ITL: Physician Reviews of HM-Relevant Research

The Hospitalist. 2012 December;2012(12):

December 1, 2012 | The Hospitalist

Aaron C. Hamilton, MD, MBA, FACP ; Anil Reddy Anumandla, MD ; Fawn Langerman, MD ; Prashant Sharma, MD ; Priyanka Bhateja, MD ; Varalakshmi Janamanchi, MD

Synopsis: Of 132,372 patients with NVAF, 2.7% had CKD and 0.7% had end-stage renal disease (ESRD). Compared to patients with no CKD, there was increased risk of stroke or systemic thromboembolism in patients with ESRD (HR, 1.83; 95% CI, 1.57-2.14) and with non-end-stage CKD (HR 1.49; 95% CI 1.38-1.59).

In patients with CKD, warfarin significantly reduced stroke risk (HR, 0.76; 95% CI, 0.64-0.91) and significantly increased bleeding risk (HR, 1.33; 95% CI, 1.16-1.53); aspirin significantly increased bleeding risk (HR, 1.17; 95% CI, 1.02-1.34) with no reduction in stroke risk.

Bottom line: CKD was associated with an increased risk of stroke among NVAF patients. While both aspirin and warfarin were associated with increased risk of bleeding, there was a reduction in the risk of stroke with warfarin, but not with aspirin.

Citation: Olesen JB, Lip GY, Kamper AL, et al. Stroke and bleeding in atrial fibrillation with chronic kidney disease. N Engl J Med. 2012;367(7):625-635.

Clinical Shorts

EARLY CORONARY COMPUTED TOMOGRAPHIC ANGIOGRAPHY (CTA) FOR SUSPECTED ACUTE CORONARY SYNDROME (ACS) NOT COST-EFFECTIVE

This multicenter randomized trial comparing early coronary CTA with standard evaluation for suspected ACS showed CTA did not decrease overall cost of care, and increased downstream testing and radiation exposure.

Citation: Hoffman U, Truong QA, Schoenfeld DA, et al. Coronary CT angiography versus standard evaluation in acute chest pain. N Engl J Med. 2012;367(4):299-308.

CDC REPORTS RECENT OUTBREAKS OF INFLUENZA A (H3N2) VARIANT VIRUS

CDC has reported outbreaks of the H3N2 variant since July 2012. Prolonged exposure to pigs is a risk factor for acquiring the virus, and children and those with chronic conditions, such as asthma and diabetes, are at increased risk for complications.

Citation: Centers for Disease Control and Prevention. Influenza A (H3N2) variant virus outbreaks. Centers for Disease Control and Prevention website. Available at: https://www.cdc.gov/flu/swineflu/h3n2v-outbreak.htm. Accessed Sept. 10, 2012.

INTRAVENOUS IMMUNOGLOBULIN (IVIG) IS AS EFFECTIVE AS PLASMA EXCHANGE (PE) IN PATIENTS WITH GUILLAIN-BARRÉ SYNDROME (GBS)

This Cochrane review provides moderate-quality evidence that in severe GBS, IVIg started within two weeks of disease onset is as effective as PE, with no significant difference in adverse events.

Citation: Hughes RA, Swan AV, van Doorn PA. Intravenous immunoglobulin for Guillain-Barré syndrome. Cochrane Database Syst Rev. 2012;7:CD002063.

COMPARATIVE STUDY SHEDS LIGHT ON UNDERAPPRECIATED VALUE OFFERED BY TEACHING HOSPITALS

A comparative study looking at publicly reported performance metrics from 4,809 U.S. hospitals demonstrated that teaching institutions were associated with higher quality and safety and similar overall costs.

Citation: Shahian DM, Nordberg P, Meyer GS, et al. Contemporary performance of U.S. teaching and non-teaching hospitals. Acad Med. 2012;87(6):701-708.

ACUTE RESPIRATORY DISTRESS SYNDROME (ARDS), THE BERLIN DEFINITION

A new ARDS definition was developed in 2011; it defines mild, moderate, and severe ARDS and predicts mortality better than the prior definition.

Citation: Ranieri VM, Rubenfeld GD, Thompson BT, et al. Acute respiratory distress syndrome. JAMA. 2012;307 (23):2526-2533.

CATARACT SURGERY REDUCES RISK OF HIP FRACTURE

Among patients 65 years and older with a cataract, those who had cataract surgery had a lower risk of hip fracture within one year compared to those who did not have cataract surgery.

Citation: Tseng VL, Yu F, Lum F, Coleman AL. Risk of fractures following cataract surgery in Medicare beneficiaries. JAMA. 2012;308(5):493-501.