Pulmonary Health Hub

Allergic contact dermatitis is often missed in pediatric patients who present with eczema-like skin eruptions, in part because less is known about ACD in children than in adults.

“Often when we see a child with dermatitis, we automatically think of atopic dermatitis, but we should also consider the possibility of allergic contact dermatitis,” Dr. Joseph F. Fowler Jr. said at the Hawaii Dermatology Seminar provided by Global Academy for Medical Education/Skin Disease Education Foundation.

A 2012 cohort study of 349 children between 0 and 15 years indicated that even very young children who were patch tested for common allergens had at least one positive result. Investigators found that nearly three-quarters of children studied tested positive for at least one allergen, typically nickel, other metals, fragrance, or preservatives (Dermatitis. 2012 Nov-Dec;23[6]:275-80).

“This is very similar to what we see in the adult population,” said Dr. Fowler, clinical professor of dermatology at the University of Louisville (Ky.). “Other studies in recent years have borne this out.”

Dr. Fowler suggested having a high degree of suspicion for ACD, especially when pediatric patients present with:

•  Chronic, difficult to control atopic condition, as this could indicate a systemic reaction.

•  Localized or facial dermatitis, as this could indicate the point of contact with an allergen.

•  Scattered, generalized dermatitis, which also could represent systemic allergic contact dermatitis.

•  Dermatitis that worsens, despite otherwise adequate treatment regimen.

•  Reactions following contact with metals, fragrances, topical components, such as preservatives or neomycin.

“In these situations, patch testing will help determine that an allergen is implicated,” Dr. Fowler said.

In children with eczema, Dr. Fowler recommended patch testing when the eczema is not in the typical areas such as behind the knees or elbows, or if it started in typical areas and then spread elsewhere, especially in children around 5 years old.

“The moral of the story is that kids can be allergic to the same things as adults, even though we have less about this in the literature,” Dr. Fowler. “Skin testing or blood testing for food allergies, unless very strongly positive, usually aren’t helpful in the management of the atopic individual. Patch test more and prick test less.”

Dr. Fowler disclosed a number of relationships with companies in the dermatology space. SDEF and this news organization are owned by the same parent company.

[email protected]

On Twitter @whitneymcknight

Allergic contact dermatitis is often missed in pediatric patients who present with eczema-like skin eruptions, in part because less is known about ACD in children than in adults.

“Often when we see a child with dermatitis, we automatically think of atopic dermatitis, but we should also consider the possibility of allergic contact dermatitis,” Dr. Joseph F. Fowler Jr. said at the Hawaii Dermatology Seminar provided by Global Academy for Medical Education/Skin Disease Education Foundation.

A 2012 cohort study of 349 children between 0 and 15 years indicated that even very young children who were patch tested for common allergens had at least one positive result. Investigators found that nearly three-quarters of children studied tested positive for at least one allergen, typically nickel, other metals, fragrance, or preservatives (Dermatitis. 2012 Nov-Dec;23[6]:275-80).

“This is very similar to what we see in the adult population,” said Dr. Fowler, clinical professor of dermatology at the University of Louisville (Ky.). “Other studies in recent years have borne this out.”

Dr. Fowler suggested having a high degree of suspicion for ACD, especially when pediatric patients present with:

•  Chronic, difficult to control atopic condition, as this could indicate a systemic reaction.

•  Localized or facial dermatitis, as this could indicate the point of contact with an allergen.

•  Scattered, generalized dermatitis, which also could represent systemic allergic contact dermatitis.

•  Dermatitis that worsens, despite otherwise adequate treatment regimen.

•  Reactions following contact with metals, fragrances, topical components, such as preservatives or neomycin.

“In these situations, patch testing will help determine that an allergen is implicated,” Dr. Fowler said.

In children with eczema, Dr. Fowler recommended patch testing when the eczema is not in the typical areas such as behind the knees or elbows, or if it started in typical areas and then spread elsewhere, especially in children around 5 years old.

“The moral of the story is that kids can be allergic to the same things as adults, even though we have less about this in the literature,” Dr. Fowler. “Skin testing or blood testing for food allergies, unless very strongly positive, usually aren’t helpful in the management of the atopic individual. Patch test more and prick test less.”

Dr. Fowler disclosed a number of relationships with companies in the dermatology space. SDEF and this news organization are owned by the same parent company.

[email protected]

On Twitter @whitneymcknight

Allergic contact dermatitis is often missed in pediatric patients who present with eczema-like skin eruptions, in part because less is known about ACD in children than in adults.

“Often when we see a child with dermatitis, we automatically think of atopic dermatitis, but we should also consider the possibility of allergic contact dermatitis,” Dr. Joseph F. Fowler Jr. said at the Hawaii Dermatology Seminar provided by Global Academy for Medical Education/Skin Disease Education Foundation.

A 2012 cohort study of 349 children between 0 and 15 years indicated that even very young children who were patch tested for common allergens had at least one positive result. Investigators found that nearly three-quarters of children studied tested positive for at least one allergen, typically nickel, other metals, fragrance, or preservatives (Dermatitis. 2012 Nov-Dec;23[6]:275-80).

“This is very similar to what we see in the adult population,” said Dr. Fowler, clinical professor of dermatology at the University of Louisville (Ky.). “Other studies in recent years have borne this out.”

Dr. Fowler suggested having a high degree of suspicion for ACD, especially when pediatric patients present with:

•  Chronic, difficult to control atopic condition, as this could indicate a systemic reaction.

•  Localized or facial dermatitis, as this could indicate the point of contact with an allergen.

•  Scattered, generalized dermatitis, which also could represent systemic allergic contact dermatitis.

•  Dermatitis that worsens, despite otherwise adequate treatment regimen.

•  Reactions following contact with metals, fragrances, topical components, such as preservatives or neomycin.

“In these situations, patch testing will help determine that an allergen is implicated,” Dr. Fowler said.

In children with eczema, Dr. Fowler recommended patch testing when the eczema is not in the typical areas such as behind the knees or elbows, or if it started in typical areas and then spread elsewhere, especially in children around 5 years old.

“The moral of the story is that kids can be allergic to the same things as adults, even though we have less about this in the literature,” Dr. Fowler. “Skin testing or blood testing for food allergies, unless very strongly positive, usually aren’t helpful in the management of the atopic individual. Patch test more and prick test less.”

Dr. Fowler disclosed a number of relationships with companies in the dermatology space. SDEF and this news organization are owned by the same parent company.

[email protected]

On Twitter @whitneymcknight

People with chronic obstructive pulmonary disease have an approximately 20% increased risk of stroke, and the risk is highest during the time after an acute exacerbation of COPD, data from a large epidemiologic study indicate.

The study also indicated that cigarette smoking was a strong risk factor for stroke and that hypertension management is important in COPD patients given the elevated risk for hemorrhagic strokes observed, according to Dr. Marileen L. P. Portegies of Erasmus MC University Medical Center, Rotterdam, the Netherlands, and her colleagues.

©stockdevil/thinkstockphotos.com

In 13,115 participants from the Rotterdam study, people with COPD had a 6.7-fold increase in the risk of stroke within the first 7 weeks of a severe exacerbation (hazard ratio, 6.66; 95% confidence interval, 2.42-18.20).

