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Featured Posts

HTN Visits Vary for Adults Living in Urban, Rural Residences

THURSDAY, Nov. 12, 2020 (HealthDay News) -- The percentage of physician visits by adults with diagnosed hypertension varies by patient residence, according to a study published online Nov. 12 in the National Health Statistics Reports, a publication from the U.S. Centers for Disease Control and Prevention.

Danielle Davis, M.P.H., and Pinyao Rui, M.P.H., from the National Center for Health Statistics in Hyattsville, Maryland, used data from the 2014 to 2016 National Ambulatory Medical Care Survey to describe urban-rural differences in office-based physician visits by adults with documented hypertension.

The researchers found that the percentage of visits by adults aged 18 years and older with diagnosed hypertension was lower for those who lived in large metro suburban areas versus small-medium metro areas and rural areas (34.2 percent versus 37.9 and 40.1 percent, respectively). The percentage of visits was higher for men versus women with hypertension overall (41.0 versus 33.5 percent) and in large metro suburban areas (38.7 versus 31.0 percent), small-medium metro areas (43.5 versus 33.8 percent), and rural areas (44.9 versus 36.5 percent). With age, there was an increase in the percentage of visits by adults with hypertension, from 10.3 to 58.6 percent for adults aged 18 to 44 years and those aged 75 years and older, respectively; this pattern was seen in all residence areas.

"During 2014 to 2016, in all areas, approximately 36 percent of visits by adults included diagnosed hypertension documented in the medical record," the authors write.

Abstract/Full Text

Statins Tied to Lower In-Hospital COVID-19 Mortality Risk

FRIDAY, Nov. 13, 2020 (HealthDay News) -- Treatment with statins prior to and during a COVID-19-related hospitalization is associated with lower COVID-19-related in-hospital mortality, according to a study published online Nov. 2 in the European Heart Journal: Cardiovascular Pharmacotherapy.

Lluís Masana, M.D., Ph.D., from Universitat Rovira i Virgili in Reus, Spain, and colleagues used clinical records to assess the effect of statin therapy at hospital admission for COVID-19 on in-hospital mortality among 2,157 patients (1,234 men; mean age, 67 years) with confirmed COVID-19 infection.

The researchers found that overall, there were 353 deaths and 581 patients were taking statins. There was a significantly lower mortality rate in patients on statin therapy versus the matched nonstatin group (19.8 versus 25.4 percent). Among the 336 patients who maintained their statin treatment during hospitalization, the mortality rate was even lower (17.4 percent). For cause-specific hazard, statins were associated with reduced COVID-19-related mortality (hazard ratio, 0.58).

"Statin therapy should not be discontinued due to the global concern of the pandemic or in patients hospitalized for COVID-19," the authors write.

Several authors disclosed financial ties to the pharmaceutical industry.

Abstract/Full Text

Targeted Efforts Do Not Alter Outcomes in Healthy Elderly

FRIDAY, Nov. 13, 2020 (HealthDay News) -- In elderly adults, vitamin D supplementation, omega-3 supplementation, and strength training, individually or in combination, do not improve clinical outcomes, according to a study published in the Nov. 10 issue of the Journal of the American Medical Association.

Heike A. Bischoff-Ferrari, M.D., from the University Hospital Zurich, and colleagues conducted a double-blind, placebo-controlled, 2 x 2 x 2 factorial randomized clinical trial among 2,157 adults aged 70 years or older with no major health events in the previous five years. Participants were randomly assigned to three years of intervention in one of the following: 2,000 IU/day vitamin D3, 1 g/day omega-3, and a strength-training exercise program; vitamin D3 and omega-3; vitamin D3 and exercise; vitamin D3 alone; omega-3 and exercise; omega-3 alone; exercise alone; or placebo. The primary outcomes were change in systolic and diastolic blood pressure, the Short Physical Performance Battery, Montreal Cognitive Assessment, and incidence rates of nonvertebral fractures and infections during a three-year follow-up.

The researchers found that at three years, there were no statistically significant benefits for any interventions individually or in combination. Twenty-five deaths occurred, with similar numbers in all treatment groups.

"In this five-country European trial of 2,157 adults aged 70 years or older without major comorbidities, vitamin D, omega-3s, and a strength-training exercise program, individually or in combination, did not improve six primary health end points," the authors write.

Several authors disclosed financial ties to pharmaceutical and nutrition companies, some of which provided funding for the study.

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MI, ASCVD Risk Higher in Older Adults With Elevated LDL-C

MONDAY, Nov. 16, 2020 (HealthDay News) -- Older adults have an increased risk for myocardial infarction and atherosclerotic cardiovascular disease (ASCVD) in association with elevated levels of low-density lipoprotein (LDL) cholesterol; and LDL-lowering therapies are effective for reducing cardiovascular events in older adults, according to two studies published online Nov. 10 in The Lancet.

