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.
1. Infusion centers associated with substantially better outcomes than the ER for patients with acute pain events and sickle cell disease
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A prospective cohort study found that treatment at an infusion center (IC) is associated with substantially better outcomes than treatment in the emergency department (ED) for patients with sickle cell disease (SCD) and uncomplicated vaso-occlusive crises. The findings are published in Annals of Internal Medicine.
Vaso-occlusive events are excruciatingly painful and the leading cause of hospital and ED use in SCD. Although SCD is considered a rare disease in the United States, the burden of ED care and subsequent hospitalization is high. As documented in a systematic review, patients presenting to the ED with severe pain from these events are often faced with structural and interpersonal racism and sub-par care.
Researchers from Johns Hopkins University School of Medicine studied 483 adults with sickle cell disease who lived within 60 miles of an IC in Baltimore, Milwaukee, Cleveland, or Baton Rouge between April 2015 and December 2016 to assess whether care in ICs or EDs would lead to better outcomes. They found that patients treated in an IC received parenteral pain medication an average of 70 minutes faster than those seen in the ED (62 minutes in the IC compared with 132 minutes in the ED). Patients in ICs were 3.8 times more likely to have their pain reassessed within 30 minutes of the first dose and 4 times more likely to be discharged home. These results suggest that ICs are more likely to provide guideline-based care than EDs and that care can improve overall outcomes.
According to the authors, these findings are important because adults with sickle cell disease have been historically underserved by the medical community. Better access to high-quality care should result in better outcomes for both the patient and the medical system.
Media contacts: For an embargoed PDF, please contact Angela Collom at firstname.lastname@example.org. To speak with the corresponding author, Sophie Lanzkron MD, MHS, please contact Patrick Smith at PJSmith@jhmi.edu.
2. Life expectancy gap closes dramatically between those with HIV and general population
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An observational cohort study finds that mortality among persons entering HIV care decreased dramatically between 1999 and 2017, with the largest decrease seen between 2011 and 2017. Those entering HIV care remained at modestly higher risk for death in the years after starting care than comparable persons in the general U.S. population. The findings are published in Annals of Internal Medicine.
HIV-related mortality has been decreasing since the introduction of effective treatment in 1996 due to improving treatment options and evolving care guidelines, but the extent to which persons entering HIV care in the United States have a higher risk for death over the years after linkage to care than their peers in the general population over the same period remains unclear.
Researchers from the University of North Carolina at Chapel Hill used data from the National Center for Health Statistics to compare 5-year all-cause mortality between 82,766 adults entering HIV clinical care between 1999 and 2017 at 13 U.S. sites participating in the North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD) and a matched subset of the U.S. population. The persons in the general population were matched to those in NA-ACCORD by calendar time, age, sex, race/ethnicity, and county of residence. The researchers found that the difference in mortality between people with HIV and the general population decreased over time, from 11.1% among those entering care between 1999 and 2004 to 2.7% among those entering care from 2011 to 2017. Of note, mortality decreased across all demographic subgroups studied and decreased more among non-Hispanic Black people than non-Hispanic White people.
According to the authors, the decrease in mortality among persons with HIV likely reflects advances in care and treatment, new guidelines indicating earlier treatment, greater engagement in care, higher levels of viral suppression, a trend toward linking persons with HIV to care earlier in the course of infection (that is, at higher CD4 cell counts), and evolving patient characteristics in the cohort over time. They say this study is important because understanding differences in mortality between persons entering HIV care and the matched U.S. population is critical to monitor opportunities to improve care.
Also new in this issue:
The importance of clinician-educators
Annals On Call
Annals of Internal Medicine