Publications by authors named "Cherinne Arundel"
Background: National heart failure guidelines recommend quadruple therapy with renin-angiotensin system inhibitors, beta-blockers, mineralocorticoid receptor antagonists, and sodium-glucose cotransporter 2 inhibitors for patients with heart failure with reduced ejection fraction (HFrEF), most of whom also receive loop diuretics. However, the guidelines are less clear about the safe approaches to discontinuing older drugs whose decreasing or residual benefit is less well understood. The objective of this study was to examine whether digoxin can be safely discontinued in patients with HFrEF receiving beta-blockers.
View Article and Find Full Text PDFBackground: Alcohol withdrawal is a common reason for admission to acute care hospitals. Prescription of medications for alcohol-use disorder (AUD) and close outpatient follow-up are commonly recommended, but few studies report their effects on postdischarge outcomes.
Objectives: The objective of this study is to evaluate the effects of medications for AUD and follow-up appointments on readmission and abstinence.
Objectives: Few studies describe contemporary alcohol withdrawal management in hospitalized settings or review current practices considering the guidelines by the American Society of Addiction Medicine (ASAM).
Methods: We conducted a retrospective cohort study of patients hospitalized with alcohol withdrawal on medical or surgical wards in 19 Veteran Health Administration (VHA) hospitals between October 1, 2018, and September 30, 2019. Demographic and comorbidity data were obtained from the Veteran Health Administration Corporate Data Warehouse.
Objectives: The coronavirus disease 2019 (COVID-19) pandemic disrupted how educational conferences were delivered, leaving programs to choose between in-person and virtual morning report formats. The objective of our study was to describe morning reports during the COVID-19 pandemic, including the use of virtual formats, attendance, leadership, and content.
Methods: A prospective observational study of morning reports was conducted at 13 Internal Medicine residency programs between September 1, 2020 and March 30, 2021, including a follow-up survey of current morning report format in January 2023.
Article Synopsis
- Renin-angiotensin system inhibitors can enhance outcomes for patients with heart failure and reduced ejection fraction (HFrEF), but their effectiveness in those with advanced kidney disease was less understood.
- In a study involving 1,582 patients with HFrEF and severe kidney issues, researchers analyzed the effects of starting ACE inhibitors or ARBs on patient outcomes.
- The results indicated that patients who started these medications experienced better outcomes regarding heart failure readmissions and overall mortality, suggesting that these drugs may be beneficial for this specific patient group.
Background: Morning report is a core educational activity in internal medicine resident education. Attending physicians regularly participate in morning report and influence the learning environment, though no previous study has described the contribution of attending physicians to this conference. This study aims to describe attending comments at internal medicine morning reports.
View Article and Find Full Text PDFObjective: Recent evidence suggests that hydroxychloroquine use is not associated with higher 1-year risk of long QT syndrome (LQTS) in patients with rheumatoid arthritis (RA). Less is known about its long-term risk, the examination of which was the objective of this study.
Methods: We conducted a propensity score-matched active-comparator safety study of hydroxychloroquine in 8,852 veterans (mean age 64 ± 12 years, 14% women, 28% Black) with newly diagnosed RA.
Background: National heart failure (HF) guidelines recommend that in patients with HF with preserved ejection fraction (EF;HFpEF) and hypertension, systolic blood pressure (SBP) should be maintained below 130 mmHg. The objective of the study is to examine the association between initiation of anti-hypertensive drugs and outcomes in patients with HFpEF with persistent hypertension.
Methods: Of the 8873 hospitalized patients with HFpEF (EF ≥50%) with a history of hypertension without renal failure in Medicare-linked OPTIMIZE-HF, 3315 had a discharge SBP ≥130 mmHg, of whom 1971 were not receiving anti-hypertensive drugs, thiazides and calcium channel blockers, before hospitalization.
Background: Acute decompensation of heart failure (HF) is often marked by fluid retention, and weight loss is a marker of successful diuresis. We examined the relationship between in-hospital weight loss and post-discharge outcomes in patients with HF.
Methods: We conducted a propensity score-matched study of 8830 patients hospitalized for decompensated HF in the Medicare-linked Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients with Heart Failure (OPTIMIZE-HF) registry, in which 4415 patients in the weight-loss group and 4415 patients in the no-weight-loss group were balanced on 75 baseline characteristics.
Article Synopsis
- Beta-blockers have been shown to improve outcomes in patients with heart failure, particularly those with reduced ejection fraction (HFrEF), but their effectiveness in older nursing home residents remains less clear.
- A study analyzed data from nearly 6,500 hospitalized patients aged 65 and over with HFrEF to assess the impact of beta-blockers on mortality and heart failure readmissions, specifically comparing outcomes between nursing home residents and other patients.
- The findings indicated that beta-blocker use was linked to reduced all-cause mortality in older adults, but there was no significant difference in heart failure readmissions, regardless of whether patients were admitted from nursing homes or not.
Background: In patients with heart failure with reduced ejection fraction (HFrEF) and hypertension, systolic blood pressure is recommended to be maintained below 130 mmHg, although this has not been shown to be associated with improved outcomes. We examined the association between anti-hypertensive drug initiation and outcomes in patients with HFrEF.
Methods: In the Medicare-linked OPTIMIZE-HF, 7966 patients with HFrEF (ejection fraction ≤40%) without renal failure were not receiving anti-hypertensive drugs before hospitalization, of whom 692 received discharge prescriptions for those drugs (thiazides and calcium channel blockers).
Importance: The COVID-19 pandemic disrupted graduate medical education, compelling training programs to abruptly transition to virtual educational formats despite minimal experience or proficiency. We surveyed residents from a national sample of internal medicine (IM) residency programs to describe their experiences with the transition to virtual morning report (MR), a highly valued core educational conference.
