Dr. Birgit Vogel is a cardiologist and cardiovascular disease researcher. She is the Director of Academic Affairs at the Center for Interventional Cardiovascular Research and Clinical Trials at the Icahn School of Medicine at Mount Sinai, in the Fuster Heart Hospital.

Brigit Vogel, MD: Exploring Geographical Disparities in PAD Care Across US

A nationwide analysis of 2,376,300 Medicare beneficiaries with 

 revealed significant racial and geographic disparities in treatment, disproportionately affecting Black Americans.

Conducted between 2018 and 2022, this study, presented at the 

American Heart Association (AHA) Scientific Sessions 2024

, found that disparities in amputation rates varied widely across states, underscoring geographical differences in PAD treatment inequities.

“There was not any correlation between revascularization and the [Social Vulnerability Index (SVI)] index, but a modest correlation between major amputation rates and SVI. That suggests that the SVI reflects socioeconomic and demographic factors like poverty and minority status,” Birgit Vogel, MD, the director of academic affairs at the Center for Interventional Cardiovascular Research and Clinical Trials at the Icahn School of Medicine at Mount Sinai, told HCPLive. “We think that community-level risk could impact these patterns of major amputation.”

In the analysis, Black patients experienced markedly higher rates of major amputations compared to White patients in every U.S. state (3.0% vs. 0.9%; 

<0.001). Despite undergoing revascularization more frequently than White patients (8.4% vs. 7.0%; 

<0.001), Black patients additionally consistently faced greater risks of limb loss.

Further analysis revealed that county-level Social Vulnerability Index (SVI) scores—a measure of community-level risk factors—were more strongly correlated with amputation rates (rho 0.46, p<0.001) than revascularization rates (rho 0.10, 

<0.001). These data suggest the contribution of structural and community factors to the disproportionate burden of limb loss in Black patients.

Notably, Black patients were younger (75.8 years vs. 76.9 years; p<0.001), more likely to be female (54.7% vs. 47.8%; p<0.001), and had a higher prevalence of comorbidities compared to their White counterparts. These findings emphasize the urgent need for targeted interventions addressing racial and geographic disparities in PAD care, particularly focusing on preventive strategies and access to limb-preserving treatments in high-risk communities.

“By looking at regional differences and identifying areas that have the largest disparities, we could think about resource allocation and prioritize those areas to not only do research, but also when we are trialing public health initiatives, or even we could even think about health policy on a state level that might differ between certain areas,” Vogel told 

Disclosures: Vogel reports no relevant disclosures.

Vogel B, Dangas K, Di Muro FM, Sartori S, et al. Geographical variations of treatment disparities between Black and White patients with peripheral artery disease across the United States. Presented at the American Heart Association (AHA) Scientific Sessions 2024. Chicago, Illinois. November 16-18, 2024.

A comprehensive analysis of Medicare beneficiaries with peripheral artery disease (PAD) highlights significant racial and geographic disparities in treatment, particularly affecting Black Americans. Conducted from 2018 to 2022, the study reveals that Black patients face higher major amputation rates despite more frequent revascularization compared to White patients. The Social Vulnerability Index (SVI) correlates more with amputation rates than revascularization, indicating the influence of socioeconomic and demographic factors. The findings underscore the need for targeted interventions to address these disparities, focusing on preventive strategies and equitable access to limb-preserving treatments.

Birgit Vogel, MD discusses racial inequities and geographic variations in peripheral artery disease care in the United States.








Birgit Vogel, MD: Exploring Geographical Disparities in PAD Care Across US

Birgit Vogel, MD

Esther Kim, MD 

 As we come to a close on this discussion, I sincerely appreciate all 3 of you taking your time to talk about atopic dermatitis; you’re all seasoned, work in well-known clinics, and are definitely leaders among your peers. Do you have any pearls, hints, words of encouragement, or topics that you’d say make sure you discuss with your patients and teach colleagues without your wealth of experience? Whether you’re talking about triggers, hints for adherence, or talking about all the features and facts associated with the disease. Everybody pick something and tell me the one thing that you must say, to make sure that these youngsters who don’t know everything, I know that I could pass along to them. Matthew, what would be your thing that you would tell new PAs [physician assistants] or colleagues who haven’t seen as much atopic dermatitis as you have?

