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Making the Case for More Specialist Training

Making the Case for More Specialist Training

Experts have reported that population growth among the elderly and the increasing prevalence of chronic diseases in these older Americans will have profound implications for the United States healthcare system in the coming decades. An estimated 89 million Americans will be 65 and older by 2050, a figure that is more than double the current population for this age group. In addition, more than 90% of elderly Americans report having one or more chronic diseases. “This trend is likely to continue,” says Timothy M. Dall, MS. “It will be challenging for the medical community to overcome the combination of increased longevity and high rates of chronic diseases like hypertension, diabetes, and obesity.” Primary care physicians (PCPs) play an important role in providing preventive services and caring for the elderly population, but recent data suggest that the need for specialist care is also likely to increase as medical knowledge and treatment options continue to advance. “Specialists play essential roles in diagnosing, treating, and monitoring patients with various health problems,” says Dall. “Understanding the needs and demand for both primary care and specialist services can help inform decisions about the number and mix of healthcare providers that the U.S. will need to train so that care is accessible, of high quality, and affordable.” Forecasting the Future In a study published in Health Affairs, Dall and colleagues forecasted future demand for healthcare services and providers. This forecast was based on projected changes in demographic characteristics and other predictors of healthcare use as well as the estimated impact of expanded medical coverage under the Affordable Care Act. According to the analysis, growth and...
Hospital Admission Risk Factors for Older HF Patients

Hospital Admission Risk Factors for Older HF Patients

The number of older people with heart failure (HF) has increased considerably over the past 20 years. Currently, 80% of patients with HF are 65 or older. The costs associated with HF are more than $35 billion per year in the United States, and these costs are largely driven by hospital stays. Yet, relatively little is known about the long-term risk for hospital admission after an HF diagnosis in older people. In addition, few data are available on the role that geriatric conditions—slow gait, muscle weakness, and cognitive impairment—play in driving HF hospitalizations. Addressing Heart Failure Knowledge Gaps My colleagues and I conducted a study in which we evaluated data from a population-based sample of people aged 65 and older who were followed for up to 20 years after being diagnosed with HF. Published in the Journal of the American College of Cardiology, the study sought to identify risk factors for lifetime hospital utilization after a new HF diagnosis and to identify risk factors for hospitalization.     Three geriatric conditions—muscle weakness, slow gait, and depression—emerged as independent risk factors for hospital admission after a diagnosis of HF, even after considering other traditional cardiovascular factors. Our analysis also found that depressed ejection fraction, New York Heart Association class III or IV symptoms, diabetes, and chronic kidney disease were other independent risk factors for admission after an HF diagnosis in older patients. Implications for Future Care After HF Diagnosis The prognostic information revealed by our study may be used to help with clinical decision making and to identify potential targets for interventions after an HF diagnosis in older patients. Muscle weakness,...

Patients With CKD Have Higher Rates of CDI

Patients with chronic kidney disease (CKD) appear to have a higher risk of Clostridium difficile infection (CDI) and hospital-associated morbidity and mortality when compared with patients who do not have CKD. A team of American researchers found that patients with CKD had a CDI rate of 1.49%, compared with a 0.70% rate for those without CKD. Abstract: Mayo Clinic Proceedings, November...

CKD Complicates AAA Repair

Among patients being considered for abdominal aortic aneurysm (AAA) repair, moderate and severe chronic kidney disease (CKD) appears to be associated with significantly increased mortality. Mortality rates were for patients with mild CKD, but escalated to 1.7% and 5.3 for those with moderate and severe CKD, respectively. Abstract: Journal of Vascular Surgery, November...

Blood Pressure & End-Stage Renal Disease in Patients With CKD

Studies have shown that treating high blood pressure (BP) is one of the most important strategies to slowing the progression from chronic kidney disease (CKD) to end-stage renal disease (ESRD). Currently, a BP goal of less than 130/80 mm Hg is recommended for patients with CKD, a target lower than the goal recommended for people without CKD (less than 140/90 mm Hg). Despite the dissemination of clinical guidelines, meeting BP targets in people with CKD may be difficult in clinical practice. “The most recent evidence supporting the use of lower BP targets in people with CKD has been conflicting,” explains Carmen A. Peralta, MD, MAS. “The association of BP levels and ESRD risk in a large, national, community-based setting of persons with established CKD has not been well studied. In addition, some recent reports have found that higher pulse pressure and lower diastolic BP (DBP) may lead to adverse cardiovascular outcomes. This can make it especially challenging for clinicians to control BP aggressively in patients with CKD.” Associations Between BP and ESRD Few studies have investigated the association of each BP component with ESRD risk. In Archives of Internal Medicine, Dr. Peralta and colleagues had a study published that investigated the independent association of systolic BP (SBP) and DBP with ESRD risk in patients with CKD who participated in the Kidney Early Evaluation Program (KEEP), a nationwide kidney health screening program offered by the National Kidney Foundation. More than 16,000 patients in KEEP were studied in the analysis, all of whom had at least stage III CKD. “In the past, questions have been raised about the established BP targets...
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