The risk for death after AF ablation is 1 in 1000 patients or 1 in 1385 procedures.
Catheter ablation is an accepted procedure for patients with atrial fibrillation in whom medical treatment is ineffective. Currently, the only indication for AF ablation is impaired quality of life (QOL); ablation is not recommended for patients without symptoms who merely wish to stop taking warfarin. Individuals with AF have an increased mortality risk, and no AF treatment, including ablation, has been shown to reduce that risk. The AF ablation procedure itself carries a variety of risks. However, the incidence of death from complications of AF ablation has not been determined, because the data are from single-center or small multicenter trials.
In this international survey of 162 centers, published in Journal Watch Cardiology May 27, 2009-32,569 patients underwent 45,115 AF ablation procedures. In all, 32 deaths occurred (0.98 per 1000 patients; 0.71 per 1000 procedures), including 7 from tamponade, 5 from atrioesophageal fistula, and 3 from stroke.
Comment by a cardiologist: These data provide useful guidance to physicians and patients regarding the risks of AF ablation. Whether a 1-in-1385 procedural mortality risk is justified by potentially improved QOL is an individual patient decision. However, to put this risk in perspective, it is roughly the equivalent of the risk of knee replacement
— another invasive QOL-improving procedure — and it is much lower than the risk of elective coronary percutaneous interventions, arguably also performed largely to improve QOL.
CITATION:
Cappato R et al. Prevalence and causes of fatal outcome in catheter ablation of atrial fibrillation. J Am Coll Cardiol 2009 May 12; 53:1798.
Please remember, as with all our articles we provide information, not medical advice.
For any treatment of your own medical condition you must visit your local doctor, with or without our article[s]. These articles are not to be taken as individual medical advice.
* Tune in tomorrow for A NEW NON INVASIVE TEST FOR ALZHEIMERS.
Deepen your understanding of "medical malpractice"... www.MedMalBook.com
Monday, August 3, 2009
Sunday, August 2, 2009
NEW RECOMMENDATIONS FROM PRESCRIBERS NEWSLETTER FOCUS MORE ON AGE TO DETERMINE WHO SHOULD GET ASPIRIN FOR PRIMARY PREVENTION.
NEW RECOMMENDATIONS FROM PRESCRIBERS NEWSLETTER FOCUS MORE ON AGE TO DETERMINE WHO SHOULD GET ASPIRIN FOR PRIMARY PREVENTION.
Previous guidelines relied more on RISK calculators...and recommended aspirin for patients with a cardiovascular risk of at least 6% over 10 years.
In general, the new recommendations recommend low-dose aspirin for men age 45 to 79...and women age 55 to 79.
These are the ages where the risk of bleeding is usually offset by aspirin's cardiovascular benefits.
Interestingly, the benefits are different for men and for women.
For men, the benefit is to prevent an MI.
For women, the primary benefit is to prevent an ischemic stroke.
Of course, patients are even more likely to benefit if they have additional CV risks...smoking, hypertension, dyslipidemia, etc.
On the other hand, patients may be better off without aspirin if they have additional BLEEDING risks...prior GI ulcers, chronic NSAIDs, etc.
Don't give aspirin to patients with additional GI risks unless their CV risk is high enough to outweigh the higher bleeding risk.
Consider adding a proton pump inhibitor if a patient at high risk for GI bleeding needs to take aspirin.
Patients 80 or older have a high risk of BOTH cardiovascular disease and GI bleeding. Give aspirin only if these seniors have no additional GI risks.
Also make sure BP is controlled before starting aspirin to reduce the risk of hemorrhagic stroke.
Prescribe just 81 mg/day of aspirin. There's no proof that higher doses work better...plus they can increase bleeding risk.
Advise patients to take either regular aspirin with food or use enteric-coated aspirin...IF needed to reduce stomach irritation. But explain that this only helps the local effects...neither approach reduces the risk of bleeding.
Please remember, as with all our articles we provide information, not medical advice.
For any treatment of your own medical condition you must visit your local doctor, with or without our article[s]. These articles are not to be taken as individual medical advice.
* Tune in tomorrow for ABLATION FOR ATRIAL FIBRILLATION: NOT RISK FREE.
Deepen your understanding of "medical malpractice"... www.MedMalBook.com
Previous guidelines relied more on RISK calculators...and recommended aspirin for patients with a cardiovascular risk of at least 6% over 10 years.
In general, the new recommendations recommend low-dose aspirin for men age 45 to 79...and women age 55 to 79.
These are the ages where the risk of bleeding is usually offset by aspirin's cardiovascular benefits.
Interestingly, the benefits are different for men and for women.
For men, the benefit is to prevent an MI.
For women, the primary benefit is to prevent an ischemic stroke.
Of course, patients are even more likely to benefit if they have additional CV risks...smoking, hypertension, dyslipidemia, etc.
On the other hand, patients may be better off without aspirin if they have additional BLEEDING risks...prior GI ulcers, chronic NSAIDs, etc.
Don't give aspirin to patients with additional GI risks unless their CV risk is high enough to outweigh the higher bleeding risk.
Consider adding a proton pump inhibitor if a patient at high risk for GI bleeding needs to take aspirin.
Patients 80 or older have a high risk of BOTH cardiovascular disease and GI bleeding. Give aspirin only if these seniors have no additional GI risks.
Also make sure BP is controlled before starting aspirin to reduce the risk of hemorrhagic stroke.
