April 2021 POLICY KEY CLINICAL QUESTION IN THE LITERATURE Volume 25 No. 4 Hospitalists engaging Checking EKGs in patients Screening for p8 in advocacy efforts p18 starting antipsychotics p24 postoperative delirium Dr. Reginaldo Filho (left) leads the hospitalist team at Hospital São Vicente in Curitiba, Brazil. COURTESY HOSPITAL SÃO VICENTE, CURITIBA Hospital medicine growing around the globe Similar needs, local adaptations By Larry Beresford around the world in the U.S. model of hospital medicine. But adaptations of that model vary across – and within – ospital medicine has evolved rapidly and spread countries, reflecting local culture, health care systems, pay- widely across the United States in the past 25 ment models, and approaches to medical education. years in response to the health care system’s Other countries have looked to U.S. experts for consul- needs for patient safety, quality, efficiency, and tations, to U.S.-trained doctors who might be willing to Heffective coordination of care in the ever–more complex relocate, and to the Society of Hospital Medicine as an environment of the acute care hospital. internationally focused source of networking and other re- ® But hospital care can be just as complex in other coun- sources. Some U.S.-based institutions, led by the Cleveland the-hospitalist.org tries, so it’s not surprising that there’s a lot of interest Continued on page 22 HOSPITALIST PROFILE COMMUNITY PHM Grace C. Huang, MD Magna Dias, MD Hospitalists are present at COVID’s impact specific p12 the ‘most intense time’ of p31 to pediatric hospital 500 PERMIT many people’s lives. medicine has been Denville, NJ 07834-3000 NJ Denville, PA HARRISBURG PAID P.O. Box 3000, 3000, Box P.O. POSTAGE U.S. substantial. CHANGE SERVICE REQUESTED SERVICE CHANGE THE HOSPITALIST THE STD PRSRT 01_22_23_HOSP21_04.indd 1 3/23/2021 8:24:55 AM NEWS April 2021 Volume 25 No. 4 Heart failure redefined PHYSICIAN EDITOR THE SOCIETY OF HOSPITAL MEDICINE Weijen W. Chang, MD, SFHM, FAAP Phone: 800-843-3360 [email protected] Fax: 267-702-2690 Website: www.HospitalMedicine.org with new PEDIATRIC EDITOR Anika Kumar, MD, FHM, FAAP Chief Executive Officer [email protected] Eric E. Howell, MD, MHM classifications, staging COORDINATING EDITORS Alan Hall, MD Director of Communications THE FUTURE HOSPITALIST Brett Radler [email protected] By Debra L. Beck comprehensive, with near universal Keri Holmes-Maybank, MD, FHM applicability, prognostic and thera- INTERPRETING DIAGNOSTIC TESTS Communications Specialist he terminology and classi- peutic viability, and acceptable sen- CONTRIBUTING WRITERS Caitlin Cowan Debra L. Beck; Larry Beresford; [email protected] fication scheme for heart sitivity and specificity.” Jeff Craven; Magna Dias, MD; failure (HF) is changing in Both left and right HF qualifies Perry H. Dubin, MD, MPH; SHM BOARD OF DIRECTORS ways that experts hope will under this definition, but conditions Kevin Dunsky, MD; President Tdirectly impact patient outcomes. that result in marked volume over- Marcia Frellick; Danielle Scheurer, MD, MSCR, SFHM Jennifer Heinen, MD; President-Elect In a new consensus statement, a load, such as chronic kidney disease, Michael Hession, MD; Jerome C. Siy, MD, SFHM multisociety group of experts pro- which may present with signs and Douglas J. Koo, MD, MPH, FHM; Treasurer posed a new universal definition of symptoms of HF, do not. Omar Mirza, DO; Rachel Thompson, MD, MPH, SFHM Caleb Rans, PharmD; Secretary heart failure and made substantial “Although some of these patients Samantha Platt; David Portnoy, MD; Kris Rehm, MD, SFHM revisions to the way in which the may have concomitant HF, these pa- Sarah Ludwig Rausch; Immediate Past President disease is staged and classified. tients have a primary abnormality David W. Rawson, MD; Christopher Frost, MD, SFHM Brian Rice; Diana Swift; Board of Directors The authors of the statement, led that may require a specific treat- Amanda Trask, MBA, MHA, FACHE, SFHM, Tracy Cardin, ACNP-BC, SFHM by writing committee chair and im- ment beyond that for HF,” said the FACMPE; Steven B. Deitelzweig, MD, mediate past president of the Heart consensus statement authors. Miriam E. Tucker MMM, FACC, SFHM Bryce Gartland, MD, FHM FRONTLINE MEDICAL Failure Society of America Biykem Overall, minimal changes have Flora Kisuule, MD, MPH, SFHM COMMUNICATIONS EDITORIAL STAFF Bozkurt, MD, PhD, hope their efforts been made to the HF stages, with Mark W. Shen, MD, SFHM Executive Editor Kathy Scarbeck, MA will go far to improve standard- tweaks intended to enhance under- Darlene Tad-y, MD, SFHM Editor Richard Pizzi Chad T. Whelan, MD, FACP, FHM ization of terminology, but more standing and address the evolving Creative Director Louise A. Koenig importantly will facilitate better role of biomarkers. Director, Production/Manufacturing Rebecca Slebodnik FRONTLINE MEDICAL management of the disease in ways The authors proposed an ap- COMMUNICATIONS ADVERTISING STAFF that keep pace with current knowl- proach to staging of HF: EDITORIAL ADVISORY BOARD Senior Director Business