CME: Pneumonia & CVD: Making the Link

CME: Pneumonia & CVD: Making the Link

Studies have shown that patients with respiratory tract infections (RTIs) often have higher risk for cardiovascular events than those without RTIs. However, these studies have mostly assessed risk within the first few months after an RTI. Investigations that have assessed long-term risk have had conflicting results. By better characterizing the short- and long-term risks of CVD after an RTI, clinicians may be able to clarify whether these infections are risk factors for CVD and help explain the short- and long-term morbidity and mortality among patients with RTIs. Assessing Risk For a study published in JAMA, Sachin Yende, MD, MS, and colleagues examined community-based cohorts from the Cardiovascular Health Study (CHS) and the Atherosclerosis Risk in Communities study (ARIC). “CHS enrolled patients older than 65 from 1989 to 1994, and we have follow-up data for about 15 years,” explains Dr. Yende. “The ARIC study enrolled patients aged 45 to 65 from 1987 to 1989, and has similar follow-up data.” To determine if the risk of CVD varied over 10 years following hospitalization for pneumonia, the authors identified pneumonia hospitalizations in the CHS and ARIC cohorts. These individuals were then matched with patients without pneumonia and monitored for the development of CVD. Risk was assessed within the 30 days of hospitalization, from 30 to 90 days, from 90 days to 1 year, and then annually thereafter. The researchers also sought to determine if any associations between pneumonia and CVD risk persisted after adjusting for traditional and cardiovascular risk factors. Persistent CVD Risk “Our study confirmed that the risk of CVD events is indeed higher among patients who have had pneumonia when...
Pneumonia & CVD: Making the Link

Pneumonia & CVD: Making the Link

Studies have shown that patients with respiratory tract infections (RTIs) often have higher risk for cardiovascular events than those without RTIs. However, these studies have mostly assessed risk within the first few months after an RTI. Investigations that have assessed long-term risk have had conflicting results. By better characterizing the short- and long-term risks of CVD after an RTI, clinicians may be able to clarify whether these infections are risk factors for CVD and help explain the short- and long-term morbidity and mortality among patients with RTIs. Assessing Risk For a study published in JAMA, Sachin Yende, MD, MS, and colleagues examined community-based cohorts from the Cardiovascular Health Study (CHS) and the Atherosclerosis Risk in Communities study (ARIC). “CHS enrolled patients older than 65 from 1989 to 1994, and we have follow-up data for about 15 years,” explains Dr. Yende. “The ARIC study enrolled patients aged 45 to 65 from 1987 to 1989, and has similar follow-up data.” To determine if the risk of CVD varied over 10 years following hospitalization for pneumonia, the authors identified pneumonia hospitalizations in the CHS and ARIC cohorts. These individuals were then matched with patients without pneumonia and monitored for the development of CVD. Risk was assessed within the 30 days of hospitalization, from 30 to 90 days, from 90 days to 1 year, and then annually thereafter. The researchers also sought to determine if any associations between pneumonia and CVD risk persisted after adjusting for traditional and cardiovascular risk factors. Persistent CVD Risk “Our study confirmed that the risk of CVD events is indeed higher among patients who have had pneumonia when...
Quality Care for Pneumonia in the Elderly