Prescribe just 81 mg/day of aspirin. There's no proof that higher doses work better...plus they can increase bleeding risk.
Advise patients to take either regular aspirin with food or use enteric-coated aspirin...IF needed to reduce stomach irritation. But explain that this only helps the local effects...neither approach reduces the risk of bleeding.
Please remember, as with all our articles we provide information, not medical advice.
For any treatment of your own medical condition you must visit your local doctor, with or without our article[s]. These articles are not to be taken as individual medical advice.
* Tune in tomorrow for ABLATION FOR ATRIAL FIBRILLATION: NOT RISK FREE.
Deepen your understanding of "medical malpractice"... www.MedMalBook.com
Saturday, August 1, 2009
FALLS IN THE ELDERLY
The Centers for Medicare and Medicaid Services (CMS) worked collaboratively with the Centers for Disease Control and Prevention (CDC) and on October 1, 2008, enacted new payment provisions: Medicare will no longer reimburse hospitals for a higher-paying DRG when one of eight selected hospital-acquired conditions develops during the hospital stay. The CMS heralded this move as an effort to align financial incentives with the quality of care, thereby promoting both quality and efficiency.
Hospital falls and trauma were included as one of the eight conditions that, the CMS argues, "should not occur after admission to the hospital." But, writing in the New England Journal of Medicine, Dr. Sharon K. Inouye of Harvard Medical School, and colleagues, "argue that because falls have proved to be such an intractable problem despite broad efforts to reduce them, they should not be included on a list of avoidable medical errors that result in hospitals not being paid." Each year, they point out about one third of persons who are 65 years of age or older living in community settings fall at least once. The percentage is 50% among those 80 years of age or older
There is little argument that hospital falls fulfill the first two criteria outlined by Congress — they are high-cost and high-volume, and they result in the assignment of a case to a higher-paying DRG. Some 3 to 20% of inpatients fall at least once during their hospital stay; these falls result in injuries, increased lengths of stay, malpractice lawsuits, and more than $4,000 in excess charges per hospitalization. Thus, hospital falls represent a major patient-safety problem and may complicate a patient's care and treatment. Yet we believe that the inclusion of falls and trauma in this initiative is misguided: it implies both that hospital falls occur as the result of lapses in the health care system and that they can reasonably be prevented through the application of evidence-based guidelines. Most important, their inclusion may have unintended consequences that may cause greater harm than the falls that the initiative is meant to prevent.
But, says the New England Journal of Medicine (NEJM), falls and injuries can occur even when hospitals provide the best possible care and unlike other hospital-acquired conditions that were selected by the CMS, falls are often the result not of medical errors but of diseases, impairments, and appropriate uses of medications and other treatments.
The CMS's statement that the selected conditions should not occur after admission to the hospital presumes that the conditions were not present before hospitalization — which is not true in the case of falls.
Of greatest concern the NEJM points out, is that the heightened focus on fall prevention will probably have unintended consequences. If hospitals are scrutinized for the occurrence of falls, the natural tendency will be to focus on such events even at the expense of competing (and perhaps more important) outcomes. Unintended consequences are likely to include a decrease in mobility and a resurgence in the use of physical restraints in a misguided effort to prevent fall-related injuries. Physical restraints have long been used because they are believed to prevent falls. Studies have shown, however, that not only do they not reduce the risk of falls or related injuries, but they are associated with increased rates of complications, including immobility, functional loss, delirium, agitation, pressure sores, asphyxiation, and death. Moreover, accumulating evidence suggests that restraints may actually increase the risk of falling or sustaining an injury from a fall.
The inclusion of hospital falls in the new Medicare initiative appears to be premature at best; at worst, it may be harmful to the very patients it is intended to protect and may ultimately increase the costs of Medicare because of its unintended consequences, concludes the NEJM.
Please remember, as with all our articles we provide information, not medical advice.
For any treatment of your own medical condition you must visit your local doctor, with or without our article[s]. These articles are not to be taken as individual medical advice.
* Tune in tomorrow for NEW RECOMMENDATIONS FROM PRESCRIBERS NEWSLETTER FOCUS MORE ON AGE TO DETERMINE WHO SHOULD GET ASPIRIN FOR PRIMARY PREVENTION.
Deepen your understanding of "medical malpractice"... www.MedMalBook.com
Hospital falls and trauma were included as one of the eight conditions that, the CMS argues, "should not occur after admission to the hospital." But, writing in the New England Journal of Medicine, Dr. Sharon K. Inouye of Harvard Medical School, and colleagues, "argue that because falls have proved to be such an intractable problem despite broad efforts to reduce them, they should not be included on a list of avoidable medical errors that result in hospitals not being paid." Each year, they point out about one third of persons who are 65 years of age or older living in community settings fall at least once. The percentage is 50% among those 80 years of age or older
There is little argument that hospital falls fulfill the first two criteria outlined by Congress — they are high-cost and high-volume, and they result in the assignment of a case to a higher-paying DRG. Some 3 to 20% of inpatients fall at least once during their hospital stay; these falls result in injuries, increased lengths of stay, malpractice lawsuits, and more than $4,000 in excess charges per hospitalization. Thus, hospital falls represent a major patient-safety problem and may complicate a patient's care and treatment. Yet we believe that the inclusion of falls and trauma in this initiative is misguided: it implies both that hospital falls occur as the result of lapses in the health care system and that they can reasonably be prevented through the application of evidence-based guidelines. Most important, their inclusion may have unintended consequences that may cause greater harm than the falls that the initiative is meant to prevent.
