The Pulse - September 2025

Greetings Readers! In this monthly edition, we examine 4 practice changing studies.

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1. From Code Blue to “K Thx”: The Need for a Hospitalist Spam Filter 

   Hospital chat apps may have replaced the pager, but apparently they’ve just given us a digital avalanche of “Thanks!” and “Got it.” In this study, nearly all messages (99%) were nonurgent, and two-thirds didn’t require any action at all. The bulk of communication (60%) was acknowledgment or courtesy chatter, with only a fraction carrying real clinical weight. Long chat threads (>10 messages) were especially risky, with more near misses than shorter exchanges. Bottom line: our “efficient” secure messaging platforms may be clogging cognitive bandwidth more than they’re clearing it. Clawson J et al. J Hosp Med 2025 Aug 

   Study Type: a qualitative content analysis of 2706 messages (representing 365 conversations, aka “threads”)

   Link: https://doi.org/10.1002/jhm.70144

2. POTCAST: This Episode Brought to You by Bananas

   Turns out the ICD’s best friend might just be a banana. In the POTCAST trial, a Danish RCT of 1200 ICD patients with potassium ≤4.3 mmol/L, nudging potassium up to a high-normal range (4.5–5.0 mmol/L) cut the risk of ventricular arrhythmias and related bad outcomes. The intervention arm got supplements, MRAs, and potassium-friendly diet advice, with close monitoring that paid off: fewer arrhythmias, ICD shocks, hospitalizations, and deaths (23% vs. 29%). Importantly, the higher-K strategy didn’t increase hypokalemia or hyperkalemia admissions. Bottom line: for patients at high risk of ventricular arrhythmia, living on the high side of “normal” may actually be optimal. Jøns C et al. N Engl J Med 2025 Aug 

   Study Type: a Danish, multicenter, open-label, event-driven, randomized superiority trial of 1200 patients at high risk for ventricular arrhythmias (ICD placed) and baseline K of 4.3 or lower, randomized in a 1:1 ratio to treatment regimen or standard of care only. 

   Link: https://doi.org/10.1056/NEJMoa2509542

3. Informed Consent or Informed Assent: The Silent Drift of Cancer Care

   It turns out that when it comes to advanced cancer care, what patients want and what they get often don’t match. About half of patients said they preferred comfort over life extension, yet cancer patients were much more likely than others to be steered toward life-prolonging interventions—even when they didn’t ask for them. In fact, more than a third of cancer patients who wanted comfort-focused care reported they were instead funneled into treatment aimed at extending life. The study’s blunt survey design can’t capture all the nuance of end-of-life care, but the take-home is clear: for hospitalists, take the time to clarify and nuance goals of care for patients with advanced cancer. Shah MP et al. Cancer 2025 Sep 

   Study Type: a post hoc cross-sectional analysis of baseline, advanced-care planning survey responses in 1099 adult patients with advanced cancer

   Link: https://doi.org/10.1002/cncr.35976

4. Interrupting Immunosuppression: All Risk, No Reward?

   Stopping immunosuppression during infection feels intuitive—like hitting the brakes in a storm—but this trial suggests it doesn’t actually prevent the car crash. In over a thousand patients with inflammatory rheumatic disease, continuing versus interrupting immunosuppressive meds made no difference in infection severity, duration, or flare risk. In fact, halting therapy might just trade infection worries for the equally unpleasant possibility of disease flare or graft rejection. The takeaway: when infection knocks, pulling the plug on immunosuppression may not be the “safer” reflex we think it is. When possible/appropriate, we recommend discussing with an expert (eg transplant team) especially in cases of severe infection where the study had lowest power. Opdam MAA et al. Clin Infect Dis 2025 Aug 

   Study Type: a large, open-label, Dutch multi-center RCT of 1142 patients with infection-free, inflammatory rheumatic disease then randomized to continue or temporarily interrupt immunomodulatory agents if infection occurred. Of the 1142 randomized, 474 developed infection. Serious infection only occurred in 3.7% in the continuation and 5.1% in the interrupted group. 

   Link: https://doi.org/10.1093/cid/ciaf442

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