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DEPRESSION IS MOST SERIOUS RISK FACTOR FOR CARDIOVASCULAR DEATH. A study of more than 24,000 patients with significant coronary artery disease (CAD) found that depressed patients had double the risk of death than patients who were not depressed. The researchers expected depression to be a significant risk factor, but were surprised to discover depression was a stronger predictor of death than traditional cardiovascular risk factors, such as diabetes, smoking, hypertension, male gender, and prior heart attack. The 15 percent of participants diagnosed with depression tended to be younger, female, diabetic, and with a history of depression, but less likely to have suffered a heart attack. As explained in the August 2017 issue of European Heart Journal Quality of Care and Clinical Outcomes, depression remained the leading risk factor for mortality, no matter when it was diagnosed within five years following the CAD diagnosis.

TYPE 2 DIABETES AND AORTIC ANEURYSM. A population study of nearly 450,000 Swedish patients with diabetes and the same number without the disease found that those with diabetes had a 28 percent lower risk of aortic aneurysm. This complication occurs when atherosclerosis settles in the largest blood vessel in the body and weakens the artery wall, causing it to bulge out. If the bulge, or aneurysm, breaks, the patient rarely survives. But, patients with type 2 diabetes were more likely to survive a ruptured aneurysm than patients without diabetes, which may be because patients with diabetes have more intense lipid or hypertension management, or more regular visits to the doctor. Findings were presented at the European Association for the Study of Diabetes 2017 in September.

NO ADVERSE IMPACT FROM EFFORTS TO LOWER HOSPITAL READMISSION RATES. When the Affordable Care Act established the Hospital Readmissions Reduction Program, there was fear that penalizing hospitals for excess readmissions would end up punishing patients with heart failure, heart attack, and pneumonia. But a study of Medicare patients hospitalized between 2008 and 2014 shows this is not so. As 30-day readmission rates declined for each condition, 30-day mortality rates rose slightly for heart failure, declined slightly for heart attack, and remained the same for pneumonia. The authors found the "weak positive correlation in most cases between changes in hospital readmission and mortality rates makes it extremely unlikely that readmission reductions worsened mortality after hospitalization." They speculated hospitals focused on better organization and coordination of care for patients who were discharged. (Journal of the American Medical Association, July 18, 2017)

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Title Annotation:NEWSBRIEFS
Publication:Duke Medicine Health News
Date:Dec 1, 2017
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