But, says the New England Journal of Medicine (NEJM), falls and injuries can occur even when hospitals provide the best possible care and unlike other hospital-acquired conditions that were selected by the CMS, falls are often the result not of medical errors but of diseases, impairments, and appropriate uses of medications and other treatments.
The CMS's statement that the selected conditions should not occur after admission to the hospital presumes that the conditions were not present before hospitalization — which is not true in the case of falls.
Of greatest concern the NEJM points out, is that the heightened focus on fall prevention will probably have unintended consequences. If hospitals are scrutinized for the occurrence of falls, the natural tendency will be to focus on such events even at the expense of competing (and perhaps more important) outcomes. Unintended consequences are likely to include a decrease in mobility and a resurgence in the use of physical restraints in a misguided effort to prevent fall-related injuries. Physical restraints have long been used because they are believed to prevent falls. Studies have shown, however, that not only do they not reduce the risk of falls or related injuries, but they are associated with increased rates of complications, including immobility, functional loss, delirium, agitation, pressure sores, asphyxiation, and death. Moreover, accumulating evidence suggests that restraints may actually increase the risk of falling or sustaining an injury from a fall.
The inclusion of hospital falls in the new Medicare initiative appears to be premature at best; at worst, it may be harmful to the very patients it is intended to protect and may ultimately increase the costs of Medicare because of its unintended consequences, concludes the NEJM.
Please remember, as with all our articles we provide information, not medical advice.
For any treatment of your own medical condition you must visit your local doctor, with or without our article[s]. These articles are not to be taken as individual medical advice.
* Tune in tomorrow for NEW RECOMMENDATIONS FROM PRESCRIBERS NEWSLETTER FOCUS MORE ON AGE TO DETERMINE WHO SHOULD GET ASPIRIN FOR PRIMARY PREVENTION.
Deepen your understanding of "medical malpractice"... www.MedMalBook.com
Friday, July 31, 2009
STUDY INDICATES 47,000 OLDER AMERICANS ARE TREATED IN EDS EACH YEAR FOR FALLS ASSOCIATED WITH WALKING AIDS.
A study in the Journal of the American Geriatrics Society "suggests that there is room for improvement in the use and design of walking aids," citing data that indicates "about 47,000 older Americans are treated in emergency" departments (EDs) "each year [for] falls associated with walkers and canes."
The study "is based on six years of" ED "medical records," which showed that "such falls, mainly involving walkers, account for about three percent of all falls among people 65 and older." The study also shows that doctors should take more time to better fit patients with walking aids and teach how to use them safely."
Women sustained 78 percent of walker-related injuries and 66 percent of cane-related injuries," and that "the risk of falling while using a walker or a cane increased with age, with the highest injury rate among those ages 85 and older." The researchers found that "fractures were the most common type of injury suffered while using canes (40 percent) and walkers (38 percent)."
“It’s important to make sure people use these devices safely,” said an epidemiologist at the Centers for Disease Control and Prevention and the study’s lead author. “It gives them greater independence, but at the same time it can be a hazard if not used properly.” The study, found that 87 percent of fall injuries involved walkers and 12 percent involved canes. Researchers examined emergency-room medical records at 66 hospitals from Jan. 1, 2001, to Dec. 31, 2006. They focused on patients 65 and older who had been treated for 3,932 nonfatal, unintentional fall injuries in which a cane or a walker was involved. A statistical analysis estimates that there are 47,312 falls a year. The study found that fractures, bruises and abrasions were the most common injuries associated with the falls. Almost a third of all injuries were to the lower trunk, including the hips.
Sixty percent of fall injuries associated with walkers and canes occurred at home, while 16 percent of falls involving a walker occurred at nursing homes, the study said.
Authors of the study said that doctors might consider taking more time to show patients how to use walkers properly and that additional research could lead to design improvements for walking aids.
Please remember, as with all our articles we provide information, not medical advice.
For any treatment of your own medical condition you must visit your local doctor, with or without our article[s]. These articles are not to be taken as individual medical advice.
* Tune in tomorrow for FALLS IN THE ELDERLY.
Deepen your understanding of "medical malpractice"... www.MedMalBook.com
The study "is based on six years of" ED "medical records," which showed that "such falls, mainly involving walkers, account for about three percent of all falls among people 65 and older." The study also shows that doctors should take more time to better fit patients with walking aids and teach how to use them safely."
Women sustained 78 percent of walker-related injuries and 66 percent of cane-related injuries," and that "the risk of falling while using a walker or a cane increased with age, with the highest injury rate among those ages 85 and older." The researchers found that "fractures were the most common type of injury suffered while using canes (40 percent) and walkers (38 percent)."
“It’s important to make sure people use these devices safely,” said an epidemiologist at the Centers for Disease Control and Prevention and the study’s lead author. “It gives them greater independence, but at the same time it can be a hazard if not used properly.” The study, found that 87 percent of fall injuries involved walkers and 12 percent involved canes. Researchers examined emergency-room medical records at 66 hospitals from Jan. 1, 2001, to Dec. 31, 2006. They focused on patients 65 and older who had been treated for 3,932 nonfatal, unintentional fall injuries in which a cane or a walker was involved. A statistical analysis estimates that there are 47,312 falls a year. The study found that fractures, bruises and abrasions were the most common injuries associated with the falls. Almost a third of all injuries were to the lower trunk, including the hips.
