Nathan Kim

On the eve of #OpenAI #ChatGPT releasing their app, @sama's wonderful advocacy to Congress, I'm thrilled to share a review about ChatGPT implications in Medicine and #MedTwitter. Would love to hear feedback and thoughts and learn your early interactions and experiences!

No wonder you're confused about what to eat. The two biggest dietary guideline organizations in the US just released opposing recommendations (American Heart Association vs. USDA). Here's where the two guidelines agree, disagree, and what the science says. 🧵

#AI scribe adoption across 5 academic centers was associated with modest reductions in EHR and documentation time, plus a slight increase in weekly visit volume, especially for primary care and female clinicians. ja.ma/3NzDzUo

Much touted AI scribes freed up 15 min per day, allowed 0.5 more pt visits per week, and no change in at-home work by physicians. Certainly far less than transformative. jamanetwork.com/journals/jama/…

The cholesterol wars are over. LDL won. New guidelines. Four landmark trials. An oral PCSK9 inhibitor that matches injectables. And data proving we should be treating patients we currently aren't. Here's everything clinicians need to know. 🧵

Just when I thought the case was closed on IVUS to guide PCI.... #ACC26

Minneapolis Heart Institute level 1 STEMI system already activates the cath lab for STEMI-Equivalents which do not meet STEMI millimeter criteria. See here: jacc.org/doi/abs/10.101… 129 very difficult OMI cases remained, all missed at initial evaluation due to "non-diagnostic" ECG. @PMcardioApp Queen of Hearts AI Model detected 58% of them with high specificity. Save myocardium. @yadersandoval sciencedirect.com/science/articl…

Occlusion MI (OMI-NOMI) is now the acknowledged next step at the American College of Cardiology meeting

Presented at #ACC26: Among patients with atherosclerotic cardiovascular disease, targeting an LDL cholesterol level below 55 mg per deciliter led to a lower 3-year risk of cardiovascular events than targeting a level below 70 mg per deciliter. Full Ez-PAVE trial results: nejm.org/doi/full/10.10… Editorial: Paving the Road toward Targeted Lipid Lowering nejm.org/doi/full/10.10… @ACCinTouch

STEMI-DTU trial: Combination of the Impella CP plus device a 30-minute delay to PCI did not reduce infarct size vs. immediate PCI in patients with anterior STEMI without shock. #ACC26 View slides here: clinicaltrialresults.org/wp-content/upl…

Presented at #ACC26: In patients with atrial fibrillation, left atrial appendage closure was noninferior to NOACs in an analysis of death from cardiovascular causes, stroke, or systemic embolism and was superior for non–procedure-related bleeding. Full CHAMPION-AF trial results: nejm.org/doi/full/10.10… Editorial: Left Atrial Appendage Closure — Should Recommendations Be Expanded? nejm.org/doi/full/10.10… @ACCinTouch

Original Article: Left Atrial Appendage Closure or Medical Therapy in Atrial Fibrillation (CLOSURE-AF trial) nejm.org/doi/full/10.10… Editorial: Left Atrial Appendage Closure — Another Overused Method in Cardiology? nejm.org/doi/full/10.10… #Cardiology

The last paragraph of this editorial is the first thing we teach our interventional fellows. “In general, the benefit from any percutaneous intervention in cardiology is often the greatest with regard to the most acute or life-threatening problem the patient is facing. In contrast, in clinical situations in which the patient’s life is not directly at risk and the symptoms are controllable by medical treatment, conservative management should always be considered to be an equally effective alternative.” nejm.org/doi/full/10.10…

You can tell a lot about a doctor by their discharge summary.

“Great leaders always give the credit to others. And great leaders also take the blame when things don’t go right. That’s how you endear yourself to a group of people. In fact, you should always point the finger back at yourself.” @TomBrady

Charlie Munger life advice for young people:

Addictive Korean marinated eggs you’ll want every day

I heard from an administrative colleague about a meeting that made his jaw drop. He was summoned to an “emergency summit” to discuss his health system’s decline in heart failure admissions. The cardiology department had been focused on reducing heart failure admissions and readmissions The focus of the “summit” would make anyone with a consicence blush: How do we increase our heart failure admissions? The most benign view is that the system wanted to get a larger share of a shrinking pie of admissions in the community. But the subtext of the meeting was unmistakeable: when patients win, hospitals lose. In many ways, outpatient management of heart failure was “too effective.” High margin heart failure admissions and ICU stays were shrinking in number. And, yet, rather than declaring victory and the stunning success of the cardiology team, the hospital was in a panic. Revenue was declining—and the hospital’s finances were suddenly in disarray. They needed more admissions—and fast. Said another way, they needed more sick people to need their services. Traditional administrators would say the dynamic is an outgrowth of our broken fee-for-service health systems. That incentives from value-based care do not make up for loss of volume. But there’s something more nefarious in this short vignette: it’s the unquestioned institutional focus on finance over health. “No margin, no mission,” some might glibly say. But has the mission been fundamentally corrupted? 
Is our mission: Keeping our beds full? Our margins high? Our doors open? 
Our teams employed at all costs? Or is our mission to promote the health and well-being of the community? We have clearly lost our way in important respects. For if it was the latter, the emergency heart failure admissions meeting would not be an institutional crisis, but a celebration. Celebration of community health. 
Celebration that patients were able to spend more time at home than in the hospital. Celebration that patients were healthier and so needed services less, not more. But, yet, health service organizations too often measure themselves by traditional business metrics: Volume. Revenue.
 Profit. Which of course are the wrong metrics for (mostly not-for-profit) health systems and hospitals who are chartered to serve the public good. It is the (hard) work of hospital administration to work proactively with payers to ensure that they are financially rewarded for doing the right thing. Not to blame the system and perverse incentives. forbes.com/sites/sachinja…

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