Ryan O'Keefe
@rokeefemd.bsky.social
MD/MBA PennMedicine/Wharton | Hospitalist | Onc, Pall Care, MedEd | Creator Point of Care Medicine | Clinical threads and pearls
I hope you've found this helpful!
Follow me @ROKeefeMD for more clinical threads and pearls!
And check out @pointofcaremed for admission checklists, differentials, dotphrases, and pearls.
Follow me @ROKeefeMD for more clinical threads and pearls!
And check out @pointofcaremed for admission checklists, differentials, dotphrases, and pearls.
October 30, 2025 at 8:58 PM
I hope you've found this helpful!
Follow me @ROKeefeMD for more clinical threads and pearls!
And check out @pointofcaremed for admission checklists, differentials, dotphrases, and pearls.
Follow me @ROKeefeMD for more clinical threads and pearls!
And check out @pointofcaremed for admission checklists, differentials, dotphrases, and pearls.
Read the full September Recap on Substack!
Subscribe for more monthly recap posts like this!
open.substack.com/pub/rokeefe...
Subscribe for more monthly recap posts like this!
open.substack.com/pub/rokeefe...
IM and Hospital Medicine Recap - Best of Podcasts and YouTube from September 2025
My favorite lessons and pearls from podcasts and YouTube videos on various clinic topics! Orthostatic hypotension, opioid withdrawal, DOAC failure, HFpEF, delirium, and Hepatitis C!
rokeefemd.substack.com
October 30, 2025 at 8:58 PM
Read the full September Recap on Substack!
Subscribe for more monthly recap posts like this!
open.substack.com/pub/rokeefe...
Subscribe for more monthly recap posts like this!
open.substack.com/pub/rokeefe...
Before treating, send baseline labs and check for interactions
When treatment is complete, check HCV RNA quant 12 weeks after the last dose to document sustained virologic response which means there is a cure
There is no post-exposure prophylaxis for HCV
When treatment is complete, check HCV RNA quant 12 weeks after the last dose to document sustained virologic response which means there is a cure
There is no post-exposure prophylaxis for HCV
October 30, 2025 at 8:58 PM
Before treating, send baseline labs and check for interactions
When treatment is complete, check HCV RNA quant 12 weeks after the last dose to document sustained virologic response which means there is a cure
There is no post-exposure prophylaxis for HCV
When treatment is complete, check HCV RNA quant 12 weeks after the last dose to document sustained virologic response which means there is a cure
There is no post-exposure prophylaxis for HCV
Genotyping is no longer routinely required for treatment naive patient
For most treatment-naïve adults without decompensated cirrhosis, two regimens cover nearly everyone:
glecaprevir/pibrentasvir for eight weeks (extend to 12 weeks in compensated cirrhosis)
sofosbuvir/velpatasvir for 12 weeks.
For most treatment-naïve adults without decompensated cirrhosis, two regimens cover nearly everyone:
glecaprevir/pibrentasvir for eight weeks (extend to 12 weeks in compensated cirrhosis)
sofosbuvir/velpatasvir for 12 weeks.
October 30, 2025 at 8:58 PM
Genotyping is no longer routinely required for treatment naive patient
For most treatment-naïve adults without decompensated cirrhosis, two regimens cover nearly everyone:
glecaprevir/pibrentasvir for eight weeks (extend to 12 weeks in compensated cirrhosis)
sofosbuvir/velpatasvir for 12 weeks.
For most treatment-naïve adults without decompensated cirrhosis, two regimens cover nearly everyone:
glecaprevir/pibrentasvir for eight weeks (extend to 12 weeks in compensated cirrhosis)
sofosbuvir/velpatasvir for 12 weeks.
If you consistently reflex-confirm viremia, stage fibrosis noninvasively, pick a pan-genotypic DAA with interactions in mind, and ensure SVR12 (sustained virologic response at 12 weeks) plus cirrhosis-appropriate surveillance, you’ll cure the vast majority of your patients and prevent complications.
October 30, 2025 at 8:58 PM
If you consistently reflex-confirm viremia, stage fibrosis noninvasively, pick a pan-genotypic DAA with interactions in mind, and ensure SVR12 (sustained virologic response at 12 weeks) plus cirrhosis-appropriate surveillance, you’ll cure the vast majority of your patients and prevent complications.
Goal is to find it, confirm active viremia, stage liver disease, treat with pan-genotypic direct-acting antiviral (DAA), and keep people from getting reinfected
October 30, 2025 at 8:58 PM
Goal is to find it, confirm active viremia, stage liver disease, treat with pan-genotypic direct-acting antiviral (DAA), and keep people from getting reinfected
FDA recently approved a point-of-care hepatitis C RNA finger-stick test that gets results within an hour.
