Menu

Recalls of Blood Pressure Med Took Toll on Patients’ Health

By Dennis Thompson
HealthDay Reporter

WEDNESDAY, Nov. 20, 2019 (HealthDay News) — Emergency room visits for high blood pressure surged following last year’s recall of the popular heart drug valsartan, Canadian researchers report.

Within the first month of the recall, there was a 55% increase of people coming to Ontario-area emergency departments complaining of high blood pressure, said lead researcher Cynthia Jackevicius. She is a senior scientist with the Institute for Clinical Evaluative Sciences, in Toronto.

Some of these patients likely were valsartan users who stopped taking the blood pressure med after seeing scary recall news citing a potential carcinogen found in some lots of the drug, Jackevicius said.

“Nine out of 10 did have an alternative replacement” for valsartan within three months. “However, that means that one out of 10 did not,” Jackevicius said.

“That’s a little bit concerning, that some of these patients may have either been confused or concerned, and decided not to switch to another medication,” she added.

The recall occurred in July 2018 in both Canada and the United States, after generics maker Mylan Pharmaceuticals detected trace amounts of a probable cancer-causing chemical called N-nitrosodiethylamine (NDEA) in valsartan meds.

It was an unusually large recall that involved intense media interest, and Jackevicius and her colleagues wondered how it might have affected the drug’s users.

So they turned to Canadian prescription and medical records to track how valsartan users responded to the crisis.

Dr. Mary Norine Walsh, a past president of the American College of Cardiology and a cardiologist at St. Vincent Heart Center of Indiana, said, “It’s really interesting data, because my assumption would have been in Canada and the U.S. that substitution was made pretty much instantly.”

That’s what happened — mostly.

Within one month, 85% of patients had a new prescription for an alternative to their generic valsartan, Jackevicius said. By three months, 90% had a prescription for a different blood pressure drug.

But that left 10% of patients with recalled valsartan who hadn’t been prescribed an alternative, Jackevicius noted.

“Maybe they heard about the recall on the news and never went to their physician or clinician to get a substitution,” Walsh said.

Continued

“When there’s a recall like this, is there a patient lack of trust in the system? Do they not get back on drugs because they’re afraid? I don’t know,” Walsh asked.

In the immediate aftermath of the recall, people swarmed Ontario emergency departments for blood pressure treatment, the researchers found.

Many of these folks likely were people who were afraid to take their valsartan and went to the ER for a replacement drug when they couldn’t reach their doctor, Jackevicius suggested.

“That’s not really the best place to go” when your drug is recalled, she said. “Going to the emergency department is not a good use of the resources there, and it’s not a good use of the patient’s time.”

However, there were also probably quite a few who stopped taking the drug altogether and suffered symptoms related to high blood pressure, Jackevicius and Walsh said.

According to Walsh, “People did worse if they came off it, which is not surprising because the primary reason they were prescribed it was for hypertension.”

Jackevicius said the incident revealed holes in medicine’s response to major drug recalls.

Empowering pharmacists to reach out to patients and prescribe alternatives could be one way to improve the response to a recall, Jackevicius said.

Pharmacists have direct knowledge of the specific drugs handed out to patients that their doctors don’t, she explained.

“It would make sense that they take more responsibility and be given the authority to substitute common medications, to be a point person in the event of a recall,” Jackevicius said. “They are accessible and would know similar medications that might be OK for that condition.”

Public health officials also could help by promptly creating a consensus list of approved alternative medications, so doctors and pharmacists could quickly and efficiently move patients onto a new prescription, she added.

Jackevicius presented her study last weekend at the American Heart Association’s annual meeting, in Philadelphia. The work was also published recently in the journal Circulation.

WebMD News from HealthDay

Sources

SOURCES: Cynthia Jackevicius, Pharm.D., senior scientist, Institute for Clinical Evaluative Sciences, Toronto, Canada; Mary Norine Walsh, M.D., past president,  American College of Cardiology, and cardiologist, St. Vincent Heart Center of Indiana; Nov. 11, 2019,Circulation

Copyright © 2013-2018 HealthDay. All rights reserved.

‘); } else { // If we match both our test Topic Ids and Buisness Ref we want to place the ad in the middle of page 1 if($ .inArray(window.s_topic, moveAdTopicIds) > -1 && $ .inArray(window.s_business_reference, moveAdBuisRef) > -1){ // The logic below reads count all nodes in page 1. Exclude the footer,ol,ul and table elements. Use the varible // moveAdAfter to know which node to place the Ad container after. window.placeAd = function(pn) { var nodeTags = [‘p’, ‘h3′,’aside’, ‘ul’], nodes, target; nodes = $ (‘.article-page:nth-child(‘ + pn + ‘)’).find(nodeTags.join()).not(‘p:empty’).not(‘footer *’).not(‘ol *, ul *, table *’); //target = nodes.eq(Math.floor(nodes.length / 2)); target = nodes.eq(moveAdAfter); $ (”).insertAfter(target); } // Currently passing in 1 to move the Ad in to page 1 window.placeAd(1); } else { // This is the default location on the bottom of page 1 $ (‘.article-page:nth-child(1)’).append(”); } } })(); $ (function(){ // Create a new conatiner where we will make our lazy load Ad call if the reach the footer section of the article $ (‘.main-container-3’).prepend(”); });

Pagination

WebMD Health

Recalls of Blood Pressure Med Took Toll on Patients’ Health

WEDNESDAY, Nov. 20, 2019 — Emergency room visits for high blood pressure surged following last year’s recall of the popular heart drug valsartan, Canadian researchers report.

Within the first month of the recall, there was a 55% increase of people coming to Ontario-area emergency departments complaining of high blood pressure, said lead researcher Cynthia Jackevicius. She is a senior scientist with the Institute for Clinical Evaluative Sciences, in Toronto.

Some of these patients likely were valsartan users who stopped taking the blood pressure med after seeing scary recall news citing a potential carcinogen found in some lots of the drug, Jackevicius said.

“Nine out of 10 did have an alternative replacement” for valsartan within three months. “However, that means that one out of 10 did not,” Jackevicius said.

“That’s a little bit concerning, that some of these patients may have either been confused or concerned, and decided not to switch to another medication,” she added.

