News in brief: Cardiac conditions the most common pre-existing illness in COVID-19 deaths; AF screening again rejected by USPSTF; Consultants urged to act on junior doctor wage theft

2 Feb 2022

Cardiac conditions the most common pre-existing illness in COVID-19 deaths

Cardiac conditions are the most common pre-existing chronic conditions in Australians who die from COVID-19 disease, new figures show.

Death certificate data for 1189 COVID-19 fatalities released by the Australian Bureau of Statistics show that chronic cardiac conditions including coronary atherosclerosis, cardiomyopathies and atrial fibrillation were the most commonly certified comorbidities, present in 36.5% of deaths.

Other pre-existing conditions included dementia (31.8% of deaths), diabetes (20.9%), chronic respiratory conditions (17.2%), hypertension (14.8%) and cancer (12.6%).

Acute diseases thought to have a causal link to death in COVID-19 patients included cardiac complication in 7.2% of deaths, whereas the most common ones were pneumonia (68.9%) and respiratory failure (11.7%).

AF screening again rejected by USPSTF

An updated evaluation of screening for atrial fibrillation by the US Preventive Services Task Force has reaffirmed previous advice that there is inadequate evidence to assess whether screening asymptomatic adults over the age of 50 has any benefit in preventing strokes.

In its 2022 recommendations released on 25 January the USPSTF said the latest evaluation went beyond previous 2018 advice covering ECG screening, to consider latest trials of other screening methods such as automated blood pressure cuffs, pulse oximeters, and consumer devices such as smartwatches and smartphone apps.

However, even with this expanded scope, the USPSTF did not find enough evidence to recommend for or against screening for AF.

“There is insufficient evidence to recommend for or against screening for AF. More research is needed to determine the benefits of screening for AF to prevent strokes. Clinicians should use their clinical judgement regarding whether to screen and how to screen for AF,” it advised.

“It is important to note that the USPSTF considers pulse palpation to be part of routine or usual care,” the taskforce statement noted.

Consultants urged to act on junior doctor wage theft

Hospital consultants are being urged to help stop public hospital ‘wage theft’ from junior doctors.

An article in MJA Insight says that doctors-in-training are deterred from claiming overtime for fear of being labelled inefficient, incompetent or greedy. Since claims must be signed off by a consultant who usually act as a referee for the junior doctor’s reappointment, these senior clinicians are in a key position to help prevent the chronic underpayment of doctors-in-training, writes Dr Leanne Rowe. They must also support junior staff access to entitlements such extra shift allowances, on call penalties, breaks and training periods, she says.

“Senior consultants must urgently re-examine how they manage legitimate claims for the basic pay entitlements by subordinates, as well as notifying public hospital management of the need for adequate funding for payroll,” she writes.

“Continuing to expect junior doctors to perform significant additional volunteer hours in the presence of many other serious occupational health and safety issues is not only grossly unjust – it’s criminal,” she concludes.

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