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Study: Many older Americans with heart failure take 10 or more meds

When older people hospitalized for heart failure are sent home, they are often given a whopping 10 medications to take for a variety of conditions.

But is this “polypharmacy” practice necessary, or does it just place a bigger burden on already frail patients?

It’s not a question so much of the quantity of the medications, but whether the medications patients are taking are the right ones for them, said senior study author Dr. Parag Goyal, a geriatric cardiologist at NewYork-Presbyterian in New York City.

“It’s not just that we’re not starting the right medications, there may be situations where we’re not stopping the wrong medications as well,” Goyal said. “I think we need to look at the medication that older adults with heart failure take in a more holistic fashion.”

For the study, Goyal’s team examined the medical charts of 558 adults aged 65 and older who were hospitalized in the United States between 2003 and 2014.

When admitted, 84% of the patients were taking five or more medications and 42% were taking 10 or more. When discharged, those numbers had risen to 95% of patients prescribed five or more medications and 55% taking 10 or more.

Most of the prescribed medicines were not for the patients’ heart failure or heart conditions, the researchers said.

A larger medication burden increases the risk of adverse drug reactions, which could lead to patients ending up in the hospital, Goyal explained. It can also require more work for the patient, which can have an impact on quality of life.

“It’s a big challenge,” Goyal said. “How exactly do you reconcile the fact that a lot of these medications are meant to prevent events and to help patients feel better with the concept that as the number of medications rise, you might be negatively affecting these parameters?”

The study found that about 90% of older adults with heart failure have at least three other medical conditions. More than 60% have at least five other conditions.

The findings were published online Oct. 13 in the journal Circulation: Heart Failure.

The researchers concluded that there is a need to develop strategies that can alleviate the negative effects of polypharmacy. Among the drugs that may be overused are proton-pump inhibitors, which reduce stomach acid.

There are a host of medications patients may have been taking for years that could be reviewed, Goyal noted.

However, the study suggested that the benefits of medication may outweigh the risks of polypharmacy for people with certain conditions, including chronic obstructive pulmonary disease COPD and diabetes.

Some medications already are multipurpose, including one that treats diabetes and heart failure, said Dr. Gregg Fonarow, chief of the University of California, Los Angeles, division of cardiology.

“That doesn’t mean there are not some medications that are not necessary and could be either reduced or consolidated, but that for patients with heart failure that have a number of other comorbid conditions there are a number of medications that are proven in randomized trials, proven in

Many Older Americans With Heart Failure Take 10 or More Meds | Health News

By Cara Roberts Murez
HealthDay Reporter

(HealthDay)

TUESDAY, Oct. 13, 2020 (HealthDay News) — When older people hospitalized for heart failure are sent home, they are often given a whopping 10 medications to take for a variety of conditions. But is this “polypharmacy” practice necessary, or does it just place a bigger burden on already frail patients?

It’s not a question so much of the quantity of the medications, but whether the medications patients are taking are the right ones for them, said senior study author Dr. Parag Goyal, a geriatric cardiologist at NewYork-Presbyterian in New York City.

“It’s not just that we’re not starting the right medications, there may be situations where we’re not stopping the wrong medications as well,” Goyal said. “I think we need to look at the medication that older adults with heart failure take in a more holistic fashion.”

For the study, Goyal’s team examined the medical charts of 558 adults aged 65 and older who were hospitalized in the United States between 2003 and 2014.

When admitted, 84% of the patients were taking five or more medications and 42% were taking 10 or more. When discharged, those numbers had risen to 95% of patients prescribed five or more medications and 55% taking 10 or more. Most of the prescribed medicines were not for the patients’ heart failure or heart conditions, the researchers said.

A larger medication burden increases the risk of adverse drug reactions, which could lead to patients ending up in the hospital, Goyal explained. It can also require more work for the patient, which can have an impact on quality of life.

“It’s a big challenge,” Goyal said. “How exactly do you reconcile the fact that a lot of these medications are meant to prevent events and to help patients feel better with the concept that as the number of medications rise, you might be negatively affecting these parameters?”

