David H. Wesorick, MD; Vineet Chopra, MD, MSc
Disclosures: Dr. Chopra reports grants from the Agency for Healthcare Research and Quality. Dr. Wesorick has disclosed no conflicts of interest. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M16-1400.
This study suggests that patients receiving first-generation paclitaxel-eluting stents with DAPT scores of 2 or higher benefit from extended courses of DAPT. However, these stents are no longer routinely used, having been replaced by later-generation stents, limiting the applicability of these results to practice.
This study supports the use of a shorter course of DAPT for patients with DAPT scores lower than2. These patients experienced no benefit and had higher rates of bleeding when treated with extended DAPT courses.
An editorial notes that further investigation will be needed to define the optimal duration of DAPT in the age of advancing stent technology and discusses other currently available clinical calculators for determining DAPT duration.
In general, this article supports the current practice of placing ICDs for primary prevention in both ischemic and nonischemic cardiomyopathy in selected patients with the appropriate degree of left ventricular dysfunction or symptoms at least 40 days after acute myocardial infarction.
Among appropriate patients, hospitalists should consider discussing ICD implantation at the time of discharge and ensuring appropriate follow up for evaluation.
Hospitals and health systems should learn from other industries and embrace emerging design concepts and advances in technology to optimize the patient experience.
Simple fixes, such as improving signs to assist with navigation, appear to be low-hanging fruit for improvement.
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Wesorick DH, Chopra V. Annals for Hospitalists - 18 July 2017. Ann Intern Med. 2017;167:HO1. doi: 10.7326/AFHO201707180
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Published: Ann Intern Med. 2017;167(2):HO1.
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