The recall occurred in July 2018 in both Canada and the United States, after generics maker Mylan Pharmaceuticals detected trace amounts of a probable cancer-causing chemical called N-nitrosodiethylamine (NDEA) in valsartan meds.

It was an unusually large recall that involved intense media interest, and Jackevicius and her colleagues wondered how it might have affected the drug’s users.

So they turned to Canadian prescription and medical records to track how valsartan users responded to the crisis.

Dr. Mary Norine Walsh, a past president of the American College of Cardiology and a cardiologist at St. Vincent Heart Center of Indiana, said, “It’s really interesting data, because my assumption would have been in Canada and the U.S. that substitution was made pretty much instantly.”

That’s what happened — mostly.

Within one month, 85% of patients had a new prescription for an alternative to their generic valsartan, Jackevicius said. By three months, 90% had a prescription for a different blood pressure drug.

But that left 10% of patients with recalled valsartan who hadn’t been prescribed an alternative, Jackevicius noted.

“Maybe they heard about the recall on the news and never went to their physician or clinician to get a substitution,” Walsh said.

“When there’s a recall like this, is there a patient lack of trust in the system? Do they not get back on drugs because they’re afraid? I don’t know,” Walsh asked.

In the immediate aftermath of the recall, people swarmed Ontario emergency departments for blood pressure treatment, the researchers found.

Many of these folks likely were people who were afraid to take their valsartan and went to the ER for a replacement drug when they couldn’t reach their doctor, Jackevicius suggested.

“That’s not really the best place to go” when your drug is recalled, she said. “Going to the emergency department is not a good use of the resources there, and it’s not a good use of the patient’s time.”

However, there were also probably quite a few who stopped taking the drug altogether and suffered symptoms related to high blood pressure, Jackevicius and Walsh said.

According to Walsh, “People did worse if they came off it, which is not surprising because the primary reason they were prescribed it was for hypertension.”

Jackevicius said the incident revealed holes in medicine’s response to major drug recalls.

Empowering pharmacists to reach out to patients and prescribe alternatives could be one way to improve the response to a recall, Jackevicius said.

Pharmacists have direct knowledge of the specific drugs handed out to patients that their doctors don’t, she explained.

“It would make sense that they take more responsibility and be given the authority to substitute common medications, to be a point person in the event of a recall,” Jackevicius said. “They are accessible and would know similar medications that might be OK for that condition.”

Public health officials also could help by promptly creating a consensus list of approved alternative medications, so doctors and pharmacists could quickly and efficiently move patients onto a new prescription, she added.

Jackevicius presented her study last weekend at the American Heart Association’s annual meeting, in Philadelphia. The work was also published recently in the journal Circulation.

More information

The American Heart Association has more about blood pressure drugs.

© 2019 HealthDay. All rights reserved.

Posted: November 2019

Drugs.com – Daily MedNews

Study Casts Doubt on Angioplasty, Bypass for Many Heart Patients

SUNDAY, Nov. 17, 2019 — Bypass operations, angioplasty and the placement of artery-opening stents: For decades, millions of Americans have undergone these expensive, invasive procedures to help treat clogged vessels.

However, the results of a large and long-awaited clinical trial suggests that, in most cases, these procedures may not have provided any benefit over medications and lifestyle changes.

In fact, people treated with meds and healthy changes in lifestyle wound up about as healthy as those who underwent an invasive procedure to open their hardened arteries, researchers reported Saturday at the American Heart Association (AHA) annual meeting in Philadelphia.

Only a subgroup of patients who suffered from frequent angina appeared to receive any benefit from an invasive procedure, and that benefit was in their quality of life, not in lowering their odds of death or future heart problems.

“Based on the trial results to date, I as a clinician would feel comfortable advising my patient not to undergo the invasive strategy if their angina was absent or controlled or it was tolerated,” said Dr. Alice Jacobs, director of the Cardiac Catheterization Laboratory and Interventional Cardiology at Boston Medical Center. She wasn’t involved in the new research.

Still, doctors are often uncomfortable limiting their treatment of clogged arteries to drugs, diet and exercise alone because they’re worried the patient will wind up suffering a heart attack or other heart-related illness, according to past AHA president Dr. Elliot Antman.

The new findings are expected to give physicians more confidence in saying no to invasive treatments, the experts said.

The study did not focus on people who are admitted to a hospital with a heart attack — these patients often receive bypass, angioplasty or stenting to quickly open a blocked artery.

Instead, the trial focused on patients with stable but severe heart disease.

A typical patient in this group might be a 71-year-old grandmother who has noticed during the past two months some chest heaviness walking from the parking lot to her grandkids’ soccer game, the AHA presenters said. Stress testing and imaging scans could reveal some moderately clogged arteries leading to her heart.

The new trial was very comprehensive, involving nearly 5,200 patients across 37 countries. Half were randomly assigned to undergo an invasive procedure: About three-quarters underwent angioplasty (most receiving a stent as well), while the others had a bypass operation.

The other half of patients were treated with medications and lifestyle changes alone.

Researchers mainly focused on whether the invasive procedure would reduce a patient’s risk of heart-related death, heart attack, hospitalization with unstable angina, heart failure or cardiac arrest.

Overall, an invasive strategy “did not demonstrate a reduced risk over a median 3.3 years” compared with the more conservative, drugs/lifestyle therapy, said trial co-chair Dr. Judith Hochman, a cardiologist and senior associate dean of clinical sciences at NYU Langone Health, in New York City.

However, invasive procedures did have a positive impact on one patient subgroup: People who regularly suffer the chest pain and shortness of breath associated with angina, said co-researcher Dr. John Spertus. He directs health outcomes research at Saint Luke’s Mid-America Heart Institute in Kansas City.

“For a patient who has weekly angina, there would be 15% of them who would be expected to be angina-free with the conservative approach, while 45% would be expected to be angina-free with the invasive approach,” Spertus said. “This is such a large difference that you would only have to treat about three patients with weekly angina for one to be angina-free at three months.”

On the other hand, patients who did not regularly have angina received only minimal quality-of-life or symptom benefits after undergoing an invasive procedure, Spertus added.