 I go back to the thing we learned when we were in our training: listen to your patient, they will tell you what’s wrong with them. Part of that is taking a good history, talk to them about their family, their personal history, things like asthma, hay fever, and sinus allergies. I always ask patients if pollen bothers them when the pollen season is bad. We have a terrible pollen season here in Georgia. I think those things help you. “Have other family members had rashes like you?” Talk to them about their experience. Sometimes the elderly patients have forgotten their history of childhood, but they’ll say, “I had a brother who had asthma.” Talking through those things and getting that history up front, that’s been the most valuable thing for me in terms of differentiating between a patient with atopic dermatitis and a patient who may just be having a single episode of eczema.

 My big thing is, we just talked about the future of 2023 and all these exciting things, to not be afraid to have a low threshold for topical therapy. Because we just spent an hour talking about how eczema is a systemic disease, so you wouldn’t treat diabetes with a topical, you would treat diabetes with an oral therapy. That’s how we look at psoriasis, and that’s how we’re going to start looking at eczema. If somebody is not responding well with topical therapy, we need to discuss and educate our patients and their parents on what else is out there because we don’t want these patients to suffer, and they truly do suffer. Itch and infection are horrible, and constant antibiotics, oral steroids, and topical steroids are not good for our patients, and long term we know that’s not good as well. We have many safe options in the biologic space and potentially in the oral space such that we are OK to have a low threshold on when it’s time to get to that next level.

 My pearl, first, for NP [nurse practitioner] or PA colleagues who are novices, is to get excited about treating atopic dermatitis. It may not be the new sexy disease on the page right now, but it is a very rewarding career to treat these patients and become the expert in your clinic for managing atopic dermatitis. Your ability to transform patients’ lives, treat these patients, and see them grow and thrive is extraordinary. Feel comfortable with this disease, become involved in your national societies, go to meetings where there are atopic dermatitis experts lecturing, and become comfortable in your algorithm and in your treatment plan. There are many resources available for you with up-to-date information so that you can become comfortable and an expert in managing atopic dermatitis.

My pearl for [working with] patients is to teach them that you are excited about treating them. When I walk in the room with a new patient with eczema or even psoriasis, I tell them how excited I am that they’re here and that I’m going to be their partner through this entire disease. Then I ask them this pivotal question, “What is it about this disease that is keeping you from finding joy in your life or living your best life? If you give me time and your trust, I’m going to help you find that joy. I’m in this with you and partnering with you to help you live the best life that you can.” I think those are 2 important things that patients want to hear from us as dermatology providers and for us to recognize within our patients, that this disease can be consequential for them and their happiness, and their ability to thrive in their lives.

 One thing I always think about that’s really important is to help them understand that it’s not their fault. There are triggers, we know it can be pollens, it can be animal dander. There are certain things that can trigger patients with atopic dermatitis that you might have some control over, but this is a disease. It’s a disease that involves a lot of components, a poorly functioning barrier, and an inappropriate cytokine response to triggers, but it is a disease. It’s not their fault, so they must understand that they’re not doing anything wrong.

For my colleagues, I would say practice evidence-based medicine, don’t get caught up in people saying, “But if I don’t eat this, or I use this CBD [cannabidiol] oil, or I use whatever, I’m a little better, or this helps.” They’re searching, and you have to say, “Look, here’s the deal, I know a little about that, but I can tell you what the science and the evidence say.” We’ve got excellent data now that explain what this disease is, what’s going wrong, and how these medicines are specific to try to treat it. So know your medicine. If you’re going to prescribe it, and diagnose and treat these patients, medicine is a wonderful thing, so make sure you really understand that.

Thank you for this insightful discussion and thank you to the audience for watching this 

 presentation with Alexa, Matthew, and Lakshi. I hope that you have learned something and that you will take this information to heart the next time you see a patient and you start thinking this child could have atopic dermatitis. As Alexa says, have a low threshold for moving along and getting them pediatric-approved therapies and get them going. You’re going to change some lives and be heroes to these patients, and really make a big difference. Thank you.