Sixty percent of fall injuries associated with walkers and canes occurred at home, while 16 percent of falls involving a walker occurred at nursing homes, the study said.
Authors of the study said that doctors might consider taking more time to show patients how to use walkers properly and that additional research could lead to design improvements for walking aids.
Please remember, as with all our articles we provide information, not medical advice.
For any treatment of your own medical condition you must visit your local doctor, with or without our article[s]. These articles are not to be taken as individual medical advice.
* Tune in tomorrow for FALLS IN THE ELDERLY.
Deepen your understanding of "medical malpractice"... www.MedMalBook.com
Thursday, July 30, 2009
WHO SAYS THE US DOES NOT RATION CARE?
Nearly half of kidney transplant waitlist patients over age 60 are at risk to die before they receive a deceased-donor organ, researchers found. The risk of death before acquiring a kidney for senior citizens is high and even higher for patients age 70 and older, for African Americans, and for diabetics.
These findings provide incentive for older patients to consider living donors as an alternative or to get on the list and navigate the deceased-donor process as quickly as possible.
Kidney transplant can nearly double the life expectancy of end-stage renal disease patients over age 60. But an increasing gap between supply and demand has produced longer waiting times and increased mortality on the waiting list, the researchers said. Expanding waiting times clearly affect all portions of the transplant candidate populations.However, older and frailer patients may be the most directly affected because of rapid mortality rates before receiving a deceased-donor transplant.
The number of newly listed kidney transplant candidates nearly tripled from 2,367 in 1995 to 6,982 in 2006, researchers found in an analysis of the Scientific Registry of Transplant Recipients database. The study included all 54,699 patients age 60 and older when placed on the U.S. waiting list for a single kidney transplant from 1995 to July 2007. Half of these older candidates were age 60 to 64 at the time of listing, and 79% were on dialysis at the time of listing.
Overall, 61% of the older population received a transplant within five years of going on the list, but the proportion projected to receive a transplant within five years declined during the study period. For those waitlisted in 2006-2007, it was projected that 46% would die before receiving a deceased-donor transplant, up from a projected 22% in 1995.
The waiting time for a deceased-donor transplant rose significantly from 1995 to 2007, but the gap between time to transplantation and average survival from waitlisting narrowed during the study period. However, the projections for the rate of death before receipt of a deceased-donor kidney varied widely within the older population:
• 61% for those with diabetes
• 52% for those older than 70
• 62% for black patients
• 60% for blood type O
• 71% for blood type B
• 68% for highly sensitized patients
• 53% for those on dialysis at listing
Where patients lived also made a big difference in projected rate of death before kidney transplantation. The mortality rate ranged from 81% for those in United Network for Organ Sharing region five (Arizona, California, Nevada, New Mexico, and Utah) to just 6% for those in region six (Alaska, Hawaii, Idaho, Montana, Oregon, and Washington).
These factors may help clinicians and patients in decision-making, the researchers said. "As these results demonstrate, a white candidate with type AB blood in region one [Connecticut, Maine, Massachusetts, New Hampshire, and Rhode Island] is in a very different circumstance than a black candidate listed with type B blood in region five," they noted. They cautioned, though, that the study was limited by its retrospective, population-based design: its database did not include many factors that ultimately influence patients' prognoses and likelihood of receiving a transplant.
"In this sense, these results provide a general framework that can be used to guide patients and illustrate the importance of various factors, but should not be used exclusively ignoring individual circumstances," they concluded. The practice of transplantation is rapidly changing, but not in favor of older patients, they noted. In particular, they cited a proposed policy for organ allocation that would give younger patients more rapid access to deceased-donor transplants than older candidates.
Clinical Journal of the American Society of Nephrology 2009
Schold J, et al "Half of kidney transplant candidates who are older than 60 years now placed on the waiting list will die before receiving a deceased-donor transplant"
Please remember, as with all our articles we provide information, not medical advice.
For any treatment of your own medical condition you must visit your local doctor, with or without our article[s]. These articles are not to be taken as individual medical advice.
* Tune in tomorrow for STUDY INDICATES 47,000 OLDER AMERICANS ARE TREATED IN EDS EACH YEAR FOR FALLS ASSOCIATED WITH WALKING AIDS.
Deepen your understanding of "medical malpractice"... www.MedMalBook.com
These findings provide incentive for older patients to consider living donors as an alternative or to get on the list and navigate the deceased-donor process as quickly as possible.
Kidney transplant can nearly double the life expectancy of end-stage renal disease patients over age 60. But an increasing gap between supply and demand has produced longer waiting times and increased mortality on the waiting list, the researchers said. Expanding waiting times clearly affect all portions of the transplant candidate populations.However, older and frailer patients may be the most directly affected because of rapid mortality rates before receiving a deceased-donor transplant.
The number of newly listed kidney transplant candidates nearly tripled from 2,367 in 1995 to 6,982 in 2006, researchers found in an analysis of the Scientific Registry of Transplant Recipients database. The study included all 54,699 patients age 60 and older when placed on the U.S. waiting list for a single kidney transplant from 1995 to July 2007. Half of these older candidates were age 60 to 64 at the time of listing, and 79% were on dialysis at the time of listing.