A smaller set of trials — this time focused on patients with chronic kidney disease — revealed even less promising results, researchers said. Patients didn’t gain any health benefits and didn’t have any improvement in their quality of life after getting an invasive treatment. Angioplasty might even help put them on dialysis earlier or increase their risk of stroke, the study found.

Dr. Glenn Levine, a professor of cardiology with Baylor College of Medicine in Houston, said that when it comes to kidney patients with clogged arteries, he “will treat them with medical [drug] therapy alone” unless they have marked or uncontrolled angina.

Experts said the main message from these studies is that doctors shouldn’t feel pressured to immediately send patients with clogged arteries into a catheterization lab, especially if they aren’t suffering any symptoms.

That could free up physicians to focus on getting patients to take their medications, Jacobs said. If drug therapy helps relieve their occasional angina or other symptoms, then angioplasty might be avoided in two out of every three patients, she estimated.

The trials were funded by the U.S. National Heart, Lung, and Blood Institute.

For more information:

There’s more on common heart procedures at the American Heart Association.

© 2019 HealthDay. All rights reserved.

Posted: November 2019

Drugs.com – Daily MedNews

Opioids Won’t Help Arthritis Patients Long-Term: Study

SATURDAY, Nov. 9, 2019 — Opioid painkillers may temporarily ease the discomfort of arthritis, but they have no clear lasting benefit, a research review finds.

In an analysis of 23 clinical trials, researchers found that, on average, opioid medications were somewhat effective at easing pain in patients with osteoarthritis. That’s the common form of arthritis in which cartilage cushioning the joints gradually wears down, leading to swelling, stiffness and pain.

But the trials found no evidence that opioids improved patients’ quality of life or helped with their depression. And any benefits for pain seemed to wane with time.

“We found that the magnitude of these effects is small and continues to decrease over time,” said lead researcher Dr. Raveendhara Bannuru. He is director of the Center for Treatment Comparison and Integrative Analysis at Tufts Medical Center, in Boston.

Treatment guidelines for chronic pain, other than cancer-related pain, already say opioids should be a last resort.

With osteoarthritis, Bannuru said, the drugs are only recommended if a patient has not gotten relief from other medical therapies, and if surgery — like knee or hip replacement — is not an option.

Instead, patients should try to exercise regularly and maintain a healthy lifestyle. As for medications, Bannuru said, topical versions of nonsteroidal anti-inflammatory drugs (NSAIDs) — like ibuprofen and naproxen — are a “first choice.”

These creams or ointments help people avoid the side effects that can come with prolonged used of oral NSAIDs (such as Motrin, Advil, Aleve), Bannuru noted. Injections of hyaluronic acid, a substance in joint fluids, are another option, he said.

In addition, aerobic activity, like walking, and exercises that strengthen the muscles around the arthritic joint can be helpful, according to Dr. Steven Eyanson, a rheumatologist who was not involved in the study.

And if a patient is overweight, shedding some pounds can help ease pain and improve joint function, said Eyanson, a retired adjunct assistant professor at the University of Iowa in Iowa City.

“In the case of osteoarthritis, the benefits of therapy by opioid pain relief are very limited,” Eyanson said.

Bannuru was scheduled to present the findings Saturday at the American College of Rheumatology’s annual meeting, in Atlanta. Research presented meetings is generally considered preliminary until it is published in a peer-reviewed journal.

For the study, the researchers pooled the results of 23 previously published clinical trials that involved more than 11,400 osteoarthritis patients.

Overall, the investigators found, opioid treatment had a modest effect on people’s pain over two to 12 weeks. At higher doses, the drugs were actually less effective, and carried a higher risk of side effects, such as nausea, constipation and diarrhea.

“In light of dependency concerns and the discomfort that many patients feel while taking the drugs, it would appear that there is no optimal therapeutic window for the use of oral opioids in osteoarthritis,” Bannuru said.

The results come during a national crisis of opioid addiction that, according to government figures, is killing 130 Americans each day.

After years of skyrocketing, prescriptions for opioids — like OxyContin, Vicodin and Percocet — have been declining since 2012, according to the U.S. Centers for Disease Control and Prevention. In recent years, illegal opioids — like heroin and illicitly manufactured fentanyl — have become the biggest concern.

Still, prescription opioids were involved in 36% of opioid overdose deaths in 2017, the CDC says.

“We hope the results of our study will empower osteoarthritis patients to have informed discussions with their health care providers about the safest and most effective treatment options for their pain,” Bannuru said.

Eyanson said that, to him, “the take-home messages are that opioids have limited benefit in osteoarthritis pain control, and have significant potential for risk.”

Most osteoarthritis patients will benefit from a “more holistic approach” — including medication and non-drug therapies, and in some cases, surgery, he added.

More information

The Arthritis Foundation has more on treating osteoarthritis.

© 2019 HealthDay. All rights reserved.

Posted: November 2019

Drugs.com – Daily MedNews

Weight-Loss Surgery Protects Heart Patients From Future Trouble

TUESDAY, Nov. 5, 2019 — If you’re an obese heart patient, weight-loss surgery might be good medicine for you.

New research suggests it significantly reduces the risk of heart failure and fatal heart attack in this vulnerable group.

“Our findings suggest, for the first time, that bariatric [weight-loss] surgery can prevent the development of systolic heart failure and remarkably reduce death from recurrent myocardial infarction, or heart attack, in patients with a higher cardiovascular risk than the average population,” said study author Dr. David Funes. He is a research fellow at the Bariatric and Metabolic Institute at Cleveland Clinic Weston, in Florida.

For the study, Funes and his team compared severely obese people with heart disease who had weight-loss surgery (8,200) with those who did not have the surgery (79,000).

Nearly half of the weight-loss surgery patients also had a history of some form of diabetes, and about 73% had high blood pressure. But those who didn’t have weight-loss surgery had even higher rates of both diseases, which are risk factors for heart disease.

Obesity itself is a major risk factor for heart disease.

Patients who didn’t have weight-loss surgery were 1.9 times more likely to develop heart failure than those who had the surgery, according to the study.

