Internal Medicine

Medicare 3‑day SNF rule: longer stays, no outcome gain

Reinstatement of Medicare’s 3‑day hospitalization requirement modestly increased the proportion of traditional beneficiaries staying at least 3 days. Among patients discharged to SNFs, the probability of ≥3‑day hospitalization increased more substantially, especially for hip fracture and dementia admissions. Despite longer inpatient stays, there were no significant changes in SNF discharge rates, 30‑day readmissions, 30‑day mortality, or total SNF days. These findings suggest additional hospital costs and bed‑days without measurable short‑term benefit, challenging the clinical value of the 3‑day rule. 1

Lay CHWs with app support improve BP control vs facility care

In rural Lesotho, nonpregnant adults with uncontrolled hypertension were randomized by village to lay CHW-led vs facility-based care. CHWs independently prescribed and titrated fixed-dose amlodipine–hydrochlorothiazide using mobile decision support, while controls were referred to clinics. At 12 months, BP <140/90 mm Hg was achieved more often with CHW-led care (58%) than with facility referral (48%; adjusted OR 1.52). Safety profiles were similar, with no relevant differences in adverse outcomes between arms. The trial supports carefully protocolized task-shifting of first-line hypertension management to lay CHWs in remote, resource-limited settings. 2

Intensive BP control benefits CKM stages 2–4 in rural China

This post hoc analysis of 33,736 rural Chinese adults with CKM stages 2–4 compared intensive BP targets <130/80 vs usual care. Over about 3 years, intensive control reduced major adverse cardiovascular events across all CKM stages, with hazard ratios around 0.61–0.71 vs control. Benefits were consistent whether patients had metabolic risk factors alone, subclinical disease, or established cardiovascular disease. Safety outcomes, including hypotension, syncope, falls, and kidney events, were monitored, and benefit–harm analysis favored intensive control. The data support intensive BP management for high-risk multimorbid patients across the CKM spectrum when monitoring resources are available. 3

Remote monitoring lowers HF hospitalizations and mortality

Meta-analysis of 79 randomized trials with 31,669 heart failure patients compared remote monitoring to standard care. Remote monitoring reduced total HF hospitalizations (incidence rate ratio 0.81) and first HF hospitalizations (risk ratio 0.82). All-cause mortality was also lower with remote monitoring (risk ratio 0.90), with consistent effects across age, ejection fraction, NYHA class, and regions. Network meta-analysis ranked invasive hemodynamic monitoring best for reducing total HF hospitalizations. Structured telephone support ranked highest for reducing first HF hospitalizations and all-cause mortality, supporting broader telemonitoring adoption. 4