Overall, 61% of the older population received a transplant within five years of going on the list, but the proportion projected to receive a transplant within five years declined during the study period. For those waitlisted in 2006-2007, it was projected that 46% would die before receiving a deceased-donor transplant, up from a projected 22% in 1995.
The waiting time for a deceased-donor transplant rose significantly from 1995 to 2007, but the gap between time to transplantation and average survival from waitlisting narrowed during the study period. However, the projections for the rate of death before receipt of a deceased-donor kidney varied widely within the older population:
• 61% for those with diabetes
• 52% for those older than 70
• 62% for black patients
• 60% for blood type O
• 71% for blood type B
• 68% for highly sensitized patients
• 53% for those on dialysis at listing
Where patients lived also made a big difference in projected rate of death before kidney transplantation. The mortality rate ranged from 81% for those in United Network for Organ Sharing region five (Arizona, California, Nevada, New Mexico, and Utah) to just 6% for those in region six (Alaska, Hawaii, Idaho, Montana, Oregon, and Washington).
These factors may help clinicians and patients in decision-making, the researchers said. "As these results demonstrate, a white candidate with type AB blood in region one [Connecticut, Maine, Massachusetts, New Hampshire, and Rhode Island] is in a very different circumstance than a black candidate listed with type B blood in region five," they noted. They cautioned, though, that the study was limited by its retrospective, population-based design: its database did not include many factors that ultimately influence patients' prognoses and likelihood of receiving a transplant.
"In this sense, these results provide a general framework that can be used to guide patients and illustrate the importance of various factors, but should not be used exclusively ignoring individual circumstances," they concluded. The practice of transplantation is rapidly changing, but not in favor of older patients, they noted. In particular, they cited a proposed policy for organ allocation that would give younger patients more rapid access to deceased-donor transplants than older candidates.
Clinical Journal of the American Society of Nephrology 2009
Schold J, et al "Half of kidney transplant candidates who are older than 60 years now placed on the waiting list will die before receiving a deceased-donor transplant"
Please remember, as with all our articles we provide information, not medical advice.
For any treatment of your own medical condition you must visit your local doctor, with or without our article[s]. These articles are not to be taken as individual medical advice.
* Tune in tomorrow for STUDY INDICATES 47,000 OLDER AMERICANS ARE TREATED IN EDS EACH YEAR FOR FALLS ASSOCIATED WITH WALKING AIDS.
Deepen your understanding of "medical malpractice"... www.MedMalBook.com
Wednesday, July 29, 2009
INCREASED RISK OF STROKE IN PATIENTS WITH PSORIASIS
Psoriasis is a chronic Th-1 and Th-17 inflammatory disease. Chronic inflammation has also been associated with atherosclerosis and thrombosis. The authors conducted a population-based cohort study of patients seen by general practitioners participating in the General Practice Research Database in the United Kingdom, 1987–2002.
Mild psoriasis was defined as any patient with a diagnostic code of psoriasis, but no history of systemic therapy. Severe psoriasis was defined as any patient with a diagnostic code of psoriasis and a history of systemic therapy consistent with severe psoriasis.
The unexposed (control) population was composed of patients with no history of a psoriasis diagnostic code.
When adjusting for major risk factors for stroke, both mild (hazard ratio (HR) 1.06, 95% confidence interval (CI) 1.0–1.1) and severe (1.43, 95% CI 1.1–1.9) psoriasis were independent risk factors for stroke. The excess risk of stroke attributable to psoriasis in patients with mild and severe disease was 1 in 4,115 per year and 1 in 530 per year, respectively.
Patients with psoriasis, particularly if severe, have an increased risk of stroke that is not explained by major stroke risk factors identified in routine medical care.
Joel M Gelfand et al.Investigative Dermatology advance online publication 21 May 2009; doi: 10.1038/jid.2009.112
Please remember, as with all our articles we provide information, not medical advice.
For any treatment of your own medical condition you must visit your local doctor, with or without our article[s]. These articles are not to be taken as individual medical advice.
* Tune in tomorrow for WHO SAYS THE US DOES NOT RATION CARE?.
Deepen your understanding of "medical malpractice"... www.MedMalBook.com
Mild psoriasis was defined as any patient with a diagnostic code of psoriasis, but no history of systemic therapy. Severe psoriasis was defined as any patient with a diagnostic code of psoriasis and a history of systemic therapy consistent with severe psoriasis.
The unexposed (control) population was composed of patients with no history of a psoriasis diagnostic code.
When adjusting for major risk factors for stroke, both mild (hazard ratio (HR) 1.06, 95% confidence interval (CI) 1.0–1.1) and severe (1.43, 95% CI 1.1–1.9) psoriasis were independent risk factors for stroke. The excess risk of stroke attributable to psoriasis in patients with mild and severe disease was 1 in 4,115 per year and 1 in 530 per year, respectively.
Patients with psoriasis, particularly if severe, have an increased risk of stroke that is not explained by major stroke risk factors identified in routine medical care.
Joel M Gelfand et al.Investigative Dermatology advance online publication 21 May 2009; doi: 10.1038/jid.2009.112
Please remember, as with all our articles we provide information, not medical advice.
For any treatment of your own medical condition you must visit your local doctor, with or without our article[s]. These articles are not to be taken as individual medical advice.
* Tune in tomorrow for WHO SAYS THE US DOES NOT RATION CARE?.
