FINEARTS-HF — Finerenone in HFpEF/HFmrEF
Hazard / Rate Ratios with 95% CI (N=6,001) | NEJM Sep 2024
Bottom line: Finerenone is the first MRA to show benefit in HFpEF. RR 0.84 for composite; RR 0.82 for worsening HF events alone. CV death alone was NS.
STRONG-HF — Rapid GDMT Up-Titration Post-Discharge
180-Day Death or HF Readmission
ARR 8.1% • NNT 12. Rapid up-titration within 2 weeks of discharge reduced the primary composite by one-third. Requires structured follow-up at 1, 2, and 6 weeks.
Mebazaa A et al. Lancet 2022;400:1938-52
Perioperative Risk — MET Levels & Mortality
30-Day and 365-Day Mortality by Functional Capacity
35× mortality gradient from MET≥9 (0.2%) to MET 1 (7.2% at 365d). Functional capacity is the strongest single predictor of perioperative outcome.
Ackermann & Whinney, SHM Converge 2026. Data from Wijeysundera DN et al. JAMA 2023.
Delirium — Outcome Risk (Odds Ratios)
Long-term consequences of inpatient delirium
OR 3.16 for incident dementia. Delirium isn't just an acute problem — it predicts cognitive decline, institutionalization, and death. Prevention via ABCDEF bundle (68% lower delirium odds) is the highest-leverage intervention.
Vasilevskis & Kaiksow, SHM Converge 2026. Data from Witlox J et al. JAMA 2010; Inouye SK et al. Lancet 2014.
New Drug NNTs — Clinical Impact Comparison
Number Needed to Treat (lower = stronger effect)
Terlipressin NNT 7 is the strongest individual drug effect. For context, aspirin for MI secondary prevention has NNT ~42. Coaching NNT 9-11 for wellness outcomes is comparable to many pharmacologic interventions.
CONFIRM (Wong F, NEJM 2021), FIDELIO-DKD (Bakris GL, NEJM 2020), STRONG-HF (Mebazaa A, Lancet 2022), Kiser (JAMA Netw Open 2024)
Furosemide Stress Test — Diagnostic Performance
Predicting AKI Stage 3 Progression
Sensitivity 87%, Specificity 84% for predicting AKI stage 3 progression. A bedside test that outperforms most biomarkers. UOP <200mL in 2 hours after IV furosemide = high risk → early nephrology consult and RRT planning.
Chawla LS et al. Crit Care 2013;17(5):R207. Rachoin, SHM Converge 2026.
Hospitalist Financial Headwinds — Policy Impact Modeling
Projected impacts from 2026 policy changes
Net −7% hospitalist payment despite CF increase. Combined with Medicaid contraction (11.8M losing coverage) and $100K H-1B fee, programs need 3-year financial contingency plans. H@H extension to 2030 is the primary growth opportunity.
Dutta et al. SHM Converge 2026. CMS Final Rule CY2026; CBO OBBBA Score 2025.
Terlipressin — CONFIRM Trial HRS Reversal
HRS-AKI Reversal Rate vs Placebo
32% vs 17% HRS reversal (p=0.006, NNT=7). First FDA-approved HRS treatment. Cost ~$45K/hospitalization but cost-per-response is lower than midodrine/octreotide ($85K vs $468K). Avoid if ACLF grade 3 or SCr >5.
Physician Peer Coaching — Kiser RCT
Change from Baseline at 3 Months (N=138)
100% would pursue coaching again. Burnout dropped 21.6% in the coaching arm while INCREASING 2.5% in controls. NNT 9-11 for impostor syndrome and moral injury. This is a systems-level wellness intervention, not self-care theater.
MINT Trial — Transfusion Strategy in MI + Anemia
Primary Outcome: Death or Recurrent MI at 30 Days (N=3,504)
Trend favoring liberal (p=0.07) but not significant. Mean units: 0.7 (restrictive) vs 2.5 (liberal). Combined with REALITY trial data (1.2% fewer deaths at 90d with liberal), the evidence leans toward a liberal threshold in acute MI with anemia.
Vonoprazan vs Lansoprazole — Erosive Esophagitis Healing
Week 8 Healing Rates by Severity
92.9% vs 84.6% overall; 17.6% superiority in severe EE. Vonoprazan (PCAB) has faster onset, no CYP2C19 variability, and more consistent acid suppression than PPIs. Reserve for PPI-refractory or severe disease given brand-only pricing (~$400-500/mo).
Vaezi MF et al. Gastroenterology 2023;164:61-71. PHALCON-EE trial.
Thoracentesis in Heart Failure — Readmission Impact
HF Readmission Rate with vs without Thoracentesis
HR 0.37 — 59% relative risk reduction in HF readmission. Thoracentesis is underutilized in HF with symptomatic pleural effusions. This effect size exceeds most pharmacologic interventions.
Smith, SHM Converge 2026. Reported HR from retrospective cohort analysis.