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Heart failure occurs when a heart weakened by disease can no longer pump effectively. Before discharge heart failure patients should receive written information on:

• Eating a proper diet;
• Engaging in appropriate physical activity;
• Taking medicines correctly;
• Monitoring their weight; and
• Knowing what to do if their symptoms worsen.

However, the current fee system in the United States doesn’t encourage a focus on prevention researchers said. In their analysis, they report that doctors and hospitals are financially awarded more for treating and hospitalizing patients, not for preventing hospitalizations through such strategies as disease management.

“Physicians aren’t paid to coordinate care,” Ross said. “That physician is busy seeing patients and that’s what they’re paid to do. If we want to deliver better care, this trend is what we need to address.”

Another barrier to optimal care is a lack of communications between doctors who care for patients in the hospital and the patients’ regular physicians who help patients manage their chronic disease, Ross said. The disruption to the continuum of care can negatively affect the patient.

The average age of patients in the study was 80 years and more than half (57 percent) were women. Most patients had multiple chronic diseases: 60 percent had heart arrhythmias; 73 percent had atherosclerosis or hardening of the arteries; 49 percent had diabetes; and 29 percent had kidney failure.

“Coming back and forth into the hospital isn’t good for patients, and it isn’t good for the healthcare system,” said Ross, who plans to research the reasons heart failure patients are readmitted to the hospital. “This is a tremendous challenge.”

Findings of the study are important for patients and hospitals, Ross said.

“Patients should use this information to vet hospitals, to look at the quality of care delivered there and ask questions about the care they receive,” he said. “Hospitals should consider the rehospitalization rate a grade which, from these findings, needs improvement.”

Study highlights:
Roughly a quarter of Medicare patients hospitalized for heart failure are back in the hospital within 30 days.
The rehospitalization rate for these patients, who are over age 65, remained the same from 2004 though 2006

DALLAS, Nov. 10, 2009 – Almost a quarter of heart failure patients with Medicare are back in the hospital within a month after discharge, researchers report in Circulation: Heart Failure, a journal of the American Heart Association.

Each year, from 2004 through 2006, more than a half million Medicare recipients over age 65 went to the hospital for heart failure and were discharged alive. And each year, about 23 percent returned to the hospital within 30 days – signaling a need to improve care, researchers said. Readmission rates for all causes were almost identical all three years.

“I was hoping for improvement and was disappointed to find that was not the case,” said Joseph S. Ross, M.D., M.H.S., the study’s lead author and an assistant professor of geriatrics and palliative medicine at Mount Sinai School of Medicine in New York. “Despite the increased focus on the need to reduce readmissions, about a quarter of patients are back into the hospital within 30 days.”

Long-term use of cholesterol-lowering statins appears to reduce the incidence of gallstones and the need for surgery to prevent the excruciating pain they cause, a new study indicates.

“We’re talking about people who have been taking them for about 1½ years,” said Susan S. Jick, director of the Boston Collaborative Drug Surveillance Study at Boston University and a member of the team reporting the finding in the Nov. 11 issue of the Journal of the American Medical Association. “The protective effect seems to grow over time. The relative risk for them is about half the risk of someone who is not exposed to a statin.”

Jick, an epidemiologist, was part of an international effort in which physicians at the University of Basel in Switzerland analyzed data collected in the United Kingdom. They studied the association between the use of statins, which are prescribed to reduce the risk of cardiovascular disease, and the incidence of gallstones.

Gallstones form in the gall bladder, which contains a fluid called bile that helps digest fats. About 80 percent of the time, gallstones consist of hardened pellets of cholesterol. They can block the ducts that carry bile from the gall bladder to the small intestine, and persistent blockage is not only painful but can cause dangerous infections. In many cases, removal of the gall bladder is necessary, through a surgical procedure called a cholecystectomy.

The study compared 27,035 people who had a cholecystectomy with 106,531 who had no history of gallstones. The numbers included 11,264 people who took statins, 2,396 of them in the cholecystectomy group.

Among those diagnosed with gallstones, the researchers found a gradual reduction in the need for surgery related to how long they had taken statins. For example, 2.6 percent of the people with five to 19 statin prescriptions required surgery, compared with 2.4 percent of those not taking the medication. For those with 20 or more prescriptions, the incidence of surgery was 3.2 percent, compared with 3.7 percent for those not taking the drug.

The study indicates that all statins provide the protective effect and that the effect increases with higher doses, the report said.

But the study results do not indicate whether a statin should be prescribed solely to help prevent gallstones in someone who did not have them, said Dr. Farid Kehdy, an assistant professor of surgery at the University of Louisville.

“This would have to be studied thoroughly, prescribing a medication for something that may or may not occur,” Kehdy said.

And prescribing a statin to reduce the chance that surgery would be needed is also questionable, he said.

“You would have to take it for a year and a half to reduce the risk ratio,” Kehdy said. “Will a patient be willing to do that? It would be a daily burden if you don’t know for sure.”