In addition, the investigators found that patients who had weight-loss surgery were 2.5 times less likely to die from a recurrent heart attack than those who didn’t have the surgery.

A history of diabetes, which improves in most patients after weight-loss surgery, considerably increased the risk of heart failure in patients who’d previously suffered a heart attack.

The study was to be presented Tuesday at the annual meeting of the American Society for Metabolic and Bariatric Surgery (ASMBS), in Las Vegas. Such research is considered preliminary until published in a peer-reviewed journal.

Dr. Eric DeMaria is ASMBS president and chief of East Carolina University’s division of general/bariatric surgery. “Metabolic surgery has been proven to have significant cardiovascular benefits and needs to be considered as part of the treatment plan for patients with severe obesity and coronary artery disease,” he said in a society news release.

“The key is to treat obesity sooner rather than later to slow the progression of heart disease, reduce other risk factors including hypertension and diabetes, and preserve heart function,” DeMaria added.

Nearly 40% of U.S. adults (over 93 million Americans) were obese in 2015-2016, according to the U.S. Centers for Disease Control and Prevention. About 24 million of these adults are severely obese, according to the ASMBS.

More information

The U.S. National Institute of Diabetes and Digestive and Kidney Diseases has more on weight-loss surgery.

© 2019 HealthDay. All rights reserved.

Posted: November 2019

Drugs.com – Daily MedNews

Fecal Transplants Benefit IBS Patients: Study

Oct. 21, 2019 — Fecal transplants from a “super-donor” reduced symptoms of irritable bowel syndrome (IBS) in many patients, a new study says.

It’s estimated that 10-15% of Americans have IBS, according to the American College of Gastroenterology. Abdominal cramping, bloating, constipation and diarrhea are among the symptoms. The condition doesn’t damage the intestines.

The cause of IBS hasn’t been pinpointed but some researchers believe it’s linked to abnormalities in the population of microorganisms in the gut. Fecal transplants — in which stool from a donor is processed and then transplanted into a patient’s gut — are meant to repopulate the gut with a healthier range of microorganisms, NBC News reported.

This study included 164 IBS patients who received either lower- or higher-dose fecal transplants or a placebo, which were delivered to the small intestine through a tube inserted into the mouth and down the throat.

Moderate symptoms improvement was reported by 23.6% of patients in the placebo group, 76.9% of those in the lower-dose fecal transplant group, and 89.1% of those in the higher-dose group, NBC News reported.

Symptoms went away entirely in 5.5% of patients in the placebo group, 35.2% of those in the lower dose group, and 47.3% of those in the higher dose group, according to the study presented at the annual United European Gastroenterology Week in Spain.

One year after the study, the benefits of fecal transplant appear to have lasted, noted lead researcher Magdy El-Salhy, a professor in the Department of Clinical Medicine at the University of Bergen, in Norway.

“The preliminary results [suggest] most, 90-95%, of the responded patients are still well and about 50% are still ‘cured,'” he told NBC News.

The donor was healthy, had been breast-fed, had a nutritious diet, took no regular medications, was a nonsmoker and had taken antibiotics only a few times, El-Salhy noted.

The fact that the study used a so-called super donor raises questions, experts said.

“These are very promising results that will certainly generate a lot of interest and attention because there is a great interest in these kinds of therapeutics for IBS,” Dr. Alexander Khoruts, medical director of the Microbiota Therapeutics Program at the University of Minnesota, told NBC News.

“But it’s not clear how you could find another ‘super donor’ to reproduce these results,” Khoruts added.

WebMD News from HealthDay

Copyright © 2013-2018 HealthDay. All rights reserved.

‘); } else { // If we match both our test Topic Ids and Buisness Ref we want to place the ad in the middle of page 1 if($ .inArray(window.s_topic, moveAdTopicIds) > -1 && $ .inArray(window.s_business_reference, moveAdBuisRef) > -1){ // The logic below reads count all nodes in page 1. Exclude the footer,ol,ul and table elements. Use the varible // moveAdAfter to know which node to place the Ad container after. window.placeAd = function(pn) { var nodeTags = [‘p’, ‘h3′,’aside’, ‘ul’], nodes, target; nodes = $ (‘.article-page:nth-child(‘ + pn + ‘)’).find(nodeTags.join()).not(‘p:empty’).not(‘footer *’).not(‘ol *, ul *, table *’); //target = nodes.eq(Math.floor(nodes.length / 2)); target = nodes.eq(moveAdAfter); $ (”).insertAfter(target); } // Currently passing in 1 to move the Ad in to page 1 window.placeAd(1); } else { // This is the default location on the bottom of page 1 $ (‘.article-page:nth-child(1)’).append(”); } } })(); $ (function(){ // Create a new conatiner where we will make our lazy load Ad call if the reach the footer section of the article $ (‘.main-container-3’).prepend(”); });

\n’ + ‘{preContent}’ + ‘

\n’ + ‘{preForm}’ + ‘\n’ + ‘{postForm}’ + ‘

\n’ + // .nls-content ‘{postContent}’ + ‘

WebMD Health

High-Fiber Diet Tied to Lower Heart Risk in Diabetes Patients

FRIDAY, Oct. 4, 2019 — A fiber-rich diet appears to help people with high blood pressure and type 2 diabetes in multiple ways, lowering their blood pressure, cholesterol and blood sugar levels, a new study suggests.

High blood pressure (hypertension) and diabetes raise the risk for heart disease, and diet may help keep it at bay, researchers say.

“This study helps us determine three important things for this patient population,” said lead author Dr. Rohit Kapoor, medical director of Care Well Heart and Super Specialty Hospital in Amritsar, India.

“Firstly, a high-fiber diet is important in cases of diabetes and hypertension to prevent future cardiovascular disease,” Kapoor said in a news release from the American College of Cardiology.

“Secondly, medical nutrition therapy and regular counseling sessions also hold great importance in treating and prevention of diabetes and hypertension,” he added.

Thirdly, this type of diet in combination with medical treatment can improve lipid levels, pulse wave velocity [a measure of arterial stiffness], waist-to-hip ratio and high blood pressure, Kapoor said.

For the study, Kapoor’s team tracked fiber consumption among 200 participants over six months. Patients sent photos of their meals on WhatsApp and engaged in phone calls three times a week during which they were asked to recall their diet.