Martin Bødtker Mortensen, Ph.D., from Aarhus University Hospital, and Børge Grønne Nordestgaard, M.D., from Copenhagen University -- both in Denmark -- examined the association between elevated LDL cholesterol and myocardial infarction and ASCVD in individuals aged 20 to 100 years. The researchers found that for the overall population, the risk for myocardial infarction was augmented per 1.0-mmol/L increase in LDL cholesterol (hazard ratio, 1.34) and was amplified for all age groups, especially those aged 70 to 100 years. Per 1.0-mmol/L increase in LDL cholesterol, the risk for atherosclerotic cardiovascular disease was increased overall (hazard ratio, 1.16) and in all age groups, especially for those aged 70 to 100 years.

Baris Gencer, M.D., from Harvard Medical School in Boston, and colleagues conducted a systematic review relating to LDL cholesterol-lowering therapies in older patients. Data were included from six articles, which included 29 trials with 244,090 patients (8.8 percent aged at least 75 years). The researchers found that in older patients, LDL cholesterol lowering significantly reduced the risk for major vascular events per 1-mmol/L reduction in LDL cholesterol (risk ratio, 0.74). The benefit for older adults was observed for each component of the composite: cardiovascular death, myocardial infarction, stroke, and coronary revascularization.

"Although lipid-lowering therapy was efficacious in older patients, we should not lose sight of the benefit of treating individuals when they are younger," write the authors of an accompanying editorial.

Several authors from the Gencer study disclosed financial ties to the pharmaceutical industry.

Abstract/Full Text - Mortensen and Nordestgaard

Abstract/Full Text - Gencer

Editorial

ACR: Warfarin Tied to Increased Risk for Knee, Hip Replacement in OA

For adults with atrial fibrillation, warfarin is associated with an increased risk for knee and hip replacements for osteoarthritis (OA), according to a study presented at ACR Convergence, the annual meeting of the American College of Rheumatology, held virtually from Nov. 5 to 9.

Priyanka Ballal, M.D., from the Boston University School of Medicine, and colleagues conducted a nested case-control study using the Health Improvement Network to examine the association between warfarin and risk for knee and hip replacements among adults aged 40 to 89 years with atrial fibrillation. Cases with knee replacement (KR) or hip replacement (HR) between 2014 and 2018 were identified; each case was age- and gender-matched with up to four controls (913 cases and 3,652 controls, respectively). The relation of warfarin versus direct oral anticoagulant (DOAC) use with the risk for KR or HR was assessed.

The researchers found that warfarin users had increased odds of KR or HR versus DOAC users after adjustment for potential confounders (adjusted odds ratio, 1.57). The association was slightly attenuated but remained significant with matching by practice identification to account for practice variation (adjusted odds ratio, 1.25). The risk for KR or HR increased with duration of warfarin versus DOAC exposure.

"Our research supports the importance of adequate vitamin K and dependent proteins for limiting progression of OA," Ballal said in a statement. "Given these potential adverse effects of warfarin on joint health, our study suggests that direct oral anticoagulants could be considered for managing atrial fibrillation among patients who have OA."

One author disclosed financial ties to the pharmaceutical industry.

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AHA: Black Patients Less Likely to Receive Indicated BP Treatment Intensification

Black patients are less likely to receive treatment intensification for blood pressure (BP) control than patients of other races, according to a study presented at the American Heart Association Scientific Sessions 2020, held virtually from Nov. 13 to 17.

Valy Fontil, M.D., from the University of California in San Francisco, and colleagues estimated the likelihood of BP control (BP < 140/90 mm Hg) in Black versus White patients with hypertension and the impact of treatment intensification and missed visits among 6,556 patients (41 percent female; 44 percent Black; mean age, 57.0 years) seen in 12 safety-net clinics from 2015 to 2017.

The researchers found that compared with White patients, Black patients had more missed opportunities for treatment intensification and missed more visits. Black patients remained less likely than White patients to achieve BP control, when adjusting for treatment intensification and missed visits (odds ratio, 0.85). The indirect effect of decreased treatment intensification accounted for 22 percent of the total effect of Black race on BP control, while missed visits accounted for 13 percent. Intensified treatment for blood pressure control was higher in Asian Americans than in other racial groups.

"Our findings should prompt further investigation to determine why Black patients are less likely to have blood pressure therapy increased and why Asian Americans are more likely to be receive more aggressive treatment," Fontil said in a statement. "These findings also reemphasize the call for adopting treatment protocols and clinical decision supports that can help standardize quality of care for hypertension and perhaps other chronic diseases."

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Food Insecurity Tied to Higher Cardiovascular Mortality

TUESDAY, Nov. 17, 2020 (HealthDay News) -- An increase in food insecurity in U.S. counties was associated with an increase in cardiovascular mortality rates for nonelderly adults between 2011 and 2017, according to a research letter published online Nov. 9 in Circulation: Cardiovascular Quality and Outcomes.