The study (Am J Respir Crit Care Med. 2016; 193:251-8) found that 1,250 of the participants had a stroke (701 were ischemic and 107 hemorrhagic) over 126,347 person-years of follow-up.

After researchers adjusted for age and sex, COPD was significantly associated with all stroke (HR, 1.20; 95% CI, 1.00-1.43), ischemic stroke (HR, 1.27; 95% CI, 1.02-1.59), and hemorrhagic stroke (HR, 1.70; 95% CI, 1.01-2.84).

Smoking was the strongest explanatory factor for the association between COPD and stroke, the researchers said. Adjustments for cardiovascular risk factors gave similar effect sizes, whereas adjustments for smoking attenuated the effect sizes: for all stroke, (HR, 1.09; 95% CI, 0.91-1.31); for ischemic stroke, (HR, 1.13; 95% CI, 0.91-1.42) ; and for hemorrhagic stroke, (HR 1.53; 95% CI, 0.91-2.59) .

“Our study reveals the importance of smoking as a shared risk factor and implicates that clinicians should be aware of the higher risk of both stroke subtypes in subjects with COPD, especially after severe exacerbations,” they concluded.

Writing in an accompanying editorial Dr. Janice M. Leung and Dr. Don D. Sin from St. Paul’s Hospital University of British Columbia, Vancouver, said there was no doubt that cardiovascular disease, stroke, and COPD all shared smoking as a common risk factor.

But smoking alone failed to account for the particularly critical period of a COPD exacerbation during which the risk for strokes and myocardial infarctions exponentially increase.

“Surely, this acute period must offer clues as to why such a strong link exists among the lung, heart, and brain in COPD,” the researchers wrote.

COPD exacerbations may represent a time of intense oxidative stress and systemic inflammation that drive endothelial dysfunction, vascular reactivity, and even atherosclerotic plaque rupture.

“Pulmonologists must work closer with cardiologists and neurologists to enable optimal vascular care for patients with COPD, because it is clear that the lungs do not stand alone and that COPD, although a lung disease, is a major risk factor for stroke, especially during exacerbations,” they concluded.

People with chronic obstructive pulmonary disease have an approximately 20% increased risk of stroke, and the risk is highest during the time after an acute exacerbation of COPD, data from a large epidemiologic study indicate.

The study also indicated that cigarette smoking was a strong risk factor for stroke and that hypertension management is important in COPD patients given the elevated risk for hemorrhagic strokes observed, according to Dr. Marileen L. P. Portegies of Erasmus MC University Medical Center, Rotterdam, the Netherlands, and her colleagues.

©stockdevil/thinkstockphotos.com

In 13,115 participants from the Rotterdam study, people with COPD had a 6.7-fold increase in the risk of stroke within the first 7 weeks of a severe exacerbation (hazard ratio, 6.66; 95% confidence interval, 2.42-18.20).

The study (Am J Respir Crit Care Med. 2016; 193:251-8) found that 1,250 of the participants had a stroke (701 were ischemic and 107 hemorrhagic) over 126,347 person-years of follow-up.

After researchers adjusted for age and sex, COPD was significantly associated with all stroke (HR, 1.20; 95% CI, 1.00-1.43), ischemic stroke (HR, 1.27; 95% CI, 1.02-1.59), and hemorrhagic stroke (HR, 1.70; 95% CI, 1.01-2.84).

Smoking was the strongest explanatory factor for the association between COPD and stroke, the researchers said. Adjustments for cardiovascular risk factors gave similar effect sizes, whereas adjustments for smoking attenuated the effect sizes: for all stroke, (HR, 1.09; 95% CI, 0.91-1.31); for ischemic stroke, (HR, 1.13; 95% CI, 0.91-1.42) ; and for hemorrhagic stroke, (HR 1.53; 95% CI, 0.91-2.59) .

“Our study reveals the importance of smoking as a shared risk factor and implicates that clinicians should be aware of the higher risk of both stroke subtypes in subjects with COPD, especially after severe exacerbations,” they concluded.

Writing in an accompanying editorial Dr. Janice M. Leung and Dr. Don D. Sin from St. Paul’s Hospital University of British Columbia, Vancouver, said there was no doubt that cardiovascular disease, stroke, and COPD all shared smoking as a common risk factor.

But smoking alone failed to account for the particularly critical period of a COPD exacerbation during which the risk for strokes and myocardial infarctions exponentially increase.

“Surely, this acute period must offer clues as to why such a strong link exists among the lung, heart, and brain in COPD,” the researchers wrote.

COPD exacerbations may represent a time of intense oxidative stress and systemic inflammation that drive endothelial dysfunction, vascular reactivity, and even atherosclerotic plaque rupture.

“Pulmonologists must work closer with cardiologists and neurologists to enable optimal vascular care for patients with COPD, because it is clear that the lungs do not stand alone and that COPD, although a lung disease, is a major risk factor for stroke, especially during exacerbations,” they concluded.

People with chronic obstructive pulmonary disease have an approximately 20% increased risk of stroke, and the risk is highest during the time after an acute exacerbation of COPD, data from a large epidemiologic study indicate.

The study also indicated that cigarette smoking was a strong risk factor for stroke and that hypertension management is important in COPD patients given the elevated risk for hemorrhagic strokes observed, according to Dr. Marileen L. P. Portegies of Erasmus MC University Medical Center, Rotterdam, the Netherlands, and her colleagues.

©stockdevil/thinkstockphotos.com

In 13,115 participants from the Rotterdam study, people with COPD had a 6.7-fold increase in the risk of stroke within the first 7 weeks of a severe exacerbation (hazard ratio, 6.66; 95% confidence interval, 2.42-18.20).

The study (Am J Respir Crit Care Med. 2016; 193:251-8) found that 1,250 of the participants had a stroke (701 were ischemic and 107 hemorrhagic) over 126,347 person-years of follow-up.

After researchers adjusted for age and sex, COPD was significantly associated with all stroke (HR, 1.20; 95% CI, 1.00-1.43), ischemic stroke (HR, 1.27; 95% CI, 1.02-1.59), and hemorrhagic stroke (HR, 1.70; 95% CI, 1.01-2.84).

Smoking was the strongest explanatory factor for the association between COPD and stroke, the researchers said. Adjustments for cardiovascular risk factors gave similar effect sizes, whereas adjustments for smoking attenuated the effect sizes: for all stroke, (HR, 1.09; 95% CI, 0.91-1.31); for ischemic stroke, (HR, 1.13; 95% CI, 0.91-1.42) ; and for hemorrhagic stroke, (HR 1.53; 95% CI, 0.91-2.59) .

“Our study reveals the importance of smoking as a shared risk factor and implicates that clinicians should be aware of the higher risk of both stroke subtypes in subjects with COPD, especially after severe exacerbations,” they concluded.

Writing in an accompanying editorial Dr. Janice M. Leung and Dr. Don D. Sin from St. Paul’s Hospital University of British Columbia, Vancouver, said there was no doubt that cardiovascular disease, stroke, and COPD all shared smoking as a common risk factor.

But smoking alone failed to account for the particularly critical period of a COPD exacerbation during which the risk for strokes and myocardial infarctions exponentially increase.

