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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.