The study found that about 90% of older adults with heart failure have at least three other medical conditions. More than 60% have at least five other conditions.

The findings were published online Oct. 13 in the journal Circulation: Heart Failure.

The researchers concluded that there is a need to develop strategies that can alleviate the negative effects of polypharmacy. Among the drugs that may be overused are proton-pump inhibitors, which reduce stomach acid. There are a host of medications patients may have been taking for years that could be reviewed, Goyal noted.

However, the study suggested that the benefits of medication may outweigh the risks of polypharmacy for people with certain conditions, including chronic obstructive pulmonary disease (COPD) and diabetes.

Some medications already are multipurpose, including one that treats diabetes and heart failure, said Dr. Gregg Fonarow, chief of the University of California, Los Angeles, division of cardiology.

“That doesn’t mean there are not some medications that are not necessary and could be either reduced or consolidated, but that for patients with heart failure that have a number of other comorbid

Coronavirus pandemic to cost Americans $16 trillion, study finds

The coronavirus pandemic will end up costing Americans $16 trillion, far more than anyone predicted when the virus first emerged in the U.S. back in March, according to a new study released on Monday.

The study, published in the Journal of the American Medical Association, was co-authored by former Treasury Secretary Lawrence Summers and Harvard University economist David Cutler. Summers was also a top economic adviser to Presidents Barack Obama and Bill Clinton and is a former president of Harvard.

Their estimated cost includes a theoretical estimate for the value of a human life, and is spread out over the next decade. It also relies on an estimate that the eventual U.S. death toll from the pandemic will more than triple by the end of next year.

But $16 trillion is still an eye-popping number, and underscores the long-term impacts of the novel coronavirus and the U.S.’s inconsistent attempts to contain it. The study is listed in the medical publication as a viewpoint, and does not appear to have been peer-reviewed.

The coronavirus is “the greatest threat to prosperity and well-being the U.S. has encountered since the Great Depression,” the authors write.

If the study is correct, the coronavirus’ eventual impact could be four times the size of the damage done by the 2008 housing bust and subsequent Great Recession. The total cost of the pandemic — including more than 10 weeks of near total lockdown across most of the country, which caused the GDP in second quarter to drop by more than a third — will eclipse the money the U.S. has spent on every war since September 11, 2001, including those in Afghanistan, Iraq and Syria, the study says.


Winners and losers in COVID economy

09:03

About half of the price tag, $8.6 trillion, is driven by the long-term health implications and costs for those who contract COVID-19, as well as statistical estimate for the loss of life.

Based on the current death rate, the coronavirus pandemic is likely to lead to a total of 625,000 premature deaths in the United States, the study estimates. It pegs the total cost to society of each death at $7 million, citing a review from earlier this year of statistical and health policy research on the matter.

The study also estimates $2.6 trillion in long-term additional costs from people who survive COVID-19 but have resulting long-term health damage. Mental health costs because of the pandemic will rise by $1.6 trillion, the authors estimate.

10 years of GDP growth thrown off track 

The rest of the coronavirus’ economic toll comes in the form of reduced economic output, which the authors peg at $7.6 trillion, relying on previous estimate from the Congressional Budget Office. The drop in GDP is the cumulative impact of how much lower the GDP will be 10 years from now, versus where it would have been if the coronavirus had never spread.

The paper does not estimate the impact of the Coronavirus Aid, Relief and Economic Security Act (CARES)

COVID-19 has killed more Americans than five wars combined

Coronavirus; Hospital; COVID-19
Coronavirus; Hospital; COVID-19

edics work with a COVID-19 patient at the isolation ward of Sheba Medical Center in Ramat Gan near the coastal city of Tel Aviv, on July 29, 2020. JACK GUEZ/AFP via Getty Images

Sometime this week, even as we see Donald Trump being treated for COVID-19, it is likely we will hit 212,000 American deaths from coronavirus in seven months. 