“Surely, this acute period must offer clues as to why such a strong link exists among the lung, heart, and brain in COPD,” the researchers wrote.

COPD exacerbations may represent a time of intense oxidative stress and systemic inflammation that drive endothelial dysfunction, vascular reactivity, and even atherosclerotic plaque rupture.

“Pulmonologists must work closer with cardiologists and neurologists to enable optimal vascular care for patients with COPD, because it is clear that the lungs do not stand alone and that COPD, although a lung disease, is a major risk factor for stroke, especially during exacerbations,” they concluded.

People with chronic obstructive pulmonary disease have an approximately 20% increased risk of stroke, and the risk is highest during the time after an acute exacerbation of COPD, data from a large epidemiologic study indicate.

The study also indicated that cigarette smoking was a strong risk factor for stroke and that hypertension management is important in COPD patients given the elevated risk for hemorrhagic strokes observed, according to Dr. Marileen L. P. Portegies of Erasmus MC University Medical Center, Rotterdam, the Netherlands, and her colleagues.

©stockdevil/thinkstockphotos.com

In 13,115 participants from the Rotterdam study, people with COPD had a 6.7-fold increase in the risk of stroke within the first 7 weeks of a severe exacerbation (hazard ratio, 6.66; 95% confidence interval, 2.42-18.20).

The study (Am J Respir Crit Care Med. 2016; 193:251-8) found that 1,250 of the participants had a stroke (701 were ischemic and 107 hemorrhagic) over 126,347 person-years of follow-up.

After researchers adjusted for age and sex, COPD was significantly associated with all stroke (HR, 1.20; 95% CI, 1.00-1.43), ischemic stroke (HR, 1.27; 95% CI, 1.02-1.59), and hemorrhagic stroke (HR, 1.70; 95% CI, 1.01-2.84).

Smoking was the strongest explanatory factor for the association between COPD and stroke, the researchers said. Adjustments for cardiovascular risk factors gave similar effect sizes, whereas adjustments for smoking attenuated the effect sizes: for all stroke, (HR, 1.09; 95% CI, 0.91-1.31); for ischemic stroke, (HR, 1.13; 95% CI, 0.91-1.42) ; and for hemorrhagic stroke, (HR 1.53; 95% CI, 0.91-2.59) .

“Our study reveals the importance of smoking as a shared risk factor and implicates that clinicians should be aware of the higher risk of both stroke subtypes in subjects with COPD, especially after severe exacerbations,” they concluded.

Writing in an accompanying editorial Dr. Janice M. Leung and Dr. Don D. Sin from St. Paul’s Hospital University of British Columbia, Vancouver, said there was no doubt that cardiovascular disease, stroke, and COPD all shared smoking as a common risk factor.

But smoking alone failed to account for the particularly critical period of a COPD exacerbation during which the risk for strokes and myocardial infarctions exponentially increase.

“Surely, this acute period must offer clues as to why such a strong link exists among the lung, heart, and brain in COPD,” the researchers wrote.

COPD exacerbations may represent a time of intense oxidative stress and systemic inflammation that drive endothelial dysfunction, vascular reactivity, and even atherosclerotic plaque rupture.

“Pulmonologists must work closer with cardiologists and neurologists to enable optimal vascular care for patients with COPD, because it is clear that the lungs do not stand alone and that COPD, although a lung disease, is a major risk factor for stroke, especially during exacerbations,” they concluded.

People with chronic obstructive pulmonary disease have an approximately 20% increased risk of stroke, and the risk is highest during the time after an acute exacerbation of COPD, data from a large epidemiologic study indicate.

The study also indicated that cigarette smoking was a strong risk factor for stroke and that hypertension management is important in COPD patients given the elevated risk for hemorrhagic strokes observed, according to Dr. Marileen L. P. Portegies of Erasmus MC University Medical Center, Rotterdam, the Netherlands, and her colleagues.

©stockdevil/thinkstockphotos.com

In 13,115 participants from the Rotterdam study, people with COPD had a 6.7-fold increase in the risk of stroke within the first 7 weeks of a severe exacerbation (hazard ratio, 6.66; 95% confidence interval, 2.42-18.20).

The study (Am J Respir Crit Care Med. 2016; 193:251-8) found that 1,250 of the participants had a stroke (701 were ischemic and 107 hemorrhagic) over 126,347 person-years of follow-up.

After researchers adjusted for age and sex, COPD was significantly associated with all stroke (HR, 1.20; 95% CI, 1.00-1.43), ischemic stroke (HR, 1.27; 95% CI, 1.02-1.59), and hemorrhagic stroke (HR, 1.70; 95% CI, 1.01-2.84).

Smoking was the strongest explanatory factor for the association between COPD and stroke, the researchers said. Adjustments for cardiovascular risk factors gave similar effect sizes, whereas adjustments for smoking attenuated the effect sizes: for all stroke, (HR, 1.09; 95% CI, 0.91-1.31); for ischemic stroke, (HR, 1.13; 95% CI, 0.91-1.42) ; and for hemorrhagic stroke, (HR 1.53; 95% CI, 0.91-2.59) .

“Our study reveals the importance of smoking as a shared risk factor and implicates that clinicians should be aware of the higher risk of both stroke subtypes in subjects with COPD, especially after severe exacerbations,” they concluded.

Writing in an accompanying editorial Dr. Janice M. Leung and Dr. Don D. Sin from St. Paul’s Hospital University of British Columbia, Vancouver, said there was no doubt that cardiovascular disease, stroke, and COPD all shared smoking as a common risk factor.

But smoking alone failed to account for the particularly critical period of a COPD exacerbation during which the risk for strokes and myocardial infarctions exponentially increase.

“Surely, this acute period must offer clues as to why such a strong link exists among the lung, heart, and brain in COPD,” the researchers wrote.

COPD exacerbations may represent a time of intense oxidative stress and systemic inflammation that drive endothelial dysfunction, vascular reactivity, and even atherosclerotic plaque rupture.

“Pulmonologists must work closer with cardiologists and neurologists to enable optimal vascular care for patients with COPD, because it is clear that the lungs do not stand alone and that COPD, although a lung disease, is a major risk factor for stroke, especially during exacerbations,” they concluded.

People with chronic obstructive pulmonary disease have an approximately 20% increased risk of stroke, and the risk is highest during the time after an acute exacerbation of COPD, data from a large epidemiologic study indicate.

The study also indicated that cigarette smoking was a strong risk factor for stroke and that hypertension management is important in COPD patients given the elevated risk for hemorrhagic strokes observed, according to Dr. Marileen L. P. Portegies of Erasmus MC University Medical Center, Rotterdam, the Netherlands, and her colleagues.

©stockdevil/thinkstockphotos.com

In 13,115 participants from the Rotterdam study, people with COPD had a 6.7-fold increase in the risk of stroke within the first 7 weeks of a severe exacerbation (hazard ratio, 6.66; 95% confidence interval, 2.42-18.20).

The study (Am J Respir Crit Care Med. 2016; 193:251-8) found that 1,250 of the participants had a stroke (701 were ischemic and 107 hemorrhagic) over 126,347 person-years of follow-up.