Alexa Hetzel, MA, PA-C; Lakshi Aldredge, MSN, ANP-BC, DCNP, and Matthew Brunner, PA, share practice pearls and clinical management tips for the care of pediatric patients with atopic dermatitis.

Practice Pearls for the Management of Atopic Dermatitis 

Lakshi Aldredge, MSN, ANP-BC, DCNP 

The complexity and heterogeneity of asthma reflects its wide range of potential triggers, clinical manifestations, and underlying drivers. Various disease pathways – spanning both innate and adaptive immunity – can serve as tributaries to the chronic inflammatory state at the core of the disease.

In many individuals with severe, uncontrolled asthma, pathogenic processes can overlap dynamically in ways that can change over time.

 This can makes it difficult to base clinical management decisions the apparent predominance of a specific inflammatory pathway and its constituent mediators.

 As a result, the estimated 1 million people in the U.S. contending with severe, uncontrolled asthma face ongoing challenges that can evolve into exacerbations, hospitalizations and consequent use of health care resources.

In recent years, new insights into the role of the airway epithelium in asthma have provided a framework for understanding how diverse and changeable inflammatory signals can converge to promote severe clinical disease. The significance of airway epithelium in asthma derives not only from the well-known structural damage it undergoes but from the proinflammatory signals it initiates.

As the first point of contact between potential asthma triggers and the lungs, the epithelium sits at the headwaters of multiple distinct inflammatory cascades. Whether the immediate trigger is a pathogen, allergen, or irritant, the epithelium can respond by releasing proinflammatory cytokines including IL-25, IL-33, and thymic stromal lymphopoietin (TSLP).

 First identified as a growth factor in the early 1990s, TSLP has more recently attracted considerable scientific interest because of its capacity to drive multiple downstream innate and adaptive immune responses.

TSLP Action Across Major Inflammatory Categories

Despite its vast phenotypic diversity, asthma can be categorized at a high level based on major patterns of inflammation. About two-thirds of individuals with severe asthma exhibit type 2 (T2) inflammatory patterns.

 T2 inflammation includes classic allergy, where antigen presentation to type 2 helper T (Th2) cells promotes the production of allergen-specific IgE antibodies, mast cell degranulation, and release of proinflammatory mediators.

T2 inflammation also encompasses nonallergic pathways that share key features with allergic inflammation. In lieu of antigen presentation and clonal selection of IgE-producing B cells, type 2 innate lymphoid cells (ILC2s) directly provide cytokine signals promoting recruitment and activation of eosinophils.

While a significant proportion of patients with severe asthma exhibit T2 inflammation, there remains a substantial portion of patients with severe asthma who exhibit a non-T2 inflammatory pattern, where target-tissue inflammation is primarily mediated by IL-17A, produced by Th17 cells. Eosinophils do not play a major role in non-T2 inflammation, although neutrophil proliferation may occur. Non-T2 inflammation is commonly associated with late-onset asthma.

, each of these broad inflammatory pathways can ladder back to the epithelial release of TSLP. A broad array of innate and adaptive immune cells – including dendritic cells, naïve and differentiated T cells, ILC2 cells, and mast cells – respond to TSLP via TSLP receptors. TSLP thus is capable of activating diverse downstream inflammatory cascades.

Regardless of the underlying inflammatory processes at play, airway narrowing through progressive tissue remodeling poses major challenges to asthma management that increase in urgency with disease severity.

Early research demonstrates a potential role of TSLP in airway remodeling. Fibroblasts and airway smooth muscle cells (ASMCs) both express TSLP receptors. TSLP has been shown in vitro to stimulate collagen production by fibroblasts and promote ASMC proliferation. ASMCs produce TSLP as well as respond to it; airway remodeling may be mediated in part through TSLP cross-talk between ASMCs and mast cells.

Multiple lines of evidence suggest a central role of TSLP in the pathogenesis of severe asthma, largely independent of inflammatory phenotype and biomarker patterns:

Airway TSLP is overexpressed in patients with asthma and increases with disease severity.

