Internal Medicine

Intensive oseltamivir prophylaxis in nursing homes reduces short-term hospitalizations

Among 29,683 residents in 404 US nursing home influenza outbreaks, intensive oseltamivir prophylaxis (≥70% within 2 days) lowered 14-day hospitalization risk. Intensive prophylaxis reduced 14-day hospitalizations by about 1% absolute (risk ratio 0.79; 95% CI, 0.64-0.96). There was no significant difference in 14-day or 30-day all-cause mortality between intensive and nonintensive prophylaxis strategies. Benefits in hospitalization persisted at 30 days but with wider confidence intervals. 1

Targeting SBP <120 mm Hg is feasible in high-risk hypertensive patients

The ESPRIT trial enrolled 11,255 high-risk hypertensive adults and implemented an intensive systolic BP target <120 mm Hg in routine-like care. Median achieved SBP in the intensive arm was 117 mm Hg, and 62.5% attained intensive control. Median time to intensive control was 62 days, longer for patients with higher baseline SBP, obesity, or diabetes. At one year, medication burden averaged 3.3 drugs in the intensive arm versus 2.0 in the standard arm, with about 1.5 extra clinic visits initially. 2

Higher vigorous-intensity activity fraction independently lowers chronic disease and mortality risk

In 96,408 UK Biobank participants with device-measured activity, higher vigorous physical activity proportion (%VPA) was linked to lower risk of eight chronic diseases and mortality. Inverse dose-response associations between %VPA and outcomes persisted after adjusting for total activity volume and across activity-volume strata. Compared with 0% VPA, >4% VPA was associated with 29%–61% lower risk of major cardiovascular events, diabetes, several chronic diseases, and death. Intensity contributed more than volume to prevention for immune-mediated inflammatory disease, cardiovascular events, chronic respiratory disease, and dementia. 3

Few patients with incident HFrEF reach quadruple GDMT, and it is delayed

In a VHA cohort of 52,850 incident HFrEF patients, only 21.2% achieved quadruple therapy during approximately three years of follow-up. Quadruple therapy required concurrent use of an evidence-based β-blocker, renin-angiotensin inhibitor, MRA, and SGLT2 inhibitor by pharmacy data. Median time to quadruple therapy was 197 days (IQR, 49-528), indicating prolonged delays in full regimen implementation. After adjustment, Black and Hispanic veterans more often reached quadruple therapy than White veterans, while prescription copays modestly reduced achievement. 4