After researchers adjusted for age and sex, COPD was significantly associated with all stroke (HR, 1.20; 95% CI, 1.00-1.43), ischemic stroke (HR, 1.27; 95% CI, 1.02-1.59), and hemorrhagic stroke (HR, 1.70; 95% CI, 1.01-2.84).

Smoking was the strongest explanatory factor for the association between COPD and stroke, the researchers said. Adjustments for cardiovascular risk factors gave similar effect sizes, whereas adjustments for smoking attenuated the effect sizes: for all stroke, (HR, 1.09; 95% CI, 0.91-1.31); for ischemic stroke, (HR, 1.13; 95% CI, 0.91-1.42) ; and for hemorrhagic stroke, (HR 1.53; 95% CI, 0.91-2.59) .

“Our study reveals the importance of smoking as a shared risk factor and implicates that clinicians should be aware of the higher risk of both stroke subtypes in subjects with COPD, especially after severe exacerbations,” they concluded.

Writing in an accompanying editorial Dr. Janice M. Leung and Dr. Don D. Sin from St. Paul’s Hospital University of British Columbia, Vancouver, said there was no doubt that cardiovascular disease, stroke, and COPD all shared smoking as a common risk factor.

But smoking alone failed to account for the particularly critical period of a COPD exacerbation during which the risk for strokes and myocardial infarctions exponentially increase.

“Surely, this acute period must offer clues as to why such a strong link exists among the lung, heart, and brain in COPD,” the researchers wrote.

COPD exacerbations may represent a time of intense oxidative stress and systemic inflammation that drive endothelial dysfunction, vascular reactivity, and even atherosclerotic plaque rupture.

“Pulmonologists must work closer with cardiologists and neurologists to enable optimal vascular care for patients with COPD, because it is clear that the lungs do not stand alone and that COPD, although a lung disease, is a major risk factor for stroke, especially during exacerbations,” they concluded.

Patients aged 50 and older with recent active asthma are at elevated risk of abdominal aortic aneurysm and aneurysm rupture, according to new research.

A common inflammatory pathway between asthma and AAA, first observed nearly a decade ago in mice, is thought to be responsible.

The new findings, published online Feb. 11 in Arteriosclerosis, Thrombosis, and Vascular Biology (Arterioscler Thromb Vasc Biol. 2016. doi: 10.1161/ATVBAHA.115.306497) support the association in humans.

©Dr. Cong-Lin Liu

In a news release accompanying the findings, lead study author Guo-Ping Shi, D.Sc., of Brigham and Women’s Hospital and Harvard Medical School, Boston, said that the findings had clear clinical implications for older patients with a recent asthma diagnosis. Such patients, particularly older men, “should be checked for signs” of abdominal aortic aneurysm, Dr. Shi said.

For their research, Dr. Shi, along with colleagues at Zhengzhou (China) University, used data from a large Danish population-based cohort of nearly 16,000 patients (81% men) with AAA between 1996 and 2012, of which about 4,500 patients had rupture. They also looked at data from a comparison cohort of patients with and without AAA from a slightly larger population-based vascular screening trial of men in Denmark.

The investigators showed that hospital diagnosis of asthma within the previous year (n = 514) was associated with significantly higher risk of hospital admission with AAA rupture (n = 146) both before and after adjustment for AAA comorbidities (adjusted odds ratio 1.51-2.06). Higher risk of rupture also was seen for patients filling prescriptions for bronchodilators within the previous 3 months (aOR = 1.10-1.31), and for patients prescribed anti-asthma drugs (aOR OR = 1.09-1.48), which were seen as indicative of an outpatient asthma diagnosis.

“A hospital diagnosis of asthma or a recently filled prescription of an anti-asthmatic drug is associated with an increased risk of admission with rAAA compared with admission with intact AAA, both before and after adjusting for AAA comorbidities and relevant medications,” the researchers wrote in their analysis.

Moreover, “an asthma diagnosis or the use of bronchodilators or other anti-asthmatic drug prescriptions closer to the date of admission with AAA correlated directly with a higher risk of aortic rupture. The results remained robust after adjusting for a wide range of relevant possible confounders,” the researchers wrote.

In the cohort of patients from the vascular screening study, which included age-matched controls without AAA, asthma (measured by recent anti-asthmatic medication use) was seen associated with a significantly elevated risk of AAA before (OR = 1.45) and after adjustment for smoking (OR = 1.45) or other risk factors (OR = 1.46). This does not refer to rupture but just AAA.

Dr. Shi and colleagues noted that the AAA cohort lacked sufficient information on cigarette smoking, a known risk factor for AAA and AAA rupture, to preclude the possibility of confounding; however, the second all-male cohort did have extensive data on smoking, “and the risk of AAA among patients with asthma remained 45% higher than that of patients with nonasthma” even after adjustment.

The researchers hypothesized that an inflammatory response characterized by elevated immunoglobulin E may be the link between AAA pathogenesis and asthma, and that other allergic inflammatory diseases, including atopic dermatitis, allergic rhinitis, and some ocular allergic diseases, could potentially carry risks for AAA formation and rupture. Dr. Shi and colleagues previously investigated the IgE and aneurysm link in animal studies.

“The results have implications for the development of much needed advances in the prevention, screening criteria, and treatment of AAA, common conditions for which we currently lack sufficiently effective approaches,” the investigators wrote.

The Chinese, Danish, and U.S. governments sponsored the study. The investigators disclosed no conflicts of interest.

Patients aged 50 and older with recent active asthma are at elevated risk of abdominal aortic aneurysm and aneurysm rupture, according to new research.

A common inflammatory pathway between asthma and AAA, first observed nearly a decade ago in mice, is thought to be responsible.

The new findings, published online Feb. 11 in Arteriosclerosis, Thrombosis, and Vascular Biology (Arterioscler Thromb Vasc Biol. 2016. doi: 10.1161/ATVBAHA.115.306497) support the association in humans.

©Dr. Cong-Lin Liu

In a news release accompanying the findings, lead study author Guo-Ping Shi, D.Sc., of Brigham and Women’s Hospital and Harvard Medical School, Boston, said that the findings had clear clinical implications for older patients with a recent asthma diagnosis. Such patients, particularly older men, “should be checked for signs” of abdominal aortic aneurysm, Dr. Shi said.

For their research, Dr. Shi, along with colleagues at Zhengzhou (China) University, used data from a large Danish population-based cohort of nearly 16,000 patients (81% men) with AAA between 1996 and 2012, of which about 4,500 patients had rupture. They also looked at data from a comparison cohort of patients with and without AAA from a slightly larger population-based vascular screening trial of men in Denmark.

The investigators showed that hospital diagnosis of asthma within the previous year (n = 514) was associated with significantly higher risk of hospital admission with AAA rupture (n = 146) both before and after adjustment for AAA comorbidities (adjusted odds ratio 1.51-2.06). Higher risk of rupture also was seen for patients filling prescriptions for bronchodilators within the previous 3 months (aOR = 1.10-1.31), and for patients prescribed anti-asthma drugs (aOR OR = 1.09-1.48), which were seen as indicative of an outpatient asthma diagnosis.

“A hospital diagnosis of asthma or a recently filled prescription of an anti-asthmatic drug is associated with an increased risk of admission with rAAA compared with admission with intact AAA, both before and after adjusting for AAA comorbidities and relevant medications,” the researchers wrote in their analysis.

