Joséphine Cool, MD

Background: Prior observational studies have suggested that a dose-dependent effect may exist between alcohol intake and incident AFib, recurrence after ablation, and cardiac structural changes.

Study design: Prospective, open-label, multicenter, randomized clinical trial, with an intention-to-treat analysis.

Setting: Six tertiary care hospitals in Australia.

Synopsis: Study authors enrolled 140 patients with symptomatic paroxysmal or persistent AFib and regular alcohol consumption of 10 or more standard drinks per week. Participants were randomized to alcohol abstinence or usual alcohol intake. They underwent comprehensive rhythm monitoring and alcohol intake assessment for 6 months with in-person visits and oral/electronic communication. Over the 6-month period, patients in the abstinence group reduced their mean drinks per week from approximately 17 to 2, with 61% achieving complete abstinence. Patients in the abstinence group had a significantly longer period before recurrence of AFib when compared with the control group. Furthermore, the AFib burden over 6 months was significantly lower in the abstinence group, compared with the control group (0.5% vs. 1.2%).

Bottom line: For patients with symptomatic paroxysmal or persistent atrial fibrillation and regular alcohol consumption, reducing alcohol intake may significantly lower AFib burden and increase the time-to-recurrence of AFib at 6 months.

Citation: Voskoboinik A et al. Alcohol abstinence in drinkers with atrial fibrillation. N Engl J Med 2020 Jan 2;382:20-8.

Dr. Cool is a hospitalist at Beth Israel Deaconess Medical Center, and instructor in medicine, Harvard Medical School, both in Boston.

Background: Prior observational studies have suggested that a dose-dependent effect may exist between alcohol intake and incident AFib, recurrence after ablation, and cardiac structural changes.

Study design: Prospective, open-label, multicenter, randomized clinical trial, with an intention-to-treat analysis.

Setting: Six tertiary care hospitals in Australia.

Synopsis: Study authors enrolled 140 patients with symptomatic paroxysmal or persistent AFib and regular alcohol consumption of 10 or more standard drinks per week. Participants were randomized to alcohol abstinence or usual alcohol intake. They underwent comprehensive rhythm monitoring and alcohol intake assessment for 6 months with in-person visits and oral/electronic communication. Over the 6-month period, patients in the abstinence group reduced their mean drinks per week from approximately 17 to 2, with 61% achieving complete abstinence. Patients in the abstinence group had a significantly longer period before recurrence of AFib when compared with the control group. Furthermore, the AFib burden over 6 months was significantly lower in the abstinence group, compared with the control group (0.5% vs. 1.2%).

Bottom line: For patients with symptomatic paroxysmal or persistent atrial fibrillation and regular alcohol consumption, reducing alcohol intake may significantly lower AFib burden and increase the time-to-recurrence of AFib at 6 months.

Citation: Voskoboinik A et al. Alcohol abstinence in drinkers with atrial fibrillation. N Engl J Med 2020 Jan 2;382:20-8.

Dr. Cool is a hospitalist at Beth Israel Deaconess Medical Center, and instructor in medicine, Harvard Medical School, both in Boston.

Background: Prior observational studies have suggested that a dose-dependent effect may exist between alcohol intake and incident AFib, recurrence after ablation, and cardiac structural changes.

Study design: Prospective, open-label, multicenter, randomized clinical trial, with an intention-to-treat analysis.

Setting: Six tertiary care hospitals in Australia.

Synopsis: Study authors enrolled 140 patients with symptomatic paroxysmal or persistent AFib and regular alcohol consumption of 10 or more standard drinks per week. Participants were randomized to alcohol abstinence or usual alcohol intake. They underwent comprehensive rhythm monitoring and alcohol intake assessment for 6 months with in-person visits and oral/electronic communication. Over the 6-month period, patients in the abstinence group reduced their mean drinks per week from approximately 17 to 2, with 61% achieving complete abstinence. Patients in the abstinence group had a significantly longer period before recurrence of AFib when compared with the control group. Furthermore, the AFib burden over 6 months was significantly lower in the abstinence group, compared with the control group (0.5% vs. 1.2%).

Bottom line: For patients with symptomatic paroxysmal or persistent atrial fibrillation and regular alcohol consumption, reducing alcohol intake may significantly lower AFib burden and increase the time-to-recurrence of AFib at 6 months.

Citation: Voskoboinik A et al. Alcohol abstinence in drinkers with atrial fibrillation. N Engl J Med 2020 Jan 2;382:20-8.

Dr. Cool is a hospitalist at Beth Israel Deaconess Medical Center, and instructor in medicine, Harvard Medical School, both in Boston.

Background: Following the ACA’s implementation, several measures were introduced to reduce unnecessary admissions of long-term nursing home residents to hospitals. These measures included an initiative to enhance a nursing home’s on-site capability to handle target populations; the accountable care organization payment model; and the Hospital Readmissions Reduction Program.

