Literature Review

Lived experiences of patients hospitalized with acute decompensated heart failure and kidney dysfunctionJAMA Network Open; Gwen M. Bernacki, MD, MHSA; Ann M. O’Hare, MD, MA; Mahlet Assefa, MD; Kevin D. O’Brien, MD; David K. Prince, PhD; James N. Kirkpatrick, MD; Nisha Bansal, MD, MAS; Catherine R. Butler, MD, MA; 1/25This qualitative study of patients currently or recently hospitalized with ADHF [acute decompensated heart failure] and kidney dysfunction offers a window on the lived experiences of members of this medically vulnerable group. Study participants offered vivid accounts of how their illness had impacted their day-to-day lives, sense of self, life priorities, and hopes and expectations for the future. However, many lacked a detailed understanding of the medical aspects of their illness and did not always feel equipped or empowered to actively participate in their care. Our findings suggest that there may be untapped opportunities to improve quality of communication for patients with ADHF and kidney dysfunction. 

Sudden unexpected infant death and disparities in infant mortality in the US, 1999-2022JAMA Pediatrics; Elizabeth R. Wolf, MD, MPH; Frederick P. Rivara, MD, MPH; Anabeel Sen, MBBS, MPH; Steven H. Woolf, MD, MPH; 1/25This study found that infant mortality from SUID [sudden unexpected infant death] has increased significantly. Previous data through 2020 showed that SUID increased among Black infants. Our analysis, which included 2021 and 2022 data, showed a more generalized increase. Possible explanations include COVID-19 or other respiratory illnesses, maternal opioid use, and social media’s influence on infant sleeping practices. SUID mortality rates were notably higher among American Indian or Alaska Native, Black, and Native Hawaiian or Other Pacific Islander infants than among Asian and White infants. Disparities in SUID could reflect unsafe sleeping position, prematurity, tobacco exposure, and/or infant feeding practices; further research is needed.

Impact of inpatient palliative care on end-of-life care among patients with early-onset colorectal cancerJournal of Clinical Oncology; Suriya Baskar, Bohae R Lee, Rajiv Midha, Udhayvir Singh Grewal; 1/25Palliative care has proven benefits in elderly patients with advanced cancer; however, the objective benefits of palliative care in younger patients with cancer remain under-studied. We sought to examine the impact of inpatient palliative care consultation on end-of-life (EOL) care among hospitalized patients with early-onset colorectal cancer (EO-CRC). Inpatient palliative care consultation at EOL among patients with EOCRC was associated with lesser use of aggressive interventions and higher rates of DNR code status. We also noted significantly lower costs of hospitalization among patients receiving inpatient palliative care consultation at EOL. These results underscore the importance of integration of inpatient palliative care consultation among patients with EOCRC at EOL. 

Underused palliative care could aid stroke survivorsJAMA; Samantha Anderer; 1/25Every year in the US, 800,000 people experience strokes, and although most survive, current treatment plans fail to adequately address their physical, emotional, psychosocial, and spiritual distress, according to a new scientific statement from the American Heart Association. Palliative care could aid in the quality of life for both patients and their families by helping during all stages of poststroke care, including adapting to functional changes, navigating complex health care systems, and preparing for death when necessary. Although all affected individuals could benefit from palliative care, the statement noted that it is most underused in Black and Hispanic populations, which tend to have a higher incidence of stroke, worse functional outcomes, and a lower likelihood of receiving acute stroke treatments.

Access tops list of Americans' healthcare concerns: 4 survey findings Becker's Clinical Leadership; by Erica Carbajal; 2/5/25A quarter of Americans rank healthcare access and affordability as the top public health priority they want government leaders to focus on, according to poll findings from Gallup and Emory University's Rollins School of Public Health. ... Four key findings:

Care for patients with a history of immigrationJAMA; Margaret Wheeler, MS, MD; Juan Raul Gutierrez, MD; Alicia Fernandez, MD; 1/25Home to 20% of the world’s immigrants, the US is the leading destination for people leaving their birth countries, and the US Census estimates that almost 14% of the US population in 2022 was born outside the US. ... The 2023 US Preventive Services Task Force Guideline on screening for latent tuberculosis recommends screening for tuberculosis in patients from Latin America, the Caribbean, Africa, Asia, Eastern Europe, and Russia because in 2020, 71% of cases of active tuberculosis in the US occurred among individuals from these areas. Assessment of clinically relevant premigration factors involves consideration of the epidemiology of disease, health care practices, and sociopolitical and environmental exposures in an immigrant’s country of origin. These factors can alter risk assessment in differential diagnoses; for example, neurocysticercosis should be considered in the differential diagnosis of seizures in a patient from Central America.

The National Donor Family Council: History, activities, achievements, and legaciesOmega-Journal of Death and Dying; Margaret B Coolican, Charles A Corr; 1/25The National Donor Family Council (NDFC) functioned under the sponsorship of the National Kidney Foundation from 1992-2014. Giving voice to the needs and views of donor families, the NDFC had an important impact on the support for those families. This article records significant points in the advocacy of donor families, summarizes the history of the NDFC, highlights the various activities and achievements of the NDFC, and offers some impressions of its legacies.

