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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

New England Journal of Medicine calls for US leadership to be voted out over Covid-19 failure

In an unprecedented move, the New England Journal of Medicine on Wednesday published an editorial written by its editors condemning the Trump administration for its response to the Covid-19 pandemic — and calling for the current leadership in the United States to be voted out of office.



Donald Trump looking at the camera: U.S. President Donald Trump leads a meeting with the White House Coronavirus Task Force and pharmaceutical executives in Cabinet Room of the White House on March 2, 2020 in Washington, DC. President Trump and his Coronavirus Task Force team met with pharmaceutical companies representatives who are actively working to develop a COVID-19 vaccine.


© Drew Angerer/Getty Images
U.S. President Donald Trump leads a meeting with the White House Coronavirus Task Force and pharmaceutical executives in Cabinet Room of the White House on March 2, 2020 in Washington, DC. President Trump and his Coronavirus Task Force team met with pharmaceutical companies representatives who are actively working to develop a COVID-19 vaccine.

“We rarely publish editorials signed by all the editors,” said Dr. Eric Rubin, editor-in-chief of the medical journal and an author of the new editorial.

The editorial, which Rubin said was drafted in August, details how the United States leads the world in Covid-19 cases and deaths. So far, more than 7.5 million people in the United States have been diagnosed with Covid-19 and more than 200,000 people have died of the disease.

“This crisis has produced a test of leadership. With no good options to combat a novel pathogen, countries were forced to make hard choices about how to respond. Here in the United States, our leaders have failed that test. They have taken a crisis and turned it into a tragedy,” the editorial says.

It does not endorse a candidate, but offers a scathing critique of the Trump administration’s leadership during the pandemic.

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“Anyone else who recklessly squandered lives and money in this way would be suffering legal consequences. Our leaders have largely claimed immunity for their actions. But this election gives us the power to render judgment,” the editorial says. “When it comes to the response to the largest public health crisis of our time, our current political leaders have demonstrated that they are dangerously incompetent. We should not abet them and enable the deaths of thousands more Americans by allowing them to keep their jobs.”

The New England Journal of Medicine began publishing in 1812. There have been only four previous editorials collectively signed by its editors in the recent past: one in 2014 about contraception; an obituary that same year for a former editor-in-chief; an editorial that year about standard-of-care research and an editorial in 2019 about abortion.

“The reason we’ve never published an editorial about elections is we’re not a political journal and I don’t think that we want to be a political journal — but the issue here is around fact, not around opinion. There have been many mistakes made that were not only foolish but reckless and I think we want people to realize that there are truths here, not just opinions,” Rubin said.

“For example, masks work. Social distancing works. Quarantine and isolation work. They’re not opinions. Deciding not to use them is

Johnson plays down technical failure of Covid-19 testing data system

British Prime Minister Boris Johnson leaves 10 Downing Street for PMQs at the House of Commons on 30 September, 2020 in London, England.

Alberto Pezzali | NurPhoto via Getty Images

British Prime Minister Boris Johnson on Monday sought to play down a failure in England’s Covid-19 testing data system that delayed 15,841 results, saying the much higher updated figures were more in line with forecasts of the outbreak’s spread.

The glitch is likely to cast further doubt over Johnson’s handling of the coronavirus pandemic: his Conservative government’s response has been cast by political opponents as slow, poorly organized and confusing.

On Sunday, authorities reported a jump in daily Covid-19 cases to a record 22,961, after saying a technical issue had meant that thousands of test results had not been transferred into computer systems on time, including for contact tracers.

“The incidence that we’re seeing in the cases really sort of corresponds to pretty much where we thought we were,” Johnson said, speaking to reporters.

“To be frank, I think that the slightly lower numbers that we’d seen didn’t really reflect where we thought that the disease was likely to go, so I think these numbers are realistic,” said Johnson.

Health Secretary Matt Hancock will update parliament on the mishap later on Monday, he said.

Johnson, who earlier this year promised a “world-beating” test-and-trace system, has more recently said there have been missteps but that the government has been confronted with the biggest health crisis since the 1918 influenza outbreak.

The technical glitch, which was identified on Friday and has now been resolved, led to 15,841 cases not being uploaded into reporting dashboards used by the National Health Service (NHS) contact-tracing system.

“We fully understand the concern this may cause and further robust measures have been put in place as a result,” said Michael Brodie, the interim chief executive of Public Health England, the government-funded body in charge of public health management in Britain’s biggest region.

PHE said that all the people concerned had been given their test results in a timely fashion, and that those who had tested positive had been told to self-isolate.

Asked about a vaccine, Johnson said it felt like an AstraZeneca project must be on the verge of one.

“We are working very very hard to get one,” Johnson said of a vaccine. “We are not there yet.”

“I went to see the scientists at Oxford at the Jenner Institute, the AstraZeneca team — incredible what they’re doing. You know you really feel they must be on the verge of it, but its got to be properly tested,” Johnson said.

Source Article

UK PM Johnson plays down technical failure of COVID-19 testing data system

LONDON (Reuters) – British Prime Minister Boris Johnson on Monday sought to play down a failure in England’s COVID-19 testing data system that delayed 15,841 results, saying the much higher updated figures were more in line with forecasts of the outbreak’s spread.

The glitch is likely to cast further doubt over Johnson’s handling of the coronavirus pandemic: his Conservative government’s response has been cast by political opponents as slow, poorly organised and confusing.

On Sunday, authorities reported a jump in daily COVID-19 cases to a record 22,961, after saying a technical issue had meant that thousands of test results had not been transferred into computer systems on time, including for contact tracers.

“The incidence that we’re seeing in the cases really sort of corresponds to pretty much where we thought we were,” Johnson said, speaking to reporters.

“To be frank, I think that the slightly lower numbers that we’d seen didn’t really reflect where we thought that the disease was likely to go, so I think these numbers are realistic,” said Johnson.

Health Secretary Matt Hancock will update parliament on the mishap later on Monday, he said.

Johnson, who earlier this year promised a “world-beating” test-and-trace system, has more recently said there have been missteps but that the government has been confronted with the biggest health crisis since the 1918 influenza outbreak.

The technical glitch, which was identified on Friday and has now been resolved, led to 15,841 cases not being uploaded into reporting dashboards used by the National Health Service (NHS) contact-tracing system.

“We fully understand the concern this may cause and further robust measures have been put in place as a result,” said Michael Brodie, the interim chief executive of Public Health England, the government-funded body in charge of public health management in Britain’s biggest region.

PHE said that all the people concerned had been given their test results in a timely fashion, and that those who had tested positive had been told to self-isolate.

Asked about a vaccine, Johnson said it felt like an AstraZeneca project must be on the verge of one.

“We are working very very hard to get one,” Johnson said of a vaccine. “We are not there yet.”

“I went to see the scientists at Oxford at the Jenner Institute, the AstraZeneca team – incredible what they’re doing. You know you really feel they must be on the verge of it, but its got to be properly tested,” Johnson said.

(Reporting by Guy Faulconbridge, William James, Estelle Shirbon, William Schomberg; editing by Kate Holton, Michael Holden and Mark Heinrich)

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