Going to the right hospital for heart attack care could add a year to your life, a new study suggests.

Using Medicare records, researchers found that roughly 17 years after a heart attack, average life expectancy was 9 to 14 months longer for patients who had been treated at hospitals that do best on widely used quality measures than for those treated at low-rated ones.

“Where you go really does matter,” not just for surviving the heart attack but also long-term, said Dr. Emily Bucholz, a study leader and researcher at Boston Children’s Hospital.

A year of life from high-quality care is a big deal; consider that some cancer drugs won approval for adding a few months or weeks. But if you’re having possible heart attack symptoms, don’t delay getting help because you’re worried about which hospital to go to, said another study leader, Yale cardiologist Dr. Harlan Krumholz.

Too many people wait at home too long," and any delay means more risk of permanent heart damage, he said.

The study was funded by the National Institutes of Health. Results were published Wednesday by the New England Journal of Medicine.

Hospitals often are rated based on their heart attack death rates at 30 days, taking into account how sick their patients were, such as how many had diabetes. 

But it’s not known whether doing well in the short term translates to a lasting benefit.

The new study finds it does. Researchers compared life expectancy for 120,000 Medicare patients treated between 1994 and 1996 at roughly 1,800 hospitals.

The difference in life expectancy at top and low performing hospitals emerged at 30 days and remained over time.

“This is really an important study,” said an independent expert, Dr. Ralph Brindis, a University of California at San Francisco cardiologist and former president of the American College of Cardiology.

“Delivering better care not only saves lives, but that the gain persists over 17 years, independent of how sick the patients were initially.”Heart attack care has improved a lot since the 1990s, but more recent comparisons of short-term hospital mortality rates show that big differences still exist.Where the good hospitals in your community are is worth knowing,” Bucholz said.

And they’re not necessarily the ones that advertise on TV. Medicare has a website that lets you check how they do in your area.

Heart attack symptoms can be sudden, but many start slowly, with mild pain or discomfort, according to the American Heart Association.

Signs can include pressure, squeezing or pain in the chest, one or both arms, the back, neck, jaw or stomach; shortness of breath; breaking out in a cold sweat; nausea, or lightheadedness.

source: Philippine Star
Health & Medicine

If the previous occupant of a hospital bed received antibiotics, the next patient who uses that bed may be at higher risk for a severe form of infectious diarrhea, according to a new study.

Clostridium difficile (C. diff) diarrhea causes 27,000 deaths each year in the U.S. Hospital patients taking antibiotics are particularly at risk for it, say the authors of the study. Antibiotics disturb the normal healthy bacteria of the gut so a C. diff infection can take hold.

The new study shows that “antibiotics given to one patient may alter the local microenvironment to influence a different patient’s risk” for C. diff infection, the researchers wrote in JAMA Internal Medicine.

“Other studies have also demonstrated that antibiotics can have a ‘herd’ effect - in other words, that antibiotics can affect people who do not themselves receive the antibiotics,” said lead author Dr. Daniel Freedberg of Columbia University Medical Center in New York.

Freedberg and his colleagues studied more than 100,000 pairs of patients who sequentially occupied a given hospital bed in four institutions between 2010 and 2015, not including those who had recent C. diff infection or whose prior bed occupant was in the bed for less than 24 hours.

More than 500 patients, or less than 1 percent of the total group, developed a C. diff infection as the second bed occupant.

The infections were 22 percent more likely when then previous occupant had received antibiotics.

Other factors about the previous bed occupant were not associated with C. diff risk.

People can be carrying C. diff organisms without having any symptoms, Freedberg told Reuters Health by email. When these colonized patients receive antibiotics, C. diff may expand within their gut microbiome and start shedding more spores, which means more spores on the bed, the bedside table, the floor, and other areas, he said.

“The next patient who enters the room is thus more likely to be exposed to C. diff spores,” he said. “It’s not easy to sterilize the room/bed between patients because C. diff spores are extremely hardy. To be killed, they need to be soaked in a bleach-containing cleaning agent for an adequate amount of time.”

About half of patients in acute care facilities take antibiotics on any given day, said Kevin Brown of the University of Toronto Dalla Lana School of Public Health, who was not part of the new study.

“That’s a huge portion of patients that could be involved in spreading the infection,” Brown told Reuters Health by email.

But the increased risk is modest, Freedberg added.

“There was a 22 percent relative increase in risk for C. diff with the prior patient’s antibiotics but there was a four-fold increase in risk related to the antibiotics received by the patient him- or herself,” he said.

Other patients, such as other antibiotic user patients within the ward, could have contributed increased risk as well, Brown said.

“Doctors (and patients) should avoid antibiotics in situations where they are not necessary,” Freedberg said. “Too often, antibiotics are prescribed without clear indications.”

“I think this evidence needs to be taken just as an association that needs further exploration,” said Jack A. Gilbert of Argonne National Laboratory in Argonne, Illinois, who was not part of the new study. “While it would be tempting to use these results to change policy, there are so many uncertainties here that such a move would not be advisable.”

source: Reuters Health
http://www.reuters.com/article/us-health-infections-hospital-beds-idUSKCN12A1VY

Common blood pressure medications may increase the risk for severe mood disorder episodes, a new study suggests.

