1881. In thrombotic antiphospholipid syndrome, DOACs vs. VKAs increase arterial thrombotic events but not major bleeding.
Khairani CD, Bejjani A, Piazza G, et al. Direct oral anticoagulants vs vitamin K antagonists in patients with antiphospholipid syndromes: meta-analysis of randomized trials. J Am Coll Cardiol. 2023;81:16-30. 36328154.
1882. In critically ill patients with COVID-19, IL-6 receptor antagonists reduced mortality vs. control at 180 d.
Writing Committee for the REMAP-CAP Investigators; Higgins AM, Berry LR, Lorenzi E, et al. Long-term (180-day) outcomes in critically ill patients with COVID-19 in the REMAP-CAP randomized clinical trial. JAMA. 2023;329:39-51. 36525245.
1883. In older patients receiving aspirin, H pylori eradication reduced hospitalization or death due to peptic ulcer bleeding at 2.5 y.
Hawkey C, Avery A, Coupland CAC, et al; HEAT trialists. Helicobacter pylori eradication for primary prevention of peptic ulcer bleeding in older patients prescribed aspirin in primary care (HEAT): a randomised, double-blind, placebo-controlled trial. Lancet. 2022;400:1597-1606. 36335970.
1884. In HF with iron deficiency, IV ferric derisomaltose was associated with lower rates of HF hospitalization or CV death.
Kalra PR, Cleland JG, Petrie MC, et al. Intravenous ferric derisomaltose in patients with heart failure and iron deficiency in the UK (IRONMAN): an investigator-initiated, prospective, randomised, open-label, blinded-endpoint trial. Lancet. 2022;400:2199-209. 36347265.
1885. Facilitating Shared Decision Making Among Black Patients at Risk for Sudden Cardiac Arrest : A Randomized Clinical Trial.
作者: Kevin L Thomas.;Sana M Al-Khatib.;Andrzej S Kosinski.;Samuel F Sears.;Nancy M Allen LaPointe.;Larry R Jackson.;Daniel D Matlock.;Daniel Haithcock.;B Judson Colley.;David S Hirsh.;Eric D Peterson.
来源: Ann Intern Med. 2023年176卷5期615-623页
Racial disparities in implantable cardioverter-defibrillator (ICD) implantation are multifactorial and are partly explained by higher refusal rates.
1886. Incremental Health Care Costs of Self-Reported Functional Impairments and Phenotypic Frailty in Community-Dwelling Older Adults : A Prospective Cohort Study.
作者: Kristine E Ensrud.;John T Schousboe.;Allyson M Kats.;Brent C Taylor.;Cynthia M Boyd.;Lisa Langsetmo.
来源: Ann Intern Med. 2023年176卷4期463-471页
Health care systems need better strategies to identify older adults at risk for costly care to select target populations for interventions to reduce health care burden.
1888. Drug Repurposing and Observational Studies: The Case of Antivirals for the Treatment of COVID-19.
Remdesivir and molnupiravir were the only 2 repurposed antivirals that were approved for emergency use during the COVID-19 pandemic. Both drugs received their emergency use authorization on the basis of a single industry-funded phase 3 trial, which was launched after evidence of in vitro activity against SARS-CoV-2. In contrast, for tenofovir disoproxil fumarate (TDF), little in vitro evidence was generated, no randomized trials for early treatment were done, and the drug was not considered for authorization. Yet, by the summer of 2020, observational evidence suggested a substantially lower risk for severe COVID-19 in TDF users compared with nonusers. The decision-making process for the launching of randomized trials for these 3 drugs is reviewed. Observational data in favor of TDF was systematically dismissed, even though no viable alternative explanations were proposed for the lower risk for severe COVID-19 among TDF users. Lessons learned from the TDF example during the first 2 years of the COVID-19 pandemic are described, and the use of observational clinical data to guide decisions about the launch of randomized trials during the next public health emergency is proposed. The goal is that gatekeepers of randomized trials make better use of the available observational evidence for the repurposing of drugs without commercial value.
1889. Effect of Medicare Advantage on Hospital Readmission and Mortality Rankings.
作者: Andrew S Oseran.;Rishi K Wadhera.;E John Orav.;Jose F Figueroa.
来源: Ann Intern Med. 2023年176卷4期480-488页
Medicare links hospital performance on readmissions and mortality to payment solely on the basis of outcomes among fee-for-service (FFS) beneficiaries. Whether including Medicare Advantage (MA) beneficiaries, who account for nearly half of all Medicare beneficiaries, in the evaluation of hospital performance affects rankings is unknown.
1890. Cases in Precision Medicine: Is There an Obligation to Return Reinterpreted Genetic Results to Former Patients?
作者: Paul S Appelbaum.;Wylie Burke.;Erik Parens.;Jessica Roberts.;Sara M Berger.;Wendy K Chung.
来源: Ann Intern Med. 2023年176卷4期563-567页
Interpretation of many genetic test results can change over time as new data accumulate. Hence, physicians who order genetic tests may subsequently receive revised reports with important implications for patients' medical treatment-even for patients who are no longer in their care. Several of the ethical principles underlying medical practice suggest an obligation to reach out to former patients with this information. Discharging that obligation can be accomplished, at a minimum, by attempting to contact the former patient with their last known contact information.
1892. Subclinical Coronary Atherosclerosis and Risk for Myocardial Infarction in a Danish Cohort : A Prospective Observational Cohort Study.
作者: Andreas Fuchs.;Jørgen Tobias Kühl.;Per Ejlstrup Sigvardsen.;Shoaib Afzal.;Andreas Dehlbæk Knudsen.;Mathias Bech Møller.;Martina Chantal de Knegt.;Mathias Holm Sørgaard.;Børge Grønne Nordestgaard.;Lars Valeur Køber.;Klaus Fuglsang Kofoed.
来源: Ann Intern Med. 2023年176卷4期433-442页
Coronary atherosclerosis may develop at an early age and remain latent for many years.
1895. Web Exclusive. Annals for Hospitalists Inpatient Notes - Clinical Pearls-Outpatient Parenteral Antimicrobial Therapy for Infective Endocarditis in Persons Who Inject Drugs. |