Objective: Assess resident views about virtual MR content and teaching strategies during the COVID-19 pandemic.
Article Synopsis
- This study investigates the cardiovascular safety of hydroxychloroquine (HCQ) in patients with rheumatoid arthritis (RA), focusing on its potential to prolong the QT interval, which can lead to serious heart issues.
- The research involved 8,852 US veterans newly diagnosed with RA, comparing outcomes between those treated with HCQ and those receiving other nonbiologic disease-modifying antirheumatic drugs over a 12-month period.
- Results showed a low incidence of long QT syndrome and arrhythmia-related hospitalizations, with no significant evidence suggesting that HCQ therapy increases the risk of cardiovascular problems or mortality in these patients.
Background: The effect of loop diuretics on clinical outcomes in heart failure has not been evaluated in randomized controlled trials. In hospitalized patients with heart failure, a discharge loop diuretic prescription has been shown to be associated with improved 30-day outcomes, which appears to be more pronounced in subgroups with congestion. In the current study, we examined these associations and association modifications during longer follow-up.
View Article and Find Full Text PDFBackground: New hypertension and heart failure guidelines recommend that systolic blood pressure (SBP) in patients with heart failure with preserved ejection fraction (HFpEF) and hypertension be lowered to <130 mm Hg.
Methods: Of the 6778 hospitalized patients with HFpEF and a history of hypertension in the Medicare-linked OPTIMIZE-HF registry, 3111 had a discharge SBP <130 mm Hg. Using propensity scores for SBP <130 mm Hg, we assembled a matched cohort of 1979 pairs with SBP <130 versus ≥130 mm Hg, balanced on 66 baseline characteristics (mean age, 79 years; 69% women; 12% African American).
Article Synopsis
- Heart failure (HF) is a serious condition that often leads to fluid buildup and difficulty breathing, for which loop diuretics are commonly prescribed; however, their effect on patient outcomes is not fully understood.
- This study analyzed data from over 25,000 older HF patients to explore the association between the use of loop diuretics and clinical outcomes.
- Results indicated that patients who received loop diuretics had a lower 30-day mortality rate and reduced risk of HF readmission compared to those who did not use them, but no significant differences were observed after 60 days.
Background: Digoxin reduces the risk of heart failure hospitalization but has no effect on mortality in patients with heart failure without atrial fibrillation in the randomized controlled trial setting. Observational studies of digoxin use in patients with atrial fibrillation have suggested a higher risk for poor outcomes. Less is known about this association in patients with heart failure and atrial fibrillation, the examination of which was the objective of the current study.
View Article and Find Full Text PDFAims: Hypokalaemia is a risk factor for ventricular arrhythmias and sudden death in ambulatory patients with chronic heart failure (HF). The objective of this study was to examine the association between hypokalaemia and outcomes in hospitalized patients with decompensated HF in whom sudden death is less common.
Methods And Results: Of the 5881 hospitalized patients with HF, 1052 had consistent hypokalaemia (both admission and discharge serum potassium <4.
Background: Digoxin reduces the risk of heart failure hospitalization in patients with heart failure with reduced ejection fraction. Less is known about this association in patients with heart failure with preserved ejection fraction (HFpEF), the examination of which was the objective of the current study.
Methods: In the Medicare-linked OPTIMIZE-HF registry, 7374 patients hospitalized for HF had ejection fraction ≥50% and were not receiving digoxin prior to admission.
Article Synopsis
- The study investigated the relationship between hospital length of stay (LoS) and readmission rates in older patients with heart failure, focusing on those hospitalized for decompensated heart failure.
- Among 8,049 patients, those with a LoS greater than 5 days were found to have a higher risk of being readmitted within 30 days and a greater chance of mortality over 8.8 years, although LoS did not correlate with readmissions specifically for heart failure.
- The findings suggest that a longer hospital stay is linked to worse health outcomes, even when excluding patients with extremely long stays (LoS > 10 days).
Background: National guidelines recommend that systolic blood pressure (SBP) in patients with heart failure with reduced ejection fraction (HFrEF) and hypertension be maintained below 130 mm Hg.
Objectives: This study sought to determine associations of SBP <130 mm Hg with outcomes in patients with HFrEF.
Methods: Of the 25,345 patients in the Medicare-linked OPTIMIZE-HF registry, 10,535 had an ejection fraction (EF) ≤40%.
Article Synopsis
- - Opioid use in older patients hospitalized for heart failure (HF) was studied, revealing that those discharged with opioids had higher all-cause mortality rates compared to those who didn’t receive opioids over an average follow-up of 8.6 years.
- - The study identified distinct differences in mortality risks between hospice and nonhospice patients, with hospice patients on opioids experiencing a significantly higher hazard ratio for mortality.
- - There were also variations in readmission rates, with opioid use linked to increased chances of non-HF related readmissions, while matched hospice patients on opioids did not have any readmissions.
Heart failure (HF) is the leading cause for 30-day all-cause readmission in older Medicare beneficiaries and 30-day all-cause readmission is associated with a higher risk of mortality. In the current analysis, we examined if that association varied by timing of 30-day all-cause readmission. Of the 8,049 Medicare beneficiaries hospitalized for HF, 1,688 had 30-day all-cause readmissions, of whom 1,519 were alive at 30 days.
View Article and Find Full Text PDFBackground: Angiotensin-converting enzyme inhibitors or angiotensin receptor blockers (ACEIs-ARBs) improve outcomes in heart failure (HF). Less is known about this association in nursing home (NH) residents.
Methods: Of the 8024 hospitalized HF patients, 542 were NH residents, of whom 250 received ACEIs-ARBs.