Venous thromboembolism (VTE) is a common cause of preventable harm among hospitalized, medically ill patients. The purpose of this study is to evaluate the accuracy of Padua VTE risk assessments, VTE prevention practices, and outcomes. In this retrospective analysis of consecutively hospitalized, medically ill patients at The Johns Hopkins Hospital from January 1 through April 30, 2019, a hematologist subject matter expert (SME) retrospectively completed a Padua VTE risk assessment for every patient. Results were compared with risk assessments completed by the admitting provider. The primary outcome was agreement between the SME and admitting provider on overall VTE risk. Secondary outcomes included agreement on VTE risk factors, risk-appropriate VTE prophylaxis prescription and administration, and VTE outcomes. Of 4,021 patients included, agreement between admitting providers and the SME on overall VTE risk was 65.3%. The SME identified 1,156 (28.7%) patients as high risk who were categorized on admission as low risk. Risk factors with the lowest agreement were reduced mobility and acute infection. 2,141 (53.2%) patients were prescribed appropriate VTE prophylaxis. Thirty-six patients developed in-hospital VTE, including 21 who had been misclassified as low risk. Significantly more doses of prescribed VTE prophylaxis were not administered among patients who developed VTE (19.6% vs. 15.2%, p=0.007). Inaccurate VTE risk assessment leads to inappropriate VTE prevention practices and preventable VTE. Leveraging existing, structured data to autopopulate VTE risk assessments can assist providers in improving accuracy. Quantitative measures of patient mobility should be incorporated into VTE risk assessment.

Key Clinical Message: Left‐atrial septal pouch (LASP) is a newly described anatomical variant caused by incomplete fusion of the septa primum and secundum. This case visualizes LASP as a potential nidus for blood stasis and cardiac embolism and highlights the need for consideration of TEE in the work up of cryptogenic stroke.

Background: This study evaluated the impact of diabetes mellitus (DM) and its treatments on cardiovascular outcomes in prostate cancer (PC) patients aged 66 years and older, with or without androgen deprivation therapy (ADT) exposure. Methods: Using the SEER-Medicare database (2009–2017), two cohorts were created: Cohort 1 included all PC patients enrolled in Medicare Parts A and B; Cohort 2 was a subset of Cohort 1 receiving ADT and enrolled in Medicare Part D. Exposures were DM and DM medications. Outcomes included cardiovascular events (CVEs), cardiovascular mortality (CVm), PC-specific mortality (PCsm), and all-cause mortality, analyzed using multivariable Fine-Gray and Cox models. Results: Cohort 1 included 150,647 PC patients (32% with DM, median age 72). DM was associated with higher risk of CVE (subdistribution hazard ratio [sHR] 1.20, 95% CI 1.17–1.22), CVm (sHR 1.35, 1.28–1.43), and all-cause mortality (adjusted HR [aHR] 1.22, 1.19–1.26) (all p < 0.001). Non-Hispanic Blacks (NHBs) and patients from lower socioeconomic (SES) and education areas experienced comparable or worse outcomes. In Cohort 2 (n = 14,938), DM patients on non-metformin therapies had higher all-cause mortality (aHR 1.33, 1.11–1.25; p = 0.002) than those on metformin, particularly in NHB and low education groups. Sensitivity analyses with follow-up limited to two years showed consistent results as overall. Conclusions: Diabetic PC patients, especially NHB, lower SES and lower education subgroups, were associated with worse cardiovascular and all-cause mortality outcomes. Metformin may be associated with better outcomes in these populations, warranting further research on the disparities in PC and diabetes, and cardioprotective effects of DM medications across different subpopulations.

Background: Breast cancer (BC) patients have heightened risks of atrial fibrillation (AF) and ischemic stroke (IS). Standard IS scores are poorly validated in cancer, omit cancer-specific factors, and guidelines offer no cancer-tailored management. Objectives: To develop and validate a novel score to predict IS risk in BC patients with AF. Methods: Data sources: UH Seidman Cancer Center (derivation; 40% set aside for internal validation) and MCG Cancer Center (external validation). Adults ≥ 18 years old with DCIS or stage I–IV BC who developed AF after diagnosis were included. Variable selection by LASSO Cox regression; continuous predictors dichotomized via cubic splines; points assigned from multivariable hazards to form B-S₂CALED. Continuous scores were split into risk groups. Discrimination of categorized B-S₂CALED versus CHA₂DS₂-VASc was assessed with the concordance index (C-index) and net reclassification improvement (NRI). Results: In the internal validation cohort (n = 935), 87 patients experienced IS/TIA. The B-S₂CALED score achieved a C-index of 0.64 (95% CI 0.59–0.70) compared with 0.54 (95% CI: 0.51–0.56) for CHA₂DS₂-VASc, yielding a total NRI of 0.188. In the external validation cohort (n = 95), 8 patients developed IS/TIA. The B-S₂CALED score produced a C-index of 0.77 (95% CI: 0.72–0.83) versus 0.53 (95% CI: 0.51–0.56) for CHA₂DS₂-VASc, with a total NRI of 0.563. Similar advantages were observed when the score was treated as a continuous variable. Conclusions: The BC-specific B-S₂CALED score outperformed CHA₂DS₂-VASc for predicting thromboembolic events in BC patients with AF. Validation in larger datasets is needed before clinical adoption.

A large proportion of ischemic strokes have an undetermined cause and are considered “cryptogenic.” A left atrial septal pouch (LASP) develops due to incomplete fusion of the septa primum and secundum, forming a pocket at the interatrial septum. It can be a potential site of blood stasis with resultant thrombus formation.