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Depression, Clinical Inertia, & Uncontrolled Hypertension

Depression, Clinical Inertia, & Uncontrolled Hypertension

Depression has been identified as a risk factor for a poor prognosis among patients with cardiovascular disease. Few studies, however, have investigated the association between depression and clinical inertia, which has been defined as the lack of intensifying treatment for those who are not meeting evidence-based goals for care. In addition, data are lacking as to whether a diagnosis of depression is connected to clinical inertia in patients with uncontrolled hypertension. Examining the Connection To address this research gap, Ian M. Kronish, MD, MPH, and colleagues had a study published in JAMA Internal Medicine that examined data from 158 older adults with uncontrolled hypertension. The study patients also had blood pressures (BPs) that were above goal, defined as at least 140/90 mm Hg for most patients or at least 130/80 mm Hg for those with diabetes or chronic kidney disease. Depression was noted in the electronic medical record for 45% of patients in the study. “Among patients with uncontrolled hypertension, those with depression were less likely to have their treatment intensified to achieve BP goals,” says Dr. Kronish. Clinical inertia occurred in 70% of patients with depression and 51% of those without depression, according to results. This difference remained significant even after excluding depressed patients who had at least one documented home or clinic systolic BP reading below goal and after adjusting for patient-reported medication non-adherence. Assessing the Implications “Clinical inertia may be one mechanism by which patients with depression have worse cardiovascular outcomes,” says Dr. Kronish. “That said, there may be cases in which clinical inertia is appropriate. More qualitative studies are needed to explore the reasons why...

Social Media Tips for Doctors

Recently, I was asked for personal advice on using Twitter. There are many articles out there that say we (physicians) don’t know how to properly use social media. Social media can be a very powerful tool in medicine. It can not only help us get medical information out there to our patients, but it can also help us connect with people, colleagues, and organizations to give us more visibility—whether for career advancement, media contacts, or just to get our voices heard. Social Media Basics: These are some of the tips I have come up with for doctors who want to take advantage of the many opportunities social media can offer: 1. Never communicate to patients through social media outlets. It is a set up for disaster and HIPAA violations. 2. Social media can be used for educating patients. Patients can follow you on these pages to get information about your practice and whatever medical information you wish to share. Twitter… 3.  Twitter is useful for growing your professional connections. It can be leveraged so you get known and also connect with other doctors, healthcare information technology people, media, etc. Patients can follow you on Twitter, but it generally is not a useful method of providing patient information because tweets are limited to 140 characters. 4. Choose your followers carefully. Block those who spam or troll you (“trolls” are people who negatively post with the deliberate intent of provoking a reaction). Many people will try to sell you things. Monitor your account because it is not uncommon for it to be hacked. 5. Grow your network. Have a group that...
Unhealthy Heart Behaviors: Getting Ahead of the Curve

Unhealthy Heart Behaviors: Getting Ahead of the Curve

The American Heart Association (AHA) has set a 2020 goal of improving the heart health of all Americans by 20% while reducing deaths from cardiovascular disease (CVD) and stroke by 20%. The AHA’s 2020 goals were designed strategically to help all individuals prevent declines in their current health behaviors and take a step toward better heart health by progressing toward ideal healthy lifestyle behaviors. “To achieve these goals, prevention is the top priority,” says Bonnie Spring, PhD. “Major strides have been made toward reducing risks for CVD and stroke, but the significant economic toll linked to these health challenges necessitates a new approach.” According to recent estimates, direct annual CVD-related costs are projected to triple, rising from $272 billion in 2010 to $818 billion in 2030. A Call to Action In 2013, the AHA released a science advisory, published in Circulation, emphasizing the importance of greater efforts to preserve cardiovascular health from childhood and to treat health risk behaviors into older ages. The call-to-action statement addresses three novel approaches to attain the AHA’s 2020 goals: 1. Preserving positive cardiovascular health by promoting healthy lifestyle behaviors. 2. Treating unhealthful behaviors in addition to risk biomarkers. 3. Combining individual-level and population-based health promotion strategies that steer the public toward the next level of improved cardiovascular health. “Clinicians need to treat unhealthy behaviors as aggressively as they treat high blood pressure (BP), cholesterol, and other CVD risk factors,” says Dr. Spring, who was lead author of the AHA statement. “It’s a paradigm shift from only treating biomarkers to also helping people change unhealthy behaviors.” Clinicians already treat physical risk factors, but people...
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