Medical Therapy No Help

March 11, 2011 by admin  
Filed under Western Treatment

Patients in their 80s appeared to get no benefit from commonly used cardiac drugs when they have heart failure with preserved ejection fraction, data from a small retrospective study suggest. Action Points

Explain to patients that this study found no benefits from medical treatment of patients older than 80 with heart failure and preserved ejection fraction.

Note that the findings were based on a retrospective subgroup analysis of a larger study and involved a relatively small number of patients, which may have limited the ability to identify significant differences.
Antihypertensives, vasodilators, and statins all failed to make an impact on survival during five years of follow-up, Ernst R. Schwarz, M.D., Ph.D., of Cedars-Sinai Medical Center here, and colleagues reported online in the American Journal of Cardiology.

In fact, the only significant difference in medication use between patients who died and those who survived five years went in the wrong direction.

“The benefits of statins and other common cardiac medications in patients older than 80 with heart failure and preserved left ventricular ejection fraction should be vigorously and specifically studied in this patient population with the intention of showing both a validated therapy and insights into novel mechanisms of disease and disease modification,” the authors concluded.

The American College of Cardiology/American Heart Association guidelines for management of chronic heart failure emphasize treatment of hypertension, atrial fibrillation, and clinical symptoms in patients with preserved ejection fraction.

Medication classes suggested in the guidelines include beta-blockers, ACE inhibitors, angiotensin receptor blockers, calcium channel blockers, and diuretics, the authors noted. Statins also have been studied in patients with heart failure and preserved ejection fraction.

However, the benefits of these commonly used medications in heart failure patients older than 80 had not been established, the authors said.

To examine the issue, they performed a subgroup analysis of a larger study involving patients of any age with heart failure and preserved ejection fraction.

The authors identified 142 study participants who were older than 80. Complete records were available for medical history and medication use.

During the five years of follow-up, 98 patients (69%) died. The authors could identify no significant differences between survivors and those who died.

Comparison of patients who died or survived revealed no statistically significant impact on survival from use of:

  • ACE inhibitors or ARBs, P=0.912
  • Beta-blockers, P=0.891
  • Calcium-channel blockers, P=0.690
  • Diuretics, P=0.303
  • Digoxin, P=0.233
  • Statins, P=0.321

“Furthermore, no medication use showed a decrease in adjusted all-cause or cardiac rehospitalization,” the authors said.

“However,” they noted, “patients using calcium-channel blockers had a statistically significant increase in annual cardiac rehospitalization.”

Also noting an increased risk of adverse drug effects in older patients, the authors called for more judicious use of medications in that patient population.

“There was no proven benefit for pharmacologic therapy, and yet there were costs, both financial and physiologic,” the authors said. “Despite the lack of proven benefit, there was still moderate use of many common cardiovascular medications in this patient population.”

The authors noted that “the present study was limited by its small retrospective nature. The limited sample size of this pilot study led to a lack of statistical significance in multiple trends in mortality with various medications.”

They also noted that effects of different agents within drug class and different dosages of different agents were not assessed.

The authors reported no disclosures.

By Charles Bankhead, Staff Writer, MedPage Today

Published: March 13, 2009
Reviewed by Zalman S. Agus, MD; Emeritus Professor
University of Pennsylvania School of Medicine.

Primary source: American Journal of Cardiology
Source reference:
Tehrani F, et al “Value of medical therapy in patients >80 years of age with heart failure and preserved ejection fraction” Am J Cardiol 2009; epub.

The Cost of Not Having a Heart Attack

March 10, 2011 by admin  
Filed under Disease & Wellness

A great article on keeping employees healthy, from MLive and Wendy Wigger. I know this comes as no surprise. But when it comes to wellness programming, how do you know if the money you invest in helping to create healthier employees will pay off?

With much of its focus on prevention of disease, decreasing risks associated with disease and creating healthier lifestyle habits, measuring the impact of worksite wellness can seem to be an elusive and daunting task. Think about it — if your programming is doing a good job of preventing disease, how do you measure the heart attack that never happened?