Moreover, “an asthma diagnosis or the use of bronchodilators or other anti-asthmatic drug prescriptions closer to the date of admission with AAA correlated directly with a higher risk of aortic rupture. The results remained robust after adjusting for a wide range of relevant possible confounders,” the researchers wrote.

In the cohort of patients from the vascular screening study, which included age-matched controls without AAA, asthma (measured by recent anti-asthmatic medication use) was seen associated with a significantly elevated risk of AAA before (OR = 1.45) and after adjustment for smoking (OR = 1.45) or other risk factors (OR = 1.46). This does not refer to rupture but just AAA.

Dr. Shi and colleagues noted that the AAA cohort lacked sufficient information on cigarette smoking, a known risk factor for AAA and AAA rupture, to preclude the possibility of confounding; however, the second all-male cohort did have extensive data on smoking, “and the risk of AAA among patients with asthma remained 45% higher than that of patients with nonasthma” even after adjustment.

The researchers hypothesized that an inflammatory response characterized by elevated immunoglobulin E may be the link between AAA pathogenesis and asthma, and that other allergic inflammatory diseases, including atopic dermatitis, allergic rhinitis, and some ocular allergic diseases, could potentially carry risks for AAA formation and rupture. Dr. Shi and colleagues previously investigated the IgE and aneurysm link in animal studies.

“The results have implications for the development of much needed advances in the prevention, screening criteria, and treatment of AAA, common conditions for which we currently lack sufficiently effective approaches,” the investigators wrote.

The Chinese, Danish, and U.S. governments sponsored the study. The investigators disclosed no conflicts of interest.

Patients aged 50 and older with recent active asthma are at elevated risk of abdominal aortic aneurysm and aneurysm rupture, according to new research.

A common inflammatory pathway between asthma and AAA, first observed nearly a decade ago in mice, is thought to be responsible.

The new findings, published online Feb. 11 in Arteriosclerosis, Thrombosis, and Vascular Biology (Arterioscler Thromb Vasc Biol. 2016. doi: 10.1161/ATVBAHA.115.306497) support the association in humans.

©Dr. Cong-Lin Liu

In a news release accompanying the findings, lead study author Guo-Ping Shi, D.Sc., of Brigham and Women’s Hospital and Harvard Medical School, Boston, said that the findings had clear clinical implications for older patients with a recent asthma diagnosis. Such patients, particularly older men, “should be checked for signs” of abdominal aortic aneurysm, Dr. Shi said.

For their research, Dr. Shi, along with colleagues at Zhengzhou (China) University, used data from a large Danish population-based cohort of nearly 16,000 patients (81% men) with AAA between 1996 and 2012, of which about 4,500 patients had rupture. They also looked at data from a comparison cohort of patients with and without AAA from a slightly larger population-based vascular screening trial of men in Denmark.

The investigators showed that hospital diagnosis of asthma within the previous year (n = 514) was associated with significantly higher risk of hospital admission with AAA rupture (n = 146) both before and after adjustment for AAA comorbidities (adjusted odds ratio 1.51-2.06). Higher risk of rupture also was seen for patients filling prescriptions for bronchodilators within the previous 3 months (aOR = 1.10-1.31), and for patients prescribed anti-asthma drugs (aOR OR = 1.09-1.48), which were seen as indicative of an outpatient asthma diagnosis.

“A hospital diagnosis of asthma or a recently filled prescription of an anti-asthmatic drug is associated with an increased risk of admission with rAAA compared with admission with intact AAA, both before and after adjusting for AAA comorbidities and relevant medications,” the researchers wrote in their analysis.

Moreover, “an asthma diagnosis or the use of bronchodilators or other anti-asthmatic drug prescriptions closer to the date of admission with AAA correlated directly with a higher risk of aortic rupture. The results remained robust after adjusting for a wide range of relevant possible confounders,” the researchers wrote.

In the cohort of patients from the vascular screening study, which included age-matched controls without AAA, asthma (measured by recent anti-asthmatic medication use) was seen associated with a significantly elevated risk of AAA before (OR = 1.45) and after adjustment for smoking (OR = 1.45) or other risk factors (OR = 1.46). This does not refer to rupture but just AAA.

Dr. Shi and colleagues noted that the AAA cohort lacked sufficient information on cigarette smoking, a known risk factor for AAA and AAA rupture, to preclude the possibility of confounding; however, the second all-male cohort did have extensive data on smoking, “and the risk of AAA among patients with asthma remained 45% higher than that of patients with nonasthma” even after adjustment.

The researchers hypothesized that an inflammatory response characterized by elevated immunoglobulin E may be the link between AAA pathogenesis and asthma, and that other allergic inflammatory diseases, including atopic dermatitis, allergic rhinitis, and some ocular allergic diseases, could potentially carry risks for AAA formation and rupture. Dr. Shi and colleagues previously investigated the IgE and aneurysm link in animal studies.

“The results have implications for the development of much needed advances in the prevention, screening criteria, and treatment of AAA, common conditions for which we currently lack sufficiently effective approaches,” the investigators wrote.

The Chinese, Danish, and U.S. governments sponsored the study. The investigators disclosed no conflicts of interest.

Health care costs almost $400 more per year for patients with chronic obstructive pulmonary disease who have a history of asthma, compared with those without asthma, according to a study using the health care and demographic records of over 45,000 adults in British Columbia.

From 1997 to 2012, the average annual health care cost for patients with COPD + asthma (n = 22,565) was $391 higher than for COPD patients who had no history of diagnosed asthma (n = 22,565), reported Dr. Mohsen Sadatsafavi of the University of British Columbia, Vancouver, and his associates (Ann Am Thorac Soc. 2016 Feb;13[2]:188-96).

The largest component of that excess was medication costs, which were $476 higher for patients with COPD + asthma, with outpatient services ($92) and community care ($19) making smaller contributions. These excesses were somewhat offset by hospitalization costs, which were $196 less per year for the COPD + asthma group, the investigators said. (All costs in the study were given in Canadian dollars and have been converted here to U.S. dollars.)

Among the respiratory medications, the drug class with the largest difference was inhaled corticosteroids/long-acting beta-agonists, which cost almost $178 more per year for the COPD + asthma patients. Inhaled corticosteroids were next, with a cost excess of $64 annually, followed by long-acting muscarinic agents ($59), short-acting beta-agonists ($46) and leukotriene receptor agonists ($19), Dr. Sadatsafavi and his associates said.

All subjects were aged 40 years or older (average, 67.8 years for COPD only and 68 years for COPD + asthma), and 57% of each group was female. Individuals were excluded if their date of first asthma-related resource use was less than 2 years before their first date of COPD-related resource use, they noted.

[email protected]

Health care costs almost $400 more per year for patients with chronic obstructive pulmonary disease who have a history of asthma, compared with those without asthma, according to a study using the health care and demographic records of over 45,000 adults in British Columbia.

From 1997 to 2012, the average annual health care cost for patients with COPD + asthma (n = 22,565) was $391 higher than for COPD patients who had no history of diagnosed asthma (n = 22,565), reported Dr. Mohsen Sadatsafavi of the University of British Columbia, Vancouver, and his associates (Ann Am Thorac Soc. 2016 Feb;13[2]:188-96).

