• Current Issue
• ACP Hospitalist Weekly
• Supplements
• Blog
• Archives
  • By Topic
• Career Connection
• Subscribe
• RSS Feeds

Journal watch: Recent studies of note

From the July ACP Hospitalist, copyright © 2008 by the American College of Physicians

Elderly who take antipsychotics at higher risk for pneumonia

Elderly people who take antipsychotics have a higher risk of developing pneumonia than those who don’t, a recent study suggested.

In a nested case-control analysis, researchers examined 22,944 people aged 65 or older (median age, 81 years) with at least one antipsychotic prescription. During or after antipsychotic treatment, 543 people were hospitalized with pneumonia; for the analysis, 2,163 case controls were assigned to those 543. Data came from a Dutch database that gathers information from community pharmacies and hospital discharge records. The article was published in the April Journal of the American Geriatrics Society.

Patients currently using antipsychotics had a 60% greater risk of pneumonia, with the risk being highest in the first week after starting the drug(s). Atypical antipsychotic users had a higher risk than did users of conventional agents, a difference that couldn’t be explained by dosing differences. Past use wasn’t associated with greater risk. The associations remained when elderly people with a diagnosis of delirium were excluded from the analysis.

Physicians should weigh the possible risks before prescribing antipsychotics to older patients.

Physicians should weigh the possible risks before prescribing antipsychotics to older patients; recent research suggests the drugs are also associated with a higher risk of death in the elderly. If doctors do prescribe antipsychotics, they should monitor elderly patients for swallowing disorders or sedation, the researchers said.

Top

Several factors linked to heart failure hospitalizations, mortality

Respiratory problems, ischemia and arrhythmia are common causes of hospitalization for heart failure (HF), while pneumonia and decreasing renal function are linked to worse in-hospital mortality rates, a recent study reported.

Researchers used data from OPTIMIZE-HF, a performance improvement program and registry, to examine the factors most likely to be associated with hospitalization for HF, as well as their effect on clinical outcomes. Data from 2003 to 2004 were available on 48,612 patients from 259 U.S. hospitals. The mean patient age was 73.1 years; 52% of patients were women, and the mean ejection fraction was 39.0%. The study appeared in the April 28 Archives of Internal Medicine.

Among all patients, 29,814 (61.3%) had at least one factor that contributed to their hospitalization for HF, most commonly pneumonia/respiratory processes (15.3%), ischemia (14.7%), arrhythmia (13.5%) and uncontrolled hypertension (10.7%). Patients with pneumonia, ischemia or decreasing renal function were more likely to have higher in-hospital mortality rates (odds ratios, 1.60, 1.20 and 1.48, respectively), while patients with uncontrolled hypertension were likely to have lower in-hospital mortality rates (odds ratio, 0.74). Rates of follow-up mortality were higher in patients with ischemia and decreasing renal function (odds ratios, 1.52 and 1.46, respectively), while rates of postdischarge death and rehospitalization were lower in those with uncontrolled hypertension (hazard ratio, 0.71).

The authors suggested that their results could help identify patients at high risk for adverse HF outcomes who would benefit from more careful monitoring during their hospital stays. These data also could help clinicians design better management strategies for patients with HF as well as prevent additional hospitalizations, the authors wrote.

Top

Study calls for MRSA screening in health care workers

Health care workers can play a role in transmitting methicillin-resistant Staphylococcus aureus (MRSA) to patients and should be screened for the infection, according to a recent study.

Two researchers performed a meta-analysis of 127 articles reporting prevalence, risk factors or management of MRSA infection or colonization in 33,318 health care workers. They found that 4.6% of the workers were MRSA carriers; of this group, 5.1% had clinical MRSA infection. Risk factors for infection among health care workers were chronic skin disease, poor hygiene and previous work in a country where MRSA infection was endemic. In 63 of 68 studies that performed genotyping (93%), MRSA transmission from health care worker to patient was likely. MRSA eradication was attempted in 510 health care workers and was successful in 449 (88%). The study appears in the May Lancet Infectious Diseases.

While acknowledging that their study has limitations, including variable quality of the evidence examined, the authors concluded that health care workers can act as vectors for MRSA and are important in the transmission of the infection to patients. Their recommendations included the following:

• Health care workers should be screened for MRSA as part of a preemployment examination and periodically thereafter.
• The anterior nares and throat should both be screened with separate swabs.
• Health care workers should be screened early in MRSA epidemics and during outbreak investigations. When resources are limited, staff who work in high-risk areas such as ICUs or burn units should receive priority.

Top

Study finds positive long-term results from GERD surgery

Laparoscopic antireflux surgery may be more successful than previously thought, according to the authors of a recent study.

The researchers used a survey, the Gastroesophageal Reflux Disease-Health-Related Quality of Life Scale (GERD-HRQL), to evaluate long-term results and quality of life among patients who had undergone laparoscopic fundoplications between 1997 and 2006. The surveys were sent to 405 consecutive patients of a tertiary care referral center, and a 54% response rate was obtained with a median follow-up of 60 months.

