In the Literature

The Hospitalist. 2007 December;2007(12):

December 1, 2007|The Hospitalist

In This Edition

C-reactive protein levels predict death from cardiac causes after MI.
SSRIs reduce risk for recurrent cardiac events in acute coronary syndrome.
Vancomycin is as effective as metronidazole in routine treatment of C. difficile and superior in severe infection.
Prevalence and severity of C. difficile are increasing in hospitalized patients in the U.S.
Deviations in recommended enoxaparin dosing in NSTEMI result in worse outcomes.
Most outpatient VTE events occur in recently hospitalized patients.
Poor health literacy predicts mortality in older adults.
A validated model predicts the risk for delirium at hospital discharge.

Do C-reactive Protein Levels Predict Death from Heart Failure?

Background: Ultra-sensitive quantitative assessment of C-reactive protein (CRP), a surrogate marker of systemic inflammation, has previously been shown to predict plaque instability in acute coronary syndromes. Data are lacking as to whether this blood test can also predict subsequent risk of heart failure or death on presentation in patients admitted for acute myocardial infarction (MI).

Study design: Prospec-tive observational study.

Setting: Olmstead County, Minn.

CLINICAL SHORTS

Resident Work-Hour Regulations Improve Outcomes

Compared with a nonteaching service, a resident teaching service had improvements in ICU utilization, favorable discharge disposition, and decreased pharmacist correction of drug errors after implementation of work-hour rules.

Citation: Horwitz LI, Kosiborod M, Lin Z. Changes in outcomes for internal medicine inpatients after work-hour regulations. Ann Intern Med. 2007;147

(2):97-103.

Lower Mortality in Medical Patients after Resident Work-Hour Limits

Medicine patients had 0.25% absolute reductions in mortality and 3.75% reduction in relative risk of death after work-hour rules were implemented, but neither reduction was seen in surgical patients.

Citation: Shetty KD, Bharracharya J. Changes in hospital mortality associated with residency work-hour regulations. Ann Intern Med. 2007;147(2):73-80.

Dark Chocolate Cuts Blood Pressure in Patients with Mild Hypertension

In a study that pleased clinicians and patients alike, low-stage and pre-hypertensive patients on a regular dark chocolate-containing diet had improvements in blood pressure and circulating vasodilator levels.

Citation: Taubert D, Roesen R, Lehmann C, et al. Effects of low habitual cocoa intake on blood pressure and bioactive nitric oxide: a randomized controlled trial. JAMA. 2007;298(1):49-60.

Hyperglycemia Associated with Mortality Increase in STEMI

Patients undergoing angioplasty for ST-elevation myocardial infarction had a higher in-hospital mortality if they were diabetics and mortality was commensurate to the degree to which admission glucose levels were elevated.

Citation: Worthley MI, Shrive FM, Anderson TJ, et al. Prognostic implications of hyperglycemia in myocardial infarction and primary angioplasty. Am J Med. 2007;120(7):643.e1-643.e7.

Vitamin Therapy in Elevated Homocysteine Levels Does Not Reduce VTE

Daily supplementation of folate, B6, and B12 did reduce levels of homocysteine in patients with multiple cardiac risk factors but did not reduce the risk of venous thromboembolism.

Citation: Ray JG, Kearon C, Qilong Y, et al. Homocysteine-lowering therapy and risk for venous thromboembolism. Ann Intern Med. 2007;146(11):761-767

Synopsis: Ultra-sensitive quantitative serum CRP levels were obtained a median of 6.1 hours following onset of symptoms in 329 patients admitted with acute MI. The patients were stratified into tertiles based levels of CRP less than 3 mg/L, 3-15 mg/L, and more than 15 mg/L.

Tertiles were similar in respect to age, male-predominance, most cardiac risk factors, body mass index, and electrocardiographic (EKG) changes. However, there were statistically significant differences between groups, particularly the frequency of diabetes (10.7%, 31.2%, and 38.0%), previous MI history (2.7%, 4.6%, and 9.3%), Killip class greater than one (15.2%, 31.2%, and 39.8%), peak cardiac enzyme levels (both were higher in the bottom tertile, and lowest in the top tertile), and likelihood of significant comorbidities (lower likelihood in the bottom tertile, higher likelihood in the top tertile).