By Steven Reinberg, HealthDay Reporter
THURSDAY, Oct. 22, 2020 (HealthDay News) — Homeless people are three times more likely to die after a heart attack than other patients, a new study finds.
“Our study shows a dramatically higher rate of mortality after heart attacks in people experiencing homelessness compared to non-homeless patients,” said researcher Dr. Samantha Liauw of the University of Toronto. “More research is needed to discover the reasons for this disparity in outcomes so that the chances of survival can be improved in this vulnerable population.”
Liauw and her colleagues compared more than 2,800 heart attack patients admitted to a Toronto hospital between 2008 and 2017. Of those, 75 were homeless.
Among homeless patients, 19% died in the hospital, compared with 6% of others. Homeless patients were younger than others and more likely to be men.
Eighty-four percent of homeless patients smoked compared to half of patients who were not homeless. Rates of high blood pressure, high cholesterol and diabetes were similar between the groups.
Also, more homeless patients suffered from mental conditions. They were more likely than others to abuse alcohol and drugs and were more likely to suffer a serious complication of heart attack called cardiogenic shock that occurs when the heart cannot supply enough blood and oxygen to the brain and other vital organs. They were more likely than other patients to go into cardiac arrest.
Both groups received medications, testing and stents, but the rate of stenting was lower in the homeless (80% versus 90% in non-homeless patients).
The findings were scheduled to be presented Wednesday at a virtual meeting of the 2020 Canadian Cardiovascular Congress.
“The elevated risk at a younger age could be related to chronic stress from being homeless, higher rates of smoking, poverty, and unreliable access to healthy food. Lack of trust in the medical system, poor access to health care for chronic conditions and slower receipt of emergency therapies may also have contributed,” Liauw said in a news release from the European Society of Cardiology, which will participate in the meeting.
Although both patient groups received timely treatment, she suspects the symptom start time listed for homeless people may be inaccurate, resulting in a longer gap before therapy began.
“This illustrates that we need new methods to study this disadvantaged part of society,” Liauw said.
Findings presented at meetings are considered preliminary until they’re published in a peer-reviewed journal.
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The virus now had the ability to potentially kill a patient — his patient — even if she wasn’t infected.
Hours before, Terry, a 47-year-old mother and wife, had suffered a heart attack in her Herriman, Utah, home. According to her sister, she had to be revived four times in the ambulance on the way to the nearest hospital.
Once there, the medical staff and her doctor quickly determined Terry would likely die if she didn’t get the more sophisticated life-saving treatment found in an intensive care unit of a larger hospital.
“He (the doctor) told us right away, we’re doing everything we can to try and find a hospital that can take Laurie, and we can’t find one,” Stephanie Deer, Terry’s sister, said.
“If you would have seen the look on that doctor’s face, he was incredulous. He couldn’t believe he was telling us this.”
Deer and her sister are not alone.
The state is experiencing “one of the worst (coronavirus) outbreaks in the country,” Utah Gov. Garry Herbert said Tuesday.
As a result, patients suffering other life-threatening medical events — non-Covid related — are in a dangerous competition for limited specialized medical care.
The state’s total ICU usage was at almost 70%, Herbert said Tuesday, and almost 16% of the state’s ICU beds are used to treat Covid-19 patients.
On Friday, the University of Utah hospital’s ICU was at 104% capacity.
Covid surge taking a toll on Utah doctors
Dr. Emily Spivak, among the doctors helping treat Covid patients in Utah, feels frustrated and upset by the surge in cases — because she said she knows this shouldn’t be happening. Coronavirus is preventable by hand washing, social distancing and mask wearing.
She reached her breaking point in a parking lot outside the level one trauma center where she works in Salt Lake City.
“Well I was trying so hard not to,” she said, referring to her tears. “I mean honestly this is just super frustrating.”
Spivak said she sees many people in public no longer following US Centers for Disease Control and Prevention guidelines — and believes they’ve just grown complacent.
“I don’t see an end. No one’s doing anything to stop what’s happening,” she said. “It’s kind of like people just are going out and living their lives not realizing that they are exhausting our healthcare system.”
Deer said she witnessed the frustration of doctors firsthand.
