Eugene S. Chu

Background Acute heart failure (AHF) exacerbations are a leading cause of hospitalization in the United States. Despite the frequency of AHF hospitalizations, there are inadequate data or practice guidelines on how quickly diuresis should be achieved. Objective To study the association of 48‐h net fluid change and (A) 72‐h change in creatinine and (B) 72‐h change in dyspnea among patients with acute heart failure. Designs, Settings, and Participants This is a retrospective, pooled cohort analysis of patients from the DOSE, ROSE, and ATHENA‐HF trials. Interventions The primary exposure was 48‐h net fluid status. Main Outcomes and Measures The co‐primary outcomes were 72‐h change in creatinine and 72‐h change in dyspnea. The secondary outcome was risk of 60‐day mortality or rehospitalization. Results Eight hundred and seven patients were included. The mean 48‐h net fluid status was −2.9 L. A nonlinear association was observed with net fluid status and creatinine change, such that creatinine improved with each liter net negative up to 3.5 L (−0.03 mg/dL per liter negative [95% confidence interval [CI]: −0.06 to −0.01) and remained stable beyond 3.5 L (−0.01 [95% CI: −0.02 to 0.001], p = .17). Net fluid loss was associated with a monotonic improvement of dyspnea (1.4‐point improvement per liter negative [95% CI: 0.7–2.2], p = .0002). Each liter net negative by 48 h was also associated with 12% decreased odds of 60‐day rehospitalization or death (odds ratio: 0.88; 95% CI: 0.82–0.95; p = .002). Conclusion Aggressive net fluid targets within the first 48 h are associated with effective relief of patient self‐reported dyspnea and improved long‐term outcomes without adversely affecting renal function.

Background Hospitalists who seek academic careers are interested in developing skills in research, education, and quality improvement (QI). Since these are not major foci of residency programs, hospitalists may pursue a hospital medicine fellowship to acquire these skill sets. Objective We sought to characterize the current state of hospital medicine fellowships in the United States, including demographics, clinical requirements, curricular focus, financial structure, and scholarly outputs. Designs, Settings, and Participants This was a cross‐sectional study of 32 hospital medicine fellowship programs across the United States in 2020–2021. An electronic survey was emailed to program leaders. Results Out of 32 eligible programs contacted, 19 (59.4%) programs responded, representing 22 fellowship tracks. Most (63.2%) programs have been in existence for 5 years or less. Fourteen (63.6%) of the tracks had multiple focus areas, while 8 (36.4%) had a single focus. Of the 14 fellowship tracks with multiple focus areas, 6 (42.8%) reported research, QI and medical education as curricular elements. All 14 reported research as one of the curricular elements. The majority (68.4%) of programs offered opportunities to obtain a master's degree, though the field of degree varied widely. A median of 50% (IQR 0) of fellows' time was spent in clinical activities. Considerable heterogeneity exists among adult hospital medicine fellowship programs. The majority focus on research, QI, and/or medical education. Hospital medicine fellowships offer opportunities for intesive faculty development and unique career pathways.