 Airway TSLP expression has been found to be higher in patients with asthma compared with healthy controls, and the elevated levels correlated significantly with asthma severity.

Airway TSLP expression correlates with reduced lung function.

 A study of 70 patients with asthma of varying severity found that airway TSLP concentrations were inversely correlated with FEV

TSLP may drive reduced corticosteroid responses.

 ILC2s obtained by bronchoalveolar lavage from patients with severe asthma showed a reduced in vitro response to dexamethasone after exposure to TSLP. Further, the reduced response to dexamethasone was greater in patients with higher airway TSLP expression.

Our increased understanding of the role of TSLP in asthma underscores the importance of the airway epithelium as the first point of contact with environmental stimuli. TSLP, a key epithelial cytokine produced in response to environmental triggers, can drive multiple downstream inflammatory pathways that may contribute to severe, uncontrolled asthma. Because TSLP sits at the top of these disparate inflammatory cascades, there is evidence that it plays a central role in the pathogenesis of severe asthma.

Global initiative for Asthma. Global strategy for asthma management and prevention, 2020. Available from: 

Roan F, Obata-Ninomiya K, Ziegler SF. Epithelial cell-derived cytokines: more than just signaling the alarm. 

Kupczyk M, Dahlen B, Sterk PJ et.al. Stability of phenotypes defined by physiological variables and biomarkers in adults with asthma. 

Busse WW. Biological treatments for severe asthma: a major advance in asthma care. 

Price D, Canonica GW. Biomarker relatability in the International Severe Asthma Network. 

Centers for Disease Control and Prevention. https://www.cdc.gov/asthma/most_recent_national_asthma_data.htm. 2021.

Chung KF, Wenzel SE, Brozek JL, et al. International ERS/ATS guidelines on definition, evaluation and treatment of severe asthma. 

Wang E, Wechsler ME, Tran TN, et al. Characterization of severe asthma worldwide: data from the International Severe Asthma Registry. 

Gauvreau GM, Sehmi R, Ambrose CS, Griffiths JM. 

Rochman Y, Leonard WJ. Thymic stromal lymphopoietin: a new cytokine in asthma. 

Peters MC, Mekonnen ZK, Yuan S, et al. Measures of gene expression in sputum cells can identify TH2-high and TH2-low subtypes of asthma. 

Bartemes KR, Kita H. Dynamic role of epithelial-derived cytokines in asthma. 

Li Y, Wang W, Lu Z et.al. Elevated expression of IL-33 and TSLP in the airways of human asthmatics In vivo: a potential biomarker of severe refractory disease. 

Liu S, Verma M, Michalec L, et al. Steroid resistance of airway type 2 innate lymphoid cells from patients with severe asthma: The role of thymic stromal lymphopoietin. 

Cao L, Liu F, Liu Y, et al. TSLP promotes asthmatic airway remodeling via p38-STAT3 signaling pathway in human lung fibroblast. 

Ko HK, Cheng SL, Lin CH, et al. Blood tryptase and thymic stromal lymphopoietin levels predict the risk of exacerbation in severe asthma. 

Ying S, O'Connor B, Ratoff J, et al. Thymic stromal lymphopoietin expression is increased in asthmatic airways and correlates with expression of Th2-attracting chemokines and disease severity. 

The Proinflammatory Role of Epithelial TSLP in Severe Asthma 

Nestor Molfino, Executive Medical Director and Global Development Lead, Amgen

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Panelists discuss how lifestyle interventions, including diet, physical activity, and smoking cessation, complement pharmacotherapy in the management of dyslipidemia, and explore unmet needs in cardiovascular risk reduction, highlighting the role of emerging therapies such as bempedoic acid, inclisiran, and gene editing technologies.

Navigating Lifestyle and Pharmacotherapy Interventions in Dyslipidemia Management  

Pam R. Taub, MD, FACC, FASPC  

Parissa Tabrizian, MD, MSc, is a surgeon who specializes in hepatobiliary and liver transplantation at the Recanati/Miller Transplantation Institute and an associate professor of surgery at Mount Sinai School of Medicine.