Deepen your understanding of "medical malpractice"... www.MedMalBook.com
Tuesday, July 28, 2009
HOW DOES #TORT REFORM AND LIMITING #DEFENSIVE MEDICINE AFFECT TOTAL U.S. #HEALTHCARE EXPENDITURES?
#EXPERTS SHOW THE NON SIGNIFICANT IMPACT ON TOTAL HEALTHCARE EXPENDITURES.
Some special interests are calling for provisions to limit the legal liability of hospitals and medical care providers. You have likely heard the claim that the rising cost of medical malpractice insurance is driving doctors out of practice. Take away the threat of lawsuits, certain special interests claim and the country’s health care costs will drop. There is also a cry that defensive medicine as a byproduct of medical malpractice activities is further exacerbating the financial burden on healthcare in the U.S.
But a new report paints a very different picture. True Risk: Medical Liability, Malpractice Insurance and Health Care,* concludes that limiting the liability of negligent hospitals and medical professionals would have virtually no impact on the cost of health care in this country. In fact, the study found that the cost of medical malpractice premiums are the lowest they have been in at least thirty years, the period for which data was studied. Medical malpractice premiums are less than ½ of 1% of all health care costs, and medical malpractice claims are a miniscule 1/5th of 1% of health care costs. Moreover, the states that have severely limited patients’ rights through so-called medical malpractice tort reform have similar malpractice insurance rates as states that have not so severely limited patients’ rights. Finally, the study found that medical malpractice insurers’ profits are generally higher than the rest of the property casualty industry.
All told, the report concludes, limiting patients’ rights will not lead to affordable health care for all Americans. All so-called medical practice tort reform does is shield the negligent from the cost of their mistakes, putting the burden on the injured patient. Significantly, the study concludes that placing further limits on the liability of negligent doctors and unsafe hospitals would be unjustifiable, and would put almost no dent in our country’s health care costs.
The study adds that “If Congress completely eliminated every single medical malpractice lawsuit,” it says, “including all legitimate cases, as part of health care reform, overall health care costs would hardly change, but the costs of medical error and hospital-induced injury would remain and someone else would have to pay.”
All of this only confirms the position trial lawyers have been taking, which is that removing or further limiting medical liability would mean robbing patients of the only meaningful check and balance they have. Limiting liability is not a way to save the country money, and it’s not fair for patients who are wrongfully injured or who lose their lives due to negligence.
"Our research makes clear that medical malpractice claims and premiums have almost no impact on the cost of health care “Our study also shows that states that have passed severe medical malpractice tort restrictions on victims of medical error have rate changes similar to those states that haven’t adopted these harsh measures.
WHAT ABOUT THE ADDED EXPENSES OF DEFENSIVE MEDICINE?
Defensive medicine is defined as "a deviation from sound medical practice, induced primarily by threat of liability."
It is divided into two categories, assurance and avoidance behaviors. Assurance behavior, or positive defensive medicine, is practiced by most physicians and involves the supply of additional services of negligible medical value to reduce adverse outcomes, deter patients from filing malpractice claims, or persuade the legal system that the standard of care was met.
Avoidance behavior, also known as negative defensive behavior, reflects physicians' efforts to distance themselves from potential legal risk. They do so by restricting their practice, refusing to perform high-risk procedures, and avoiding patients with complex problems or patients perceived as litigious. This type of behavior usually stems from a fear of uninsured non-monetary costs driving the physician out of business or the view that the downside of malpractice is greater than the upside of treatment.
To demonstrate the prevalence of defensive medicine, the Harvard School of Public Health and Columbia Law School surveyed physicians practicing in Pennsylvania, a state once infamous for having the highest malpractice insurance premiums in the country. The study, conducted in 2005, received responses from over 800 physicians in six specialties, with approximately 93% of doctors responding affirmatively when asked whether they practiced medicine defensively.
Defensive medicine is accompanied by an unexpectedly high overall cost, masked by the fact that these costs are split between doctors, patients, insurers, and the government. To gauge the burden of defensive medicine, Daniel P. Kessler and Mark B. McClellan compared healthcare costs in the 28 states with laws that limit punitive damages that can be paid out in malpractice lawsuits with states that do not. The effects of malpractice liability reforms were analyzed using data on Medicare beneficiaries treated for serious heart disease in 1984, 1987 and 1990. In contrast to the above study Kessler and McClellan found that liability reforms could reduce defensive medicine practices.
The results of Kessler and McClellan's study applied to current health care expenditure to approximate the cost of defensive medicine and the nation's $1.4 trillion annual health care expenditure in 2005 (estimated to be over $2 trillion this fiscal year by President Obama), show that health care costs could have been reduced by $124 billion overall and government expenses by $50 billion per year. Adding the cost of defending malpractice cases, paying compensation, and covering additional administrative costs is a total of $29.4 billion. If these numbers are correct and one calculates the savings to the nations health care expenditures if defensive medicine was eliminated on my calculator [ph] the total cost of defensive medicine using Kessler and McClellan's numbers is $205 billion divided by the total cost of the nation’s healthcare expenditures of < $2 trillion equals > 1%.
Overall, while defensive medicine, is a negative trend in medical care, the total costs associated with it appears to be nor more than <1% of the total U.S. healthcare expenditures. Healthcare in the United States is already a financial burden for many Americans, but placing caps on punitive fines for these lawsuits through tort reform and even completely eliminating all direct and indirect costs of defensive medicine will not significantly alleviate the financial burden of the American healthcare system.
