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With Special Guest Dr. Emily Reams

In this special episode of Inpatient Update, Dr. Mason Turner is joined by hospitalist Dr. Emily Reams to break down the most practice-changing takeaways from SHM Converge 2026.

No fluff — just what you can start doing on rounds tomorrow.

Topics include:

• Flu shots in heart failure — real mortality benefit
• Stopping aspirin in patients on DOACs
• Anticoagulation in AFib despite fall risk
• Naltrexone for alcohol use disorder — start inpatient
• Phenobarbital for withdrawal — coming soon
• Metformin in the hospital — dogma challenged
• Transfusion thresholds in MI
• “Things We Do for No Reason” highlights

Practical take-homes and what to actually change this week.

Practice-Changing Highlights

💉 Flu shots in heart failure
NNT ≈ 17 for death/readmission
→ Vaccinate before discharge during flu season

💊 Stop aspirin with DOACs
↑ bleeding and mortality without benefit
→ Stop aspirin ~6–12 months post-stent (most patients)

🧠 AFib + fall risk
Benefit >> risk (would need >450 falls/year to offset)
→ Don’t withhold anticoagulation for falls alone

🍺 Alcohol use disorder

• Naltrexone: start before discharge → ↓ cravings, ↓ readmissions
• Phenobarbital: increasing use, likely future standard

💊 Metformin inpatient
May be safe in select patients
→ Consider if GFR ≥30 and no lactic acidosis

🩸 Transfusion in MI
Target Hgb ~10 may reduce mortality
→ Evolving — keep on radar

💊 Anticoagulation updates

• Apixaban preferred over rivaroxaban
• Reduce dose after 3–6 months for VTE
  → Reassess dosing routinely

Big Picture

• Biggest wins = simple changes
• Often: stop meds or use basics better
• Hospitalists have high-impact touchpoints

If You Change Nothing Else This Week

• Give flu shots in heart failure
• Stop aspirin in DOAC patients (when appropriate)
• Anticoagulate AFib despite fall risk
• Start naltrexone before discharge

Small changes. Massive reach. Real impact.