In the Literature

The Hospitalist. 2008 February;2008(02):

February 1, 2008|The Hospitalist

Steven Deitelzweig Md;Kevin Hude Md;David Lee Md,stacy McDonald Md;Renee Meadows Md Srinivas Vuppala Md;Frank Wharton Md

In This Edition

Statin and beta-blocker use reduces probability of long-term mortality after vascular surgery.
Low-probability clinical assessment does not exclude pulmonary embolism.
Upper-extremity DVT is increasing and warrants more aggressive treatment.
Intensive clinical case management reduces length of hospital stay in CAP.
Daily chest radiographs have low diagnostic and therapeutic value in the ICU.
CDAD is associated with high 30-day mortality rate in the ICU setting.
Frequent nocturnal hemodialysis reduces left ventricular mass and blood pressure.
Glycemic control in hospitalized patients remains suboptimal.
Carvedilol fails to show benefit for children with heart failure.

CDAD is associated with high 30-day mortality rate but no less attributable mortality. Preventing horizontal transmission in the hospital may reduce mortality.

Does Ambulatory Use of Statins, Beta-blockers Reduce Mortality After Vascular Surgery?

Background: Mortality for vascular surgery remains high. Considering promising new data on use of perioperative statins, the question is, does use of statins and/or beta-blockers within 30 days of surgery reduce long-term mortality? Long-term post-operative mortality has not commonly been reported.

Study design: A retrospective observational cohort study.

Setting: Five Veterans Affairs (VA) medical centers in four western states.

Synopsis: Data were gathered from the regional Department of Veterans Affairs administrative and relational database for the 3,062 patients who had vascular surgery at five VA medical centers from January 1998 to March 2005. All had decreased long-term mortality after vascular surgery when they started taking beta-blockers or statins or both within 30 days before or after surgery, compared with patients taking neither drug. Higher-risk patients benefited the most from combination therapy with statins and beta-blockers, with a 33% reduction in mortality after two years.

Study results were limited by several factors, most related to the study’s retrospective nature. There were differences between users and non-users of statins and beta-blockers. Use of the medications was not random, only 1% of study participants were women, and perhaps most importantly, information regarding tobacco use was available for only 47% of the patients.

Bottom Line: The use of statins and beta-blockers in combination should be considered for all patients undergoing vascular surgery.

Citation: Barrett TW, Mori M, DeBoer D. Association of ambulatory use of statins and beta-blockers with long-term mortality after vascular surgery. J Hosp Med. 2007; 2(4):241-252.

CLINICAL SHORTS

Antimicrobial-Impregnated Urinary Catheter Decreases Bacteriuria, Funguria

Randomized controlled trial demonstrated that the use of nitrofurazone (Furacin)-impregnated urinary catheters in place of standard silicone catheters reduced the incidence of catheter-associated bacteriuria and funguria in trauma patients..

Citation: Stensballe J, Tvede M, Looms D, et al. Infection risk with nitrofurazone-impregnated urinary catheters in trauma patients. Ann Intern Med. 2007;147:285-293.

Pioglitazone May Decrease Risk of Death, Increase Risk of Serious Heart Failure

Meta-analysis of data from the drug manufacturer suggested lower death, nonfatal myocardial infarction (MI), and nonfatal stroke in diabetics taking pioglitizone (Actos) along with an increase in serious heart failure, without associated mortality..

Citation: Lincoff MA, Wolski K, Nicholls SJ, et al. Pioglitazone and risk of cardiovascular events in patients with type 2 diabetes mellitus. JAMA. 2007;298(10):1180-1188.

Rosiglitazone Appears to Increase MI, Heart Failure

Meta-analysis suggested increased risk of MI and heart failure in patients taking rosiglitizone for more than a year but no significant increase in cardiovascular mortality.

Citation: Singh S, Loke YK, Furberg CD. Long-term risk of cardiovascular events with rosiglitazone. JAMA. 2007;298(10):1189-1195.

ACGME Duty-Hour Reform Does Not Increase Mortality in Medicare Patients

Observational study demonstrating duty-hour changes instituted by the Accreditation Council for Graduate Medical Education

(ACGME) two years prior to the study did not show a change in mortality among Medicare patients in teaching and non-teaching hospitals.

Citation: Volpp KG, Rosen AK, Rosenbaum PR, et al. Mortality among hospitalized Medicare beneficiaries in the first two years following ACGME resident duty hour reform. JAMA. 2007;298(9):975-983.

ACGME Duty-Hour Reform Decreases Mortality among VA Medical Patients

Observational study demonstrating ACGME duty-hour changes instituted two years prior to the study showed a reduction in mortality for selected medical diagnoses in patients in teaching-intensive VA hospitals.

Citation: Volpp KG, Rosen AK, Rosenbaum PR, et al. Mortality among patients in VA hospitals in the first 2 years following ACGME resident duty hour reform. JAMA. 2007;298(9):984-992.

In-Hospital Hypoglycemia Common without Attempting Tight Glycemic Control

Prospective, single-institution review reveals that with usual care, almost 10% of hospitalized patients treated with anti-hyperglycemic agents experience hypoglycemia and 4% of hypoglycemic episodes result in adverse events.

Citation: Varghese P, Gleason V, Sorokin R, et al. Hypoglycemia in hospitalized patients treated with antihyperglycemic agents. J Hosp Med. 2007;2:234-240.