WEDNESDAY, Nov. 12 (HealthDay News) -- Medicare beneficiaries with heart failure have many more doctor visits and take more medications than those without heart failure, researchers are reporting.
They based their conclusion on an analysis of data on 173,000 Medicare beneficiaries. The overall average age of the beneficiaries was 70.7 years, while the average age for those with heart failure was between 76 and 77 years.
The analysis found that:
- Patients with severe heart failure saw an average of 23 different Medicare providers a year, compared with about 7.9 providers for typical Medicare beneficiaries.
- Those with mild heart failure saw an average of 15.9 providers a year, and those with moderate heart failure saw an average of 18.6 providers a year.
- Patients with all stages of heart failure received an average of 61 prescriptions annually, compared with 29 for a typical beneficiary.
- About 26 percent of office visits for heart failure were to internal medicine specialists and about 20 percent were to family practice physicians. Visits to cardiologists for those with mild, moderate and severe heart failure increased as heart failure worsened and were 16 percent, 18 percent, and 20 percent, respectively.
- About 46 percent of severe heart failure patients had diabetes, 46 percent had chronic obstructive pulmonary disease (COPD) or other respiratory diseases, and about 32 percent had kidney disease.
- In 2005, beneficiaries with heart failure accounted for 37 percent of all Medicare spending and almost 50 percent of all hospital inpatient costs. Typical inpatient costs for a severe heart failure patient were about $24,000 a year, compared to about $3,000 for a typical beneficiary.
The findings were expected to be presented Nov. 12 at the American Heart Association's annual scientific sessions, in New Orleans.
"These findings highlight the complexity of treating heart failure patients who often have serious co-morbidities," and "stress the importance of developing comprehensive and coordinated care," study lead author Robert Page, an associate professor of clinical pharmacy and physical medicine, and clinical specialist in the cardiology division at the University of Colorado School of Pharmacy and Medicine, said in a heart association news release.
More information
The U.S. National Institute on Aging has more about heart failure.
TUESDAY, Nov. 11 (HealthDay News) -- A study using an advanced brain scanning technology supports the growing body of evidence that education levels and some form of intellectual activity decrease the impact of Alzheimer's disease.
People with a greater "cognitive reserve" suffer less damage from the beta-amyloid plaques in the brain that are a leading marker of Alzheimer's disease, according to the study in the November issue of the Archives of Neurology.
Cognitive reserve is the concept that "the way that some people process information, the brain networks they use, allows them to cope better," said study author Catherine M. Roe, a research instructor in neurology at Washington University School of Medicine in St Louis.
The study used education levels as a yardstick of cognitive reserve, a customary practice in Alzheimer's studies, Roe said.
The researchers employed positron emission tomography (PET) scans to study the brains of 37 people with Alzheimer's-type dementia and 161 people with no dementia. All were injected with a radio-carbon-labeled compound that attaches itself to amyloid plaques, allowing the researchers to determine the size of those plaques in the brains of the participants. All the participants also took tests to measure their thinking ability.
"We divided the individuals into two groups, those with high uptake of the compound, indicating more plaques in the brain and those with low uptake, indicating few or no plaques," Roe said. "For people with low uptake, there was no relation to education in their cognitive scores. For high uptake, meaning significant plaques in the brain, we found an association with education. The more education they had, the fewer the symptoms of dementia."
So having a greater cognitive reserve, as measured by educational level, "may help you cope with that [Alzheimer's] pathology without having dementia symptoms," Roe said.
It's hard to say whether people can do anything to increase their cognitive reserve, said Yaakov Stern, professor of clinical neuropsychology at the Taub Institute for Research on Alzheimer's Disease at Columbia University and an originator of the cognitive reserve hypothesis.
Stern has taken part in several studies similar to the one now being reported, measuring blood flow to various parts of the brain as an indicator of Alzheimer's pathology. Those studies also showed that people with greater cognitive reserve "are walking around with more pathology than they exhibit," he said.
Whether people can consciously increase their cognitive reserve "is the big question," Stern said. "I am more and more convinced from studies like this that there are aspects of life experience that allow people to cope with Alzheimer's pathology better."
Any activities in particular? "We really don't know the recipe of what activity and how much would work," Stern said. "We really need controlled studies."
But, as a general rule, he said, "It doesn't hurt to remain active, physically as well as mentally. It's just that there are no studies to show that these activities really make a difference."
More information
To learn more about Alzheimer's disease, visit the U.S. National Institute on Aging.