1 in 5 COVID deaths potentially attributable to hospital caseload strain

Embargoed for release until 5:00 p.m. ET on Monday 9 September 2024

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Below please find summaries of new articles that will be published in the next issue of Annals of Internal Medicine. The summaries are not intended to substitute for the full articles as a source of information. This information is under strict embargo and by taking it into possession, media representatives are committing to the terms of the embargo not only on their own behalf, but also on behalf of the organization they represent.    
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1. 1 in 5 COVID deaths potentially attributable to hospital caseload strain

Abstract: https://www.acpjournals.org/doi/10.7326/M24-0869

URL goes live when the embargo lifts     

A nationwide retrospective cohort study evaluated the effect of COVID-19 caseload stress on the probability of in-hospital mortality or discharge to hospice. The data revealed a detrimental relationship between COVID-19 caseload and survival across all hospital types, far beyond the pandemic’s learning curve. The study is published in Annals of Internal Medicine.

Researchers from the National Institutes of Health Clinical Center studied data from inpatient encounters of adults with COVID-19 at 620 US hospitals during the Delta wave surges between July 1 and November 21, 2021. The goal was to determine whether hospitals’ care infrastructure, ICU types, and native bed capacity influenced the care quality during hospital stress and staffing shortages. The primary exposure variable to the data was COVID-19 surge index, a metric for strain separated into percentiles, which includes all patients hospitalized with COVID-19 and adjusted for patient severity and baseline bed capacity the Delta variant phase. The study classified hospitals into mutually exclusive groups to organize their types and levels of infrastructure. To account for potential confounding factors and improve findings’ validity and accuracy, the study incorporated many patient-, hospital-, and community-level covariates. Through statistical, exploratory, and sensitivity analysis, researchers found that caseload strain remained substantially detrimental to survival in patients with COVID-19 across hospitals, regardless of hospital size, location, or resource complexity. Approximately 1 in every 5 COVID-19 deaths were attributable to hospital caseload strain.

According to the authors, this is the first study to examine the effect of hospital type and infrastructure on the care quality for COVID-19 amid caseload stress. The findings provide hypothesis-generating insights for the ongoing staff shortage crisis in U.S. hospitals and heighten the importance of minimizing caseload surge during future public health emergencies. The researchers conclude that avoiding surging caseload might be lifesaving.

Media contacts: For an embargoed PDF, please contact Angela Collom at acollom@acponline.org. To speak with corresponding author Sameer S. Kadri, MD, MS, please email Sameer.Kadri@nih.gov.

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2. Systematic review finds 3 medications with potential to treat vaginal symptoms of GSM in menopause

Review: https://www.acpjournals.org/doi/10.7326/ANNALS-24-00610

Evidence Map: https://www.acpjournals.org/doi/10.7326/ANNALS-24-00603

URL goes live when the embargo lifts     

A systematic review of existing literature on genitourinary syndrome of menopause (GSM) treatments found that vaginal estrogen, vaginal DHEA, oral ospemifene, and vaginal moisturizers may improve some GSM symptoms in the short term. However, few long-term data exist on efficacy, comparative effectiveness, tolerability, and safety of GSM treatments. The review is published in the Annals of Internal Medicine.

Researchers from the Center for Care Delivery and Outcomes Research, Minneapolis VA Health Care System and the Agency for Healthcare Research and Patient-Centered Outcomes Research Institute studied data from postmenopausal women with at least 1 GSM symptom, such as dryness of the vulvar or vaginal area, urgency or pain with urination, pain with intercourse, or decreased libido. Based on a search of 3 databases, researchers conducted a systematic review of 46 unique RCTs and identified 4 treatments with potential benefits for GSM symptoms in the short-term: vaginal estrogen, vaginal dehydroepiandrosterone (DHEA), oral ospemifene, and vaginal moisturizers. While none of the treatments were found to improve discomfort or irritation of the vulvar or vaginal area or pain with urination, all 4 may improve dryness of the vulvar or vaginal area. The data did not provide evidence of efficacy or vaginal testosterone, vaginal oxytocin, raloxifene, or bazedoxifene for any GSM symptom.

In a related review, also published in Annals of Internal Medicine, researchers summarized published evidence of using complementary and alternative medicine or therapies (CAMs) as a treatment for those seeking nonhormonal interventions for vulvovaginal, urinary, and sexual symptoms associated with genitourinary syndrome of menopause (GSM). They found large and heterogenous literature that revealed insights into trends in research on CAM interventions for GSM. Researchers studied 57 randomized control trials and employed an evidence map approach to systematically organize and describe the data. They found that most studies were too limited in scope, time, geography, and heterogeneity to allow for evidence synthesis. Notably, limiting trends in study designs include (1) symptom severity not being an inclusion criterion nor often reported, (2) authors infrequently using standard validated measures to assess sexual function, and (3) few studies testing identical products. These limitations make it difficult to compare CAM interventions with broader GSM literature. The authors ground the study in a larger context, remarking that inconsistencies in the natural products and supplements industry are compounded by a lack of regulation. They conclude that more well-designed trials are needed to assist patients and clinicians to make informed decisions about how to best manage patient symptoms.

Media contacts: For an embargoed PDF, please contact Angela Collom at acollom@acponline.org. . To speak with authors Elisheva R. Danan, MD, MPH or Kristen Ullman, MPH regarding the reviews, please email Brad Doboszenski at brad.doboszenski@va.gov.

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Knee Osteoarthritis

Allan C. Gelber, MD, MPH, PhD

Annals in the Clinic

https://www.acpjournals.org/doi/10.7326/ANNALS-24-01249

Guidelines Recommending That Clinicians Advise Patients on Lifestyle Changes: A Popular but Questionable Approach to Improve Public Health

Minna Johansson, MD, PhD; Amanda Niklasson, MD; Loai Albarqouni, MD, PhD; Karsten Juhl Jørgensen, MD, DrMedSci; Gordon Guyatt, MD, MSc; and Victor M. Montori, MD, MSc

Ideas and Opinions

https://www.acpjournals.org/doi/10.7326/ANNALS-24-00283