The study found that those participants eating a high-fiber diet showed significant improvement in several risk factors, including a 9% reduction in cholesterol, 23% reduction in triglycerides, 15% reduction in systolic (top number) blood pressure and a 28% reduction in blood sugar.

Foods high in fiber include fruits and vegetables, beans, whole grains and nuts.

The study results were scheduled to be presented Thursday at an American College of Cardiology meeting, in Dubai, United Arab Emirates. Data and conclusions presented at meetings are usually considered preliminary until published in a peer-reviewed medical journal.

More information

For more on type 2 diabetes, head to the American Diabetes Association.

© 2019 HealthDay. All rights reserved.

Posted: October 2019

Drugs.com – Daily MedNews

Opioid Prescriptions for Eye Surgery Patients Surge

THURSDAY, Sept. 19, 2019 — Though eye surgery has gotten easier for patients, the percentage who filled an opioid prescription after an eye operation tripled between 2000 and 2014, a new study reports.

“This really is surprising, given that there have been tremendous strides in the past decade to reduce the invasiveness and recovery time for these procedures,” said senior study author Dr. Brian VanderBeek. “We would have expected rates to go down, not up.”

VanderBeek is an assistant professor of ophthalmology at the University of Pennsylvania in Philadelphia.

For the study, his team tracked filled opioid prescriptions among more than 2.4 million patients who had “incisional” eye surgery in the United States between 2000 and 2016.

In 2000-2001, across six different ocular subspecialties, 1.2% of patients undergoing cataract surgery or other types of incisional eye surgeries filled an opioid prescription afterward.

But by 2014, that figure rose to 2.5% of patients. The uptick eased in 2015 to 2.2%, and then again in 2016 to 2.1%, according to the report published in the Sept. 19 issue of JAMA Ophthalmology.

Eye surgery patients in the Northeast were least likely to fill an opioid prescription; those in the Mountain states were most likely to do so. Odds were highest among black patients, men and those without a college degree, the findings showed.

After accounting for other factors, opioid prescriptions tripled during the study period across all of the eye procedures in the study, the researchers found.

VanderBeek pointed out that the procedures are unrelated to one another, yet the rise in prescription rates among them was nearly identical. That suggests something other than surgery-related pain is driving the increase, he said.

The findings dovetail with a nationwide opioid epidemic that resulted in more than 47,000 deaths in 2017 alone.

Still, compared with patients who undergo other types of surgery, prescription of opioids among eye surgery patients remains very low, the study authors stressed.

“Whenever you have an epidemic, I think it’s reasonable to ask what you can do to curb it,” VanderBeek said in a university news release.

“Even if eye surgeries are a minor source of the problem, if we can limit some of the exposure to opioids, in light of the national emergency, we are obligated to do what we can. We don’t want people to be in pain, but we also don’t want to continue to fuel the problem if we can avoid it,” he added.

More information

For more about the opioid epidemic, visit the U.S. Department of Health and Human Services.

© 2019 HealthDay. All rights reserved.

Posted: September 2019

Drugs.com – Daily MedNews

Surgery Not a Relapse Risk for MS Patients

FRIDAY, July 26, 2019 — Surgery is safe for people with multiple sclerosis (MS), a new study finds.

“The idea that patients with MS might be at an increased risk of relapse following surgery isn’t necessarily the case, so we need to be careful delaying important surgeries,” said study first author Dr. Lindsey De Lott. She is an assistant professor of neurology at the University of Michigan, in Ann Arbor.

Many doctors worry that surgery or anesthesia may increase the risk of MS relapse, and this concern can lead to delays in important surgeries, the researchers explained.

However, there’s been a lack of study on the issue, the study authors added.

So De Lott and her colleagues looked at 281 MS patients, aged 18 to 75, who underwent a total of 609 surgeries, and found no significant difference in the rates of relapse before and after surgery. The rates were 7.1% and 5.5% per patient per year, respectively.

The study was published online recently in the Multiple Sclerosis Journal.

The findings should help doctors and MS patients make decisions about surgery, according to the researchers.

Study senior author Dr. Tiffany Braley, an associate professor of neurology and a multiple sclerosis specialist at Michigan, noted that the “vast majority” of her MS patients do well after surgery.

“In the rare instance when we have encountered a person with MS who developed neurological symptoms after surgery, the symptoms could usually be explained by a fever or infection, yet the limited research previously done on this topic did not take these factors into account,” Braley said in a university news release.

The authors did note that MS relapse can take many different forms, and there’s always a risk of over- or under-reporting patients’ MS symptoms after surgery.

De Lott pointed out that “a relapse, or flare, can present as any neurologic symptom. It can include weakness in an arm or leg, loss of sensation, vision loss, problems with walking or coordination … it spans the spectrum.”

More information

The U.S. National Institute of Neurological Disorders and Stroke has more on multiple sclerosis.

© 2019 HealthDay. All rights reserved.

Posted: July 2019

Drugs.com – Daily MedNews

New Cholesterol Drugs’ Cost Put Patients at Risk

By Dennis Thompson
HealthDay Reporter

TUESDAY, July 23, 2019 (HealthDay News) — Heart attacks, strokes and other heart problems are more likely in high-risk patients denied access to cutting-edge cholesterol-busting drugs called PCSK9 inhibitors, a new study reports.

Patients are 16% more likely to have a heart-related health crisis if their PCSK9 prescription is rejected than if it is covered and filled for a year, according to researchers.

Patients who have a prescription but don’t fill it — probably because they can’t afford the copay — have a 21% greater risk of a heart-related emergency, the researchers added.

“We should be a little up in arms that we have the tools to help people, and we aren’t helping them,” said study co-author Katherine Wilemon, founder and CEO of the FH Foundation, a research and advocacy group for patients with familial hypercholesterolemia, high cholesterol related to their genetics.

PCSK9 inhibitors entered the U.S. market in 2015, but remain costly compared with first-line statin therapy, researchers said. The new drugs work by boosting the liver’s ability to remove excess cholesterol from the bloodstream.