Pretransplant Immunotherapy for Hepatocellular Carcinoma, with Parissa Tabrizian, MD

Immunotherapy has reshaped the treatment of 

, offering survival benefits once thought unattainable. While its success in advanced disease is well established, its potential in surgical and transplant settings remains a subject of debate.

The use of immunotherapy before liver transplantation presents both promise and risk, raising hopes for improved outcomes while also sparking concerns about immune-mediated rejection. With limited long-term data and no formal guidelines supporting its use in this setting, ongoing research is necessary to determine which patients may benefit, how to mitigate risks, and whether this approach could become a viable strategy for bridging patients to transplant.

“The role of immunotherapy in surgery and in the neoadjuvant setting really started with the experience that we had with resection cases,” Parissa Tabrizian, MD, MSc, a surgeon who specializes in hepatobiliary and liver transplantation at the Recanati/Miller Transplantation Institute and an associate professor of surgery at Mount Sinai School of Medicine, explained to 

. “As a high-volume center here at Sinai and many others, we explored the use of the neoadjuvant therapy in resectable HCC cases and we've shown excellent outcomes in a small group of patients.”

However, she notes current guidelines do not support the use of pretransplant immunotherapy, and she says this is “rightfully so” due to concerns about immune-mediated rejection, adverse events, and a lack of positive long-term data.

Tabrizian cites key studies in the field, including a large retrospective study from China and a meta-analysis showing that shorter washout periods correlate with higher rejection rates. Her own multi-center study, the VITALITY study, demonstrated the feasibility of immunotherapy in 117 consecutive patients with HCC assessed for liver transplantation and treated preoperatively with immune checkpoint inhibitors, reporting no severe adverse effects and promising survival outcomes.

“Unfortunately, we have a lot of unanswered questions because we don't do not have robust data or level one evidence,” Tabrizian said.

Specifically, she outlines lingering unanswered questions about optimal patient selection, the best timing for discontinuation before transplant, and the management of immunosuppression post-transplant, although she suggests that patients at high risk of disease progression or those with long waitlist times may benefit most from a neoadjuvant approach.

While preliminary data is encouraging, Tabrizian stresses that more research is necessary to define the role of immunotherapy in transplantation and ensure its safe integration into clinical practice.

Editors’ note: Tabrizian has relevant disclosures with Boston Scientific and AstaZeneca.

Tabrizian P, Abdelrahim M, Schwartz M, et al. Immunotherapy and transplantation for hepatocellular carcinoma. Journal of Hepatology. doi:

Tabrizian P, Holzner ML, Ajmera V, et al. Intention-to-treat outcomes of patients with hepatocellular carcinoma receiving immunotherapy before liver transplant: The multicenter VITALITY study. Journal of Hepatology. doi:

Tabrizian discusses neoadjuvant immunotherapy for HCC, describing its success in the adjuvant setting but uncertainties about its use before transplant.

Parissa Tabrizian, MD, MSc

panel discussion on a head-to-head sequence study of rizankizumab vs ustekinumab in the treatment of CD, as well as approaches to choosing first-line treatment.

Sequence Study of Risankizumab vs Ustekinumab in CD

This is a video synopsis/summary of a panel discussion involving Marla Dubinsky, MD; David Rubin, MD; Miguel Regueiro, MD; Remo Panaccione, MD, FRCPC; and Sara Horst, MD, MPH.

The transcript discusses the findings of the sequence study, focusing on the comparison between two drugs, P41 (referred to as risankizumab) and P19 (referred to as IL (interleukin)-23 therapy). The study aimed to evaluate the efficacy of risankizumab in patients with Crohn's disease who had been exposed to TNF.

The results indicate that risankizumab-exposed patients were more likely to achieve clinical response, clinical remission, and endoscopic improvement compared to those on P40 (risankizumab with IL-12 and IL-23). The transcript emphasizes that the head-to-head comparison provides valuable insights, guiding clinicians in choosing the most effective therapy.