That is a mark passing U.S. deaths from conflicts in Vietnam, Korea, Iraq, Afghanistan and World War I – reflected symbolically over the weekend with 20,000 empty chairs on the Washington Mall. 

Globally, of course, we’re over a million deaths. 

It’s a sober and ignoble achievement—a total that public awareness and attention should have kept lower, one whose growth rate should be diminishing and one that seems to encapsulate our divisive mentality about safety for others.

Related Articles

Despite whatever efforts Trump, state governors, government health officials or others want to claim, the maps of disease growth show the United States faring worse than most other industrialized nations on most measures of per population disease control and deaths. This comes even as treatment options have improved and medical treatment has adjusted to recognizing opportunities for earlier intervention.

The total contagion counts show the insistence of Americans to resist even the simplest forms of protection, even while demanding that someone else provide it – for free.

And the president’s own nuttiness about insisting on a spin around the block as if to show off his good health before returning to the hospital just illustrates he is not even taking his own case very seriously. He just exposed everyone in the car. His personal campaign to look strong despite illness frankly is a mystifying version of leadership, for pushing for earlier-than-expected release back to the White House.

Even as pro-Trump crowds were gathering outside Walter Reed Hospital to cheer an ailing president, those waving flags and banners were standing together mostly mask-less, without proscribed physical distancing in some kind of tribal rejection of public health rules. The White House was reported to be doing little toward tracing those who may have been infected in contact with Trump or his close circle. And the president was taking pains to show himself publicly as a strong survivor of the coronavirus challenge, making the White House itself a live contagion point, as if that makes the disease less potent for those without his access to daily testing.

The reality we still face is that whether Trump emerges days from now in peachy health to successfully pursue election victory as one who has survived the coronavirus or opponent Joe Biden wins for being a far more sober, careful candidate respectful of the demands of the disease, coronavirus is still going to be here. It will be a long slog to get through it – something that Trump does not want to own. Even if we get a vaccine, Americans are saying by droves that they don’t see taking it.

Change of

COVID Could Add 20K+ Americans a Day to ‘Preexisting Conditions’

Editor’s note: Find the latest COVID-19 news and guidance in Medscape’s Coronavirus Resource Center.

Every day, another 20,000 Americans between 20 and 60 years of age could be classified as living with a “preexisting condition” because of COVID-19, researchers from the Commonwealth Fund report.

Overall, the pandemic could cause almost 3.5 million Americans to be added to this category, a fact that has important implications approximately 1 month before the US Supreme Court is expected to weigh in on the constitutionality of the Affordable Care Act (ACA), the investigators note.



Dr Eric Schneider

“Polls show that most Americans are worried that preexisting conditions could lead to loss of insurance coverage. People are surprised and even more worried when they realize that the pandemic is adding to this problem,” lead author Eric Schneider, MD, PhD, told Medscape Medical News.

The study was posted online in a blog post on October 8 by the Commonwealth Fund.

Schneider, senior vice president for policy and research at the Commonwealth Fund, and research associate Arnav Shah based their calculations on approximately 7.5 million cases of COVID-19 reported in the United States as of October 7, 2020. The figures include an estimated 45,000 new cases reported daily.

Using data from the Centers for Disease Control and Prevention and Johns Hopkins University, they found that 32% of 1,502,309 people with laboratory-confirmed or probable COVID-19 already had an underlying condition. This proportion varied by age.

Table. COVID-19 and Underlying Conditions

Age in years Proportion of confirmed or probable COVID-19 cases
20 – 29 23%
30 – 39 28%
40 – 49 36%
50 – 59 44%
Source: CDC Case Surveillance Task Force data.

 

If almost one third already have an underlying condition, this means that for the remaining 68%, insurers might consider COVID-19 their first preexisting condition.

More Than 3 Million Could Be Affected

“We estimated that just over 3.4 million nonelderly adults had COVID-19 as a new pre-existing condition,” the authors write.

“If the Supreme Court overturns the preexisting condition provision of the ACA, private insurers will be able to deny insurance coverage to adults under age 65 who are unable to get insurance through an employer or large group,” Schneider said. “Testing positive for COVID-19 could be treated as a preexisting condition.”