The reality is that while it may not be easy, there are steps you can take to create a good baseline for measuring the long-term impact of your program. It starts with realistic expectations, outlining your goals and setting the stage to monitor your program impact. The following data sources and evaluation methods can give you a good start:

• A health-risk appraisal can provide an aggregate look at the health status and behaviors of your employees. While the data is self-reported, the information can be a good baseline and annual barometer of changes in employee behaviors, health risks and readiness to change. You can monitor changes in risk levels by monitoring whether employees are moving from high to moderate risk, or moderate to low risk.

• Biometric screens can arm employees with clinical measures that can make for an even richer health-risk appraisal report — for both the employer and individuals. In addition, monitoring the changes in screening factors such as body-mass index, blood pressure, cholesterol levels and other risk factors can provide another baseline against which to measure your program’s impact and cost savings based on reduced risks.

• Your health care claims can help tell your medical story as well. We know that much of the cost of health care is associated with chronic disease — much of which is preventable through good lifestyle habits. Work with your health plan to monitor trends and changes in the type of claims and associated costs, but be realistic in terms of your results.

There are many factors that contribute to health care costs beyond disease and lifestyle habits: improvements in technology, pharmacy costs and physician malpractice rates, just to name a few. So, while worksite wellness can make a difference, this alone will not be the answer to solving the increase in health care costs.

Claim costs also can point to misuse of benefits. For example, if you find your employees are using the emergency room for non-emergencies like the flu or sneezes and sniffles, you may need to adjust your plan to have a higher Emergency Room c0-pay.

Employees absent from their jobs — whether due to health issues, family needs or a lack of commitment — means increased costs to the employer. Worksite wellness programs can have a positive impact on absenteeism through improved morale, creating healthier employees and providing helpful life balance skills.

Monitoring and trending your “unscheduled” absences for your employee population — prior to launching your wellness program as well as afterward — also can point to a potential area of cost savings.

Another factor is employee turnover. If you’re losing good employees even in these tough economic times, a quality wellness program sometimes can make the difference between someone staying with you or going to the competition.

It’s important to offer your employees a variety of creative ways to stay fit and healthy. It’s equally important to know whether these kinds of wellness efforts are achieving bottom-line results.

If it Works for Humans…

March 10, 2011 by admin  
Filed under Disease & Wellness

As more people are seeking a natural approach to their own health, it is no surprise that many are doing the same for their dogs.

Holistic care looks at the whole dog on a physical, mental, emotional, and spiritual level. It is thought that most illness and disease is a result of unresolved emotional issues. Just as Einstein believed all life was made of energy, holistic care focuses on healing your dog’s body and its energy system.

While holistic care is not meant to replace veterinary care, it can be a wonderful addition to it. While most dog owners are familiar with acupuncture and chiropractic adjustments, there are a number of simple and affordable methods that you may not be aware of.

Nutrition is vital to your dog’s health. Many people do not realize an improper diet can result in health issues such as allergies and behavioral problems such as separation anxiety. Supplements can also be supportive. MSM and glucosamine are frequently used for mobility issues, often reducing or eliminating the need for pain relief. Kinesiology, also called muscle testing, is a way to determine what food and supplements are best for your dog.

Canine massage can provide relaxation, relief from muscle soreness and comfort for dogs with arthritis and hip dysplasia. It is beneficial for performance, aging, and less active dogs.

Homeopathy is a method known for treating the cause of the condition, not just the symptoms. For the dog owner, homeopathic remedies are best used to resolve acute conditions like diarrhea, vomiting and insect bite or vaccination reactions.

Animal communication is something everyone can do; it is just a matter of awakening the intuitive abilities inside of you. By talking to your dog, you can find out how they are feeling, why they are acting a certain way, help resolve behavioral problems and develop a stronger relationship.

Reiki is a Japanese form of energy healing that is offered in hospitals such as MD Anderson. It can have amazing results in calming your dog, helping with illness and discomfort, and providing comfort to both of you when it is time for them to pass on.

Holistic care can help your dog live a happier, healthier and longer life. When you take the time to connect with your dog’s body, mind and spirit, you can also experience a deeper bond like never before. And through this journey, you can profoundly affect your own life, too.

Kim Shotola has worked with animals at the Houston Zoo for over 17 years. She has been a supervisor for 14 years, helping manage the care of over 1,000 domestic, livestock, wildlife and exotic animals in the Children’s Zoo. She is a holistic animal instructor and consultant and has a private practice that is not affiliated with the zoo. To learn more about holistic animal care, please visit Kim’s website.