Development Hyung (Harry) Cho, MD, SFHM; edge and advances in the field. • At-risk for HF (stage A), for patients Angelique Ricci, 973-206-2335 Marina S. Farah, MD, MHA; cell 917-526-0383 [email protected] “There is a great need for refram- at risk for HF but without current Ilaria Gadalla, DMSc, PA-C; Classified Sales Representative ing and standardizing the terminol- or prior symptoms or signs of HF James Kim, MD; Heather Gonroski, 973-290-8259 Ponon Dileep Kumar, MD, FACP, CPE; [email protected] ogy across societies and different and without structural or biomark- Shyam Odeti, MD, MS, FHM; stakeholders, and importantly for pa- ers evidence of heart disease. Venkataraman Palabindala, MD, SFHM; Linda Wilson, 973-290-8243 [email protected] tients because a lot of the terminol- • Pre-HF (stage B), for patients with- Tiffani M. Panek, MA, SFHM, CLHM; Adhikari Ramesh, MD, MS; Senior Director of Classified Sales ogy we were using was understood out current or prior symptoms or Raj Sehgal, MD, FHM; Tim LaPella, 484-921-5001 by academicians, but were not being signs of HF, but evidence of struc- Kranthi Sitammagari, MD; cell 610-506-3474 [email protected] translated in important ways to en- tural heart disease or abnormal Amith Skandhan, MD, FHM; Advertising Offices 7 Century Drive, Lonika Sood, MD, FACP, FHM; Suite 302, Parsippany, NJ 07054-4609 sure patients are being appropriately cardiac function, or elevated natri- Amit Vashist, MD, FACP treated,” said Dr. Bozkurt, of Baylor uretic peptide levels. 973-206-3434, fax 973-206-9378 College of Medicine, Houston. • HF (stage C), for patients with cur- The consensus statement was a rent or prior symptoms, signs of THE HOSPITALIST is the official newspaper of the THE HOSPITALIST (ISSN 1553-085X) is published Society of Hospital Medicine, reporting on issues monthly for the Society of Hospital Medicine by group effort led by the HFSA, the HF caused by a structural and/or and trends in hospital medicine. THE HOSPITALIST Frontline Medical Communications Inc., 7 Century Heart Failure Association of the Eu- functional cardiac abnormality. reaches more than 35,000 hospitalists, physician Drive, Suite 302, Parsippany, NJ 07054-4609. Print assistants, nurse practitioners, medical residents, and subscriptions are free for Society of Hospital Medi- ropean Society of Cardiology, and the • Advanced HF (stage D), for patients health care administrators interested in the practice cine members. Annual paid subscriptions are avail- Japanese Heart Failure Society, with with severe symptoms and/or signs and business of hospital medicine. Content for able to all others for the following rates: THE HOSPITALIST is provided by Frontline Medical endorsements from the Canadian of HF at rest, recurrent hospital- Communications. Content for the Society Pages is Individual: Domestic – $195 (One Year), Heart Failure Society, the Heart Failure izations despite guideline-directed provided by the Society of Hospital Medicine. $360 (Two Years), $520 (Three Years), Canada/Mexico – $285 (One Year), $525 (Two Years), Association of India, the Cardiac Soci- management and therapy (GDMT), Copyright 2021 Society of Hospital Medicine. All $790 (Three Years), Other Nations - Surface – $350 ety of Australia and New Zealand, and refractory or intolerant to GDMT, rights reserved. No part of this publication may be (One Year), $680 (Two Years), $995 (Three Years), reproduced, stored, or transmitted in any form or by Other Nations - Air – $450 (One Year), $875 (Two the Chinese Heart Failure Association. requiring advanced therapies such any means and without the prior permission in writing Years), $1,325 (Three Years) The article was published in the as consideration for transplant, from the copyright holder. The ideas and opinions expressed in The Hospitalist do not necessarily Institution: United States – $400; Journal of Cardiac Failure (doi: mechanical circulatory support, or reflect those of the Society or the Publisher. The Canada/Mexico – $485 All Other Nations – $565 10.1016/j.cardfail.2021.01.022), authored palliative care. Society of Hospital Medicine and Frontline Medical Student/Resident: $55 Communications will not assume responsibility for by a committee of 38 individuals with For his part, Douglas L. Mann, MD, damages, loss, or claims of any kind arising from Single Issue: Current – $35 (US), $45 (Canada/ domain expertise in HF, cardiomyopa- of Washington University, St. Louis, or related to the information contained in this Mexico), $60 (All Other Nations) Back Issue – $45 publication, including any claims related to the (US), $60 (Canada/Mexico), $70 (All Other Nations) thy, and cardiovascular disease. is happy to see what he considers a products, drugs, or services mentioned herein. POSTMASTER: Send changes of address (with old “[HF] is a clinical syndrome with more accurate and practical defini- Letters to the Editor: [email protected] mailing label) to THE HOSPITALIST, Subscription Services, P.O. Box 3000, Denville, NJ 07834-3000. symptoms and or signs caused by a tion for heart failure.