Annals of Internal Medicine Tip Sheet
@Annalsofim
Below please find summaries of new articles that will be published in the next issue of Annals of Internal Medicine. The summaries are not intended to substitute for the full articles as a source of information. This information is under strict embargo and by taking it into possession, media representatives are committing to the terms of the embargo not only on their own behalf, but also on behalf of the organization they represent.
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1. One in 3 adults with new-onset AFib occurring during hospitalization will have recurrent episode within a year
Abstract: https://www.acpjournals.org/doi/10.7326/M23-1411
URL goes live when the embargo lifts
A study of more than 130 hospitalized adults with transient new-onset atrial fibrillation (AF) found that 1 in 3 patients experienced a recurrent episode of AF within a year of hospitalization – a rate approximately 7 times higher than in matched control participants. These findings suggest that oral anticoagulation therapy may be warranted in these patients. The study is published in Annals of Internal Medicine.
AF frequently occurs in patients who are hospitalized for illness or surgery. It remains unclear if these instances of AF are caused by physiologic stress and are reversed when the patient is discharged, or if these AF episodes detected in hospital settings will recur in the future. Capturing recurrent episodes of AF after hospital discharge in these patients may help identify those who can benefit from treatment.
Researchers from McMaster University and Population Health Research Institute enrolled 139 patients hospitalized for noncardiac surgery or medical illness who had transient new-onset AF. They aimed to estimate the risk for AF recurrence in those patients compared with a matched population without AF. Study participants in both groups were monitored using a 14-day electrocardiographic (ECG) monitor at 1 and 6 months and telephone assessment at 1, 6, and 12 months. The authors found recurrent AF was detected in 32.3 percent of participants within 1 year of hospitalization compared with only 3 percent of matched controls. According to the researchers, these findings suggest that the patients in their study who had AF detected in follow-up are similar to contemporary patients with AF for whom evidence-based therapies, including oral anticoagulation, are warranted.
Media contacts: For an embargoed PDF, please contact Angela Collom at acollom@acponline.org. To speak with the corresponding author William F. McIntyre, MD, PhD, please contact William.Mcintyre@phri.ca.
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2. Suspected bronchiectasis associated with increased mortality risk in people with history of smoking
Abstract: https://www.acpjournals.org/doi/10.7326/M23-1125
URL goes live when the embargo lifts
A study of more than 7,600 current and former smokers found that suspected bronchiectasis is associated with a heightened risk of all-cause mortality, even without the presence of chronic obstructive pulmonary disease (COPD). According to the authors, these findings support including lung imaging as a tool for clinically defining bronchiectasis and for COPD workup to improve patient care. The study is published in Annals of Internal Medicine.
Bronchiectasis is a clinical condition characterized by the pathologic widening of airways and repeated infection and inflammation cycles resulting in lung structural damage. It often occurs in adults with COPD, a condition which is mainly caused by exposure to cigarette smoking in the United States. Incidental bronchiectasis is found in 12 to 30 percent of adults with a history of smoking in CT images. However, whether incidental bronchiectasis plus symptoms —termed suspected bronchiectasis— is associated with increased mortality in adults with a history of smoking, even without a COPD diagnosis, is unknown.
In a secondary analysis, researchers from Brigham and Women’s Hospital used data collected from the COPDGene (Genetic Epidemiology of Chronic Obstructive Pulmonary Disease) study, a study of patients with COPD and non-COPD control participants, to determine the association between suspected bronchiectasis and mortality in adults with normal spirometry, preserved ratio impaired spirometry (PRISm), and obstructive spirometry. Among 7,662 non-Hispanic Black or White adults, aged 45 to 80 years, with 10 or more pack-years of smoking history, 17.6 percent had suspected bronchiectasis. During a median follow-up of 11 years, 27.3 percent of participants died. The presence of suspected bronchiectasis was associated with a 15 percent higher risk for all-cause mortality. The authors did not find evidence that in patients without COPD, bronchiectasis on CT images per se (i.e., without accompanying clinical manifestations) definitely increased mortality risk.
Media contacts: For an embargoed PDF, please contact Angela Collom at acollom@acponline.org. To speak with the corresponding author Alejandro A. Diaz, MD, MPH, please contact adiaz6@bwh.harvard.edu.