Future treatments may include long-acting injectables to bypass issues of adherence and follow up. True elimination will likely require a vaccine.
Future treatments may include long-acting injectables to bypass issues of adherence and follow up. True elimination will likely require a vaccine.
October 30, 2025 at 8:58 PM
FDA recently approved a point-of-care hepatitis C RNA finger-stick test that gets results within an hour.
Future treatments may include long-acting injectables to bypass issues of adherence and follow up. True elimination will likely require a vaccine.
Future treatments may include long-acting injectables to bypass issues of adherence and follow up. True elimination will likely require a vaccine.
New models bring care to these patients rather than expecting them to come to the clinic. Examples including treating patients at opioid treatment programs.
October 30, 2025 at 8:58 PM
New models bring care to these patients rather than expecting them to come to the clinic. Examples including treating patients at opioid treatment programs.
Those with HepC are those least likely to engage meaningfully with the outpatient healthcare system and include those who are homeless, incarcerated, or who use injection drugs.
October 30, 2025 at 8:58 PM
Those with HepC are those least likely to engage meaningfully with the outpatient healthcare system and include those who are homeless, incarcerated, or who use injection drugs.
While we have a cure, we are far from elimination. Rates of new infections are actually increasing due to the opioid epidemic. 2.4-4 million people in the US are estimated to be living with HepC. Only 1 in 3 of those diagnosed have actually been cured.
October 30, 2025 at 8:58 PM
While we have a cure, we are far from elimination. Rates of new infections are actually increasing due to the opioid epidemic. 2.4-4 million people in the US are estimated to be living with HepC. Only 1 in 3 of those diagnosed have actually been cured.
Treatments are now pan-genotypic, all oral regimens like Mayvret (8 weeks), or Epclusa (12 weeks).
October 30, 2025 at 8:58 PM
Treatments are now pan-genotypic, all oral regimens like Mayvret (8 weeks), or Epclusa (12 weeks).
In 2013, sobosbuvir, a direct-acting antiviral (DAA) was approved. These oral medications were well tolerated and achieved cure rates in 95% of cases.
DAA medications prevent cirrhosis, cancer, and improve all-case mortality.
DAA medications prevent cirrhosis, cancer, and improve all-case mortality.
October 30, 2025 at 8:58 PM
In 2013, sobosbuvir, a direct-acting antiviral (DAA) was approved. These oral medications were well tolerated and achieved cure rates in 95% of cases.
DAA medications prevent cirrhosis, cancer, and improve all-case mortality.
DAA medications prevent cirrhosis, cancer, and improve all-case mortality.
In the late 1980’s, interferon monotherapy was standard of care and it was grueling for patients.
By 2011, standard management was a year long course of pegylated interferon and ribavirin - this course has debilitating side effects and only 50% chance of cure. Many patients were never even treated.
By 2011, standard management was a year long course of pegylated interferon and ribavirin - this course has debilitating side effects and only 50% chance of cure. Many patients were never even treated.
October 30, 2025 at 8:58 PM
In the late 1980’s, interferon monotherapy was standard of care and it was grueling for patients.
By 2011, standard management was a year long course of pegylated interferon and ribavirin - this course has debilitating side effects and only 50% chance of cure. Many patients were never even treated.
By 2011, standard management was a year long course of pegylated interferon and ribavirin - this course has debilitating side effects and only 50% chance of cure. Many patients were never even treated.
In the 1970’s hepatitis C was just known as “non-A, non-B” hepatitis.
In 1989, the Hepatitis C virus was identified via molecular cloning.
This meant it could be screened for in the blood supply - this essentially eliminated post-transfusion hepatitis in the U.S by the early 1990’s.
In 1989, the Hepatitis C virus was identified via molecular cloning.
This meant it could be screened for in the blood supply - this essentially eliminated post-transfusion hepatitis in the U.S by the early 1990’s.
October 30, 2025 at 8:58 PM
In the 1970’s hepatitis C was just known as “non-A, non-B” hepatitis.
In 1989, the Hepatitis C virus was identified via molecular cloning.
This meant it could be screened for in the blood supply - this essentially eliminated post-transfusion hepatitis in the U.S by the early 1990’s.
In 1989, the Hepatitis C virus was identified via molecular cloning.
This meant it could be screened for in the blood supply - this essentially eliminated post-transfusion hepatitis in the U.S by the early 1990’s.
I hope you've found this helpful!
Follow me @ROKeefeMD for more clinical threads and pearls!
And check out @pointofcaremed for admission checklists, differentials, dotphrases, and pearls for this topic and many more!
