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.
The authors conclude that any of the 3 studied postdischarge care models are superior to standard care, and suggest that these transitional care models should become the standard of care for patients discharged after heart failure hospital admissions.
The model assumptions were based on heterogeneous trials involving a small number of patients, which might limit the generalizability of the findings. However, the assumptions were very conservative, and the effects were relatively consistent across a wide range of sensitivity analyses.
An editorialist points out that these interventions do not reduce costs. Rather, they appear to increase QALYs at a cost that is lower than other widely accepted interventions. The added expense, including upfront costs to set up the programs, are one of the barriers to widespread implementation of these interventions.
Currently, no hs-cTnI cutoff level can safely exclude inducible myocardial ischemia in patients with CAD and stable angina.
hs-Tn levels provided prognostic information, independent of whether inducible ischemia was present.
An editorialist suggests that the demonstration of inducible ischemia and significant coronary stenosis may not prove to be the best predictor of risk in patients with stable CAD symptoms.
The authors call for a more nuanced understanding of the entire spectrum of the sepsis syndrome, and they suggest including a broader group of providers on the committees that are responsible for sepsis definitions and guidelines.
The perspectives of hospitalists, primary care providers, and infectious disease specialists, in addition to critical care specialists, may highlight the need for different approaches to patients with sepsis that are treated outside of the ICU.
Wesorick DH, Chopra V. Annals for Hospitalists - 18 February 2020. Ann Intern Med. 2020;172:HO1. doi: https://doi.org/10.7326/AWHO202002180
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Published: Ann Intern Med. 2020;172(4):HO1.
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