People taking drugs known as beta-blockers and calcium antagonists for more than 90 days were twice as likely to be hospitalized for a mood disorder such as major depression or bipolar disease, compared to people treating their high blood pressure with so-called angiotensin antagonists, researchers report.

Commonly prescribed beta-blockers include propranolol, metoprolol, and atenolol, for example. Calcium channels blockers include amlodipine, nifedipine, verapamil, and diltiazem, while losartan, valsartan, telmisartan, and candesartan are all angiotensin blockers.

Still, people on these medications shouldn't change their prescription or do anything differently, said senior author Dr. Sandosh Padmanabhan, of the Institute of Cardiovascular and Medical Sciences at the University of Glasgow in the U.K.

"People need to take their drugs because these drugs are effective at preventing heart attack and stroke," he told Reuters Health.

He and his colleagues write in the journal Hypertension that depression and heart disease are both common health problems, and the links between them may go in both directions.

For example, bipolar disorder is tied to about a two-fold increased risk of high blood pressure and death related to heart problems, they write. Additionally, major depressive disorder is tied to an increased risk of high blood pressure.

There is also evidence to suggest that beta-blockers are tied to mood problems, like depression, said Padmanabhan. Some recent genetic evidence suggest calcium antagonists may also be tied to mood disorders.

To examine the link between blood pressure drugs and mood disorders, the researchers analyzed hospital data on 144,066 patients ages 40 to 80 who had been taking medicines for at least 90 days to control their high blood pressure - either angiotensin antagonists, beta-blockers, calcium antagonists or thiazide diuretics (water pills).

Anyone who had previously been admitted to a hospital for a mood disorder was excluded from the study.

The blood pressure patients were compared to 111,936 people not taking blood pressure medications.

Over roughly five years, 299 of the patients were admitted to a hospital for mood disorders.

Those using beta-blockers and calcium antagonists were about twice as likely to be hospitalized for a mood disorder as people taking angiotensin antagonists after accounting for a number of factors that might influence the results, like age, sex and overall health.

Angiotensin antagonists, in contrast, seem to protect against severe mood disorder, Padmanabhan noted. People using these drugs were less likely to be admitted to the hospital for mood disorder problems than people not taking medications at all.

Dr. Maan Fares, a cardiologist at the Cleveland Clinic in Ohio, agreed that patients shouldn't change their medication based on this study.

"It’s based on a retrospective analysis and the evidence isn’t sufficient to make any changes in our treatment patterns today," said Fares, who wasn't involved in the new study.

The study does, however, confirm the need for better designed trials, he said.

Padmanabhan also cautioned that the study's findings are limited. He and his colleagues are currently looking at previous clinical trials of blood pressure drugs to see if those researchers captured data on depression, which would make it easier to confirm the findings.

source: Reuters Health
http://www.reuters.com/article/us-health-heart-bp-depression-idUSKCN12A2IP

Intense physical exertion or extreme emotional upset can each trigger a heart attack, and the risk may be highest if the two are combined, according to a new study.

“Our study is the largest study exploring this issue, and unlike previous studies we included people from many different countries and ethnicities,” said lead author Andrew Smyth of the Population Health Research Institute at McMaster University in Hamilton, Ontario, Canada.

The association between the triggers and the onset of heart attack was similar across all locations, he added.

The researchers used data from more than 12,000 cases of first heart attack in 52 countries, recorded in the INTERHEART study. After the heart attack, study staff asked patients if they had been engaged in heavy physical exertion or were angry or emotionally upset in the hour leading up to the heart attack and in the same hour on the previous day.

Almost 14 percent said they had been engaged in heavy physical exertion and 14 percent said they were angry or emotionally upset in the hour leading up to the heart attack.

Being angry or physically strained roughly doubled the heart attack risk. If the two factors were combined, heart attack was about three times as likely, as reported in Circulation.

The researchers didn’t explicitly define “upset” or “exertion” for patients, who decided this for themselves, Smyth told Reuters Health by email.

In terms of heart attack triggers, there was no difference between those with and without diabetes or high blood pressure, he said.

“It’s useful to know that either getting angry to an extreme or exercising to an extreme could potentially be harmful especially for middle aged people with cardiac risk factors,” said psychologist Barry Jacobs, director of behavioral sciences at the Crozer-Keystone Family Medicine Residency Program in Springfield, Pennsylvania, and spokesperson for the American Heart Association, who was not part of the new study.

“One of the weaknesses of the study is that it doesn’t define what an extreme physical exertion experience would be or an extreme anger experience,” Jacobs told Reuters Health by phone.

Everyone can benefit from keeping their tempers in check, and when angry, it’s not a good idea to throw yourself into extreme physical exercise, he said.

source: Reuters Health
http://www.reuters.com/article/us-health-heart-stress-idUSKCN12A2CM