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3. ACP reviews performance measures for osteoporosis, ID’s gap in measuring early treatment
Changes to performance measures could inform practice and improve osteoporosis care
Abstract: https://www.acpjournals.org/doi/10.7326/M23-1291
URL goes live when the embargo lifts
A review of current performance measures that are applied to evaluate quality of osteoporosis care found that of the six osteoporosis performance measures relevant to internal medicine physicians, only one was found to be valid. According to the authors from the American College of Physicians (ACP), these findings suggest that new performance measures should be developed that could improve osteoporosis diagnosis, treatment, and care. The ACP position paper is published in Annals of Internal Medicine.
Primary osteoporosis is characterized by decreasing bone mass and density and reduced bone strength that leads to a higher risk for fracture. The prevalence of osteoporosis in the United States is estimated at 12.6% for adults over the age of 50. Osteoporosis is considered a major health issue, which has prompted the development and use of several performance measures to assess and improve the effectiveness of screening, diagnosis, and treatment.
The ACP Performance Measurement Committee (PMC) believes performance measures must demonstrate a methodologically sound basis with appropriate statistical analysis to evaluate quality of care and apply them to physicians and support their use in accountability, public reporting, or payment programs. The analysis of these performance measures looks to assess and eliminate performance measures that do not meet the necessary reliability, validity, evidence, and attribution standards.
As part of the PMC’s effort to ensure performance measures are aligned with clinical quality guidelines, an algorithm was developed to categorize ACP’s guideline recommendations and determine if there is enough to support a performance measure concept. The algorithm considers strength and certainty of evidence, performance gaps, feasibility, and applicability.
Currently, there is no performance measure that addresses the initial approach to therapy of patients with a new diagnosis of osteoporosis. The closest performance measure evaluates whether a patient with a fracture received a dual-energy x-ray absorptiometry scan or a prescription for any pharmacotherapy to treat osteoporosis, even though there is clear guidance around using bisphosphonates for initial pharmacologic management. The PMC used its algorithm to validate a performance measure concept from ACP’s clinical guideline to fill this gap in currently available performance measures.
The PMC suggestions in this paper, if adopted, will help improve development of reliable and valid performance measures that can move the quality needle and reduce the burden of performance measurement on physicians, group practices and health systems.
The paper includes a detailed algorithm for translating clinical guidelines to performance measures and a table, “ACP Median Rating by Domain and Level of Attribution.”
Media contacts: For an embargoed PDF, please contact Angela Collom at acollom@acponline.org. To speak with someone from ACP, please contact Andy Hachadorian at ahachadorian@acponline.org.
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4. PET imaging at diagnosis may help estimate aneurysm formation risk in patients with giant cell arteritis
Abstract: https://www.acpjournals.org/doi/10.7326/M23-0679
URL goes live when the embargo lifts
A cohort study of 106 persons with giant cell arteritis (GCA) who underwent 18F-fluorodeoxyglucose
(FDG) positron emission tomography (PET) imaging found that higher total vascular score (TVS) was associated with greater yearly increase in thoracic aortic dimensions. The authors suggest that performing PET imaging at diagnosis may help to estimate the risk for aortic aneurysm formation in these patients. The study is published in Annals of Internal Medicine.
GCA is a large vessel vasculitis that preferentially affects the cranial arteries and the aorta and its proximal branches. Early imaging is recommended for diagnosis of GCA. Two severe complications of GCA are sudden irreversible vision loss and aortic aneurysm formation and dissection. FDG PET imaging may be used for the assessment of large vessel vasculitis; however, previous retrospective research has indicated that FDG uptake in large vessels at diagnosis increases the risk for aortic complications.
Researchers from University Hospitals Leuven, Leuven, Belgium prospectively studied 106 patients with GCA and FDG PET imaging 3 days or less after initiation of glucocorticoids to measure the association between vascular FDG uptake at diagnosis and the change in aortic dimensions. Participants had PET and computed tomography (CT) imaging at diagnosis and CT imaging yearly for a maximum of 10 years. The authors report that compared with patients with a negative PET scan result, those with a positive scan result had experienced aortic dimension and volume changes associated with TVS. They also report that patients with a positive PET scan result had a higher risk for thoracic aortic aneurysms. According to the authors, their study confirms that vascular FDG uptake is an independent predictor of the development of thoracic aortic aneurysms with a higher increase in thoracic aortic diameters and volume in patients with higher TVS.
Media contacts: For an embargoed PDF, please contact Angela Collom at acollom@acponline.org. To speak with the corresponding author Daniel Blockmans, MD, PhD, please contact daniel.blockmans@uzleuven.be
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