Posts Tagged health
Heart Failure Hospital Admissions Continue to Rise
The number of Americans admitted to hospitals for heart failure has jumped in recent years, and the trend almost certainly will continue, says a report in the Journal of the American College of Cardiology.
“Our study covers more than two decades, from 1979 to 2004, and the number of hospitalizations almost tripled during that time,” says Dr. Jing Fang, an epidemiologist with Centers for Disease Control and Prevention (CDC).
A major reason for the increase is the aging of the American population, says Dr. Fang. Heart failure, in which the heart progressively loses its ability to pump blood, is more common among older people.
“Another reason is the improvement in technology for treatment of patients with other heart diseases, such as acute myocardial infarction [heart attack],” adds Dr. Fang. “So, people with diseases of the heart live longer.”
Therapy Limited for a Declining Heart
The National Heart Discharge Survey shows that the number of admissions to hospitals with any mention of heart failure rose from over one million in 1979 to nearly four million in 2004, the report says.
More than 80 percent of those admitted to hospitals were 65 or older, with Medicare or Medicaid covering the cost.
The report did not cover the cost of the hospitalizations, but the American Heart Association has estimated it to be more than $20 billion annually, says Dr. Fang.
There has been a marked increase in the number of hospitalizations for which heart failure was not the primary cause.
Heart failure was listed as the primary cause in no more than 35 percent of cases, with respiratory diseases and other conditions given as the reason for hospital admission in all other cases.
“Most are due to pneumonia or another disease that makes heart failure worse,” says Dr. Fang.
Better control of those other conditions, which include diabetes and kidney disease, could reduce hospitalizations for heart failure.
But those people tend to keep coming back to the hospital because “you cannot cure people with heart failure,” explains Dr. Fang. “The best medicine [we] can do is to keep the heart functioning enough for the patient to have good quality of life.”
Hospital-Based Care Could Improve
A basic problem is that there is no effective treatment for heart failure severe enough to cause hospitalization, says Dr. Javed Butler, director of the heart failure research program at Emory University in Atlanta, and co-author of an accompanying editorial.
“When you are talking about medications that have been proven, they all are for chronic, stable outpatients,” explains Dr. Butler. “We don’t have any proven medications for treatment in the hospital.”
What is needed is a major effort to develop in-hospital treatments for severe heart failure, he says.
“When you consider the huge cost, it is right up high on the list of conditions we need to study,” says Dr. Butler. “It is a least-studied, most costly problem. We need to get a better grasp on what we should be doing.”
Always consult your physician for more information.
Online Resources
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Centers for Disease Control and Prevention (CDC)
Heart Failure Society of America
Add comment October 9, 2008
“Silent Strokes” Different than TIAs, Experts Say
If you are an older American with no major health problems, chances are about one in 10 that you have had a stroke and did not know it, according to a report in the medical journal Stroke.
It was probably not severe enough to cause recognizable symptoms, such as vision problems, facial weakness, or trouble walking, but it was still a blockage of a brain artery, and it reduced your thinking powers just a bit.
That estimate comes from a new study of 2,040 people, average age 62, in the long-running Framingham Offspring Study.
Magnetic resonance imaging (MRI) scans showed that 10.7 percent of them had experienced what study author Dr. Sudha Seshadri, at Boston University, calls “a silent brain infarct.”
It is the cerebral equivalent of what physicians call a myocardial infarct – blockage of a blood vessel that causes damage to heart tissue. In the case of a silent stroke, the blockage and the damage occurs in the brain, without symptoms.
TIA Has Symptoms, Silent Stroke May Not
A silent stroke is different from a transient ischemic attack (TIA), a momentary loss of brain function, says Dr. Seshadri. A TIA causes some symptoms, while a silent stroke, by definition, does not.
But both are warning signs to pay attention to the well-known risk factors for stroke, such as cholesterol levels, blood pressure, obesity, and smoking.
The incidence found in the Framingham Offspring study “was within the ballpark of what prior studies have suggested,” notes Dr. Seshadri.
“But this was a group of people who were younger than in most of the prior studies,” she says. “The fact that one in 10 persons had silent attacks that had subtle side effects on the brain is something we should be concerned about and should address.”
The effects of a silent brain infarct show up on an MRI scan as “small lesions in various parts of the brain,” says Dr. Seshadri. “We can’t tell from that whether they had a symptomatic attack.”
And the MRI scans give no clues as to when the silent stroke occurred.
Testing showed that “on average, compared to age-matched controls, those with lesions do have subtle signs, such as loss of flexibility of talk,” she says.
Address Risks Through Lifestyle Changes
The incidence seen in the study did not startle Dr. Claudette Brooks, at West Virginia University Health Sciences Center.
“When I look for the cause of headaches and similar problems, it doesn’t surprise me when I see these lesions, and other colleagues tell me they see them,” says Dr. Brooks.
An even higher rate of silent strokes might be expected in a study of African Americans, she notes.
“They have a higher incidence of hypertension [high blood pressure], atherosclerosis, and hyperlipidemia [excess blood fat],” says Dr. Brooks.
Nothing special needs to be done to reduce the risk of silent stroke, both physicians say.
“I wouldn’t recommend that people rush out to have an MRI,” says Dr. Seshadri. “It’s up to the medical and public health community to emphasize the importance of controlling risk factors.”
“The whole thing boils down to modifying risk factors,” explains Dr. Brooks. “If you don’t have risk factors such as high cholesterol, obesity, and diabetes, try to keep yourself out of the group that does. If you do, modify them by keeping blood pressure and cholesterol down, things like that.”
Always consult your physician for more information.
Online Resources
(Our Organization is not responsible for the content of Internet sites.)
National Heart, Lung, and Blood Institute (NHLBI)
National Institute of Neurological Disorders and Stroke
Stroke – Prevalence and Correlates of Silent Cerebral Infarcts in the Framingham Offspring Study
Add comment September 9, 2008
