Editorialists note that this study adds yet another reason for health professionals to regularly discuss alcohol use with their patients because it is a modifiable lifestyle risk factor for many conditions, including acute AF episodes.Getting Through COVID-19: Keeping Clinicians in the WorkforceAnn Intern Med. 2021;174:1614–1615. Published 28 September 2021. doi:10.7326/M21-3381This Ideas and Opinions article offers 10 tangible steps that employers can take to protect health care workers from physical harm, exhaustion, burnout, and disillusionment as they continue to care for patients with COVID-19.Key points for hospitalists include:Some of the key steps are highlighted here:Universal mask and vaccination mandates should be strictly enforced, and adequate personal protective equipment availability and ventilation should be ensured.Extend support to clinicians who are parents by offering flexible work schedules, recognizing the challenges of having to balance work and childcare responsibilities.Reduce administrative tasks that are not mission-critical, such as mandatory online training, promotion or tenure reporting requirements, or unnecessary meetings.Offer free and confidential resources to support clinicians' mental health, including “wellness check-ins.” The article recommends external resources for small practices that may not be able to provide these services internally.Encourage clinicians to take vacation and professional development days to nurture a mentally healthy workplace.The Latest Highlights From Journal ClubDoes intravenous (IV) iron therapy improve quality of life in patients with heart failure (HF) and iron deficiency?In patients with acute HF and iron deficiency, IV ferric carboxymaltose improved quality of life at 4 to 24 wkAnn Intern Med. 2021;174:JC110. doi:10.7326/ACPJ202110190-110In this randomized controlled trial done in 121 centers in Europe, Singapore, and South America, 1132 patients with iron deficiency and hospitalized with acute HF were randomly assigned to the administration of IV ferric carboxymaltose or placebo, initiated at the time of hospital discharge (and repeated, as needed, after discharge). Patients in the IV ferric carboxymaltose group demonstrated improved quality of life at 4 to 24 weeks.In patients hospitalized with COVID-19, is therapeutic dosing of anticoagulant medications superior to prophylactic dosing for preventing thromboembolic events?In COVID-19, therapeutic vs. prophylactic anticoagulation did not improve clinical outcomes and increased bleedingAnn Intern Med. 2021;174:JC112. doi:10.7326/ACPJ202110190-112In this randomized controlled trial, 615 patients hospitalized with COVID-19, with elevated D-dimer levels, were randomly assigned to either therapeutic dosing of anticoagulants (rivaroxaban, enoxaparin, or IV unfractionated heparin) or prophylactic dosing of enoxaparin or subcutaneous unfractionated heparin. The 2 groups had similar rates of thrombosis (composite outcome), but the therapeutic dosing group had much higher rates of major or clinically relevant bleeding.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 (M.M., M.L., D.H.W.)Disclosures:Authors have reported no disclosures of interest. Forms can be viewed at http://www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M21-3315.* The authors contributed equally to the article. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoAnnals for Hospitalists Inpatient Notes - Myocarditis After Vaccination for SARS-CoV-2 Adam L. Dorfman and Venkatesh L. Murthy Metrics November 2021Volume 174, Issue 11Page: HO11 ePublished: 16 November 2021 Issue Published: November 2021 Copyright & PermissionsCopyright © 2021 by American College of Physicians. All Rights Reserved.Loading ...