It highlights that risankizumab, along with its biosimilar, is an approved and effective option for Crohn's disease. The discussion touches upon the significance of the sequence study's second primary endpoint, endoscopic remission, and how it could be a pivotal moment in the field.

The conversation also touches on the evolution of clinical trials in Crohn's disease, emphasizing the importance of endoscopic outcomes and the progression from subjective measures to objective proof of efficacy. The participants express optimism about the potential impact of risankizumab, especially when used as a first-line therapy.

Furthermore, the transcript discusses the importance of early intervention in Crohn's disease, suggesting that initiating treatment early is more likely to result in a positive response and prevent further damage. The participants encourage setting higher expectations for patients and discuss the advantages of using risankizumab in biologic treatment-naive patients.

In conclusion, the discussion underscores the positive findings from the sequence study, positioning risankizumab as a promising option for Crohn's disease, particularly in terms of achieving endoscopic remission and improving patient outcomes. The participants stress the need for effective communication with patients about treatment options and the potential long-term benefits of early intervention.

Video synopsis is AI-generated and reviewed by HCPLive editorial staff.

David Rubin, MD, leads the panel discussion on a head-to-head sequence study of rizankizumab vs ustekinumab in the treatment of CD, as well as approaches to choosing first-line treatment.

Remo Panaccione, MD, FRCPC

Older adults often need to manage multiple medications to treat different conditions, but the pharmacological mix can have negative interactions that cause unintentional harm. For this reason, many clinicians who care for older patients engage in the process of deprescribing—identifying and discontinuing medications that cause more harm than benefit.

Deprescribing begins with a conversation between the clinician and patient, but this step has proven to be a daunting obstacle for both sides engaged in the dialogue. That’s because the patient doesn’t always understand the benefit of stopping certain medications, while the clinician may not fully appreciate the patient’s treatment preferences.

To develop a framework to improve the deprescribing conversation across healthcare and community organizations, 

, MD, Humana Foundation Professor of Medicine at Yale School of Medicine, led a multi-institutional, international Communications Working Group composed of 14 experts in geriatrics, pharmacology, and communication, along with community outreach stakeholders who conducted a literature search of deprescribing articles published over the past two decades. The results, which included recommendations for improvements, were recently published in the 

“More is not always better,” said Fried. “We have to recognize that when we add on medications to treat multiple chronic conditions, inevitably there is a tipping point where having more is associated with greater risks.”

Prescribing guidelines may not benefit older adults

Currently, clinicians follow clinical practice guidelines, typically written by professional medical organizations, when providing care, but this approach may be counterproductive for older adults. Fried points to high blood pressure medications as an example. The medication can lower a patient’s blood pressure to a target range, but it could also make the individual vulnerable to dizzy spells and falls.

“In many ways, deprescribing is going against years and years of effort to promote appropriate prescribing,” said Fried. “Physicians can follow clinical practice guidelines that make it easy to prescribe the correct medications for, say, diabetes or high blood pressure, but following these guidelines can sometimes cause more harm than good. When older persons with multiple conditions are prescribed all of the individual medications included in the different guidelines, these medications can interact with one another, side effects can begin to accumulate, and a medication prescribed to help one condition may worsen another. Medications need to be prioritized depending upon the outcomes that matter most to the patient.”

A new communication framework for prescribing practices takes form

The working group conducted a review of articles, published over the past two decades, that explored different approaches to deprescribing—a term that was introduced in an article published in 2003 in the 

Journal of Pharmacy Practice and Research

 describing the principles and practice of removing unnecessary or inappropriate medications and avoiding polypharmacy.

From the 78 papers identified, the Communications Working Group determined that most interventions consist of a clinician being alerted to a potential problem with the patient’s medication but does not provide guidance to the clinician about how to communicate with the patient. Moreover, these interventions do not consider the larger context in which a patient’s view of medications is shaped.

To improve this effort, the team developed a framework that expands the sphere of influence for this important decision-making process. The framework consists of “nested spheres,” in which the innermost sphere is the traditional doctor–patient office visit. Each additional sphere captures opportunities to initiate and continue the deprescribing conversation across the greater healthcare system as well as at different community interactions. This framework allows for input from additional practitioners, including nurses and other specialists, and community partners, such as pharmacists, faith-based groups, and other community-focused organizations.