SUMMARY
� Medical malpractice premiums, inflation-adjusted, are nearly the lowest they have been in over 30 years.
� Medical malpractice claims, inflation-adjusted, are dropping significantly, down 45 percent since 2000.
� Medical malpractice premiums are less than one-half of one percent of the country"s overall health care costs; medical malpractice claims are a mere one-fifth of one percent of health care costs. In over 30 years, premiums and claims have never been greater than 1% of our nation"s health care costs.
� Medical malpractice insurer profits are higher than the rest of the property casualty industry, which has been remarkably profitable over the last five years.
� The periodic premium spikes that doctors experience, as they did from 2002 until 2005, are not related to claims but to the economic cycle of insurers and to drops in investment income.
� Many states that have resisted enacting severe restrictions on injured patients" legal rights experienced rate changes (i.e., premium increases or decreases for doctors) have similar costs to those states that enacted severe restrictions on patients" rights, i.e., there is no correlation between "tort reform" and insurance rates for doctors.
The total costs of defensive medicine are a mere 1% of the total U.S.healthcare expenditures and eliminating these costs would have virtually no impact on the cost of health care in this country. Indeed medical practice tort reform to prevent defensive medicine would instead shield the negligent from the cost of their mistakes, and put the burden on the patient who is wrongfully injured.
*The study was co-authored by Gillian Cassell-Stiga and Joanne Doroshow of the Center for Justice & Democracy and J. Robert Hunter, an actuary who serves as Director for the Consumer Federation of America. Hunter is also the former Commissioner of Insurance for the State of Texas and served as Federal Insurance Administrator under the Ford and Carter Administrations.
Articles Referenced:
Hellinger, FJ, WE Encinosa. "The Impact of State Laws Limiting Malpractice Damage Awards on Health Care Expenditures." American Journal of Public Health 96(8)(2006): 1375-81.
• Kessler, DP, N Summerton, JR Graham. "Effects of the Medical Liability System in Australia, the UK and the USA." Lancet 368(9531)(2006): 240-6.
• Manner, Paul A.. "Practicing defensive medicine--Not good for patients or physicians." AAOS Now (2007).
• Studdert, DM, MM Mello, WM Sage, CM DesRoches, J Peugh, K Zapert, TA Brennan. "Defensive Medicine among High-Risk Specialist Physicians in a Volatile Malpractice Environment." The Journal of the American Medical Association 293(21)(2005): 2660-2.
• Weinstein, Stuart L.. "The Cost of Defensive Medicine." AAOS Now (2008).
Please remember, as with all our articles we provide information, not medical advice.
For any treatment of your own medical condition you must visit your local doctor, with or without our article[s]. These articles are not to be taken as individual medical advice.
* Tune in tomorrow for INCREASED RISK OF STROKE IN PATIENTS WITH PSORIASIS.
Deepen your understanding of "medical malpractice"... www.MedMalBook.com
Some special interests are calling for provisions to limit the legal liability of hospitals and medical care providers. You have likely heard the claim that the rising cost of medical malpractice insurance is driving doctors out of practice. Take away the threat of lawsuits, certain special interests claim and the country’s health care costs will drop. There is also a cry that defensive medicine as a byproduct of medical malpractice activities is further exacerbating the financial burden on healthcare in the U.S.
But a new report paints a very different picture. True Risk: Medical Liability, Malpractice Insurance and Health Care,* concludes that limiting the liability of negligent hospitals and medical professionals would have virtually no impact on the cost of health care in this country. In fact, the study found that the cost of medical malpractice premiums are the lowest they have been in at least thirty years, the period for which data was studied. Medical malpractice premiums are less than ½ of 1% of all health care costs, and medical malpractice claims are a miniscule 1/5th of 1% of health care costs. Moreover, the states that have severely limited patients’ rights through so-called medical malpractice tort reform have similar malpractice insurance rates as states that have not so severely limited patients’ rights. Finally, the study found that medical malpractice insurers’ profits are generally higher than the rest of the property casualty industry.
All told, the report concludes, limiting patients’ rights will not lead to affordable health care for all Americans. All so-called medical practice tort reform does is shield the negligent from the cost of their mistakes, putting the burden on the injured patient. Significantly, the study concludes that placing further limits on the liability of negligent doctors and unsafe hospitals would be unjustifiable, and would put almost no dent in our country’s health care costs.
The study adds that “If Congress completely eliminated every single medical malpractice lawsuit,” it says, “including all legitimate cases, as part of health care reform, overall health care costs would hardly change, but the costs of medical error and hospital-induced injury would remain and someone else would have to pay.”
All of this only confirms the position trial lawyers have been taking, which is that removing or further limiting medical liability would mean robbing patients of the only meaningful check and balance they have. Limiting liability is not a way to save the country money, and it’s not fair for patients who are wrongfully injured or who lose their lives due to negligence.
"Our research makes clear that medical malpractice claims and premiums have almost no impact on the cost of health care “Our study also shows that states that have passed severe medical malpractice tort restrictions on victims of medical error have rate changes similar to those states that haven’t adopted these harsh measures.
WHAT ABOUT THE ADDED EXPENSES OF DEFENSIVE MEDICINE?
Defensive medicine is defined as "a deviation from sound medical practice, induced primarily by threat of liability."
It is divided into two categories, assurance and avoidance behaviors. Assurance behavior, or positive defensive medicine, is practiced by most physicians and involves the supply of additional services of negligible medical value to reduce adverse outcomes, deter patients from filing malpractice claims, or persuade the legal system that the standard of care was met.