Stephen Y. Wang, M.D., from Yale-New Haven Hospital in Connecticut, and colleagues analyzed data from the National Center for Health Statistics to identify county-level, annual, age-adjusted (to the 2000 U.S. census) cardiovascular mortality rates for nonelderly U.S. adults (20 to 64 years old) from 2011 to 2017. The Map the Meal Gap project was used to determine annual county-level food insecurity rates.

Among 3,142 counties across the United States, the researchers found that mean county-level food insecurity rates decreased from 14.7 to 13.3 percent during the study period. There were no significant changes noted in age-adjusted cardiovascular mortality rates in counties in the lowest quartile for mean annual percent change in food insecurity, but mortality rates increased significantly in the other three quartiles. A 1-percentage point increase in food insecurity was independently associated with a 0.83 percent increase in age-adjusted cardiovascular mortality rates for nonelderly adults. When adjusting for baseline food insecurity quartiles, this association remained significant only in the third and fourth quartiles.

"What's going on outside the clinic has significant impact on patients' health," a coauthor said in a statement. "There are many factors beyond the medications we may be prescribing that can influence their well-being, food insecurity being one of them."

Abstract/Full Text

AHA: Polypill, With or Without Aspirin, Reduces Cardiovascular Events

A polypill comprising statins and blood pressure-lowering drugs, with or without aspirin, is associated with a lower incidence of cardiovascular events, according to a study published online Nov. 13 in the New England Journal of Medicine to coincide with the American Heart Association Scientific Sessions 2020, held virtually from Nov. 13 to 17.

Salim Yusuf, D.Phil., from McMaster University in Hamilton, Ontario, Canada, and colleagues randomly assigned 5,713 participants without cardiovascular disease who had an elevated INTERHEART Risk Score to receive either a polypill or placebo daily; aspirin or placebo daily; and vitamin D or placebo monthly. The primary outcome for the polypill alone and polypill plus aspirin comparisons was death from cardiovascular causes, myocardial infarction, stroke, resuscitated cardiac arrest, heart failure, or revascularization. The primary outcome for the aspirin comparison was death from cardiovascular causes, myocardial infarction, or stroke.

The researchers found that for the polypill comparison, the primary outcome occurred in 4.4 and 5.5 percent of the polypill and placebo groups, respectively (hazard ratio, 0.79; 95 percent confidence interval, 0.63 to 1.00). For the aspirin comparison, the primary outcome occurred in 4.1 and 4.7 percent of the aspirin and placebo groups, respectively (hazard ratio, 0.86; 95 percent confidence interval, 0.67 to 1.10). For the polypill plus aspirin comparison, the primary outcome occurred in 4.1 and 5.8 percent of the combined treatment and double placebo groups, respectively (hazard ratio, 0.69; 95 percent confidence interval, 0.50 to 0.97).

"We could save millions of people from experiencing serious heart disease or stroke each year with effective use of the polypill and aspirin," Yusuf said in a statement.

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Patients Happier With Doctors of Same Race

MONDAY, Nov. 16, 2020 (HealthDay News) -- Racial/ethnic concordance between patients and their physicians is associated with higher patient satisfaction scores, according to a study published online Nov. 9 in JAMA Network Open.

Junko Takeshita, M.D., Ph.D., from the University of Pennsylvania in Philadelphia, and colleagues evaluated patient- and physician-related determinants of the patient experience using data from Press Ganey surveys returned for outpatient visits within the University of Pennsylvania Health System between 2014 and 2017.

The researchers evaluated 117,589 surveys (92,238 unique patients [mean age, 57.7 years; 40.1 percent men; 81.6 percent White] and 747 unique physicians [mean age, 45.5 years; 63.2 percent men; 71.4 percent White]). Compared with racially/ethnically concordant patient-physician dyads, racial/ethnic discordance was associated with a lower likelihood of physicians receiving the maximum score (adjusted odds ratio [aOR], 0.88; 95 percent confidence interval [CI], 0.82 to 0.94; P < 0.001). Lower patient experience ratings were associated with Black (aOR, 0.73; 95 percent CI, 0.68 to 0.78; P < 0.001) and Asian (aOR, 0.55; 95 percent CI, 0.50 to 0.60; P < 0.001) patient race. There was no association between patient-physician gender concordance and Press Ganey scores (aOR, 1.00; 95 percent CI, 0.96 to 1.04; P = 0.90).

"Our data highlights why it's more important than ever to have a diverse physician workforce who looks like all the different types of patients we take care of, including different genders and different races," a coauthor said in a statement.

One author disclosed financial ties to the pharmaceutical industry.

