American College of Physicians, April 27-29

The annual meeting of the American College of Physicians was held April 27 to 29 in San Diego and attracted participants from around the world, including internists, adult medicine specialists, subspecialists, medical students, and allied health professionals. The conference highlighted recent advances in the prevention, detection, and treatment of illnesses in adults, with presentations focusing primarily on updates in neurology, oncology, infectious diseases, endocrinology, and cardiology.

During one presentation, Michael S. Emery, M.D., of the Cleveland Clinic Lerner College of Medicine at Case Western Reserve University, discussed cardiovascular screening for athlete participation in sports.

Emery noted that sport is not a cause of enhanced mortality, but it can trigger sudden death in athletes who are affected by cardiovascular conditions predisposing to them to life-threatening ventricular arrhythmias during physical exercise. Guidelines for participation in sports with cardiovascular disease serve as a framework to discuss return to play and risk, but not as a mandate.

"Shared decision-making shifts away from the paternalistic and binary process of sports disqualification, involving equal participation from the athlete and other key stakeholders in the shared risk decisions to either proceed with sports participation or not," Emery said.

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During another presentation, David B. Reuben, M.D., of the University of California in Los Angeles, offered insight into managing older adults with frailty and multimorbidity.

Reuben discussed four syndromes, including frailty, multiple chronic conditions/multimorbidity, sarcopenia, and cachexia, which can affect prognosis and are often difficult to distinguish clinically. There are many instruments used to measure frailty, which falls into two general categories: physical/phenotypic frailty and deficit accumulation frailty. The former relies on signs and symptoms and the latter usually includes diagnoses/conditions, functional deficits, and lab values. Electronic health record data can be mined to determine deficit accumulation frailty. Reuben noted that the best evidence for preventing and treating frailty includes nonspecific treatments (i.e., physical exercise and nutritional supplementation) that may benefit any of the four syndromes.

"For many frail older patients, it is appropriate to switch from disease-based care to patient goal-directed care that can span medical conditions and focus on what matters to the patient," Reuben said. "If a patient looks frail, exclude treatable causes (e.g., cancer, malnutrition) and, if none are found, treat with exercise and nutrition supplementation."

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Sarah Starling Crossan, a regulatory affairs associate at the American College of Physicians in Washington, D.C., discussed a policy paper developed by the College, through the Council of Subspecialty Societies, that provides recommendations for improving care coordination and care transitions of patients moving from one health care setting to another.

Crossan noted that suboptimal care transitions have significant health implications and financial costs. Optimal care transitions improve health outcomes and reduce costs to the health care system by decreasing hospital readmissions and other health complications. She noted it is important to recognize that optimal care transitions take adequate reimbursement, community resources, and patient-centered care plans.

"Implications on clinical practice can include a strengthened patient-physician relationship, long-term physician burden reduction, improved patient outcomes, and care coordination," Crossan said.

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