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Health & Medicine for Senior Citizens

Key Topics for Many Seniors Presented at American Heart Association Session

Heart attack patients treated faster at PCI hospitals, pharmacists on telemonitors help control blood pressure, physically fit in mid-life saves money in aging, stroke patients on blood thinner warfarin can be treated with clot-busting tPA, Romney health plan made no big difference in heart attack readmissions

May 10, 2012 - The American Heart Association's Quality of Care and Outcomes Research 2012 Scientific Sessions is off to a running start with several research reports of interest to senior citizens presented today. These included studies that found heart attack patients get much faster treatment if taken to a properly equipped hospital, patients getting telemonitoring support from pharmacists are more likely to control their blood pressures, physically fit middle-aged adults have significantly lower healthcare costs as they age, and the Romney health care bill did not improve heart attack readmission rates.

Jump to the report:

1. Heart Attack Patients Taken to PCI Hospitals Treated Faster

2. Home Telemonitoring by Pharmacists Helps Control Patients' Blood Pressure

3. Clot-Busting Drug Safe for Stroke Patients Taking Blood Thinner

4. Midlife Fitness Means Lower Healthcare Costs in Old Age

5. Massachusetts Health Insurance Reform Hasn't Significantly Improved Heart Attack Readmission Rates


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Heart Attack Patients Taken to PCI Hospitals First Treated Faster

Heart attack patients in North Carolina who were rushed directly to hospitals equipped to do percutaneous coronary intervention (PCI) received treatment significantly faster than patients first taken to hospitals unequipped to perform PCI and then later transferred for treatment.

The study focused on the most serious form of heart attack, ST-elevation myocardial infarction (STEMI). A STEMI typically involves complete blockage of the blood flow to the heart. Opening the blocked artery as quickly as possible is crucial to improving survival.

Physicians often use PCI, also known as angioplasty, to open blocked coronary arteries. A tiny balloon is inserted through a catheter, or tube, into the affected area. The balloon is inflated to widen the blocked areas. Physicians often combine the procedure with the insertion of a stent to help prop the artery open and decrease the chance of another blockage.

Opening the blockage with clot-busting drugs is used when timely access to PCI is not an option.

Many emergency medical services (EMS) guidelines for transporting STEMI patients recommend bypassing hospitals that can't provide PCI and going to one that can.

"Until now, no well designed study had examined this recommendation," said Emil L. Fosbol, M.D., Ph.D., the study's first author and a research fellow at Duke University in Durham, N.C. "The only rationale we had was the sooner you get there, the better."

The researchers reviewed North Carolina's EMS records from June 2008 to September 2010 and linked these to a clinical registry of patients with STEMI. Of the 1,224 STEMI patients who met the study's specifications, 765 (63 percent) went directly to a PCI-capable hospital (bypass group), and 479 (37 percent) stopped first at a non-PCI hospital (non-bypass group) before being transferred for a PCI procedure.

Researchers found:

The time from first medical contact (FMC) to artery-opening treatment - PCI or clot-busting drug - averaged 93 minutes for the bypass group and 124 minutes for the non-bypass group, a substantial time difference that could improve a STEMI patient's chances of surviving.

For patients who received only PCI, the time from FMC to PCI averaged 93 minutes for the bypass group and 161 minutes for the non-bypass arm. -- Patients in the bypass group were almost three times as likely to get treatment within guideline recommendations compared to the non-bypass group.

"PCI is contingent on getting the patient very quickly to a hospital with a catheter lab," Fosbol said. "Our results suggest that when logistically feasible, EMS should transfer STEMI patients directly to the nearest PCI-capable hospital."

Co-authors are Christopher Granger, M.D.; James Jollis, M.D.; Lisa Monk, M.D.; Li Lin, M.D.; Barbara Lytle, M.D.; Ying Xian, M.D.; Lee Garvey, M.D.; Greg Mears, M.D.; Claire M Corbett, M.D.; Eric D Peterson, M.D.; and Seth Glickman, M.D.

The American Heart Association-Pharmaceutical Roundtable and David and Stevie Spina funded the study.

Home Telemonitoring by Pharmacists Helps Control Patients' Blood Pressure

Patients receiving telemonitoring along with high blood pressure management support from a pharmacist were more likely to lower their blood pressure than those not receiving extra support.

"Patients with high blood pressure visit physicians an average of four times each year, yet blood pressure is controlled in only about half of U.S. patients," said Karen Margolis, M.D., M.P.H., the study's lead author and director of clinical research of HealthPartners Research Foundation in Bloomington, Minn. "We looked at how the addition of a pharmacist-led, at-home telemonitoring program might improve patients' blood pressure control."

Margolis and colleagues studied 450 patients with uncontrolled high blood pressure. Approximately half (222) of the patients were assigned to traditional care through their primary care providers. The other half (228 in the intervention group) saw a primary care provider and received additional high blood pressure management and telemonitoring support from a pharmacist.

The intervention patients measured their blood pressure at home and sent the readings electronically to a secure website. Participating pharmacists accessed the information and consulted the patients every two to four weeks by phone.

All 450 patients came to a special research clinic to have their blood pressure measured at the beginning of the study, and 403 of them were seen again after six months, Margolis said.

The researchers found:

   ● Six months into the study, 45.2 percent of participants in the traditional care group and 71.8 percent in the telemonitoring intervention had reduced their blood pressure to healthy levels under 140/90 millimeters of mercury (mm Hg) in most patients, and under 130/80 mm Hg in those with diabetes or kidney disease.

   ● Blood pressure decreased more in the telemonitoring group. At the start of the study, patients' blood pressures averaged 148/85 mm Hg. At six months, the average was 126/76 mm Hg in the telemonitoring intervention and 138/82 mm Hg in the traditional care group.