Furthermore, he added, “Because the long-term health effects of COVID-19 are unknown, these adults could be uninsurable until they reach age 65 and qualify for Medicare.”

There could also be economic consequences, Schneider said. “If COVID-19 causes long-term health problems the way hepatitis C or HIV do, these costs could be high for patients, providers, and government programs.”

Removing preexisting condition protections could also act as a disincentive. “Healthy people might avoid COVID-19 testing altogether. And that is exactly the opposite of what must happen if we are ever to get this pandemic under control,” the researchers note.

“A Frightening Picture”

“These findings highlight the importance of preexisting protection,” Nathalie Huguet, PhD, who was not affiliated with the study, told Medscape Medical News.



Dr

Personal resilience plays big part in heart health for Black Americans

Black people who have a strong sense of psychological well-being may have better heart health, a new study indicates.

It suggests that feelings of optimism and a sense of purpose and control — hallmarks of psychosocial resilience — are more important to heart health than where people live, researchers said.

Lead researcher Tené Lewis, an associate professor at Emory University’s Rollins School of Public Health in Atlanta, noted that differences in heart health between Black and White Americans have been documented for decades. But individual factors affecting Black Americans have not been well understood.

“Almost everything we know about Black Americans and their health focuses on deficits, yet we really need to begin to identify strengths,” she said. “Understanding which strengths matter most for Black Americans — and under which contexts — will allow us to develop the most appropriate and applicable public health interventions for this group.”

For the study, the researchers recruited nearly 400 Black volunteers between the ages of 30 and 70. They investigated whether the American Heart Association’s Life’s Simple 7 metrics were linked to better heart health among them. The seven measures include smoking, physical activity, diet, weight, blood sugar, cholesterol and blood pressure.

Participants also completed standard questionnaires gauging their psychosocial health.

This information was then compared with neighborhood data on heart disease and stroke and death rates.

In neighborhoods with high rates of heart disease and stroke, Black adults with higher psychosocial resilience had a 12.5% lower risk of heart disease than those who were less resilient, the researchers found.
The findings were published Oct. 7 in the journal Circulation: Cardiovascular Quality and Outcomes.

“We assumed that being both high on psychosocial resilience and living in a resilient neighborhood would be the most beneficial for cardiovascular health, yet what we found was that psychosocial resilience demonstrated the most robust association regardless of the neighborhood resilience measure,” Lewis said in a journal news release.

She said more studies like this one are needed to fully understand and respond to factors that promote better health for Black Americans.

More information

For more on mental health and heart health, head to the American Heart Association.

Copyright 2020 HealthDay. All rights reserved.

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How Much Would Trump’s Coronavirus Treatment Cost Most Americans?

The New York Times is investigating the costs associated with testing and treatment for the coronavirus and how the pandemic is changing health care in America. You can read more about the project and submit your medical bills here.

President Trump spent three days in the hospital. He arrived and left by helicopter. And he received multiple coronavirus tests, oxygen, steroids and an experimental antibody treatment.

For someone who isn’t president, that would cost more than $100,000 in the American health system. Patients could face significant surprise bills and medical debt even after health insurance paid its share.

The biggest financial risks would come not from the hospital stay but from the services provided elsewhere, including helicopter transit and repeated coronavirus testing.

Mr. Trump has praised the high quality of care he received at Walter Reed National Military Medical Center, and has played down the risk of the virus. “Don’t be afraid of Covid,” Mr. Trump tweeted on Monday, before returning to the White House. “Don’t let it dominate your life.”

Across the country, patients have struggled with both the long-term health and financial effects of contracting coronavirus. Nearly half a million have been hospitalized. Routine tests can result in thousands of dollars in uncovered charges; hospitalized patients have received bills upward of $400,000.

Mr. Trump did not have to worry about the costs of his care, which are covered by the federal government. Most Americans, including many who carry health coverage, do worry about receiving medical care they cannot afford.

