Letter from the Editor

This month's issue discusses implantation of endovascular therapy in stroke, reversal agents for the direct oral anticoagulants, antibiotics at the end of life, and more.

The challenge of getting new discoveries from the bench to the bedside is a focus for us this month. It was just about a year ago that stroke researchers first reported definitive improvements in stroke patients who receive endovascular therapy. Now, as our cover story describes, hospitals are working out how to bring those benefits to their patients—by developing protocols, setting up transfer systems, and even hiring new physicians. Implementing the new systems may be time- and cost-intensive, but the change holds great potential rewards, including altering patient outcomes from “totally dependent or bedridden to walking and looking after themselves,” as 1 expert put it.

A successful trial and then FDA approval of idarucizumab, the reversal agent for dabigatran, also generated excitement last year. But in response to this innovation, those in the know recommend calm rather than a rush to implementation. In our story, anticoagulation experts explain that although the drug is effective, its application is narrow and the potential clinical benefits are relatively limited. The most significant impact of this drug, and the similar antidotes expected to follow, may actually be psychological—making physicians and patients more willing to use direct oral anticoagulants.

Psychology may be driving some prescriptions for antibiotics at the end of life, too. Our article describes the factors to consider and conversations to have when deciding how to treat suspected infection in a terminally ill patient. Careful thought should also be applied to prescribing decisions for heart failure patients, reminds our article. Hospitalization presents an opportunity to get patients' medication regimens in accordance with guidelines, but cardiologists debate the benefits and risks of adding multiple new drugs during a short inpatient stay. This issue also includes a Test Yourself section on heart failure.

In other regular features, this month's Q&A discusses hospitalists' role in ICU care, and our Success Story offers a solution to the common problem of depression during residency.

Stacey Butterfield
Editor-in-Chief, ACP Hospitalist