“I watched those nurses call for hours, trying other systems, doing everything they could, I mean desperate.” she said.
“I don’t know how the doctors and nurses and things are going to be able to keep this up when your whole life, your whole profession is dedicated to saving people’s lives and you can’t access medical care for a patient.”
Younger women who suffer a heart attack are more likely than men to die in the decade after surgery, a new study finds.
It included more than 400 women and nearly 1,700 men, average age 45, who had a first heart attack between 2000 and 2016.
During an average follow-up of more than 11 years, there were no statistically significant differences between men and women for deaths while in the hospital, or for heart-related deaths.
However, women had a 1.6-fold increased risk of dying from other causes during the follow-up, according to the study published this week in the European Heart Journal.
“Cardiovascular deaths occurred in 73 men and 21 women, 4.4% versus 5.3% respectively, over a median follow-up time of 11.2 years,” said study leader Dr. Ron Blankstein, a preventive cardiologist at Brigham and Women’s Hospital in Boston.
“However, when excluding deaths that occurred in the hospital, there were 157 deaths in men and 54 deaths in women from all causes during the follow-up period: 9.5% versus 13.5% respectively, which is a significant difference, and a greater proportion of women died from causes other than cardiovascular problems, 8.4% versus 5.4% respectively,” Blankstein said in a journal news release.
The study also found that women were less likely than men to undergo invasive procedures after admission to the hospital with a heart attack, or to be treated with certain medications when they were discharged, such as aspirin, beta blockers, ACE inhibitors and statins.
“It’s important to note that overall most heart attacks in people under the age of 50 occur in men. Only 19% of the people in this study were women. However, women who experience a heart attack at a young age often present with similar symptoms as men, are more likely to have diabetes, have lower socioeconomic status and ultimately are more likely to die in the longer term,” Blankstein noted.
The American Academy of Family Physicians has more on heart attacks.
Copyright 2020 HealthDay. All rights reserved.
Today marks the beginning of FDA hearings on Avandia (rosiglitazone), a popular drug for diabetes. The hearing centers on whether Avandia places a patient at higher risk of a heart attack.
Patients taking Avandia may not realize that one of the primary reasons doctors use Avandia is not only to lower one’s blood sugar, but to thereby prevent heart attacks. Thus the question is highly relevant for every diabetic taking this medication.
There is no question that Avandia lowers blood sugar – that is easily proven. The blood glucose-lowering effects can be demonstrated over the course of weeks and months, with evidence of on-going decrease in blood sugar levels for years. And since it is well known that high blood sugar (diabetes) is associated with increased risk of heart attacks, it is only logical that lowering blood sugar levels should decrease the risk of heart attack (myocardial infarction).
Yet this is not necessarily so. Might Avandia be doing something else as yet unidentified within the body? This is often the case with drugs. In fact, it has long been known that taking Avandia increases the risk of liver problems. That is why your doctor checks the liver enzymes in your blood frequently. In certain patients Avandia also causes fluid retention that in some cases is associated with congestive heart failure. Clearly, Avandia does do something in the body besides lower blood sugar, but the question remains, which is more dangerous: to take the medicine or not?
There are many medications on the market for diabetes. Of course, insulin is the prototype and some might think the final answer. But patients do not like to inject themselves and so a number of oral medicines have been developed. Also, taking insulin tends to cause weight gain in Type 2 diabetics, and since weight gain is a big part of the problem to begin with, to some degree it worsens the situation.
Knowing all this, should you stop taking Avandia? At this point the answer is we don’t know. Since the drug was released I have seen a very few patients suffer from excess fluid retention, but since that problem was recognized, the drug has not been advised for patients with swelling or heart failure. To date, only a few of my patients have had abnormal liver tests, and these have all been reversible with discontinuation of the drug. For my patients, Avandia has been effective at lowering blood sugars.
Yet the question remains, what about heart attacks? This week the FDA will be reviewing data from scientific trials regarding the use of Avandia (rosiglitazone), as well as health claims data related to its use. When all the information is gathered, statisticians and physicians will have more accurate information on which to make an informed decision. If we already knew the answer, the hearings would be unnecessary.
But what should you do in the meantime? Here is one way to think about the problem: if the answer has not become clear over 10 …