Follow me @ROKeefeMD for more clinical threads and pearls!
And check out @pointofcaremed for admission checklists, differentials, dotphrases, and pearls for this topic and many more!
October 29, 2025 at 9:00 PM
I hope you've found this helpful!
Follow me @ROKeefeMD for more clinical threads and pearls!
And check out @pointofcaremed for admission checklists, differentials, dotphrases, and pearls for this topic and many more!
Follow me @ROKeefeMD for more clinical threads and pearls!
And check out @pointofcaremed for admission checklists, differentials, dotphrases, and pearls for this topic and many more!
Check out the @pointofcaremed page to learn more about ADHF and inpatient diuresis!
www.pointofcaremedicine.com/cardiology/...
www.pointofcaremedicine.com/blog-post/d...
www.pointofcaremedicine.com/cardiology/...
www.pointofcaremedicine.com/blog-post/d...
October 29, 2025 at 9:00 PM
Check out the @pointofcaremed page to learn more about ADHF and inpatient diuresis!
www.pointofcaremedicine.com/cardiology/...
www.pointofcaremedicine.com/blog-post/d...
www.pointofcaremedicine.com/cardiology/...
www.pointofcaremedicine.com/blog-post/d...
STEP-HFpEF trial demonstrated that Glucagon-like peptide-1 (GLP-1) receptor agonists significantly improve symptoms, physical function, and weight in patients with obesity-related HFpEF
October 29, 2025 at 9:00 PM
STEP-HFpEF trial demonstrated that Glucagon-like peptide-1 (GLP-1) receptor agonists significantly improve symptoms, physical function, and weight in patients with obesity-related HFpEF
Angiotensin Receptor-Neprilysin Inhibitors (ARNIs) - Entresto - also have a class 2b recommendation, having missed the primary endpoint in the PARAGON-HF trial, episode suggests it may be considered, particularly for patients with lower-range ejection fractions or persistent hypertension.
October 29, 2025 at 9:00 PM
Angiotensin Receptor-Neprilysin Inhibitors (ARNIs) - Entresto - also have a class 2b recommendation, having missed the primary endpoint in the PARAGON-HF trial, episode suggests it may be considered, particularly for patients with lower-range ejection fractions or persistent hypertension.
Mineralocorticoid Receptor Antagonists (MRAs) like spironolactone hold a class 2b recommendation; TOPCAT trial was neutral but subgroup analyses of patients from the Americas showed a benefit in reducing hospitalizations; the Jury is still out though
October 29, 2025 at 9:00 PM
Mineralocorticoid Receptor Antagonists (MRAs) like spironolactone hold a class 2b recommendation; TOPCAT trial was neutral but subgroup analyses of patients from the Americas showed a benefit in reducing hospitalizations; the Jury is still out though
Sodium-glucose cotransporter-2 (SGLT2) inhibitors were the first drug class to meet primary endpoints in RCTs, reducing the composite of cardiovascular death and heart failure hospitalizations. (EMPEROR-Preserved Trial)
October 29, 2025 at 9:00 PM
Sodium-glucose cotransporter-2 (SGLT2) inhibitors were the first drug class to meet primary endpoints in RCTs, reducing the composite of cardiovascular death and heart failure hospitalizations. (EMPEROR-Preserved Trial)
The cornerstone of management of HFpEF involves addressing the comorbidities that are associated with it, including HTN, AFib, CKD, obesity, and sleep apnea.
I've started to see more HFpEF patients on "GDMT" medications
I've started to see more HFpEF patients on "GDMT" medications
October 29, 2025 at 9:00 PM
The cornerstone of management of HFpEF involves addressing the comorbidities that are associated with it, including HTN, AFib, CKD, obesity, and sleep apnea.
I've started to see more HFpEF patients on "GDMT" medications
I've started to see more HFpEF patients on "GDMT" medications
An average E/e′ ≥ 14–15 at rest is generally considered abnormal and supports elevated LV filling pressure; an average ≤ 8 suggests normal pressure; and 9–14 is a gray zone that needs additional data.
October 29, 2025 at 9:00 PM
An average E/e′ ≥ 14–15 at rest is generally considered abnormal and supports elevated LV filling pressure; an average ≤ 8 suggests normal pressure; and 9–14 is a gray zone that needs additional data.
Because E rises with higher left atrial (LA) pressure while e′ falls with impaired relaxation, a higher E/e′ implies higher LV filling pressures, the hemodynamic signature of HFpEF.
October 29, 2025 at 9:00 PM
Because E rises with higher left atrial (LA) pressure while e′ falls with impaired relaxation, a higher E/e′ implies higher LV filling pressures, the hemodynamic signature of HFpEF.