Quality Care for Pneumonia in the Elderly

Adherence to recommended processes of care for patients hospitalized with pneumonia is publicly reported throughout the United States by CMS. Despite this reporting, little is known regarding whether more physicians are now performing these process measures and how they have impacted patient outcomes. Taking a Closer Look For a study published in JAMA Internal Medicine, Jonathan S. Lee, MD, and colleagues sought to describe the processes of care, mortality, and readmissions for elderly patients hospitalized with pneumonia. “The morbidity and mortality associated with pneumonia are especially prominent in the elderly,” says Dr. Lee. “We assessed how these patients are being cared for and whether there are steps that should be taken to potentially improve their mortality and readmissions rates.” The researchers conducted a retrospective analysis that involved more than 1.8 million Medicare fee-for-service patients aged 65 and older who were hospitalized for pneumonia in 2006 to 2010. Participants were eligible for at least one of seven inpatient processes of care that are tracked by CMS during their hospitalization, including: Influenza vaccination. Pneumococcal vaccination. Smoking cessation counseling. Performance of blood cultures before antibiotic therapy in the ED. Performance of blood cultures within 24 hours for ICU patients. Appropriate antibiotic selection. Antibiotic initiation within 6 hours. Based on the processes and outcomes of care, Dr. Lee and colleagues assessed the quality of care for pneumonia from 2006 to 2010. “By 2010, more than 92% of patients were receiving all of the processes of care for which they were eligible,” Dr. Lee says. “Mortality and readmission rates both decreased slightly during the study period. All seven processes of care were associated with...
CME: The Increasing Costs of COPD

CME: The Increasing Costs of COPD

Chronic lower respiratory disease—the large majority of which is COPD—currently ranks as the third leading cause of mortality in the United States. Recent estimates of the costs associated with chronic lower respiratory disease have presented asthma and COPD together, which does not allow for a true understanding of the costs of COPD to the national healthcare system. Fur-ther complicating available data is the fact that patients with COPD often have a multitude of comorbidities. “Most COPD is attributable to smoking, which can also cause heart disease, cancer, and many other conditions,” explains Earl S. Ford, MD, MPH. “This makes it difficult to understand what costs are directly attributable to COPD and what costs are actually attributable to conditions that co-exist with COPD. Some of the previous studies looking at the costs of COPD have likely included ‘double counting’ from not factoring in costs that are actually attributable to these comorbidities.” A Thorough Analysis For a study published in Chest, Dr. Ford and colleagues estimated national and state-specific COPD-attributable annual medical costs by payer and absenteeism in 2010 and projected medical costs through 2020. The team used the 2006 to 2010 Medical Expenditure Panel Survey, 2004 National Nursing Home Survey, and 2010 CMS data to generate cost estimates and 2010 census data to project medical costs through 2020. “We felt that the most presentable costs were those that were estimated after accounting for 11 comorbidities, including heart disease, pneumonia, diabetes, asthma, and depression,” adds Dr. Ford. After accounting for these other comorbidities, the researchers estimated that the 2010 costs attributable to COPD and its sequelae were $32.1 billion (Figure). By...
The Increasing Costs of COPD

The Increasing Costs of COPD

Chronic lower respiratory disease—the large majority of which is COPD—currently ranks as the third leading cause of mortality in the United States. Recent estimates of the costs associated with chronic lower respiratory disease have presented asthma and COPD together, which does not allow for a true understanding of the costs of COPD to the national healthcare system. Fur-ther complicating available data is the fact that patients with COPD often have a multitude of comorbidities. “Most COPD is attributable to smoking, which can also cause heart disease, cancer, and many other conditions,” explains Earl S. Ford, MD, MPH. “This makes it difficult to understand what costs are directly attributable to COPD and what costs are actually attributable to conditions that co-exist with COPD. Some of the previous studies looking at the costs of COPD have likely included ‘double counting’ from not factoring in costs that are actually attributable to these comorbidities.” A Thorough Analysis For a study published in Chest, Dr. Ford and colleagues estimated national and state-specific COPD-attributable annual medical costs by payer and absenteeism in 2010 and projected medical costs through 2020. The team used the 2006 to 2010 Medical Expenditure Panel Survey, 2004 National Nursing Home Survey, and 2010 CMS data to generate cost estimates and 2010 census data to project medical costs through 2020. “We felt that the most presentable costs were those that were estimated after accounting for 11 comorbidities, including heart disease, pneumonia, diabetes, asthma, and depression,” adds Dr. Ford. After accounting for these other comorbidities, the researchers estimated that the 2010 costs attributable to COPD and its sequelae were $32.1 billion (Figure). By...
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