For some Americans, the bills could start mounting with frequent tests. Insurers are generally required to pay for those tests when physicians order them, but not when employers do.

The Trump administration made that clear in June, when it issued guidance stating that insurers do not have to pay for “testing conducted to screen for general workplace health and safety.” Instead, patients need to pay for that type of testing themselves. Some might be able to get free tests at public sites, and some employers may voluntarily cover the costs. Others could face significant medical debt from tests delivered at hospitals or urgent care centers.

Covid tests can be expensive. Although they typically cost $100, one emergency room in Texas has charged as much as $6,408 for a drive-through test. About 2.4 percent of coronavirus tests billed to insurers leave the patient responsible for some portion of payment, according to the health data firm Castlight. With 108 million tests performed in the United States, that could amount to millions of tests that leave patients responsible for some share of the cost.

Marta Bartan, who works as a hair colorist in Brooklyn, needed a coronavirus test to return to her job this summer. She received a $1,394 bill from the hospital running the drive-through site where she was tested.

“I was so confused,” said Ms. Bartan, who is contesting the bill. “You go in to get a Covid test expecting it to be free. What could they have possibly

Trump Leaves Hospital, Minimizing Virus and Urging Americans ‘Don’t Let It Dominate Your Lives’

But advisers said Mr. Trump wanted to demonstrate from the Oval Office that he was back and healthy, and they were unsure if they could prevent that. Mr. Trump is eager to show that he is a viable candidate for re-election, and advisers said he still planned to go ahead with the second debate with Mr. Biden scheduled for Oct. 15.

While not as equipped as Walter Reed, the White House has a medical unit fully staffed by military doctors and assistants around the clock and capable of providing care to the president. With private examination rooms, a supply of medicine and a crash cart for emergency resuscitation, it has been described by one former White House physician as “like a mini urgent-care center.”

The outbreak in the West Wing continued to spread on Monday as Kayleigh McEnany, the White House press secretary, and two of her assistants tested positive for the virus, heightening fears that more cases were still to come.

Ms. McEnany said she had tested negative several times, “including every day since Thursday,” but health experts said she might have been infectious for days — including when she spoke briefly to reporters without a mask outside the White House on Sunday. Two more members of the press team, Karoline Leavitt and Chad Gilmartin, who is Ms. McEnany’s relative, also tested positive, according to two people familiar with the diagnoses.

The three joined a growing list of people around the president who have tested positive, including Melania Trump, the first lady; Hope Hicks, a senior adviser; Nicholas F. Luna, the director of Oval Office Operations; Bill Stepien, the president’s campaign manager; Ronna McDaniel, the chairwoman of the Republican National Committee; Kellyanne Conway, the president’s former counselor; former Gov. Chris Christie of New Jersey, the president’s debate coach; and at least three White House reporters and two members of the residence staff.

The culture of the White House under Mr. Trump is not to talk about the coronavirus tests. When he received his own initial positive result on a rapid test last Thursday shortly after returning from Bedminster, N.J., he wanted it kept quiet, according to people close to him. Likewise, the two members of the residential staff who tested positive a few weeks ago were advised by colleagues to “use discretion” in discussing it, people familiar with the conversations said.

Vice President Mike Pence, who tested negative on Sunday, was scheduled to travel to Utah ahead of Wednesday night’s vice-presidential debate. Mr. Pence also plans to attend campaign events in Arizona and Florida this week before stopping in his home state, Indiana, to vote early.

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Americans Over 30 Are Drinking 14% More Often During Pandemic, Study Finds : NPR

American adults over 30 say they’re drinking 14% more often during the coronavirus pandemic, according to a report in the journal JAMA Network Open.

Luca Bruno/AP


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Luca Bruno/AP

American adults over 30 say they’re drinking 14% more often during the coronavirus pandemic, according to a report in the journal JAMA Network Open.

Luca Bruno/AP

Perhaps it’s no surprise, but people are drinking more during the pandemic.

In some cases, by a lot.

American adults say they’re drinking 14% more often during the coronavirus pandemic, according to a report in the journal JAMA Network Open. The increase in frequency of drinking for women was more pronounced, up 17% compared to last year.