   ● Patients in the telemonitoring group received more high blood pressure medicines after six months than patients in the traditional care group. -- Patients in the telemonitoring group reported that they were better at remembering to take their medications consistently than those in the traditional care group.

"These early results suggest that home blood pressure telemonitoring with extra telephone care by a pharmacist was very effective in improving blood pressure control," Margolis said. "If these early results can be sustained over the long run, it might decrease the number of patients who suffer heart attacks, strokes or other complication of high blood pressure."

Margolis and colleagues are continuing to follow these patients to determine the effects of the intervention for the longer term.

The study participants were health-conscious, so results might be different for a less motivated group, Margolis said.

Co-authors are Anna R. Bergdall, M.P.H.; Stephen E. Asche, M.A.; Joann M. Sperl-Hillen, M.D.; Michael V. Maciosek, Ph.D.; Nicole K Schneider, B.A.; Tessa J. Kerby, M.P.H.; Rachel A. Pritchard, B.A.; Jaime L. Sekenski, B.S.; and Patrick J. O'Connor, M.D., M.P.H.

To learn more about the risks of high blood pressure and how to control it, visit www.heart.org/hbp.

Clot-Busting Drug Safe for Stroke Patients Taking Blood Thinner

Acute ischemic stroke patients taking the blood thinner warfarin can be treated safely with the clot-busting drug tissue plasminogen activator (tPA).

"Although it's the only drug approved by the Food and Drug Administration to treat acute ischemic stroke, tPA is underused among patients on home warfarin therapy mainly because of the fear that it will cause bleeding," said Ying Xian, M.D., Ph.D., the study's lead author and a research fellow at Duke Clinical Research Institute, in Durham, N.C.

Xian and colleagues used data from the American Heart Association/American Stroke Association's Get With The Guidelines(R)-Stroke registry to evaluate tPA safety in warfarin-treated patients who had an ischemic stroke, which occurs when a blood vessel to the brain becomes blocked.

The data was from 23,437 ischemic stroke patients treated with tPA in 1,203 Get With The Guidelines-Stroke hospitals between April 2009 and June 2011. Almost 8 percent (1,802) of patients were taking warfarin prior to admission.

Patients on warfarin prior to hospitalization for an ischemic stroke tended to be older (77 years vs. 71 years), had more illnesses at the time of their strokes and had more severe strokes than patients not on warfarin.

Nevertheless, the risk of severe bleeding from brain hemorrhage was similar among stroke patients who received tPA after stroke, regardless of whether they were on warfarin.

The researchers also didn't find notable differences between warfarin and non-warfarin patients when they compared risks of tPA-related complications or in-hospital death after tPA.

"Our study suggests tPA is not associated with excessive bleeding or death among warfarin patients, when used according to American Heart Association/American Stroke Association guidelines," Xian said. "tPA has been shown to minimize brain damage and disability from stroke and should not be withheld from these patients."

The study is the largest on the safety of tPA in warfarin-treated patients who meet clinical guideline criteria. However, Xian said they didn't measure functional, neurological or long-term results of tPA treatment.

Co-authors are Gregg C. Fonarow, M.D.; Eric E. Smith M.D., M.P.H.; Lee H. Schwamm, M.D.; Mathew J. Reeves, Ph.D.; Li Liang, Ph.D.; DaiWai M. Olson, Ph.D.; Adrian F. Hernandez, M.D., M.H.S.; and Eric D. Peterson, M.D., M.P.H.

Quick treatment for ischemic stroke is critical -- learn more about the risks and symptoms at www.strokeassociation.org. The American Heart Association/American Stroke Association is working to improve quick and appropriate treatment for stroke patients, learn more at www.heart.org/targetstroke.

Midlife Fitness Means Lower Healthcare Costs in Old Age

Physically fit, healthy middle-aged adults have significantly lower healthcare costs as they age, compared to their less physically fit counterparts.

The study tracked Medicare coverage in 20,489 healthy people, free of prior heart attack, stroke or cancer, from 1999-2009. The average age was 51 years and 21 percent were women. Risk factors and physical fitness were determined at the beginning of the study.

Associations between midlife fitness and healthcare costs in later life were estimated after being adjusted for each patient's age, body mass index, blood pressure, cholesterol profile, diabetes, smoking status and medical history.

Compared to people in the lowest fitness category, those in the highest categories at age 51 had significantly lower healthcare costs after age 65.

After age 65, for men, annual costs were $3,277 (highest fitness) versus $5,134 (lowest fitness) and for women, $2,755 (highest fitness) versus $4,565 (lowest fitness). This inverse association between fitness and healthcare costs was consistent across all levels of traditional risk factors, as well as after adjustment for patient gender.

Massachusetts Health Insurance Reform Hasn't Significantly Improved Heart Attack Readmission Rates

A 2006 Massachusetts law that increased health insurance to near-universal levels has not significantly reduced overall heart attack readmission rates, or reduced the gaps in readmission rates between minorities and whites, according to an analysis presented at the American Heart Association's Quality of Care and Outcomes Research 2012 Scientific Sessions.

Researchers examined 2004-2009 discharge data and 30-day readmission rates for heart attack by age, race and ethnicity. Patients were divided by age ― 18-64 years old (most affected by reform) and 65 and older (least affected).

The post-reform decrease in readmissions was similar in younger patients and older patients. For patients 18-64, pre- and post-reform heart attack readmission rates were 11.5 percent and 10.5 percent, respectively, and for those 65 and older, 24.0 percent and 22.2 percent.

African-Americans under age 65 had higher readmission rates than whites, before and after reform, and rates between non-elderly and elderly adults, divided by race and ethnicity, were unaffected.

This suggests that the law has not significantly affected heart attack readmission rates by age or the difference in heart attack readmission rates by race, the researchers said.


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