Only 1 in 10 patients with heart failure is referred to a cardiac rehabilitation program after being hospitalized, even though exercise programs can improve quality of life and reduce the likelihood of future hospitalization. Investigators analyzed data from 2005 to 2014 on 105,619 hospitalized heart failure patients from the national Get With The Guidelines-Heart Failure registry. Just 10.4% of eligible patients were referred to a cardiac rehabilitation program when they were discharged from the hospital. Although referral rates increased over time in the Journal of the American College of Cardiology study, they remained low.
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TIME (8/25, Sifferlin) reports that, according to a new study published in Public Health Nutrition, people who “eat at regular times and pack lunches” generally have healthier diets overall. Researchers “found that college students who made their meals at home and regularly consumed breakfast and an evening meal, had overall better diets.” These individuals typically “avoided fast food and sugary drinks and ate more vegetables and fruit compared to people who did not keep an eating routine.”
A new study found that one-third of community-dwelling very elderly individuals without vascular disease take statins despite a lack of randomized clinical trials to support their use. In the study of 13,099 adults >79 years of age, there was an increasing trend in statin use in both primary and secondary prevention from 1999 to 2012. Among the primary prevention population without vascular disease, the rate of statin use increased from 8.8% in 1999–2000 to 34.1% in 2011–2012. The authors of the JAMA Internal Medicinestudy note that there are potential dangers of expanding marginally effective treatments to untested populations.
Medscape reported, “Acetaminophen falsely elevates continuous glucose monitor (CGM) readings by a large margin, according to a” study published online in Diabetes Care. The “analysis conducted with 40 type 1 diabetes patients” revealed that “CGM readings were as much as two- to nearly fourfold higher than finger-stick readings following ingestion of acetaminophen.”
A series of Watchdog reports examines the expanding use of new anticoagulant medications to prevent strokes in patients with atrial fibrillation. The medications are convenient, but they are also expensive and have serious and sometimes even deadly side effects.
In a Watchdog report, the Milwaukee Journal Sentinel(8/1, Fauber, Jones) reported that during the past five years, “at least 8,000 deaths have been linked to...three...new anticoagulant drugs, compared to 700 for warfarin, a Milwaukee Journal Sentinel/MedPage Today investigation found,” even though “warfarin accounted for roughly three times as many prescriptions” last year alone. The three anticoagulants in question are Pradaxa (dabigatran etexilate mesylate), Eliquis (apixaban), and Xarelto (rivaroxaban). A fourth anticoagulant called Savaysa (edoxaban) was just approved this year, so data are still lacking on any adverse effects. In another Watchdog report, the Milwaukee Journal Sentinel (8/1, Fauber, Jones) reported that of the four new anticoagulants listed as warfarin alternatives, “Eliquis [apixaban] is the only one that can claim it reduces deaths in people with atrial fibrillation.” When the medication was undergoing clinical studies, patients who received it “were 11% less likely to die from any cause than those getting warfarin.” However, “because vital data – primarily involving deaths – was missing from the trial, FDA reviewer Thomas Marciniak concluded that if there was one more death among Eliquis patients or one less warfarin death, the benefit would no longer be considered statistically significant.” Reuters (7/28, Seaman) reports that a US Preventive Services Task Force (USPSTF) panel has recommended that adults in the US should undergo depression screening in the primary care setting.
HealthDay (7/28, Thompson) reports that the USPSTF “urged that family doctors regularly screen patients for depression, using standardized questionnaires that detect warning signs of the mental disorder.” Should patients display “signs of depression, they would be referred to a specialist for a full-fledged diagnosis and treatment using medication, therapy or a combination of the two, according to the recommendation.” The USPSTF recommends use of questionnaires, such as the PHQ-9, which is “a list of 10 questions that focus on problems that a person might have experienced during the past two weeks, including poor appetite, low energy, sleep problems and a lack of interest in doing things.” EDITOR NOTE-- Standardized depression screening is already a reported quality measure for physicians enrolled in ACOs and is a component of the G-code Medicare Annual Wellness examination. This USPSTF recommendation expands this as a general population screening. The Washington Post (7/28, Johnson) reports in its “Wonkblog” that a new study in the Annals of Internal Medicine found that how a placebo drug is administered in a study can affect how well the placebo “works.” The researchers “reviewed more than 100 clinical trials for knee osteoarthritis, focusing not on the drugs, treatments and injections that were the original point of the studies, but on the patients that got a fake treatment for their pain.” They found “that a sham injection with saline solution was not only better than a fake pill; it was also 1.6 times better at relieving pain than an actual drug – Tylenol.” The researchers conclude that this variance needs to be taken into account in future randomized trials.
HealthDay reported that “despite smaller, prior studies suggesting that” pioglitazone may increase “users’ risk of bladder cancer, a large new study finds no evidence for such an effect.” But, the research, published in the Journal of the American Medical Association, “did find an association between the use of” the medication “and a rise in the risk of pancreatic cancer, although experts say it’s too early to draw any conclusive link.”
New research shows that dicloxacillin may lessen the effects of some blood-thinning medications. Among 236 patients who took warfarin and dicloxacillin, blood thinning in 61% of patients became less effective within 2 to 4 weeks after treatment with the antibiotic. The median age of patients was 68 years on average, and 61% were male. Although the reasons for this effect are unclear, the authors of the JAMAstudy said it may be related to how the liver processes the medication and caution is advised when prescribing the antibiotic to patients on warfarin or similar medications.
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