The drugs cost about $ 14,000 a year during the time covered by this study, 2015 to 2017, researchers said. Manufacturers last year announced price cuts to the two leading PCSK9 inhibitors — Praluent (alirocumab) and Repatha (evolocumab) — but the cost is still $ 4,500 to $ 8,000 a year.

For this study, researchers reviewed medical records and pharmacy claims of about 139,000 high-risk adults after PCSK9 inhibitors became available in 2015. On average, patients were tracked for about a year after their prescription date.

Patients were considered at high risk if they had familial hypercholesterolemia or had suffered heart problems related to clogged arteries.

“This group was at extremely high risk in total,” said lead researcher Kelly Myers, chief technology officer for the FH Foundation. “The annual rate of cardiovascular events in this group was about 3.5%. The annual rate for the entire adult U.S. population is less than half a percent.”

The researchers specifically looked at access to the new cholesterol drugs, and whether it influenced patients’ risk for heart-related health events such as heart attacks, unstable angina, angioplasty, coronary bypass surgery, cardiac arrest, and heart disease or stroke caused by congested arteries.

Continued

Insurance companies rejected about two-thirds of PCSK9 prescriptions among high-risk patients, researchers found.

Even after the 2018 price cuts, rejection rates have remained high, Myers said.

“We haven’t seen a lot of evidence in the data that there’s been a compelling change yet,” he said. “There’s general improvement, but over 50% of individuals in a lot of plans are still being rejected therapy.”

In addition, about 15% of people with an approved prescription didn’t have it filled, probably because they couldn’t afford it, Myers added.

Two-thirds of patients who didn’t fill their PCSK9 inhibitor prescription are on Medicare, which doesn’t allow for copay assistance, Myers said. Their average copay for the drugs is $ 200 a month, compared to $ 100 month for people with private prescription insurance.

“They’re probably abandoning their therapy because of extremely high copay costs,” Myers said.

Lack of access to these drugs had an immediate impact on their risk of heart attack, stroke and other heart problems, researchers found.

“People whose cholesterol-lowering drug prescriptions are rejected or abandoned are more likely to have heart events than those whose prescriptions are covered,” said Dr. Donald Lloyd-Jones, chairman of preventive medicine at Northwestern University Feinberg School of Medicine in Chicago and a American Heart Association (AHA) spokesman.

The researchers also found that a prescription was more likely to be rejected if a patient is female, black or Hispanic.

“The study clearly shows how disparities in access to PCSK9 inhibitor prescriptions affect cardiovascular outcomes and the need to improve health equity,” Lloyd-Jones added. “So as we continue to make inroads to prevent and treat heart disease — the world’s leading killer — we must capitalize on data from this study and others that quantify ways we can make a difference.”

The AHA changed its cholesterol guidelines in 2018 to promote the use of PCSK9 inhibitors among high-risk people who are already taking the largest dose of statins they can tolerate.

The findings were published July 23 in the journal Circulation: Cardiovascular Quality and Outcomes.

WebMD News from HealthDay

Sources

SOURCES: Katherine Wilemon, founder and CEO, FH Foundation, Pasadena, Calif.; Kelly Myers, chief technology officer, FH Foundation; Donald Lloyd-Jones, M.D., Sc.M., senior associate dean, clinical and translational research, and chairman, Department of Preventive Medicine, Northwestern University, Feinberg School of Medicine, Chicago, and spokesman, American Heart Association;Circulation: Cardiovascular Quality and Outcomes, July 23, 2019

Copyright © 2013-2018 HealthDay. All rights reserved.

‘); } else { // If we match both our test Topic Ids and Buisness Ref we want to place the ad in the middle of page 1 if($ .inArray(window.s_topic, moveAdTopicIds) > -1 && $ .inArray(window.s_business_reference, moveAdBuisRef) > -1){ // The logic below reads count all nodes in page 1. Exclude the footer,ol,ul and table elements. Use the varible // moveAdAfter to know which node to place the Ad container after. window.placeAd = function(pn) { var nodeTags = [‘p’, ‘h3′,’aside’, ‘ul’], nodes, target; nodes = $ (‘.article-page:nth-child(‘ + pn + ‘)’).find(nodeTags.join()).not(‘p:empty’).not(‘footer *’).not(‘ol *, ul *, table *’); //target = nodes.eq(Math.floor(nodes.length / 2)); target = nodes.eq(moveAdAfter); $ (”).insertAfter(target); } // Currently passing in 1 to move the Ad in to page 1 window.placeAd(1); } else { // This is the default location on the bottom of page 1 $ (‘.article-page:nth-child(1)’).append(”); } } })(); $ (function(){ // Create a new conatiner where we will make our lazy load Ad call if the reach the footer section of the article $ (‘.main-container-3’).prepend(”); });

Pagination

WebMD Health

Higher Cost of New Cholesterol Drugs Putting Patients at Risk: Study

TUESDAY, July 23, 2019 — Heart attacks, strokes and other heart problems are more likely in high-risk patients denied access to cutting-edge cholesterol-busting drugs called PCSK9 inhibitors, a new study reports.

Patients are 16% more likely to have a heart-related health crisis if their PCSK9 prescription is rejected than if it is covered and filled for a year, according to researchers.

Patients who have a prescription but don’t fill it — probably because they can’t afford the copay — have a 21% greater risk of a heart-related emergency, the researchers added.

“We should be a little up in arms that we have the tools to help people, and we aren’t helping them,” said study co-author Katherine Wilemon, founder and CEO of the FH Foundation, a research and advocacy group for patients with familial hypercholesterolemia, high cholesterol related to their genetics.

PCSK9 inhibitors entered the U.S. market in 2015, but remain costly compared with first-line statin therapy, researchers said. The new drugs work by boosting the liver’s ability to remove excess cholesterol from the bloodstream.

The drugs cost about $ 14,000 a year during the time covered by this study, 2015 to 2017, researchers said. Manufacturers last year announced price cuts to the two leading PCSK9 inhibitors — Praluent (alirocumab) and Repatha (evolocumab) — but the cost is still $ 4,500 to $ 8,000 a year.

For this study, researchers reviewed medical records and pharmacy claims of about 139,000 high-risk adults after PCSK9 inhibitors became available in 2015. On average, patients were tracked for about a year after their prescription date.