Flaws in the Medicare Advantage Star RatingsJAMA Health Forum; David J. Meyers, PhD, MPH; Amal N. Trivedi, MD; Andrew M. Ryan, PhD; 1/25The objective of the star ratings is to help beneficiaries select better plans, and to reward plans that deliver high-quality care. In June 2024, a US district court judge ruled that the Centers for Medicare and Medicaid Services (CMS) inappropriately calculated Medicare Advantage (MA) Star ratings due to not implementing a previously announced statistical adjustment. First, it is not clear if the star ratings are actually capturing a higher quality, as several measures in the star rating are reported by the plans themselves and plans often overstate their performance. Second, over 80% of contracts by enrollment are rated 4 stars or higher, which is the threshold needed to earn bonus payments, and a single star rating is assigned to each contract even when contracts may cover many different states and regions. Third, while bonus payments for star ratings are costly, plans eligible for enhanced bonuses have not shown greater improvement in measures related to clinical quality or administrative effectiveness. Taken together, the current star ratings are neither useful for all beneficiaries to make their plan decisions, nor do they appear to be capturing quality or catalyzing improvement. 

Suzetrigine: First-in-class nonopioid pain therapy is approved by FDAAmerican Journal of Managed Care; Giuliana Grossi; 1/25Suzetrigine (Journavx; Vertex Pharmaceuticals) received approval from the FDA for the treatment of adults with moderate-to-severe acute pain, according to an announcement from Vertex. The therapy is a novel oral, non-opioid, highly selective NaV1.8 pain signal inhibitor ... offering a non-opioid alternative amid the opioid crisis. Clinical trials demonstrated significant efficacy in postsurgical pain relief, though results varied across different conditions. Despite this, suzetrigine offers the potential to energize the nonopioid pain market, which includes other companies like Tris Pharma, Latigo Biotherapeutics, and SiteOne Therapeutics—all actively developing alternatives to opioids. Key findings from the Institute for Clinical and Economic Review analysis of the phase 3 trials include potential lifetime cost savings of $200 per patient when comparing suzetrigine with opioids, assuming a 1-week course priced at $420.

Palliative care initiated in the Emergency Department-A cluster randomized clinical trialJAMA; Corita R. Grudzen, MD, MSHS; Nina Siman, MA, MSEd; Allison M. Cuthel, MPH; Oluwaseun Adeyemi, MBBS, PhD; Rebecca Liddicoat Yamarik, MD; Keith S. Goldfeld, DrPH, MS, MPA; PRIM-ER Investigators; 1/25Question-What is the effect of a multicomponent intervention to initiate palliative care in the emergency department on hospital admission in older adults with serious, life-limiting illness? In this cluster randomized clinical trial, which was conducted at 29 US emergency departments and included 98,922 initial visits, there was no difference in the rate of hospital admission in older adults with serious, life-limiting illness receiving care before (64.4%) vs after (61.3%) emergency department clinical staff receipt of a multicomponent primary palliative care intervention. Relevance-This multicomponent intervention to initiate palliative care in the ED did not have an effect on hospital admission, subsequent health care use, or short-term mortality in older adults with serious, life-limiting illness.

Study explores Native Hawaiian end-of-life careNational Indigenous Times; by Joseph Guenzler; 2/4/25A study by the University of Hawaiʻi at Mānoa's Hā Kūpuna – National Resource Center for Native Hawaiian Elders has examined the end-of-life care preferences of Native Hawaiian kūpuna (Elders). Led by Laguna Pueblo and Quechan woman, Assistant Professor Miquela Ibrao, researchers from UH and ALU LIKE, Inc. identified culturally specific approaches to support kūpuna values in healthcare. "Death is not an end but a transition that honors relationality, ancestors and the land,' Assistant Professor Ibrao said. "Decolonizing end-of-life care means respecting cultural beliefs and embracing Indigenous wisdom about healing and living well." The study, published in the Journal of Palliative Medicine, is based on interviews with 20 kūpuna aged 60 and over from rural areas across Hawaiʻi. It highlights four key themes.

Use of digital health technologies by older US adultsJAMA Network Open; Cornelius A. James, MD; Tanima Basu, MS, MA; Brahmajee K. Nallamothu, MD, MPH; Jeffery T. Kullgren, MD, MPH, MS; 1/25Older adults use various types of DHT [digital health technologies], and they use patient portals most often. Although some older adults have unique physical and cognitive needs that can affect the utility and usability of DHTs, in aggregate they share some predictors of DHT use with younger adults. Additionally, our study showed a statistically significant association between non-Hispanic Black race and ethnicity and DHT use. Various factors may contribute to this finding, including medical mistrust among Black patients leading to decreased engagement with the health system and increased reliance on DHTs. This study highlights the need to carefully consider the unique characteristics of older adults when developing and deploying DHTs to avoid worsening the digital divide. 

Hospice care in the Emergency Department: An evolving landscapeJournal of Palliative Medicine; by Eliot Hill, Ky Stoltzfus, Joanna Brooks; 1/25Despite the increasing focus on goal-concordant care in the emergency department (ED), there is limited data about patients who receive a new hospice referral and the care paths of patients on hospice who present there. [In this study,] six patients received a new hospice referral. Of these, four had a primary diagnosis of cancer, three received a palliative care consult, and three were discharged to an inpatient hospice facility (hospice house). No patients had repeat health care encounters at our hospital. 42% (31/74) of patients enrolled in hospice required admission. Conclusion: New hospice referrals in the ED are possible but rare. Further research should investigate possible missed opportunities to provide goal-concordant care.