Avoidance behavior, also known as negative defensive behavior, reflects physicians' efforts to distance themselves from potential legal risk. They do so by restricting their practice, refusing to perform high-risk procedures, and avoiding patients with complex problems or patients perceived as litigious. This type of behavior usually stems from a fear of uninsured non-monetary costs driving the physician out of business or the view that the downside of malpractice is greater than the upside of treatment.
To demonstrate the prevalence of defensive medicine, the Harvard School of Public Health and Columbia Law School surveyed physicians practicing in Pennsylvania, a state once infamous for having the highest malpractice insurance premiums in the country. The study, conducted in 2005, received responses from over 800 physicians in six specialties, with approximately 93% of doctors responding affirmatively when asked whether they practiced medicine defensively.
Defensive medicine is accompanied by an unexpectedly high overall cost, masked by the fact that these costs are split between doctors, patients, insurers, and the government. To gauge the burden of defensive medicine, Daniel P. Kessler and Mark B. McClellan compared healthcare costs in the 28 states with laws that limit punitive damages that can be paid out in malpractice lawsuits with states that do not. The effects of malpractice liability reforms were analyzed using data on Medicare beneficiaries treated for serious heart disease in 1984, 1987 and 1990. In contrast to the above study Kessler and McClellan found that liability reforms could reduce defensive medicine practices.
The results of Kessler and McClellan's study applied to current health care expenditure to approximate the cost of defensive medicine and the nation's $1.4 trillion annual health care expenditure in 2005 (estimated to be over $2 trillion this fiscal year by President Obama), show that health care costs could have been reduced by $124 billion overall and government expenses by $50 billion per year. Adding the cost of defending malpractice cases, paying compensation, and covering additional administrative costs is a total of $29.4 billion. If these numbers are correct and one calculates the savings to the nations health care expenditures if defensive medicine was eliminated on my calculator [ph] the total cost of defensive medicine using Kessler and McClellan's numbers is $205 billion divided by the total cost of the nation’s healthcare expenditures of < $2 trillion equals > 1%.
Overall, while defensive medicine, is a negative trend in medical care, the total costs associated with it appears to be nor more than <1% of the total U.S. healthcare expenditures. Healthcare in the United States is already a financial burden for many Americans, but placing caps on punitive fines for these lawsuits through tort reform and even completely eliminating all direct and indirect costs of defensive medicine will not significantly alleviate the financial burden of the American healthcare system.
SUMMARY
� Medical malpractice premiums, inflation-adjusted, are nearly the lowest they have been in over 30 years.
� Medical malpractice claims, inflation-adjusted, are dropping significantly, down 45 percent since 2000.
� Medical malpractice premiums are less than one-half of one percent of the country"s overall health care costs; medical malpractice claims are a mere one-fifth of one percent of health care costs. In over 30 years, premiums and claims have never been greater than 1% of our nation"s health care costs.
� Medical malpractice insurer profits are higher than the rest of the property casualty industry, which has been remarkably profitable over the last five years.
� The periodic premium spikes that doctors experience, as they did from 2002 until 2005, are not related to claims but to the economic cycle of insurers and to drops in investment income.
� Many states that have resisted enacting severe restrictions on injured patients" legal rights experienced rate changes (i.e., premium increases or decreases for doctors) have similar costs to those states that enacted severe restrictions on patients" rights, i.e., there is no correlation between "tort reform" and insurance rates for doctors.
The total costs of defensive medicine are a mere 1% of the total U.S.healthcare expenditures and eliminating these costs would have virtually no impact on the cost of health care in this country. Indeed medical practice tort reform to prevent defensive medicine would instead shield the negligent from the cost of their mistakes, and put the burden on the patient who is wrongfully injured.
*The study was co-authored by Gillian Cassell-Stiga and Joanne Doroshow of the Center for Justice & Democracy and J. Robert Hunter, an actuary who serves as Director for the Consumer Federation of America. Hunter is also the former Commissioner of Insurance for the State of Texas and served as Federal Insurance Administrator under the Ford and Carter Administrations.
Articles Referenced:
Hellinger, FJ, WE Encinosa. "The Impact of State Laws Limiting Malpractice Damage Awards on Health Care Expenditures." American Journal of Public Health 96(8)(2006): 1375-81.
• Kessler, DP, N Summerton, JR Graham. "Effects of the Medical Liability System in Australia, the UK and the USA." Lancet 368(9531)(2006): 240-6.
• Manner, Paul A.. "Practicing defensive medicine--Not good for patients or physicians." AAOS Now (2007).
• Studdert, DM, MM Mello, WM Sage, CM DesRoches, J Peugh, K Zapert, TA Brennan. "Defensive Medicine among High-Risk Specialist Physicians in a Volatile Malpractice Environment." The Journal of the American Medical Association 293(21)(2005): 2660-2.
• Weinstein, Stuart L.. "The Cost of Defensive Medicine." AAOS Now (2008).
Please remember, as with all our articles we provide information, not medical advice.
For any treatment of your own medical condition you must visit your local doctor, with or without our article[s]. These articles are not to be taken as individual medical advice.
* Tune in tomorrow for INCREASED RISK OF STROKE IN PATIENTS WITH PSORIASIS.
Deepen your understanding of "medical malpractice"... www.MedMalBook.com
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