Guideline updates that make a difference
The rules for four medical specialties have changed over the past year.
Keeping up with the Joneses is nothing compared to keeping up with the latest changes to medical guidelines. At least four major updates were issued over the past year that will make a difference in your day-to-day hospital practice.
“Every guideline has multiple points, some of which are involved in what we as hospitalists do and many of which fall into other areas,” said Alfred Burger, MD, FACP, SFHM, professor of medicine and medical education at the Icahn School of Medicine at Mount Sinai. “We are going to focus on issues that hospitalists deal with every day, things like chest pain, heart failure, GI bleeds, ascites, and cirrhosis. This is the one session at Converge where you can get the highlights of four major guidelines that affect the daily life of just about every practicing hospitalist.”
Dr. Burger will co-present Line Dancing: Guideline Updates along with Mel L. Anderson, MD, MACP, executive director of the Veterans Health Administration National Hospital Medicine Program and associate professor of medicine at the University of Colorado School of Medicine in Denver.
“Guidelines can be a challenge because not every element is useful for hospitalists,” Dr. Andeson said. “We’re cutting through the verbiage to extract the nuggets that we can adopt into practice or areas we should be leery about continuing to practice as we have in the past, new frameworks that can help us approach problems in more useful ways.”
For example, the American College of Gastroenterology updated its clinical guidelines for upper gastrointestinal bleeding in 2021. The new guidelines include risk assessment, early hospital management, endoscopic approaches for different types of bleeds, pharmacotherapy after endoscopy, and when to consider repeat endoscopy.
“The average hospitalist isn’t deciding whether to use a laser or a clip or any of the other endoscopic therapies,” Dr. Burger explained. “We leave that to the people who are expert in the procedures. But we are very much involved in the management of patients from the time they are admitted until they go in for endoscopy and very possibly after. Those are the areas we may need to adjust our daily practice.”
Approaches to heart failure are also shifting. The approval of sodium-glucose cotransporter-2 (SGLT2) inhibitors brought new thinking to heart failure assessment and treatment with new guidelines from the American College of Cardiology and the American Heart Association.
“Heart failure guidelines are very clear about the use of SGLT2 inhibitors, but what is rather unclear is how do we get these new medications on board?” Dr. Anderson said. “Even ACC publications have different versions of how that might be done. We are looking at the underpinnings of the guideline to give hospitalists a methodology to translate guidelines into practice.”
Look for similar distillation of guidelines on chest pain and the management of ascites in patients with cirrhosis due to hepatitis C and other causes.
“This session is the take-home points on each of these big topics,” Dr. Burger said, “plus quick hits on key changes to topics like venous thromboembolism that hospitalists see on a daily basis. More important than remembering every single change is knowing there have been changes, and I can look them up.”
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