Abstract/Full Text

Editorial

AHA: Adding Omega-3 Fatty Acids Does Not Cut High CV Risk

A carboxylic acid formulation of eicosapentaenoic acid and docosahexaenoic acid (omega-3 CA) does not improve outcomes among statin-treated patients at high cardiovascular risk, according to a study published online Nov. 15 in the Journal of the American Medical Association to coincide with the American Heart Association Scientific Sessions 2020, held virtually from Nov. 13 to 17.

Stephen J. Nicholls, M.B.B.S., Ph.D., from Monash University in Melbourne, Australia, and colleagues conducted a double-blind trial comparing omega-3 CA to corn oil in 13,078 statin-treated patients with high cardiovascular risk, hypertriglyceridemia, and low high-density lipoprotein cholesterol from 675 academic and community hospitals in 22 countries. Participants were randomly assigned in a 1:1 ratio to either 4 g/day omega-3 CA or corn oil (6,539 to each) in addition to usual background therapies, including statins.

The trial was halted prematurely based on an interim analysis indicating low probability of clinical benefit of omega-3 CA, when 1,384 patients had experienced a primary end-point event. The researchers found that the primary end point (composite of cardiovascular death, nonfatal myocardial infarction, nonfatal stroke, coronary revascularization, or unstable angina requiring hospitalization) occurred in 12.0 and 12.2 percent of those treated with omega-3 CA and corn oil, respectively (hazard ratio, 0.99; 95 percent confidence interval, 0.90 to 1.09; P = 0.84).

"These findings do not support use of this omega-3 fatty acid formulation to reduce major adverse cardiovascular events in high-risk patients," the authors write.

Several authors disclosed financial ties to pharmaceutical companies, including AstraZeneca, which funded the study.

Abstract/Full Text

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TAVR Volumes in the U.S. Have Risen Each Year Since 2011

THURSDAY, Nov. 19, 2020 (HealthDay News) -- The volume of transcatheter aortic valve replacement (TAVR) procedures in the United States increased from 2011 to 2019, exceeding surgical aortic valve replacements in 2019, and 30-day mortality and stroke rates have decreased since 2011, according to a study published in the Nov. 24 issue of the Journal of the American College of Cardiology.

John D. Carroll, M.D., from the University of Colorado School of Medicine in Aurora, and colleagues present data from the Society of Thoracic Surgeons-American College of Cardiology Transcatheter Valve Therapy Registry from 2011 to 2019 for 276,316 patients undergoing TAVR in all U.S. states, including 8,395 low-risk patients treated in 2019.

TAVR volumes increased each year; in 2019, they exceeded surgical aortic valve replacement (72,991 versus 57,626). The researchers found that for the entire cohort, femoral access increased to 95.3 percent in 2019, hospital stay was two days, and 90.3 percent of patients were discharged home. From 2011, there was a decrease in the 30-day mortality rate (7.2 to 2.5 percent) and a decrease in stroke (2.75 to 2.3 percent), while the need for a pacemaker was unchanged (10.9 to 10.8 percent). At one year, eight of 10 patients achieved the status of alive with acceptable patient-reported outcomes.

"We have also seen TAVR become the leading choice for aortic valve replacement," Carroll said in a statement. "Furthermore, the data on outcomes after TAVR document a substantial improvement in quality of care in the last nine years."

Several authors disclosed financial ties to the pharmaceutical and medical device industries.

Abstract/Full Text

Less Than One in 20 Eligible Adults Receives Lung Cancer Screening

FRIDAY, Nov. 20, 2020 (HealthDay News) -- Less than one in 20 eligible U.S. adults receives annual lung cancer screening (LCS) using low-dose computed tomography scans, with wide geographic variance in screening rates, according to a study published online Nov. 12 in the Journal of the National Cancer Institute.

Stacey A. Fedewa, Ph.D., from the American Cancer Society in Atlanta, and colleagues estimated the LCS rate and growth at the national and state level between 2016 and 2018 using data from the American College of Radiology Lung Cancer Screening Registry.

The researchers found that nationally, the screening rate was steady between 2016 (3.3 percent) and 2017 (3.4 percent) and increased to 5 percent in 2018 (2018 versus 2016 screening rate ratio, 1.52). Several Southern states with a high lung cancer burden (e.g., Mississippi, West Virginia, Arkansas) had relatively low screening rates in 2018 (less than 4 percent) among eligible adults compared with Northeastern states with lower lung cancer burden but the highest screening rates (e.g., Massachusetts, Vermont, New Hampshire: screening rate ratio range, 12.8 to 15.2 percent). Kentucky, which had the nation's highest lung cancer mortality rate, also had one of the highest screening rates (13.7 percent).

"Deliberate effort from various stakeholders such as policy makers, cancer control, health systems, and providers [is] needed to boost lung cancer screening rates among eligible adults with a heavy smoking history, a group facing multiple barriers to lung cancer screening and cancer care," the authors write.

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