Internal Medicine — Weekly Evidence Brief

Polypharmacy composition, particularly a dominance of symptomatic treatments, significantly impacts adverse outcomes like mortality, hospitalization, and fractures in older adults, with effects varying by frailty status 1. This finding highlights the need for targeted medication reviews beyond just the number of drugs, especially given concerns about appropriate prescribing, such as for antipsychotics in older adults 2. Re-evaluating combination therapies in cardiovascular care is also critical; adding aspirin to oral anticoagulant therapy in patients with chronic coronary syndrome and high atherothrombotic risk actually increased adverse cardiovascular events over two years 3. Similarly, for acute coronary syndrome, P2Y12 inhibitor monotherapy soon after PCI was found to be not noninferior to DAPT for preventing death or ischemic events 4.

Nuance is essential in applying beta-blocker therapy post-myocardial infarction (MI). While one study demonstrated no reduction in composite adverse outcomes over 3.7 years for MI patients with LVEF >40% after invasive care 5, another found that beta-blocker therapy did reduce a composite adverse outcome over 3.5 years in adults with MI and LVEF ">=\"40% 6. These findings underscore the ongoing complexity in defining optimal patient subgroups for specific therapies. Beyond medication, eHealth-based cardiovascular disease (CVD) risk communication offers a scalable prevention strategy, significantly improving systolic blood pressure, LDL levels, physical activity, and smoking cessation, alongside increased disease awareness and quality of life 7. Meanwhile, cardiac rehabilitation shows sustained behavioral benefits post-program, but clinical measures like weight, blood pressure, and depression often revert, indicating a need for innovative, long-term strategies like digital technology for sustained impact 8.

The concept of "risk stacking" is crucial for public health, as multimorbidity across multiple non-immunocompromising high-risk conditions—such as hypertension, obesity, and diabetes—significantly increases COVID-19 healthcare utilization across all age groups, including younger adults 9. This expands the definition of high-risk beyond traditional categories for public health strategies. Beyond managing specific conditions, integrating social support into care is vital. Social worker navigation has proven effective in helping vulnerable Veteran subgroups, particularly those with low income or multiple comorbidities, connect to essential resources for their social needs 10.

Leveraging technology and targeted interventions can significantly improve patient outcomes. An EHR-linked best practice alert successfully increased the assessment rates of HbA1c and LDL-C in hemorrhagic stroke patients, although it did not immediately translate to improved treatment intensification for abnormal findings 11. This highlights technology's role in enhancing diagnostics but also points to continued gaps in translating assessment into action. Additionally, simple primary care-based interventions can yield substantial benefits, such as a fall prevention program that significantly reduced self-reported falls in older adults living in rural China 12. For older adults post-traumatic brain injury, while long-term readmission rates might be lower than expected, the first year post-hospitalization remains a critical period for targeted interventions and follow-up to prevent adverse events 13.