News in brief: Anaemia underdiagnosed  in HF patients; Some children with ALL at higher risk of treatment toxicity; One in four patients wait too long for essential procedures

Anaemia underdiagnosed  in heart failure patients

Anaemia and iron deficiency are common in heart failure, though often underdiagnosed and undertreated, an Australian study has shown.

The study of 245 heart failure patients found 137 had anaemia by WHO standards (Hb < 130 in males or < 120 in females), and 70% of those had clinically significant anaemia ( Hb < 110 g/L).

Of the 84 patients who had iron studies, 70% had iron deficiency (absolute iron deficiency in 42 patients and functional deficiency in 17), yet only 18 patients received an iron infusion and gastrointestinal investigations were considered in seven.

Patients with clinically significant anaemia had higher all-cause mortality and readmission rates during the 12 months from diagnosis than those with anaemia by WHO criteria (70.5% vs 51.2%, P = 0.03), the authors noted in the Internal Medicine Journal.

Though not statistically significant, adverse events also occurred more frequently in patients with iron deficiency versus those without (77% vs 60%, P = 0.08).

Anaemia and iron deficiency, both absolute and functional, are common in patients with heart failure, but are often under diagnosed and under treated, the authors wrote.

Readmission and/or all cause morality during 12 months post-discharge appear high among these patients.

Which children with ALL are at higher risk of treatment toxicity?

Obese, older children with acute lymphoblastic leukaemia (ALL) are at higher risk of toxicities and truncated asparaginase treatment than those of healthy weight, which could driving poorer outcomes in this patient cohort, study findings suggest.

The research, published in the British Journal of Haematology and led by Paediatric Oncologist Christina Egnell, from the Karolinska University Hospital in Sweden, investigated the role of obesity in the occurrence of severe adverse events and treatment delays in 1,443 children will ALL, aged 2-17.9 years.

Overall, obese children in the study were found to have a higher incidence rate ratio (IRR) for severe toxic events (1.55), liver and kidney failures, bleeding, abdominal complication, suspected unexpected severe adverse reactions and hyperlipidaemia compared with healthy-weight children.

When divided into two age groups, the IRR only stayed significant for older obese children (aged 10-17.9 years).

Obese children aged 10 years or over had increased IRRs for asparaginase-related toxicities compared with healthy-weight older children: thromboses (2.87) and anaphylactic reactions (7.95) as well as higher risk for truncation of asparaginase (3.54).

However, obese children with ALL did not experience significantly longer treatment delays than healthy-weight children, the data showed.

According to the researchers, the high prevalence of toxicity and a higher risk of truncation of asparaginase could be driving the poor prognosis of children with ALL who are obese and aged 10 years or older.

“Obese children can benefit from dietary and physical training interventions or new immunological treatment strategies to decrease serious treatment-related toxicities,” they said.

One in four patients wait too long for essential procedures: AMA Report Card

The AMA’s latest hospital report card shows that nationally only 75% of patients classified as Category 2 for elective surgery received treatment within the recommended timeframe.

Federal AMA President, Dr Omar Khorshid said the hospital system was already overwhelmed before the COVID-19 pandemic hit in 2020, due to an relentless decline in the number of beds available per head of population.

“While called ‘elective’ surgery, this really is essential surgery that includes serious conditions like heart valve replacements and cancer investigations,” he said.

“In reality, what this means is that 25% of people will wait longer than 90 days for surgeries, which in this category can include treatment for an unruptured brain aneurism, decompression of a spinal cord and treatment for ovarian cysts or unhealed fractures.

Dr Khorshid said the problem was particularly bad for patients in states such as Tasmania where more than a 63% are waiting longer than the recommended period for essential surgery.

The report card showed that the ratio of beds available for people over the age of 65 (the most intensive users of public hospital beds) has been on a downward trend for 27 years, halving from 33 to just over 15 per 1000 people.

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