News in brief: AF risk high in young athletes; DOACs could replace warfarin in heart pumps; Call for Medicare review of procedural specialist incomes

Tuesday, 13 Jul 2021

Young athletes run higher risk of atrial fibrillation

Athletes are more likely to develop atrial fibrillation (AF) than non-athletes, with young and mixed-sport athletes at greatest risk, new UK research shows.

Analysis of 13 studies, observing 6816 athletes and 63662 controls, revealed athletes’ AF risk was almost two and a half times higher than non-athletes.

The increased risk may result from high-intensity exercise-induced strain of augmented cardiac output and atrial stretch.

Athletes under 55 years old were over three and a half times more likely to develop AF than their older counterparts.

Mixed sports, such as football, netball and rugby conferred a greater AF risk than endurance sports like cycling, running, swimming, Nordic skiing, orienteering and rowing.

“The mechanisms by which exercise training increases the risk of AF are complex and speculative, but may include atrial dilation, adrenergic activation, vagal tone, chronic inflammation, pulmonary foci and interstitial fibrosis,” the study authors said in the British Journal of Sports Medicine.

DOACs could replace warfarin in heart pumps

DOACs could potentially replace warfarin as the anticoagulants used in a left ventricular assist device for heart failure, an Australian study suggests.

In vitro tests conducted by researchers at the Heart and Lung Transplant Unit, St. Vincent’s Hospital, Sydney, showed that apixaban was at least as effective as warfarin in preventing thrombus formation when used under simulated conditions in a continuous flow HeartWare left ventricular assist device.

The DOAC had a similar haemostatic profile to warfarin, and high-dose apixaban was not associated with pump clot, the study showed. Thrombosis findings were also similar to the aggregation assays that were performed. There also appeared to be reduced haemolysis with stable pump function in the apixaban and warfarin groups when compared with the control, aspirin, and dabigatran groups.

The investigators said the safe use of DOACs would represent a step forward for left ventricular assist device patients. but further evaluation was needed before changes to clinical recommendations can be made.

Call for Medicare review of procedural specialist incomes

Procedural specialists are overpaid compared to other specialists and there needs to be a review of the inequities in the Medicare Benefits Schedule, according to two senior physicians.

The high incomes for procedural specialists are not justified by their long years of training, level of skill or the hours worked compared to other physicians or GPs, according to Dr Kerry Breen and Dr Kerry Goulston.

Writing in Pearls and Irritations, they say the imbalance in incomes between specialties has become wider and more distorted in recent years because of a flaw in the original MBS when Medicare was set up favoured procedural work over consultations.

The distortion is now deterring medical graduates from working in low income specialities, and there is an urgent need for the federal health department to commission a new study to review the 2005 Productivity Commission report on how to address  the income bias.

“Such a study should also be invited to examine whether the earning differentials between various groups of doctors are justifiable and are in the best interests of the health care system and patients,” they suggest.

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