The largest component of that excess was medication costs, which were $476 higher for patients with COPD + asthma, with outpatient services ($92) and community care ($19) making smaller contributions. These excesses were somewhat offset by hospitalization costs, which were $196 less per year for the COPD + asthma group, the investigators said. (All costs in the study were given in Canadian dollars and have been converted here to U.S. dollars.)

Among the respiratory medications, the drug class with the largest difference was inhaled corticosteroids/long-acting beta-agonists, which cost almost $178 more per year for the COPD + asthma patients. Inhaled corticosteroids were next, with a cost excess of $64 annually, followed by long-acting muscarinic agents ($59), short-acting beta-agonists ($46) and leukotriene receptor agonists ($19), Dr. Sadatsafavi and his associates said.

All subjects were aged 40 years or older (average, 67.8 years for COPD only and 68 years for COPD + asthma), and 57% of each group was female. Individuals were excluded if their date of first asthma-related resource use was less than 2 years before their first date of COPD-related resource use, they noted.

[email protected]

Health care costs almost $400 more per year for patients with chronic obstructive pulmonary disease who have a history of asthma, compared with those without asthma, according to a study using the health care and demographic records of over 45,000 adults in British Columbia.

From 1997 to 2012, the average annual health care cost for patients with COPD + asthma (n = 22,565) was $391 higher than for COPD patients who had no history of diagnosed asthma (n = 22,565), reported Dr. Mohsen Sadatsafavi of the University of British Columbia, Vancouver, and his associates (Ann Am Thorac Soc. 2016 Feb;13[2]:188-96).

The largest component of that excess was medication costs, which were $476 higher for patients with COPD + asthma, with outpatient services ($92) and community care ($19) making smaller contributions. These excesses were somewhat offset by hospitalization costs, which were $196 less per year for the COPD + asthma group, the investigators said. (All costs in the study were given in Canadian dollars and have been converted here to U.S. dollars.)

Among the respiratory medications, the drug class with the largest difference was inhaled corticosteroids/long-acting beta-agonists, which cost almost $178 more per year for the COPD + asthma patients. Inhaled corticosteroids were next, with a cost excess of $64 annually, followed by long-acting muscarinic agents ($59), short-acting beta-agonists ($46) and leukotriene receptor agonists ($19), Dr. Sadatsafavi and his associates said.

All subjects were aged 40 years or older (average, 67.8 years for COPD only and 68 years for COPD + asthma), and 57% of each group was female. Individuals were excluded if their date of first asthma-related resource use was less than 2 years before their first date of COPD-related resource use, they noted.

[email protected]

Two behavioral interventions for primary care clinicians cut the rate of inappropriate antibiotic prescribing for acute respiratory tract infections significantly, according to a report published online Feb. 9 in JAMA.

Compared with a control condition that included clinician education, the two interventions reduced inappropriate prescribing by 5.2% and 7.0%, respectively.

oksix/thinkstock

“We believe these effect sizes are clinically significant, especially when measured against control clinicians who were motivated to join a trial, knew they were being monitored, and who had relatively low antibiotic prescribing rates at baseline,” said Daniella Meeker, Ph.D., of the Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles, and her associates.

In a cluster-randomized trial involving 248 clinicians at 47 primary care practices in Boston and Los Angeles, the investigators designed three interventions and tested various combinations of them against a control condition during an 18-month period. The number of inappropriate antibiotic prescriptions given during this intervention period was then compared with that during a baseline period, the 18 months preceding the intervention.

The analysis included 14,753 patient visits for acute respiratory tract infections during the baseline period and 16,959 visits during the intervention period.

The first behavioral intervention, termed “accountable justification,” used an alert each time a clinician prescribed an antibiotic in a patient’s electronic health record – a prompt asking for an explicit justification for doing so. That approach was based on the hope that to preserve their reputations, clinicians would tailor their behavior to fall in line with norms followed by their peers and recommended in clinical guidelines.

The second intervention, “peer comparison,” used monthly e-mails to inform clinicians whether or not they were “top performers” (within the lowest decile) for inappropriate prescribing in their geographical region. The emails included the number and proportion of antibiotic prescriptions they wrote inappropriately for acute upper respiratory tract infections, compared with the proportion written by top performers.

The mean rate of antibiotic prescribing decreased during the intervention in all the study groups, including the control group, which showed an absolute decrease of 11% (from 24.1% to 13.1%). The absolute decrease was significantly greater, at 18.1%, in the accountable justification group (from 23.2% to 5.2%) and at 16.3% in the peer comparison group (from 19.9% to 3.7%), Dr. Meeker and her associates said (JAMA. 2016 Feb 9;315[6]:562-70). The rate of return visits for possible bacterial infections within 30 days of the index visit was used as a measure of safety for withholding antibiotic prescriptions. This rate was 0.4% in the control group. The only intervention group that showed a “modestly higher” rate of return visits was the one that used both the accountable justification and the peer comparison interventions together, for which the rate of return visits was 1.4%.

The study was supported by the American Recovery and Reinvestment Act of 2009, the National Institutes of Health, the National Institute on Aging, the Agency for Healthcare Research and Quality, the University of Southern California’s Medical Information Network for Experimental Research, and the Patient-Centered Outcomes Research Institute. Dr. Meeker and her associates reported having no relevant financial disclosures.

Two behavioral interventions for primary care clinicians cut the rate of inappropriate antibiotic prescribing for acute respiratory tract infections significantly, according to a report published online Feb. 9 in JAMA.

Compared with a control condition that included clinician education, the two interventions reduced inappropriate prescribing by 5.2% and 7.0%, respectively.

oksix/thinkstock

“We believe these effect sizes are clinically significant, especially when measured against control clinicians who were motivated to join a trial, knew they were being monitored, and who had relatively low antibiotic prescribing rates at baseline,” said Daniella Meeker, Ph.D., of the Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles, and her associates.

In a cluster-randomized trial involving 248 clinicians at 47 primary care practices in Boston and Los Angeles, the investigators designed three interventions and tested various combinations of them against a control condition during an 18-month period. The number of inappropriate antibiotic prescriptions given during this intervention period was then compared with that during a baseline period, the 18 months preceding the intervention.

The analysis included 14,753 patient visits for acute respiratory tract infections during the baseline period and 16,959 visits during the intervention period.

The first behavioral intervention, termed “accountable justification,” used an alert each time a clinician prescribed an antibiotic in a patient’s electronic health record – a prompt asking for an explicit justification for doing so. That approach was based on the hope that to preserve their reputations, clinicians would tailor their behavior to fall in line with norms followed by their peers and recommended in clinical guidelines.

The second intervention, “peer comparison,” used monthly e-mails to inform clinicians whether or not they were “top performers” (within the lowest decile) for inappropriate prescribing in their geographical region. The emails included the number and proportion of antibiotic prescriptions they wrote inappropriately for acute upper respiratory tract infections, compared with the proportion written by top performers.