Instances of heavy drinking among women, which for women was defined as four or more drinks within a couple of hours, spiked by 41%.

The study’s participants were aged 30 to 80, so the report does not offer insight on the pandemic drinking habits of younger adults.

The study took a sample of 1,540 adults and compared their self-reported drinking habits this spring with a year prior.

A quick look at social media suggests many people are using alcohol as a way to relax. Whether it’s “quarantinis” or Zoom happy hours, Americans seem to find a plethora of reasons to drink during the pandemic.

And as people began going to bars less, retail alcohol sales went up.

Stores sold 54% more alcohol in late March compared the year prior, according to Nielsen. Online sales more than doubled.

Some states like New York, Florida and Texas relaxed laws during the pandemic to allow expanded alcohol delivery.

The study used data collected using the RAND Corporation American Life Panel. The authors note a limitation of the study: its findings are based on self-reported data that could be skewed due to societal expectations. Nonetheless, they concluded more research could be warranted on alcohol use and its psychological and physical effects during the pandemic.

Earlier this year, the World Health Organization European office warned against excessive drinking and even said access should be limited during the pandemic.

Drinking may be even more dangerous now as it can negatively affect the body’s immune system, according to the WHO warning.

“Alcohol compromises the body’s immune system and increases the risk of adverse health outcomes,” the WHO stated. “Therefore, people should minimize their alcohol consumption at any time, and particularly during the COVID-19 pandemic.”

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Americans and Briton win Nobel Prize in medicine for discovery of Hepatitis C virus

Researchers Harvey J. Alter, Michael Houghton and Charles M. Rice have won the Nobel Prize in physiology or medicine for the discovery of Hepatitis C virus, the committe announced on Monday.

Prior to their work, the committee said, the discovery of the Hepatitis A and B viruses had been critical steps forward, but the majority of blood-borne hepatitis cases was still unexplained.

“The discovery of Hepatitis C virus revealed the cause of the remaining cases of chronic hepatitis and made possible blood tests and new medicines that have saved millions of lives,” the statement shared by the committee said.

Alter and Rice were both born in the U.S. while Hougton was born in the U.K.

An estimated 71 million people have chronic hepatitis C virus infection, according to the World Health Organization. A significant number of those who are chronically infected will develop cirrhosis, scarring of the liver caused by long-term liver damage, or liver cancer.

Each laureate made a significant contribution to Hepatitis C research, with much of their work dating back to the 1970s and 1980s.

The studies of transfusion-associated hepatitis conducted by Alter demonstrated that an unknown virus was a common cause of chronic hepatitis.

“To see so many people get cured is astounding,” Alter told the committee after getting the news Monday morning that he will share the prize.

Houghton worked to isolate the genome of the new virus while Rice provided the final evidence showing that Hepatitis C virus alone could cause hepatitis.

Thanks to their work, highly sensitive blood tests and antiviral treatments for the virus are now available.

“For the first time in history, the disease can now be cured, raising hopes of eradicating Hepatitis C virus from the world population,” the committee said.

The award comes with a gold medal and prize money of 10 million Swedish kronor (over $1,118,000), courtesy of a bequest left 124 years ago by the prize’s creator, Swedish inventor Alfred Nobel.

The Nobel Prize in physiology or medicine has been awarded 110 times to 219 Nobel laureates between 1901 and 2019.

Two Americans and a Briton won the medicine prize last year for their discoveries of how cells sense and adapt to oxygen availability.

This year, the medicine prize carries particular significance amid the coronavirus pandemic, which has highlighted the importance of medical research.

The pandemic has meant that the Nobel ceremonies will have a lower profile this year with many of the traditional celebrations postponed or re-jigged as digital events.

The foundation has cancelled the banquet, the highlight of the celebrations that takes place every December, and the traditional prize-giving ceremony in Stockholm’s Concert Hall will be replaced by a televised event where winners receive their prizes in their home nations.

Prizes in physics, chemistry,