Of the patients who answered the survey, 71% were satisfied with their long-term results, although 43% took antireflux medications at some point following surgery. Patients who were having a redo of their surgery were less satisfied, were more likely to require medication, and had higher GERD-HRQL scores. That finding highlights the importance of careful patient selection and surgical technique during primary surgeries, the study authors concluded.

They also found a relation between body mass index and GERD-HQRL scores, with thin patients and the morbidly obese having worse outcomes from the surgery. Overall, however, the vast majority of patients said they would have the surgery again (88% in the primary group, 76% of the redo patients). The research was published in the May issue of the Archives of Surgery.

The study differs from much of the medical literature in finding that most patients who have the laparoscopic operation have very good results, the study authors said. They also noted that even among the patients who took acid suppression medication after the surgery, there was frequently no physiologic evidence of recurrent reflux.

Top

Stroke outcomes after rehab differ by racial and ethnic groups, study finds

Non-Hispanic white patients have better outcomes after post-acute care for stroke than Hispanic and black patients, according to a recent study.

Previous studies have found racial and ethnic differences in stroke incidence, type and severity. Researchers used data from the Uniform Data System for Medical Rehabilitation, a U.S. registry of rehabilitation inpatients, to determine whether outcomes after inpatient stroke rehab also differed by race and ethnicity. Data from 161,692 patients (mean age, approximately 71 years) were analyzed. Seventy-six percent of patients were of non-Hispanic white ethnicity, and 53% were women. The study appeared in the May issue of Stroke.

The authors found that although length of stay was similar for all ethnic groups, non-Hispanic white patients had better functional status at hospital discharge than patients of other racial or ethnic backgrounds. Differences in functional status by race or ethnicity increased with age. Non-Hispanic white patients were less likely to be discharged home than black patients (odds ratio, 0.64), Hispanic patients (odds ratio, 0.58) or those from other minority groups (odds ratio, 0.67). Although discharge to home is generally considered a positive outcome, the authors speculated that their findings could reflect differences in family support, attitudes toward nursing homes or financial resources.

The authors acknowledged that their study had limitations, including possible selection bias and lack of detailed treatment and rehab information. However, the authors concluded that outcomes after acute care vary by race and ethnicity in stroke patients. Future studies, they wrote, should attempt to replicate their findings and begin to search for ways to resolve such disparities.

Top

Statins before cardiac surgery may improve outcomes

Preoperative therapy with statins may lead to better outcomes in patients undergoing cardiac surgery, a recent study reports.

German researchers performed a meta-analysis of 19 trials examining outcomes of cardiac surgery in 31,725 patients who did or did not receive preoperative statins. The main purpose of the study was to evaluate whether statins helped reduce all-cause mortality and major postoperative adverse events, including myocardial infarction, atrial fibrillation, stroke and renal failure. The results were published online May 27 by the European Heart Journal.

Patients who received statins before cardiac surgery had a 1.5% absolute risk reduction in all-cause mortality and a 43% odds reduction for early all-cause mortality. Statin recipients were also significantly less likely to have postoperative atrial fibrillation (24.9% vs. 29.3%; P< 0.0001) and stroke (2.1% vs. 2.9%; P= 0.001), although no significant difference between statin and nonstatin groups was seen for myocardial infarction (4.2% vs. 3.9%; P= 0.373) or renal failure (3.9% vs. 4.5%; P= 0.275).

The authors acknowledged their study’s limitations, including lack of accounting for differences in study quality and the possibility of treatment bias, but concluded that pretreatment with statins substantially improves early clinical outcomes in patients undergoing cardiac surgery. Until future randomized, controlled trials are performed, the authors recommended that statins be prescribed before and continued after cardiac surgery in patients with hyperlipemia, cardiac risk and coronary heart disease.

These summaries come from ACP HospitalistWeekly, an e-newsletter provided every Wednesday by ACP Hospitalist. If you're not already receiving ACP HospitalistWeekly, contact Customer Service at 800-523-1546, ext. 2600, or direct at 215-351-2600 (M-F, 9 a.m. to 5 p.m. EST) or send an e-mail to custserv@acponline.org.

Top

Share

 

Hospitalist Archives
Quick Links

ACP Hospitalist Weekly

From the February 8, 2012 edition

• Score predicts outcomes of using IV alteplase with stroke patient
• CT angiography as good as MRI to predict recurrent stroke

View issue

Cartoon Caption Contest

ACP staff has selected three finalists for the latest contest and is now asking readers to vote for their favorite caption to determine the winner.

Prepare with the Experts: Live Recert Prep Courses from ACP

ACP Launches Depression Care Guide

© ACP Hospitalist and American College of Physicians

ACP Hospitalist provides news and information for internists about the practice of medicine and reports on the policies, products and activities of ACP. All published material, which is covered by copyright, represents the views of the contributor and does not reflect the opinion of the American College of Physicians or any other institution unless clearly stated