AZense Journal Club

HORIZON proved that annual intravenous zoledronic acid after a hip fracture reduces new clinical fractures and all-cause mortality. What it did not test is timing. No randomized trial has ever compared in-hospital dosing against delayed outpatient dosing, but a 2024 target trial emulation and the 2023 Five Nations Consensus both support giving the infusion before discharge - because for most of these patients the hospitalization is the only treatment opportunity anyone gets.

Saline is not physiologic, but the outcome differences are small and context-dependent. SALT-ED and SMART favor balanced crystalloids by about one percentage point on kidney events, BaSICS and PLUS are neutral for mortality, the BEST-Living pooled analysis suggests probable rather than proven benefit with possible harm in traumatic brain injury, and WATERFALL shows that in pancreatitis the strategy matters more than the bag. A 2025 meta-analysis of five small trials supports lactated Ringer's over saline in acute pancreatitis, and the WATERLAND trial is the ongoing head-to-head that should answer the fluid question directly.

A 2026 wave of trials moves finerenone from a diabetic-kidney drug toward a broad cardiorenal agent. FIND-CKD is the first Phase 3 win in non-diabetic CKD, but the glomerular subgroup, the INFINITY pooled analysis, and CONFIDENCE are exploratory or surrogate-based, and hyperkalemia remains the constant caveat.

A triple GIP, GLP-1, and glucagon agonist with striking phase 2 and phase 3 signals — and a real hospitalist problem when patients obtain unapproved products outside trials.

Suzetrigine (Journavx) is the first genuinely new pharmacologic class of pain medicine since the COX-2 inhibitors. It beat placebo and carries no addiction liability, but it did not outperform a generic opioid on pain, and its chronic-pain data remain unproven.

The LRINEC score looked near-perfect in 2004, but twenty years of external validation show it misses roughly one in three necrotizing soft tissue infections. Why a low score must never defer surgical consultation.

After the positive CAPE COD trial and the messy, neutral REMAP-CAP result, does hydrocortisone still reduce mortality and mechanical ventilation in severe CAP, and in whom?

After the neutral CLEAR-SYNERGY trial, does low-dose colchicine still have a role in chronic coronary disease and after acute coronary syndrome?

In prior-MI patients with an ICD and ventricular tachycardia who have not failed drug therapy, is first-line catheter ablation better than antiarrhythmic drugs?

In truly asymptomatic severe aortic stenosis with preserved ejection fraction, does early transcatheter aortic valve replacement beat watchful waiting?

In intermediate-high risk pulmonary embolism, is large-bore mechanical thrombectomy superior to catheter-directed thrombolysis for preventing deterioration and bleeding?

In non-intubated ICU patients with hyperactive delirium, does dexmedetomidine shorten delirium duration compared with placebo, without the respiratory depression of standard sedatives?

Can an AI early warning system built from nursing surveillance documentation improve hospital ward outcomes, or does it just create more alerts?

In adults with newly reduced LVEF from non-ischaemic cardiomyopathy or recent myocardial infarction on contemporary 4-pillar GDMT, what is the rate of life-threatening ventricular arrhythmias captured by a wearable cardioverter-defibrillator during the early high-risk window before permanent ICD candidacy is established?

In adults at increased risk of acute kidney injury after major noncardiac surgery, does urinary biomarker-triggered application of the Kidney Disease Improving Global Outcomes (KDIGO) acute kidney injury bundle reduce moderate to severe acute kidney injury?

Do patients of female physicians have different mortality and readmission rates compared to patients of male physicians?

In opioid-naive adults undergoing major noncardiac surgery, does routine perioperative gabapentin or pregabalin reduce opioid use and pain without unacceptable harms?

Is tirzepatide non-inferior to dulaglutide for MACE prevention in T2DM with established CVD?

Does targeting albumin infusions to maintain levels >=30 g/L reduce complications in hospitalized cirrhosis patients?

Does early diagnostic paracentesis (within 12-24h of admission) improve outcomes in hospitalized cirrhosis patients with ascites?

For intermediate-risk PE with RV dysfunction, when should advanced therapy (CDT or thrombectomy) be used?

Does surgical LAA occlusion during cardiac surgery reduce stroke in AF patients?

In hospitalized adults with complicated Staphylococcus aureus bacteremia who cleared blood cultures after 72 hours to 10 days of intravenous therapy, can two weekly dalbavancin doses complete therapy compared with 4 to 8 weeks of standard intravenous therapy?

Does piperacillin-tazobactam increase AKI compared to cefepime? Does either antibiotic cause more neurotoxicity?

Is early transition to oral antibiotics safer and equally effective compared to continued IV therapy for serious infections?

Is rapid correction of severe hyponatremia associated with worse outcomes (ODS) or better outcomes (lower mortality)?

Does empagliflozin reduce CKD progression in a broad population including non-diabetic patients?

Does indication-based conservative dialysis improve kidney recovery vs scheduled thrice-weekly dialysis in AKI?

Does phenotype-guided immunotherapy (anakinra for MALS, interferon-gamma for immunoparalysis) improve sepsis outcomes?

In AECOPD with hypercapnic respiratory failure, is HFNC or NIV the better initial respiratory support?

Does IV hydrocortisone reduce mortality in ICU-admitted patients with severe CAP?

In adults with established cardiovascular disease and obesity but no diabetes, weekly semaglutide reduced major adverse cardiovascular events by 20%. Here is what hospitalists need to know.

Is IV cangrelor superior to crushed ticagrelor for antiplatelet effect and clinical outcomes in STEMI with cardiogenic shock?

Is personalized DAPT duration (using DAPT score) better than standard 12-month DAPT after PCI?

Does digitoxin reduce death or HF hospitalization in patients with HFrEF on guideline therapy?

Does the survival benefit of Impella CP in STEMI shock persist over 10 years?

In arrhythmia-free patients after catheter ablation for AF, is stopping oral anticoagulation safe compared to continuing?

Two large 2025 studies push carvedilol to the front of the formulary for portal hypertension. Here is what the evidence says, where the guidelines stand, and how to translate this at discharge.

Does ultrasound-facilitated catheter-directed fibrinolysis reduce decompensation in intermediate-risk pulmonary embolism?

Can daily procalcitonin-guided decision-making safely shorten antibiotic duration in ICU sepsis compared to standard care?

Does rapid up-titration of all four GDMT pillars starting before discharge reduce 180-day HF readmission or death?

Is routine antibiotic prophylaxis for 5 to 7 days actually necessary for cirrhosis patients presenting with upper GI bleeding?

Does semaglutide improve symptoms, function, and weight in patients with obesity-related HFpEF?

Does a structured, multifaceted algorithm for correcting chronic hyponatremia reduce mortality and rehospitalization in hospitalized patients?

What hemoglobin threshold should trigger a transfusion in a patient with acute MI and anemia?

Does infusing piperacillin-tazobactam or meropenem as a continuous drip improve 90-day survival compared to standard intermittent dosing in ICU sepsis?

Can we safely switch low-risk Staph aureus bacteremia patients to oral antibiotics after 5 to 7 days of IV therapy?

Should SGLT2 inhibitors be started during a heart failure hospitalization rather than waiting until after discharge?

Does empagliflozin started early after high-risk acute MI prevent heart failure hospitalization or death?

DISTAL and ESCAPE-MeVO: No Benefit (and Possible Harm) from EVT in Medium-Vessel Stroke