Patients were considered at high risk if they had familial hypercholesterolemia or had suffered heart problems related to clogged arteries.

“This group was at extremely high risk in total,” said lead researcher Kelly Myers, chief technology officer for the FH Foundation. “The annual rate of cardiovascular events in this group was about 3.5%. The annual rate for the entire adult U.S. population is less than half a percent.”

The researchers specifically looked at access to the new cholesterol drugs, and whether it influenced patients’ risk for heart-related health events such as heart attacks, unstable angina, angioplasty, coronary bypass surgery, cardiac arrest, and heart disease or stroke caused by congested arteries.

Insurance companies rejected about two-thirds of PCSK9 prescriptions among high-risk patients, researchers found.

Even after the 2018 price cuts, rejection rates have remained high, Myers said.

“We haven’t seen a lot of evidence in the data that there’s been a compelling change yet,” he said. “There’s general improvement, but over 50% of individuals in a lot of plans are still being rejected therapy.”

In addition, about 15% of people with an approved prescription didn’t have it filled, probably because they couldn’t afford it, Myers added.

Two-thirds of patients who didn’t fill their PCSK9 inhibitor prescription are on Medicare, which doesn’t allow for copay assistance, Myers said. Their average copay for the drugs is $ 200 a month, compared to $ 100 month for people with private prescription insurance.

“They’re probably abandoning their therapy because of extremely high copay costs,” Myers said.

Lack of access to these drugs had an immediate impact on their risk of heart attack, stroke and other heart problems, researchers found.

“People whose cholesterol-lowering drug prescriptions are rejected or abandoned are more likely to have heart events than those whose prescriptions are covered,” said Dr. Donald Lloyd-Jones, chairman of preventive medicine at Northwestern University Feinberg School of Medicine in Chicago and a American Heart Association (AHA) spokesman.

The researchers also found that a prescription was more likely to be rejected if a patient is female, black or Hispanic.

“The study clearly shows how disparities in access to PCSK9 inhibitor prescriptions affect cardiovascular outcomes and the need to improve health equity,” Lloyd-Jones added. “So as we continue to make inroads to prevent and treat heart disease — the world’s leading killer — we must capitalize on data from this study and others that quantify ways we can make a difference.”

The AHA changed its cholesterol guidelines in 2018 to promote the use of PCSK9 inhibitors among high-risk people who are already taking the largest dose of statins they can tolerate.

The findings were published July 23 in the journal Circulation: Cardiovascular Quality and Outcomes.

More information

The FH Foundation has more about insurance coverage for cholesterol drugs.

© 2019 HealthDay. All rights reserved.

Posted: July 2019

Drugs.com – Daily MedNews

Many Pneumonia Patients Get Too Many Antibiotics

By Robert Preidt
HealthDay Reporter

FRIDAY, July 12, 2019 (HealthDay News) — Two-thirds of hospitalized pneumonia patients may be prescribed antibiotics for too long, increasing their risk for potentially harmful side effects, researchers say.

In 93% of cases, overprescription involved the number of antibiotics patients received upon being discharged from the hospital.

Each year in the United States, pneumonia sends 1 million adults to the hospital. The new study examined the medical records of 6,500 pneumonia patients treated at 43 Michigan hospitals. Of those, 60% were interviewed by phone within a month after they left the hospital.

Most patients who received too-long prescriptions for antibiotics got an average of two extra days’ worth of pills, according to a research team led by Dr. Valerie Vaughn of the University of Michigan. As she explained, the more days of antibiotics a patient received beyond the recommended minimum, the higher their risk of experiencing side effects such as upset stomach or yeast infections.

“‘Antibiotic stewardship,’ which includes choosing the right drug and the right duration for each patient, has become a part of most hospitals,” said Vaughn, an assistant professor of internal medicine.

“But these results show us that we need to pay more attention to stewardship at discharge — and suggest that guidelines for prescribers should be clearer about how to calculate an appropriate duration based on a patient’s condition,” she said in a university news release.

Overprescription of antibiotics is also a known contributor to antibiotic resistance, where bacteria find ways to mutate around the drugs.

The study found wide variation among hospitals in the percentage of pneumonia patients who were prescribed antibiotics for too long. In some hospitals less than 50% of patients got too many of the drugs, while other hospitals gave an oversupply to nearly every patient.

Adding to the problem is the fact that national guidelines for treating pneumonia are not precise, Vaughn noted.

She said that determining the amount of antibiotics a pneumonia patient requires depends on their diagnosis, plus how long it took them to stabilize after treatment began. In general, most patients without risk factors need about five days’ worth of antibiotics; while those with risk factors, or pneumonia caused by especially difficult bacteria, need about seven days’ worth, Vaughn said.

The study was published June 8 in the journal Annals of Internal Medicine.

WebMD News from HealthDay

Sources

SOURCE: University of Michigan, news release, July 8, 2019

Copyright © 2013-2018 HealthDay. All rights reserved.

‘); } else { // If we match both our test Topic Ids and Buisness Ref we want to place the ad in the middle of page 1 if($ .inArray(window.s_topic, moveAdTopicIds) > -1 && $ .inArray(window.s_business_reference, moveAdBuisRef) > -1){ // The logic below reads count all nodes in page 1. Exclude the footer,ol,ul and table elements. Use the varible // moveAdAfter to know which node to place the Ad container after. window.placeAd = function(pn) { var nodeTags = [‘p’, ‘h3′,’aside’, ‘ul’], nodes, target; nodes = $ (‘.article-page:nth-child(‘ + pn + ‘)’).find(nodeTags.join()).not(‘p:empty’).not(‘footer *’).not(‘ol *, ul *, table *’); //target = nodes.eq(Math.floor(nodes.length / 2)); target = nodes.eq(moveAdAfter); $ (”).insertAfter(target); } // Currently passing in 1 to move the Ad in to page 1 window.placeAd(1); } else { // This is the default location on the bottom of page 1 $ (‘.article-page:nth-child(1)’).append(”); } } })(); $ (function(){ // Create a new conatiner where we will make our lazy load Ad call if the reach the footer section of the article $ (‘.main-container-3’).prepend(”); });

\n’ + ‘{preContent}’ + ‘

\n’ + ‘{preForm}’ + ‘\n’ + ‘{postForm}’ + ‘

\n’ + // .nls-content ‘{postContent}’ + ‘

WebMD Health

Many Pneumonia Patients Get Too Many Antibiotics

FRIDAY, July 12, 2019 — Two-thirds of hospitalized pneumonia patients may be prescribed antibiotics for too long, increasing their risk for potentially harmful side effects, researchers say.

