News in brief: Prestigious award for Prof Stephen Nicholls; Lower INR targets for Asian patients; Hospital-acquired complications may not be so preventable

Prestigious award for Prof Stephen Nicholls

Professor Stephen Nicholls of Monash University has been jointly awarded the RACP’s 2021 Eric Susman Prize for outstanding contributions to the knowledge of internal medicine.

According to the RACP, the award recognises Professor Nicholls’ contribution to the field of preventative cardiology, including work on novel vascular imaging, understanding the factors that promote plaque formation, and leadership of large-scale clinical trials of new therapies.

He shares the award with Professor Flavia Cicuttini, Head of Rheumatology, Alfred Hospital and Head of Musculoskeletal Unit from the School of Public Health and Preventive Medicine.

Professor Nicholls is the inaugural Director of the Victorian Heart Institute, Director (clinical) at MonashHeart and will be the inaugural Clinical Director of the Victorian Heart Hospital when it opens in late 2022.

He said he was humbled to share the recognition with another Monash researcher.

“This award reflects the culmination of a lot of work by many people.The collaborative nature of what we do means that it really does take a village to deliver academic and clinical excellence. I’m grateful to have worked with a number of teams and individuals whose dedication and expertise has contributed to our success in this space,” he said.

Lower INR targets for Asian patients

Asian patients may have improved outcomes with INR targets lower than those recommended in current evidence-based guidelines, a study has found.

With warfarin still the preferred anticoagulant for mechanical heart valve procedures, clinicians in Taiwan noted that the rate of thromboembolic events at INRs between 2.0 and 2.5 was not significantly higher than at INRs between 2.5 and 3.0 for mitral valve replacement procedures. In patients having aortic valve replacement, the incidence of thromboembolic events among patients with INRs in 1.5 to 2.0 range was not significantly higher than that among those with INRs in the 2.0 to 2.5 range, the results published in JAMA Network Open showed.

The study authors said these data and other studies suggested that a lower INR target for Asian patients compared with current Western guidelines could decrease bleeding events without increasing thromboembolism risk.

Hospital-acquired complications may not be so preventable

Complications are common in hospitalised patients but rates are driven more by patient factors rather than hospital care quality factors that can be modified, new Australian research shows.

A review of 1.5 million admissions at 38 major public hospitals in South Australia and Victoria between 2015–2018 found that almost one in ten patients (9.7%) had a complication episode.

However the variations between hospitals were determined mostly by patient factors (overall correlation coefficient 0.55) whereas hospital factors accounted for only 5% of the variation.

The findings have important implications for the interpretation of hospital‐acquired complication reports and implementation of mitigation programs, the study authors said.

“Failure to differentiate between the two groups of factors may lead to practice changes that are clinically sound but ineffective in reducing complication rates. Increasing the funding of health care, improved clinical guidelines, and training and education may reduce rates of complications attributable to hospital factors and health care errors, but are unlikely to reduce those linked with patient‐related factors,” they wrote in the MJA.

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