HealthDay News — Hospitalized Medicare patients treated by physicians who work more clinical days have lower 30-day mortality, according to a study published online Sept. 13 in JAMA Internal Medicine.

Hirotaka Kato, Ph.D., from the David Geffen School of Medicine at the University of California in Los Angeles, and colleagues examined the association between the number of days worked clinically per year by physicians and patient mortality. The analysis included a 20 percent random sample of Medicare fee-for-service beneficiaries admitted to the hospital with an emergency medical condition (392,797 hospitalizations) and treated by 19,170 hospitalists (2011 through 2016).

The researchers found that patients treated by physicians with more days worked clinically exhibited lower mortality. For physicians in the first (bottom), second, third, and fourth (top) quartile of days worked clinically, the adjusted 30-day mortality rates were 10.5 (reference), 10.0, 9.5, and 9.6 percent, respectively. There was no association noted between readmission rates and the numbers of days a physician worked clinically (adjusted 30-day readmissions for physicians in the bottom quartile of days worked clinically per year versus those in the top quartile, 15.3 versus 15.2 percent).


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“Given that physicians with reduced clinical time must often balance clinical and nonclinical obligations, improved support by institutions may be necessary to maintain the clinical performance of these physicians,” the authors write.


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A history of renin-angiotensin-aldosterone system (RAAS) antagonism may be associated with less severe coronavirus disease 2019 (COVID-19) among patients with obesity-related hypertension that requires hospitalization, according to research recently presented at the annual meeting of the Endocrine Society (ENDO) 2021 conference, held virtually from March 20 to 23, 2021.

This retrospective study included 138 inpatients with COVID-19 admitted between March 1 and July 8, 2020. All participants had hypertension, were classified as either overweight (body mass index [BMI] ≥25 kg/m2) or obese (BMI ≥30 kg/m2), and were treated as outpatients with or without angiotensin converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs).

The control group (n=59) was composed of individuals who had not been exposed to RAAS antagonists, while the larger cohort (n=79) was composed of those treated with ACEIs/ARBs. The ACEI/ARB cohort contained 24% women, compared with 47% in the control group. The ACEI/ARB cohort also had a higher rate of diabetes (ACEI/ARB 63.2%; control 45.7%).

Researchers assessed both severity and mortality of COVID-19 by the use of noninvasive and mechanical ventilation, extracorporeal membrane oxygenation (ECMO), supplemental oxygen, and vasopressors. Compared with the ACEI/ARB group, the control group exhibited higher mortality (ACEI/ARB 15.1%; control 32.2%) and intensive care unit admissions (ACEI/ARB 46.8%; control 57.6%), as well as higher use of mechanical ventilation (ACEI/ARB 1.2%; control 37.2%), vasopressors (ACEI/ARB 31.6%; control 38.9%), and supplemental oxygen (ACEI/ARB 49.3%; control 52.5%). However, the control group had lower rates of both noninvasive ventilation (ACEI/ARB 20.2%; control 18.6%) and ECMO (ACEI/ARB 20.2%; control 0%).

The study authors concluded that the severity and mortality of COVID-19 are lower among those individuals with obesity-related hypertension and a history of RAAS antagonism who required hospitalization.

Reference

Kamalumpundi V, Shams E, Cheng L, et al. Patients with obesity-related hypertension treated with renin-angiotensin-aldosterone system antagonists exhibit lower mortality and less severe COVID-19: a retrospective study. Poster presented at: Endocrine Society (ENDO) 2021 virtual conference; March 20-23, 2021. Session P12.

This article originally appeared on Endocrinology Advisor