In 93.2% of cases, overprescription involved the number of antibiotics patients received upon being discharged from the hospital.

Each year in the United States, pneumonia sends 1 million adults to the hospital. The new study examined the medical records of 6,500 pneumonia patients treated at 43 Michigan hospitals. Of those, 60% were interviewed by phone within a month after they left the hospital.

Most patients who received too-long prescriptions for antibiotics got an average of two extra days’ worth of pills, according to a research team led by Dr. Valerie Vaughn of the University of Michigan. As she explained, the more days of antibiotics a patient received beyond the recommended minimum, the higher their risk of experiencing side effects such as upset stomach or yeast infections.

“‘Antibiotic stewardship,’ which includes choosing the right drug and the right duration for each patient, has become a part of most hospitals,” said Vaughn, an assistant professor of internal medicine.

“But these results show us that we need to pay more attention to stewardship at discharge — and suggest that guidelines for prescribers should be clearer about how to calculate an appropriate duration based on a patient’s condition,” she said in a university news release.

Overprescription of antibiotics is also a known contributor to antibiotic resistance, where bacteria find ways to mutate around the drugs.

The study found wide variation among hospitals in the percentage of pneumonia patients who were prescribed antibiotics for too long. In some hospitals, less than 50% of patients got too many of the drugs, while other hospitals gave an oversupply to nearly every patient.

Adding to the problem is the fact that national guidelines for treating pneumonia are not precise, Vaughn noted.

She said that determining the amount of antibiotics a pneumonia patient requires depends on their diagnosis, plus how long it took them to stabilize after treatment began. In general, most patients without risk factors need about five days’ worth of antibiotics; while those with risk factors, or pneumonia caused by especially difficult bacteria, need about seven days’ worth, Vaughn said.

The study was published June 8 in the journal Annals of Internal Medicine.

More information

The U.S. National Heart, Lung, and Blood Institute has more on pneumonia.

© 2019 HealthDay. All rights reserved.

Posted: July 2019

Drugs.com – Daily MedNews

Patients Who Read Docs’ Notes Take Meds Better

By Robert Preidt

HealthDay Reporter

FRIDAY, May 31, 2019 (HealthDay News) — Reading the notes your doctor makes during your visit appears to be good medicine.

An online survey of 20,000 adults treated at three U.S. health systems that have made clinical notes available to patients for several years finds that those who actually read them may be more likely to take medications as prescribed.

Patients listed several benefits of reading the notes: 64% said doing so helped them understand why a medication was prescribed; 62% felt more in control of their medications; 57% said the notes answered questions about medications; and 61% felt more comfortable with their prescriptions.

And 14% of patients at two of the health systems — Beth Israel Deaconess Medical Center (BIDMC) in Boston and Geisinger in rural Pennsylvania — said they were more likely to take their medications as prescribed after reading doctors’ notes, the study found.

Meanwhile, 33% of patients at the University of Washington Medicine in Seattle, the third health system studied, considered clinical notes very helpful.

“Sharing clinical notes with patients is a relatively low-cost, low-touch intervention,” lead author Catherine DesRoches, executive director of OpenNotes at BIDMC, said in a news release.

Though sharing notes is a cultural shift, electronic health record systems make it easier, she said, adding that the payoff could be “enormous” because poor adherence to medications costs the health care system about $ 300 billion a year.

“Anything that we can do to improve adherence to medications has significant value,” DesRoches said.

Patients whose primary language was not English and those with lower levels of education were more likely to report benefits from being able to read their doctor’s notes, according to the study published May 28 in the Annals of Internal Medicine.

Still, this kind of transparent communication initially makes doctors uneasy, said study co-author Dr. Tom Delbanco, co-founder of OpenNotes.

“They worry about many things, including potential effects on their workflow, and scaring their patients. But once they start, we know of few doctors who decide to stop, and patients overwhelmingly love it,” he added in the news release. “The promise it holds for medication adherence is enormous, and we are really excited by these findings.”

An accompanying editorial by Dr. David Blumenthal and Melinda Abrams of the Commonwealth Fund noted that transparency is mandated by federal law and policy.

“Our challenge now is to make the best and most of shared health care information as a tool for clinical management and health improvement,” Blumenthal and Abrams wrote.

WebMD News from HealthDay

Sources

SOURCE: Beth Israel Deaconess Medical Center, news release, May 28, 2019

Copyright © 2013-2018 HealthDay. All rights reserved.

‘); } else { // If we match both our test Topic Ids and Buisness Ref we want to place the ad in the middle of page 1 if($ .inArray(window.s_topic, moveAdTopicIds) > -1 && $ .inArray(window.s_business_reference, moveAdBuisRef) > -1){ // The logic below reads count all nodes in page 1. Exclude the footer,ol,ul and table elements. Use the varible // moveAdAfter to know which node to place the Ad container after. window.placeAd = function(pn) { var nodeTags = [‘p’, ‘h3′,’aside’, ‘ul’], nodes, target; nodes = $ (‘.article-page:nth-child(‘ + pn + ‘)’).find(nodeTags.join()).not(‘p:empty’).not(‘footer *’).not(‘ol *, ul *, table *’); //target = nodes.eq(Math.floor(nodes.length / 2)); target = nodes.eq(moveAdAfter); $ (”).insertAfter(target); } // Currently passing in 1 to move the Ad in to page 1 window.placeAd(1); } else { // This is the default location on the bottom of page 1 $ (‘.article-page:nth-child(1)’).append(”); } } })(); $ (function(){ // Create a new conatiner where we will make our lazy load Ad call if the reach the footer section of the article $ (‘.main-container-3’).prepend(”); });
WebMD Health