Medical history indicates that such a prescription would be questionable, he said. Several decades ago, Kehdy said, physicians routinely prescribed a medication, ursodeoxycholic acid, to help dissolve gallstones, but the high cost, inconvenience and side effects of the medication led to abandonment of the practice.

So a decision to prescribe a statin should center on its known benefits in cardiovascular disease, with gallstones a side issue, he said.

“If you are on a statin, the risk of gallstones would be lessened,” Kehdy said. “If someone does not have gallstones, would you want to take a statin for the sake of preventing gallstones? That question remains to be addressed.”

Although many wedding vows include the phrase “in sickness and in health,” a stroke can put that promise to the test by causing major relationship problems for married couples, according to British researchers.

The University of Ulster study included 16 married stroke survivors (nine males, seven females), aged 33 to 78. The time since their stroke ranged from two months to four years, with an average of 18 months.

The researchers found that the stroke significantly affected sexual activity, led to blurred relationship roles, and feelings such as anger and frustration were confounded by persistent fatigue and lack of independence.

Among the findings:
All but one of the stroke survivors experienced a reduction or total loss of sexual desire. Some believed this was due to the effects of medication or fear of another stroke.
Most of the females lost interest in their appearance, regardless of age.
All the survivors said they’d changed since their stroke. Many said they experienced irritability, anger, agitation and intolerance due to their frustration at not being able to perform daily activities. In some cases, over-protective spouses increased feelings of anger and frustration.
Many survivors were reluctant to resume social activities with their spouses because of fatigue, anxiety and swallowing problems.
Fatigue was often associated with reduced independence and guilt because survivors didn’t know how they’d feel from day to day and couldn’t plan ahead.

“All the participants perceived a stroke as a life-changing event. They faced a continuous daily struggle to achieve some sense of normality and that required huge amounts of physical and mental effort,” study co-author Assumpta Ryan, of the University of Ulster’s Nursing Research Institute, said in a university news release.

While there are plenty of good reasons to avoid obesity in your teens, a new study now suggests that extra weight in adolescence may increase your risk of multiple sclerosis (MS) later.

Reporting in the Nov. 10 issue of Neurology, Harvard researchers found that being obese at age 18 more than doubles a woman’s risk of developing MS later in life compared to her slimmer peers.

“This is one more study that shows obesity leads to another unhealthy outcome, and obesity during adolescence may be critical in determining MS risk,” said study author Kassandra Munger, a research associate at the Harvard School of Public Health in Boston.

Multiple sclerosis is a chronic disorder of the central nervous system, according to the National Multiple Sclerosis Society. Although no one is certain what the exact cause of the disease is, scientists believe it’s an autoimmune disease. That means the body’s immune system mistakenly targets its own cells. In the case of MS, the immune system destroys myelin, a fatty substance that covers nerve fibers, according to the MS society.

The current study included more than 238,000 women who participated in the Nurses’ Health Study or the Nurses’ Health II study between 1976 and 2002. The women were between 25 and 55 years old at the start of the study.

Body mass index (BMI) was calculated using information given by the women about what their height and weight were when they were 18 and at the start of the study. A BMI of 18.5 to 24.9 is considered normal, according to the U.S. Centers for Disease Control and Prevention, while 25 to 29.9 is overweight and above 30 is obese.

The women were also asked to look at pictures of nine different body silhouettes that ranged in size from very thin to extremely obese, and to identify which silhouette most closely matched hers at ages 5, 10 and 20.

Women who were obese at age 18 had a 2.25 times greater risk of developing MS, according to the study. Being overweight seemed to increase the risk slightly, but not to a level that was statistically significant, Munger noted.

A large body silhouette at age 20 increased the risk of MS by 96 percent, the researchers found. A large body size at age 5 or 10 was not associated with an increased risk of MS, provided that the woman had slimmed down by age 20.

Although this study wasn’t designed to find the reason behind the increase, Munger said low vitamin D levels have been suspected of playing a role in the development of MS, and that people who are obese may have lower circulating levels of vitamin D. Another possibility, suggested Munger, is that fat tissue secretes a lot of substances that can affect the immune system.

“We’re beginning now to get clues about things that might predispose a person to MS,” said Dr. John Richert, executive vice president of research and clinical programs at the National Multiple Sclerosis Society. “Up until recently, we’ve looked at MS as a disease for which the onset can’t be controlled, and though it’s still mostly that way, maybe there are circumstances where people might be able to lower their risk a little bit. If all the incoming data [from this and other studies] is correct, not smoking and maintaining an ideal weight might lower the risk of MS.”

But, of the current study, he added, “As with so many interesting observations, this study raises a lot more questions than it answers.”

Munger noted that the study was done solely in women, so the results may not hold true for men. And, additionally, she said, the study participants were almost all white, so it’s not clear if this association would hold up for other races.