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When HF Worsens in the Hospital

When HF Worsens in the Hospital

Acute heart failure (HF) leads to more than 1 million hospitalizations in the United States each year, and the 1-year mortality rate after these events ranges between 20% and 30%. “Some of these patients will experience worsening HF during their hospitalization, showing signs or symptoms that require therapy to be escalated,” says Adam D. DeVore, MD. Although worsening HF has been used as an endpoint in many clinical trials, few data are available that look at the prevalence of worsening in-hospital HF and its associated outcomes. In a study published in the Journal of the American Heart Association, Dr. DeVore and colleagues used inpatient data from the Acute Decompensated Heart Failure National Registry to examine the prevalence and outcomes of patients with worsening HF, which was defined as requiring escalation of therapy at least 12 hours after patients present to the hospital. “Our study was unique in that it provided ‘real world’ data on these patients,” says Dr. DeVore. Patients with worsening HF were compared with those who had an uncomplicated hospital course and those who had a complicated presentation. Assessing Outcomes “Our study showed that 11% of patients with acute HF developed in-hospital worsening HF,” says Dr. DeVore. Those with worsening HF in the hospital had the highest rates of mortality, all-cause readmission, and Medicare payments at 30 days and 1 year after being hospitalized. These patients also had worse post-discharge outcomes and higher costs when compared with patients who had uncomplicated hospital courses and with those who had complicated presentations. When compared with an uncomplicated hospital course, worsening in-hospital HF was associated with more than a two-fold...
Hypertension: Examining Cost Effectiveness of Treatment

Hypertension: Examining Cost Effectiveness of Treatment

According to current estimates, 44% of the 64 million adults in the United States with hypertension did not have their condition controlled in 2014. In 2014, the Eighth Joint National Committee released its first updated guidelines on hypertension since 2003. Several important changes were made from the earlier guideline, including recommendations to focus on diastolic rather than systolic blood pressure (BP) for adults younger than 60 and setting more conservative BP goals for adults aged 60 and older (150/90 mm Hg) as well as for patients with diabetes or chronic kidney disease (140/90 mm Hg). Estimating Cost Effectiveness “Few analyses have examined the health benefits and cost-effectiveness of treating hypertension in the U.S.,” says Andrew E. Moran, MD, MPH. To address this research gap, Dr. Moran and colleagues published a study in the New England Journal of Medicine that sought to estimate the incremental health gains and cost-effectiveness of implementing the strongest recommendations for hypertension therapy in the 2014 guidelines among adults. Using the Cardiovascular Disease Policy Model, the study team simulated drug-treatment and monitoring costs, costs averted for the treatment of cardiovascular disease (CVD), and quality-adjusted life-years gained by treating previously untreated adults between the ages of 35 and 74 from 2014 through 2024. “Our model pulled together data from many studies to quantify the value of treating hypertension,” adds Dr. Moran. “This information is important for policy-makers and physicians to determine if controlling hypertension is a worthwhile investment.” Big Rewards for Achieving Goals The study found that, on average, about 860,000 people with existing CVD and hypertension who are not being treated with antihypertensive medications would be...

Appeals Court Strips Graduate of MD Degree

A three-judge panel of the US Court of Appeals for the Sixth Circuit reversed a federal district court decision and said that Case Western Reserve University could withhold an MD degree from a student who they said exhibited unprofessional behavior. I have written about this situation on two previous occasions—here and here. Briefly, a medical student who had performed well academically had committed a few transgressions outside the classroom. These included: sexually harassing some female students at a dance; attempting to avoid payment of a taxi fare; having problems interacting with staff, patients, and families, resulting in a failing grade and requirement to repeat a [sub?]internship; and asking faculty members not to mark him late for teaching sessions, which occurred 30% of the time. The issue that prompted the school to expel the student just prior to graduation was a conviction in another state for driving while intoxicated. He denied or had excuses for most of the incidents. The original court decision pointed out that his earlier problems had apparently not been considered serious because the school had given him positive letters of recommendation. The lower court also opined that professionalism was distinct from academic matters. The appeals court disagreed and said, “professionalism is part of what [medical] students must learn and practice.” It added that the school’s definition of professionalism in moral judgment terms was appropriate and should not be separated from academic performance. Here are some of the ways the school defined professionalism in its curriculum: ethical, honest, responsible and reliable behavior; respectful dialogue with peers, faculty, and patients, to enhance learning and resolve differences; recognize personal...
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