The mean rate of antibiotic prescribing decreased during the intervention in all the study groups, including the control group, which showed an absolute decrease of 11% (from 24.1% to 13.1%). The absolute decrease was significantly greater, at 18.1%, in the accountable justification group (from 23.2% to 5.2%) and at 16.3% in the peer comparison group (from 19.9% to 3.7%), Dr. Meeker and her associates said (JAMA. 2016 Feb 9;315[6]:562-70). The rate of return visits for possible bacterial infections within 30 days of the index visit was used as a measure of safety for withholding antibiotic prescriptions. This rate was 0.4% in the control group. The only intervention group that showed a “modestly higher” rate of return visits was the one that used both the accountable justification and the peer comparison interventions together, for which the rate of return visits was 1.4%.

The study was supported by the American Recovery and Reinvestment Act of 2009, the National Institutes of Health, the National Institute on Aging, the Agency for Healthcare Research and Quality, the University of Southern California’s Medical Information Network for Experimental Research, and the Patient-Centered Outcomes Research Institute. Dr. Meeker and her associates reported having no relevant financial disclosures.

Two behavioral interventions for primary care clinicians cut the rate of inappropriate antibiotic prescribing for acute respiratory tract infections significantly, according to a report published online Feb. 9 in JAMA.

Compared with a control condition that included clinician education, the two interventions reduced inappropriate prescribing by 5.2% and 7.0%, respectively.

oksix/thinkstock

“We believe these effect sizes are clinically significant, especially when measured against control clinicians who were motivated to join a trial, knew they were being monitored, and who had relatively low antibiotic prescribing rates at baseline,” said Daniella Meeker, Ph.D., of the Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles, and her associates.

In a cluster-randomized trial involving 248 clinicians at 47 primary care practices in Boston and Los Angeles, the investigators designed three interventions and tested various combinations of them against a control condition during an 18-month period. The number of inappropriate antibiotic prescriptions given during this intervention period was then compared with that during a baseline period, the 18 months preceding the intervention.

The analysis included 14,753 patient visits for acute respiratory tract infections during the baseline period and 16,959 visits during the intervention period.

The first behavioral intervention, termed “accountable justification,” used an alert each time a clinician prescribed an antibiotic in a patient’s electronic health record – a prompt asking for an explicit justification for doing so. That approach was based on the hope that to preserve their reputations, clinicians would tailor their behavior to fall in line with norms followed by their peers and recommended in clinical guidelines.

The second intervention, “peer comparison,” used monthly e-mails to inform clinicians whether or not they were “top performers” (within the lowest decile) for inappropriate prescribing in their geographical region. The emails included the number and proportion of antibiotic prescriptions they wrote inappropriately for acute upper respiratory tract infections, compared with the proportion written by top performers.

The mean rate of antibiotic prescribing decreased during the intervention in all the study groups, including the control group, which showed an absolute decrease of 11% (from 24.1% to 13.1%). The absolute decrease was significantly greater, at 18.1%, in the accountable justification group (from 23.2% to 5.2%) and at 16.3% in the peer comparison group (from 19.9% to 3.7%), Dr. Meeker and her associates said (JAMA. 2016 Feb 9;315[6]:562-70). The rate of return visits for possible bacterial infections within 30 days of the index visit was used as a measure of safety for withholding antibiotic prescriptions. This rate was 0.4% in the control group. The only intervention group that showed a “modestly higher” rate of return visits was the one that used both the accountable justification and the peer comparison interventions together, for which the rate of return visits was 1.4%.

The study was supported by the American Recovery and Reinvestment Act of 2009, the National Institutes of Health, the National Institute on Aging, the Agency for Healthcare Research and Quality, the University of Southern California’s Medical Information Network for Experimental Research, and the Patient-Centered Outcomes Research Institute. Dr. Meeker and her associates reported having no relevant financial disclosures.

Mortality rates among older men in Veterans Affairs hospitals were lower for acute myocardial infarction and heart failure but higher for pneumonia, compared with non–Veterans Affairs hospitals, a study has found.

Researchers conducted a cross-sectional analysis of more than 7,900 male Medicare fee-for-service beneficiaries aged 65 years and older who were hospitalized in 104 VA and 1,513 non-VA acute care hospitals for acute myocardial infarction, heart failure, or pneumonia between 2010 and 2013.

The analysis, published online Feb. 9, showed that, for the VA hospitals, after adjusting for risk, 30-day mortality for acute MI was 0.17 percentage points lower (P = .02) and 30-day heart failure mortality was 0.44 percentage points lower (P = .008), compared with non-VA hospitals (JAMA. 2016;315[6]:582-92. doi: 10.1001/jama.2016.0278).

The differences between VA and non-VA hospitals were even greater when the comparison was made between hospitals in the same metropolitan statistical area: differences of 0.22 percentage points for 30-day mortality for acute MI (P = .02) and 0.63 percentage points for heart failure (P < .001).

©Daniel Mirer/thinkstockphotos.com

“The finding that risk standardized mortality rates for cardiovascular conditions were lower, albeit with small absolute differences, in VA hospitals may reflect higher quality of care in VA hospitals as represented by adherence to process measures,” wrote Sudhakar V. Nuti of the Center for Outcomes Research and Evaluation at Yale-New Haven (Conn.) Hospital and coauthors.

“The lower mortality rates also may be due to the quality improvement efforts that can be implemented across the VA’s integrated delivery system,” they added.

Mortality rates for pneumonia were 0.46 percentage points higher in VA hospitals, compared with non-VA hospitals (P = .045). But after comparing hospitals within the same metropolitan area, this difference disappeared.

VA hospitals also had higher readmission rates than non-VA hospitals for all three conditions: 0.63 percentage points higher for acute MI, 1.2 points higher for heart failure, and 0.76 points higher for pneumonia (P < .001 for all).

This difference persisted when hospitals within the same area were compared.

Commenting on the readmission differences, the investigators suggested that VA hospitals may have a greater propensity to readmit patients, or that veterans may have to travel further to VA hospitals – which has been associated with higher readmission rates among veterans. They also pointed out, however, that non-VA hospitals had recently been subject to national interventions to reduce readmissions.

The study also showed that VA hospitals were more likely to be teaching hospitals and were larger and had a greater number of beds than non-VA hospitals. Around 12% of individuals who were initially hospitalized at VA hospitals were readmitted to non-VA hospitals, but less than 1% of individuals admitted to a non-VA hospital initially were later readmitted to a VA hospital, irrespective of their condition.

“The current study serves as an example of national performance comparison for VA and non-VA hospital care, which sets the stage for future performance and quality improvement studies,” the authors reported.

“Moreover, the results of our study and other benchmarking efforts could inform efforts to improve quality in the VA, particularly our findings of variation in performance, by identifying and learning from high performing hospitals and disseminating best practices to lower performing hospitals to elevate the entire performance curve.”

The authors stressed that, since the study population was limited to men over age 65 years who were VA or Medicare patients, the results were not generalizable to younger or female populations.

Some of the study’s authors were supported by grants from the National Institute on Aging; the American Federation for Aging Research; the National Heart, Lung, and Blood Institute; and the VA Connecticut Healthcare System. Two authors declared research agreements from Medtronic and Johnson & Johnson, one declared positions on a cardiac scientific advisory board for UnitedHealth, and four declared contract work for the Centers for Medicare & Medicaid Services. No other conflicts of interest were declared.

