Many Medicaid Patients Skip Drugs That Could Prevent Heart Trouble

HealthDay – 1 hr 22 mins ago FRIDAY, July 20 (HealthDay News) -- Many Medicaid recipients with chronic health conditions that can lead to heart disease -- diabetes, high blood pressure and high cholesterol -- do not take their prescribed medications, a new study has found.

The researchers said failure to take medications leads to higher costs of care and an increased risk of hospitalization and even death.

They looked at 2008 and 2009 data from more than 150,000 Medicaid patients in New York City, aged 20 to 64, and found that only 63 percent of those with the three chronic conditions took their prescribed medications. Older patients and white and Asian patients were most likely to take their medications, while black and Hispanic patients were least likely.

"The outcome of this study is concerning, as it shows a large number of people with chronic conditions that lead to cardiovascular disease aren't taking prescribed medications, which could prevent a potential stroke or heart attack," lead author Dr. Kelly Kyanko, an instructor in the department of population health at the NYU Langone Medical Center, said in a center news release.

"We hope these findings will help local health authorities in the New York City area address this problem by creating programs to increase adherence rates, specifically in patient populations most at risk," Kyanko added.

The study was published online recently in the Journal of Urban Health.

"We believe that patients and their doctors can work to improve medication adherence through simple measures such as switching to once-a-day or combination pills, keeping a pill box and obtaining 90-day refills instead of 30-day refills for medications they take on a regular basis," Kyanko said.

High-risk patients may require more intensive interventions, such as working with a nurse or pharmacist to ensure they take their prescribed medications, she added.

Cardiovascular disease is the leading cause of death both in New York and in the United States, according to the release.

More information

The U.S. Centers for Disease Control and Prevention outlines ways to prevent heart disease.

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Heavy Backpacks Give Kids Back Trouble

HealthDay – 15 hrs ago SATURDAY, April 7 (HealthDay News) -- Many teens carry school backpacks that exceed 10 percent to 15 percent of their body weight, which puts them at risk for back pain and related disorders, a new study says.

The threat posed by the heavy weight is made greater by the fact that most teens don't get enough exercise, according to the researchers.

The study included more than 1,400 students, aged 12 to 17, in 11 schools in a province in northwestern Spain. The teens were first weighed with the backpack they normally carry to school and then weighed again without the backpack.

The researchers also collected information about the students' height, exercise levels, underlying health problems and back health.

The average weight of the students' backpacks was almost 7 kilograms (15.4 pounds). Nearly 62 percent of the students carried backpacks that exceeded 10 percent of their body weight, and 18 percent carried backpacks that exceeded 15 percent of their body weight.

One in four students said they had experienced back pain for more than 15 days during the previous year. The most common problem was scoliosis, or curvature of the spine, which was diagnosed in 70 percent of the students with back pain. Low back pain and continuous and involuntary muscle contraction were also common problems.

Girls were more likely to have back problems than boys, and their risk seemed to increase with age.

Teens with the heaviest backpacks were 50 percent more likely to have back pain for longer than 15 days, compared to those with the lightest backpacks.

The study appears online in the Archives of Disease in Childhood.

Doctors and teachers need to educate parents and children about the risks of carrying heavy backpacks to school every day, the researchers said.

More information

The American Academy of Orthopaedic Surgeons has more about backpack safety.

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CT Scans Can Spot Heart Trouble Fast

HealthDay – 1 hr 45 mins ago MONDAY, March 26 (HealthDay News) -- Most people who go to the emergency room with chest pain aren't having a heart attack, but it can take hours or days to make a definitive diagnosis.

However, a new study finds that a special kind of CT scan given in the emergency room seems to identify a heart attack faster than traditional methods, so patients can be sent home safely sooner.

"You can go to an emergency department with chest pain, be concerned it might be a heart attack -- get a CT scan, like we do for everything else in the emergency department -- and we can say it's not your heart and you can go home, within a couple of hours," said researcher Dr. Judd Hollander, clinical research director of the department of emergency medicine at the University of Pennsylvania, in Philadelphia.

"We can now answer the questions faster, and let people go home sooner," he said.

Using the CT scan is faster, Hollander said, noting it can take 25 hours to get the results of blood tests that indicate whether a patient has had a heart attack.

"And an EKG only shows if you are having the big one," Hollander added. "So, if it's negative it doesn't tell you if you are having a smaller heart attack, and two-thirds of heart attacks will have an EKG that's not diagnostic."

For every 100 patients who go to an ER with chest pain, only 10 or 15 have cardiac disease, Hollander said. "The other 90 percent end up with nothing serious," he added.

In addition, ERs are busy and crowded, and this is a way to move patients out faster and increase the ability to see more patients sooner, he said.

The findings were to be presented Monday at the American College of Cardiology's annual meeting in Chicago. They will also be published simultaneously in the New England Journal of Medicine.

For the study, Hollander's team randomly assigned more than 1,300 patients with chest pain, but no previous history of heart disease or risk factors such as high blood pressure or diabetes, to CT scans or regular care.

The scans generate three-dimensional images of the heart and the blood vessels surrounding it, the researchers noted.

Among those with a normal scan, none died or had a heart attack within a month after being seen in the ER. In addition, more of these patients were sent home than those who received usual care -- about 50 percent versus 23 percent, the researchers found.

Those who received scans spent less time in the hospital and had heart problems diagnosed faster.

Scans are also cost-effective, Hollander said. The tests, which are like a standard CT scan, cost about $1,500. Patients who have a normal scan can be sent home within a few hours. A patient who is admitted to the hospital can run up bills of more than $4,000 for stress tests and monitoring alone, the researchers noted.

Chest pain is one of the most common reasons people go to the emergency room in the United States, accounting for as many as 8 million visits each year, at a cost of several billion dollars, they noted.

Many patients with chest pain are suffering from anxiety, pneumonia or indigestion that can cause the same symptoms as a heart attack, the researchers explained. Yet, more than half of patients with chest pain are admitted to the hospital for observation or testing such as cardiac catheterization or a stress test.

Commenting on the study, Dr. Gregg Fonarow, director of the Ahmanson-UCLA Cardiomyopathy Center and co-director of the UCLA Preventative Cardiology Program, said that "there are 8 million men and women that present to emergency medical centers with chest pain each year."

There has been great interest in developing strategies to more efficiently evaluate these patients and identify which ones can be safely discharged, he said.

The trial demonstrated that these scans may be useful to screen low- to moderate-risk patients, Fonarow said.

"However, further studies are needed to evaluate the cost-effectiveness of this strategy and how it compares to protocols using high-sensitivity troponin tests," he added.

A troponin test measures the levels of one of two proteins, troponin T or troponin I, in blood, Fonarow explained. These proteins are released when the heart has been damaged, such as during a heart attack. However, this test is usually repeated over 12 to 16 hours, so the results do not come back as quickly as a CT scan.

More information

For more on heart attacks, visit the American Heart Association.

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