For this cohort study, Goodwin and colleagues described the association of hospitalist years of experience with 30-day mortality and hospital mortality of their patients by using a sample of national Medicare data of patient and hospital characteristics. Results showed that patients cared for by hospitalists in their first year of practice experience higher mortality, and early-career hospitalists may require additional support to ensure optimal outcomes for their patients.
Continuing Medical Education
Bansal and colleagues examined the the utilization of and outcomes associated with left ventricular assist devices (LVAD) in nationally representative cohorts of patients with and without end-stage renal disease (ESRD). Results showed that patients with ESRD at the time of LVAD placement had an extremely poor prognosis, with most surviving for less than 3 weeks. This information may be crucial in supporting shared decision-making around treatments for advanced heart failure for patients with ESRD. Thomas and colleagues provide the Invited Commentary.
Invited Commentary
For this secondary analysis, Reinhardt and colleagues examined differences in outcomes with clinical evaluation and noninvasive testing (coronary computed tomographic angiography or stress testing) vs clinical evaluation alone. Results showed that in patients presenting to the emergency department with acute chest pain, negative biomarkers, and a nonischemic electrocardiogram result, noninvasive testing with coronary computed tomographic angiography or stress testing leads to longer length of stay, more downstream testing, more radiation exposure, and greater cost without an improvement in clinical outcomes. Curfman provides the Editor’s Note.
Editor’s Note
This cross-sectional analysis of age-, sex-, and race-adjusted Medicare data by Welch and colleagues examined the geographic variation in the United States in computed tomography (CT) imaging and the corresponding association with one of the most consequential sequelae of incidental detection: nephrectomy. Results showed that fee-for-service Medicare beneficiaries are commonly exposed to CT imaging. Those residing in high-scanning regions face a higher risk of nephrectomy, presumably reflecting the incidental detection of renal masses, and additional surgery should be considered one of the risks of excessive CT imaging. Smith-Bindman provides the Invited Commentary.
Invited Commentary
Continuing Medical Education
For this nested case-control study, Wang and colleagues investigated risk of cardiovascular disease associated with long-acting β2-agonists (LABAs) and antimuscarinic antagonists (LAMAs), focusing on the initiation and duration of LABA and LAMA therapies. LABA or LAMA use was measured in the year preceding the event or index date, stratified by duration since initiation of LABA or LAMA treatment, new and prevalent users, concomitant chronic obstructive pulmonary disease medications, and individual agents. Results showed that new initiation of LABAs or LAMAs in patients with chronic obstructive pulmonary disease is associated with an increased severe cardiovascular risk, irrespective of prior cardiovascular disease status and history of exacerbations.
For this cross-sectional study, Zhang and colleagues compared physician visual assessment (PVA) with quantitative coronary angiography (QCA) as a means of assessing stenosis severity among patients undergoing percutaneous coronary intervention (PCI) in China. Results showed that for coronary lesions treated with PCI, PVA resulted in substantially higher readings of stenosis severity than QCA, with large variation across hospitals and physicians. These findings highlight the need to improve the accuracy of information used to guide treatment decisions in catheterization laboratories. Redberg provides an Editor’s Note.
Editor’s Note
Le and Rothberg examined whether a new adjuvanted herpes zoster subunit vaccine is cost-effective. The live attenuated herpes zoster vaccine is recommended for immunocompetent adults 60 years or older, but the efficacy wanes with age and over time. Based on modeled data from 23 randomized clinical trials, at a price of $280 per series ($140 per dose), the adjuvanted herpes zoster subunit vaccine was more effective and less expensive than herpes zoster vaccine at all ages. Najafzadeh provides the Invited Commentary.
Invited Commentary
For this study, Roberts and colleagues compared changes in hospital and primary care use through the first 2 years of Maryland’s hospital global budget program among fee-for-service Medicare beneficiaries in Maryland vs matched control areas. Results did not show consistent evidence that Maryland’s hospital global budget program was associated with reductions in hospital use or increases in primary care visits among fee-for-service Medicare beneficiaries after 2 years; evaluations over longer periods should be pursued. Sharfstein and colleagues provide the Invited Commentary.
Invited Commentary