Mortality rates among older men in Veterans Affairs hospitals were lower for acute myocardial infarction and heart failure but higher for pneumonia, compared with non–Veterans Affairs hospitals, a study has found.

Researchers conducted a cross-sectional analysis of more than 7,900 male Medicare fee-for-service beneficiaries aged 65 years and older who were hospitalized in 104 VA and 1,513 non-VA acute care hospitals for acute myocardial infarction, heart failure, or pneumonia between 2010 and 2013.

The analysis, published online Feb. 9, showed that, for the VA hospitals, after adjusting for risk, 30-day mortality for acute MI was 0.17 percentage points lower (P = .02) and 30-day heart failure mortality was 0.44 percentage points lower (P = .008), compared with non-VA hospitals (JAMA. 2016;315[6]:582-92. doi: 10.1001/jama.2016.0278).

The differences between VA and non-VA hospitals were even greater when the comparison was made between hospitals in the same metropolitan statistical area: differences of 0.22 percentage points for 30-day mortality for acute MI (P = .02) and 0.63 percentage points for heart failure (P < .001).

©Daniel Mirer/thinkstockphotos.com

“The finding that risk standardized mortality rates for cardiovascular conditions were lower, albeit with small absolute differences, in VA hospitals may reflect higher quality of care in VA hospitals as represented by adherence to process measures,” wrote Sudhakar V. Nuti of the Center for Outcomes Research and Evaluation at Yale-New Haven (Conn.) Hospital and coauthors.

“The lower mortality rates also may be due to the quality improvement efforts that can be implemented across the VA’s integrated delivery system,” they added.

Mortality rates for pneumonia were 0.46 percentage points higher in VA hospitals, compared with non-VA hospitals (P = .045). But after comparing hospitals within the same metropolitan area, this difference disappeared.

VA hospitals also had higher readmission rates than non-VA hospitals for all three conditions: 0.63 percentage points higher for acute MI, 1.2 points higher for heart failure, and 0.76 points higher for pneumonia (P < .001 for all).

This difference persisted when hospitals within the same area were compared.

Commenting on the readmission differences, the investigators suggested that VA hospitals may have a greater propensity to readmit patients, or that veterans may have to travel further to VA hospitals – which has been associated with higher readmission rates among veterans. They also pointed out, however, that non-VA hospitals had recently been subject to national interventions to reduce readmissions.

The study also showed that VA hospitals were more likely to be teaching hospitals and were larger and had a greater number of beds than non-VA hospitals. Around 12% of individuals who were initially hospitalized at VA hospitals were readmitted to non-VA hospitals, but less than 1% of individuals admitted to a non-VA hospital initially were later readmitted to a VA hospital, irrespective of their condition.

“The current study serves as an example of national performance comparison for VA and non-VA hospital care, which sets the stage for future performance and quality improvement studies,” the authors reported.

“Moreover, the results of our study and other benchmarking efforts could inform efforts to improve quality in the VA, particularly our findings of variation in performance, by identifying and learning from high performing hospitals and disseminating best practices to lower performing hospitals to elevate the entire performance curve.”

The authors stressed that, since the study population was limited to men over age 65 years who were VA or Medicare patients, the results were not generalizable to younger or female populations.

Some of the study’s authors were supported by grants from the National Institute on Aging; the American Federation for Aging Research; the National Heart, Lung, and Blood Institute; and the VA Connecticut Healthcare System. Two authors declared research agreements from Medtronic and Johnson & Johnson, one declared positions on a cardiac scientific advisory board for UnitedHealth, and four declared contract work for the Centers for Medicare & Medicaid Services. No other conflicts of interest were declared.

Mortality rates among older men in Veterans Affairs hospitals were lower for acute myocardial infarction and heart failure but higher for pneumonia, compared with non–Veterans Affairs hospitals, a study has found.

Researchers conducted a cross-sectional analysis of more than 7,900 male Medicare fee-for-service beneficiaries aged 65 years and older who were hospitalized in 104 VA and 1,513 non-VA acute care hospitals for acute myocardial infarction, heart failure, or pneumonia between 2010 and 2013.

The analysis, published online Feb. 9, showed that, for the VA hospitals, after adjusting for risk, 30-day mortality for acute MI was 0.17 percentage points lower (P = .02) and 30-day heart failure mortality was 0.44 percentage points lower (P = .008), compared with non-VA hospitals (JAMA. 2016;315[6]:582-92. doi: 10.1001/jama.2016.0278).

The differences between VA and non-VA hospitals were even greater when the comparison was made between hospitals in the same metropolitan statistical area: differences of 0.22 percentage points for 30-day mortality for acute MI (P = .02) and 0.63 percentage points for heart failure (P < .001).

©Daniel Mirer/thinkstockphotos.com

“The finding that risk standardized mortality rates for cardiovascular conditions were lower, albeit with small absolute differences, in VA hospitals may reflect higher quality of care in VA hospitals as represented by adherence to process measures,” wrote Sudhakar V. Nuti of the Center for Outcomes Research and Evaluation at Yale-New Haven (Conn.) Hospital and coauthors.

“The lower mortality rates also may be due to the quality improvement efforts that can be implemented across the VA’s integrated delivery system,” they added.

Mortality rates for pneumonia were 0.46 percentage points higher in VA hospitals, compared with non-VA hospitals (P = .045). But after comparing hospitals within the same metropolitan area, this difference disappeared.

VA hospitals also had higher readmission rates than non-VA hospitals for all three conditions: 0.63 percentage points higher for acute MI, 1.2 points higher for heart failure, and 0.76 points higher for pneumonia (P < .001 for all).

This difference persisted when hospitals within the same area were compared.

Commenting on the readmission differences, the investigators suggested that VA hospitals may have a greater propensity to readmit patients, or that veterans may have to travel further to VA hospitals – which has been associated with higher readmission rates among veterans. They also pointed out, however, that non-VA hospitals had recently been subject to national interventions to reduce readmissions.

The study also showed that VA hospitals were more likely to be teaching hospitals and were larger and had a greater number of beds than non-VA hospitals. Around 12% of individuals who were initially hospitalized at VA hospitals were readmitted to non-VA hospitals, but less than 1% of individuals admitted to a non-VA hospital initially were later readmitted to a VA hospital, irrespective of their condition.

“The current study serves as an example of national performance comparison for VA and non-VA hospital care, which sets the stage for future performance and quality improvement studies,” the authors reported.

“Moreover, the results of our study and other benchmarking efforts could inform efforts to improve quality in the VA, particularly our findings of variation in performance, by identifying and learning from high performing hospitals and disseminating best practices to lower performing hospitals to elevate the entire performance curve.”

The authors stressed that, since the study population was limited to men over age 65 years who were VA or Medicare patients, the results were not generalizable to younger or female populations.

Some of the study’s authors were supported by grants from the National Institute on Aging; the American Federation for Aging Research; the National Heart, Lung, and Blood Institute; and the VA Connecticut Healthcare System. Two authors declared research agreements from Medtronic and Johnson & Johnson, one declared positions on a cardiac scientific advisory board for UnitedHealth, and four declared contract work for the Centers for Medicare & Medicaid Services. No other conflicts of interest were declared.