Tuesday, January 17, 2022 |
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Hello Health Rounds readers! Highly sensitive blood tests for confirming a heart attack are widely employed around the world, but a new study suggests most U.S. hospitals still don't use them. Data from this study may help put to rest some concerns that have contributed to slow adoption.
In other news: Minority elderly dying of cancer in the U.S. are less likely than their white peers to get opioids for pain relief - and when the pain drugs are prescribed, these patients get lower doses, national data show. And, an increased risk for cholesterol problems can be added to the list of COVID-19 after-effects, researchers warn. |
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A technician performs electrocardiography to check a patient's heart rhythm. To confirm a heart attack, doctors check blood levels of an enzyme called troponin, but U.S. hospitals have been slow to implement newer, more-sensitive troponin tests. Reuters/Jessica Rinaldi. |
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U.S. slow to adopt new heart attack blood tests |
Despite widespread use in other countries of newer blood tests to detect heart attacks, few U.S. hospitals employ them, a new study found.
The tests are used in patients with chest pain to measure levels of troponin, an enzyme released by damaged heart muscle. Using older troponin blood tests, it took up to 12 hours to rule out a heart attack. The new "high-sensitivity" tests can shorten this to a couple of hours.
Manufacturers of U.S.-approved high-sensitivity tests include Abbott, Beckman Coulter, Roche, and Siemens.
Researchers who analyzed use of the new tests at 550 U.S. hospitals found that implementation rose from 3.3% in the first quarter of 2019 to 32.6% in the third quarter of 2021, according to a report published on Monday in the Journal of the American College of Cardiology.
Doctors' reluctance to switch has been partly due to fears the new tests might lead to overuse of invasive procedures in low-risk patients, or that it might miss some difficult-to-diagnose heart attacks in high-risk patients, the researchers said.
The study, however, found that at hospitals employing the new more sensitive tests, there was no excess resource use, patients were on average discharged sooner, and fewer invasive procedures were performed in low-risk chest pain patients, with no difference in mortality rates.
Implementing the tests more widely "could optimize care" for patients with conditions causing reduced blood flow to the heart, the researchers concluded. |
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Minority elderly in U.S. get less cancer pain relief |
Among older U.S. cancer patients approaching the end of life, Blacks and Hispanics are "substantially" less likely than whites to receive opioids for pain relief, and when they do receive these drugs, they get lower doses, researchers reported in the Journal of Clinical Oncology.
Using Medicare data from 2007-2019, they analyzed opioid prescriptions for 318,549 people older than 65 with poor-prognosis cancers within 30 days of death or admission to hospice.
Compared with white patients, Black and Hispanic patients, respectively, were 4.3 and 3.6 percentage points less likely to receive opioid painkillers, the data showed.
Blacks and Hispanics also received lower daily doses and lower total doses, amounting to the equivalent of about 25 fewer 5-milligram oxycodone tablets in the final month of life than the average white patient, the researchers found. The difference represents a "meaningful amount of pain control," study leader Andrea Enzinger of Dana-Farber Cancer Institute in Boston said in a statement.
Blacks were also more likely to undergo urine tests for improper drug use, researchers found.
"These inequities disproportionately affected Black men, and were not mitigated by adjusting for measures of poverty, community-level deprivation, or rurality," the researchers wrote.
The findings show "ongoing racial and ethnic inequities in opioid access among Medicare-insured patients dying of cancer ... potentially representing prejudice and structural racism" in healthcare, Stephanie Wheeler, an associate editor of the journal, wrote in a commentary. |
High cholesterol risk climbs after COVID-19 |
For at least a year after recovery from COVID-19, people are at increased risk for newly detected dyslipidemia, or unhealthy levels of fats in their blood, according to a study of patients in the U.S. Veterans Affairs Health System.
Increased risks for new-onset dyslipidemia starting 30 days after a COVID infection and continuing over the following 11 months were significant even among those who were not hospitalized for the virus, researchers reported in The Lancet Diabetes & Endocrinology.
The researchers compared nearly 52,000 patients who recovered from COVID-19 between March 2020 and January 2021 with more than 5.2 million uninfected individuals. Overall, among recovered COVID patients risks were higher by 26% for high total cholesterol levels, 27% for high triglycerides, 24% for high "bad" LDL cholesterol, and 20% for having low levels of "good" HDL cholesterol.
For all those outcomes, the risks increased with severity of COVID-19 illness, the researchers found.
Recovered individuals were also 54% more likely to start taking medications such as statins like Lipitor during the study period.
The researchers advise doctors caring for people who have recovered from COVID-19 to monitor them for abnormal lipid levels. This newsletter was edited by Bill Berkrot. |
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