The Pulse - March 2025

Keep your finger on it

Author

Jonathan Kooiman
March 31, 2025

In partnership with

The pulse is a monthly online newsletter summarizing key literature curated for the hospitalist/inpatient provider. Given the brevity, this is not meant to supplant reading primary literature independently.

In this monthly edition, we examine 3 practice changing studies from March 2025.

Exclusive content for Premium subscribers this month includes reviews of studies on (1) lower anticoagulation dosing in patients at high risk of recurrent VTE, (2) anticoagulation in patients with history of ICH and Afib, (3) oral cephalosporins at discharge for pyelonephritis, and (4) antibiotics vs surgery for appendicitis.

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  1. PEG Me Not: The Data Says No (Again) to Feeding Tubes in Dementia. Feeding tubes in elderly, demented, hospitalized patients? Still a bad idea. This massive study confirms what we already knew—patients who receive them endure longer hospital stays (66 vs 15 days), more ICU admissions (43% vs 10%), and higher mortality rates both in the hospital (22% vs 10%) and a year later (50% vs 28%). While only 1% of patients in this cohort got a feeding tube, the real number is likely higher due to coding limitations. Hartford A-M et al. JAMA Netw Open 2025 Feb.

    Study Type: population-based, retrospective cohort study conducted in Ontario, Canada of 143,331 elderly, demented patients requiring hospitalization

    Link: https://doi.org/10.1001/jamanetworkopen.2024.60780

  2. Fast and Infarctious

    The Risks of Driving Too Soon After STEMI

    After a STEMI, older patients might want to take their foot off the gas—literally—for about a month. A Canadian study found that the risk of sudden cardiovascular incapacitation (like death, cardiac arrest, or stroke) is highest in the first 15 days post-STEMI, particularly for those over 65. While European and Canadian guidelines recommend a brief driving break, the U.S. has no official stance. Physicians might consider advising older patients (and those with low LVEF) to pump the brakes temporarily before hitting the road again. Singer Z et al. Circulation 2025 Jan.
    Study Type: retrospective, population-based cohort study of nearly 25,000 Canadian patients discharged after STEMI

    Link: https://doi.org/10.1161/CIRCULATIONAHA.124.071649

  3. Things We Do For No Reason: Not Screening for Primary Aldosteronism 

    Usually TWDFNR recommends that we stop doing something. This month they are shaking things up. Hospitalists are on the front lines of hypertensive urgency and emergency, yet too often, they miss a golden opportunity to diagnose primary aldosteronism—one of the most common yet underrecognized causes of secondary hypertension. Instead of reflexively labeling every case as essential hypertension, hospitalists should consider screening, especially when red flags like hypokalemia appear. Screening still has a high sensitivity (96%) even before washout period of RAAS agents. Shih M et al. J Hosp Med 2025 Mar.

    Link: https://doi.org/10.1002/jhm.70035

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