“Broadening the spheres in which communication about deprescribing occurs can help to normalize the process, address concerns that deprescribing is somehow related to rationing, and help to counteract the prevailing messaging around medications that ‘more is better,’” said Fried.

The literature review is limited by the content that has been published, which only addresses the patients’ priorities and views concerning the benefits and risks of their current medication regimen. While the proposed framework offers a new approach that incorporates shared decision-making, Fried acknowledges that more studies are needed to explore how the deprescribing conversation unfolds during an office visit. These studies could evaluate communication content and style to advance this conversation, especially addressing sensitivities among a more diverse patient population.

“Our community partners helped us remember the bigger world beyond the individual patient and clinician, and reminded us of the need to build trust in the patient–clinician relationship,” said Fried. “Our insights will benefit the next generation of interventions that will be designed for deprescribing.”

Fried and her team received funding from the National Health and Medical Research Council and the National Institute on Aging.

Deprescribing in older adults is crucial to mitigate negative drug interactions, yet challenging due to communication barriers between clinicians and patients. A multi-institutional team led by Dr. Terri Fried developed a framework to enhance deprescribing conversations, emphasizing shared decision-making and broader community involvement. Current prescribing guidelines may not suit older adults, as they can lead to harmful polypharmacy. The new framework involves "nested spheres" to facilitate deprescribing discussions beyond traditional doctor-patient interactions, involving various healthcare and community stakeholders. Further studies are needed to refine communication strategies.

Most deprescribing interventions consist of a clinician being alerted to a potential problem with the patient’s medication but does not provide guidance to the clinician about how to communicate with the patient.

When Drugs Cause More Harm Than Good for Older Adults

Stacy Kish

Moving Beyond the Joint: The Interplay Between Gout and Kidney Disease

Nehad Soloman, MD, FACR; Andrew Sharobeem, DO, FACR, and Sunil Patel, MD, explore the nephrologist's vital role in gout diagnosis, treatment options for gout patients with chronic kidney disease, and strategies for managing refractory gout and its associated challenges.

Moving Beyond the Joint: The Interplay Between Gout and Kidney Disease 

Sunil Patel, MD  

Louis discussed the ASKmeGOC study and an electronic tool to help facilitate patient preference documentation.

Centering Patient Autonomy in Hospital Care for Older Adults, with Valerie Louis

Hospitalized older adults are often not asked about their goals of care until a health crisis occurs—if at all. In the absence of documented preferences, the default is to initiate full resuscitative measures, which may not align with patient values or best interests.

Valerie Louis, a medical student at Northern Ontario School of Medicine University in Canada, is working on addressing this unmet need and empowering elderly patients in their care with the AKmeGOC (goals of care) study. She presented an overview of the study and the electronic tool she and her colleagues developed that documented elderly patients’ preferences and goals for their care before a health crisis at the American College of Physicians (ACP) Internal Medicine (IM) Meeting 2025, held April 3-5, in New Orleans, Louisiana.

caught up with Louis during the meeting to learn more.

Louis and colleagues found that after using the tool and having conversations with elderly patients about their care, the proportion of patients who had no preferences documented in their charts dropped from 25% to 4% in the intervention group. Furthermore, the number of ICU days dropped by 30% for patients who got the conversation, and the number of ventilator days dropped by 60%.

“The 2 big things we’re working on are… letting patients have their own autonomy in decision making, it's their care, they should be the ones making the decisions; and reducing low value care, so reducing care that isn't actually beneficial for them. By scaling up this tool and expanding also to primary care offices or long-term care homes as well… are all things that we're working on expanding,” Louis told 

Louis V. Assessment of Shared Decision-making Tool for Eliciting Informed Goals of Care in the Hospitalized Elderly: A Randomized Trial (ASKmeGOC Study). Presented at: ACP IM Meeting 2025; April 3-5; New Orleans, Louisiana.

Authors