News in brief: Costly end of life ED visits for heart patients; Triple pill provides improved BP control; Cardiovascular benefits seen after bariatric surgery

21 Apr 2022

Costly end of life ED visits for heart patients 

The increase in cost burden as patients with heart disease near death is attributable to more frequent ED presentations rather than more expensive ED presentations.

A study of 1,000 Queenslanders with heart disease, and linking ED and death registry data, found 94% had at least one ED presentation during their last three years of life and 85% in their last year of life.

“The rate of ED presentations increased closer to the time of death, and consequently, per patient costs of ED presentations gradually increased over the final years of life due to this greater frequency of ED presentations.”

The study said patients with heart disease may become increasingly frail in their last years of life, which may contribute to ED presentations for other reasons such as falls and injuries.

“Additionally, complex comorbid health states and multimorbidity may contribute to elevated rate of ED presentations, which was consistent with findings reported in this study.“

“Clinical care models that have potential to promote integrated safe and efficient care, including hospital in the home and integrated virtual care models remain a priority for patients with heart disease during their last years of life,” the study concluded.

Read more in Health Services Insights

Triple pill provides improved BP control

A low-dose triple combination of antihypertensive therapy is associated with greater rates of time at target blood pressure (BP) compared with usual care.

The TRIUMPH trial of 700 Sri Lankan patients with mild to moderate hypertension found the once-daily fixed-dose combination of telmisartan 20 mg, amlodipine 2.5 mg, and chlorthalidone 12.5 mg almost doubled the numbers of people achieving more than 50% time at target by 12 weeks.

“The association of the triple pill with an increase in time at target was seen early, with most patients achieving more than 50% time at target by 12 weeks,” the study said.

Overall, patients allocated to the triple pill group (n = 349) had higher time at target compared with those in the usual care group (n = 351) over 24 weeks’ follow-up (64% vs 43%; risk difference, 21%; 95% CI, 16-26; P < .001).

“Those receiving the triple pill achieved a consistently higher time at target at all follow-up periods compared with those receiving usual care (mean [SD]: 0-6 weeks, 36.3% [30.9%] vs 21.7% [28.9%]; P < .001; 6-12 weeks, 5.2% [31.9%] vs 33.7% [33.0%]; P < .001; 12-24 weeks, 66.0% [31.1%] vs 43.5% [34.3%]; P < .001).”

The study was led by The George Institute for Global Health.

Read more in JAMA Cardiology

Cardiovascular benefits seen after bariatric surgery

Bariatric surgery has substantial cardiovascular benefits for people with obesity, reducing the risk of heart failure, myocardial infarction and stroke by up to 50%, according to international research.

A study from the Cleveland Clinic analysed outcomes for almost 95,000 obese patients who underwent bariatric surgery with a matched group of people who did not have surgery.

They found that after a median follow-up of four years bariatric surgery was associated with a 37% lower risk of mortality (9.2 vs 14.7 per 1,000 person-years; Hazard Ratio: 0.63), 54% lower risk of new-onset heart failure (HR: 0.46), 37% lower risk of MI (HR: 0.63), and 29% reduced risk of stroke (HR: 0.71) (P < 0.001).

The number needed to treat with bariatric surgery to prevent death at three years was 64 and to prevent a major cardiovascular event was 15 patients.

The benefit of bariatric surgery was most evident in patients who were 65 years and older, the authors wrote in the Journal of the American College of Cardiology.

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