Study design: Cross-sectional study using the claims-based nationwide Minimum Data Set during 2011-2016.

Setting: Federally licensed nursing homes in the United States.

Synopsis: The authors examined the number of transfers between federally funded nursing homes and the hospital settings (EDs, observation, or inpatient hospitalizations) for greater than 460,000 long term–stay patients with advanced dementia, advanced heart failure, and/or advanced chronic obstructive pulmonary disease (COPD). A risk-adjusted model showed that, during 2011-2016, there were significant decreases in transfers rates for potentially avoidable conditions, measured as the mean number of transfers per person-year alive, for patients with advanced dementia (2.4 vs. 1.6), heart failure (8.5 vs. 6.7), and COPD (7.8 vs 5.5). Most of this decrease was linked to reductions in acute hospitalizations. Notably, hospice enrollment remained low throughout this time period, despite a high 1-year mortality.

Bottom line: During the 2011-2016 period, transfer rates for patients with advanced dementia, heart failure, and/or COPD from nursing homes to the hospital setting decreased.

Citation: McCarthy EP et al. Hospital transfer rates among U.S. nursing home residents with advanced illness before and after initiatives to reduce hospitalizations. JAMA Intern Med. 2019 Dec 30. doi: 10.1001/jamainternmed.2019.6130.

Dr. Cool is a hospitalist at Beth Israel Deaconess Medical Center, and instructor in medicine, Harvard Medical School, both in Boston.

Background: Following the ACA’s implementation, several measures were introduced to reduce unnecessary admissions of long-term nursing home residents to hospitals. These measures included an initiative to enhance a nursing home’s on-site capability to handle target populations; the accountable care organization payment model; and the Hospital Readmissions Reduction Program.

Study design: Cross-sectional study using the claims-based nationwide Minimum Data Set during 2011-2016.

Setting: Federally licensed nursing homes in the United States.

Synopsis: The authors examined the number of transfers between federally funded nursing homes and the hospital settings (EDs, observation, or inpatient hospitalizations) for greater than 460,000 long term–stay patients with advanced dementia, advanced heart failure, and/or advanced chronic obstructive pulmonary disease (COPD). A risk-adjusted model showed that, during 2011-2016, there were significant decreases in transfers rates for potentially avoidable conditions, measured as the mean number of transfers per person-year alive, for patients with advanced dementia (2.4 vs. 1.6), heart failure (8.5 vs. 6.7), and COPD (7.8 vs 5.5). Most of this decrease was linked to reductions in acute hospitalizations. Notably, hospice enrollment remained low throughout this time period, despite a high 1-year mortality.

Bottom line: During the 2011-2016 period, transfer rates for patients with advanced dementia, heart failure, and/or COPD from nursing homes to the hospital setting decreased.

Citation: McCarthy EP et al. Hospital transfer rates among U.S. nursing home residents with advanced illness before and after initiatives to reduce hospitalizations. JAMA Intern Med. 2019 Dec 30. doi: 10.1001/jamainternmed.2019.6130.

Dr. Cool is a hospitalist at Beth Israel Deaconess Medical Center, and instructor in medicine, Harvard Medical School, both in Boston.

Background: Following the ACA’s implementation, several measures were introduced to reduce unnecessary admissions of long-term nursing home residents to hospitals. These measures included an initiative to enhance a nursing home’s on-site capability to handle target populations; the accountable care organization payment model; and the Hospital Readmissions Reduction Program.

Study design: Cross-sectional study using the claims-based nationwide Minimum Data Set during 2011-2016.

Setting: Federally licensed nursing homes in the United States.

Synopsis: The authors examined the number of transfers between federally funded nursing homes and the hospital settings (EDs, observation, or inpatient hospitalizations) for greater than 460,000 long term–stay patients with advanced dementia, advanced heart failure, and/or advanced chronic obstructive pulmonary disease (COPD). A risk-adjusted model showed that, during 2011-2016, there were significant decreases in transfers rates for potentially avoidable conditions, measured as the mean number of transfers per person-year alive, for patients with advanced dementia (2.4 vs. 1.6), heart failure (8.5 vs. 6.7), and COPD (7.8 vs 5.5). Most of this decrease was linked to reductions in acute hospitalizations. Notably, hospice enrollment remained low throughout this time period, despite a high 1-year mortality.

Bottom line: During the 2011-2016 period, transfer rates for patients with advanced dementia, heart failure, and/or COPD from nursing homes to the hospital setting decreased.

Citation: McCarthy EP et al. Hospital transfer rates among U.S. nursing home residents with advanced illness before and after initiatives to reduce hospitalizations. JAMA Intern Med. 2019 Dec 30. doi: 10.1001/jamainternmed.2019.6130.

Dr. Cool is a hospitalist at Beth Israel Deaconess Medical Center, and instructor in medicine, Harvard Medical School, both in Boston.