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Study: Black patients get worse care after cardiac arrest



Minority patients who suffer life-threatening cardiac arrest may get fewer treatments in the hospital — and face a grimmer outlook — than White patients, a new, preliminary study suggests.

The findings add to a large body of research finding racial disparities in U.S. health care, including heart disease treatment.

What’s different is that the study looked at a “particularly dramatic presentation” of heart disease, said senior researcher Dr. Saraschandra Vallabhajosyula.

The study focused on over 180,000 Americans who were hospitalized for a heart attack and suffered cardiac arrest as a complication. During cardiac arrest, the heart stops beating normally and can no longer pump blood and oxygen to the body. It’s fatal within minutes without emergency measures.

There are “very clear-cut” guidelines on how to manage cardiac arrest, as well as guidelines on heart attack care, said Vallabhajosyula, an interventional cardiology fellow at Emory University, in Atlanta.

Yet, his team found, there were racial disparities in certain aspects of hospital care.

Compared with white patients, minority patients were less likely to undergo an angiogram, an imaging technique that looks for blockages in the heart arteries. Just under 62% of Black patients had an angiogram, versus 70% of Asian, Hispanic and Native American patients, and 73% of White patients.

Similarly, while 58% of White patients had angioplasty to clear any heart blockages, that was true for only 45% of Black patients and 53% of other minority patients.

Disparities were seen in survival, as well. As a group, Asian, Hispanic and Native American patients were 11% more likely to die in the hospital than white patients were. The exception was Black patients, whose death risk was not elevated once factors like overall health were taken into account.

The reasons for the findings are unclear, according to Vallabhajosyula. One potential factor is the hospitals — if, for instance, minority patients tended to land in hospitals with fewer resources.

But Vallabhajosyula said his team accounted for broad hospital characteristics — whether they were rural or urban, for example — and that did not fully explain the racial inequities.

The findings were scheduled for presentation this week at the American Heart Association’s virtual annual meeting. Studies presented at meetings are generally considered preliminary.

But a body of research has documented long-standing racial disparities in heart attack care, with Black patients less likely than White people to get angiograms and more aggressive treatments like angioplasty and bypass surgery.

And the gap has not narrowed much over the years.

“This study is yet another example of persistent racial disparities in care throughout the U.S. health care system,” said Dr. Khadijah Breathett, an assistant professor of cardiology at the University of Arizona College of Medicine, in Tucson.

In her own research, Breathett has found racial gaps in care for heart failure — a serious chronic condition that disproportionately strikes Black Americans.

In one study, Black patients hospitalized for worsening heart failure were less likely to be treated by a cardiologist, versus White patients. And care from a cardiologist was linked to better survival.

Breathett called the new findings “worrisome,” partly because hospital care for these acute cardiac complications should be “fairly regimented and standardized.”

Government figures show that Black Americans have the highest death rates from heart disease of all racial groups. That’s due to a mix of factors, from socioeconomics and lack of health insurance to institutional racism.

When it comes to disparities in care, Breathett said “the elephant in the room” is health care providers’ own implicit biases.

In one study, Breathett and her colleagues asked a group of providers to consider whether a heart transplant should be recommended to various hypothetical patients — all Black or White men.

Overall, providers tended to perceive Black men as less healthy than white men, and less likely to stick to post-transplant care.

On the positive side, Breathett said there is evidence that training can help health care providers recognize their own biases.

She said that medical centers should “do the hard work” of finding out where disparities exist within their own walls, and then address them.

Vallabhajosyula agreed that medical professionals need to evaluate themselves. “Are we carrying implicit biases that affect our care decisions?” he said.

And when it comes to cardiac arrest, Vallabhajosyula noted, even lay people’s biases might matter.

Quick action from bystanders — including CPR chest compressions — can make the difference between life and death for cardiac arrest victims.

Yet studies have found that people are more hesitant to perform CPR on women than men — partly out of fear over hurting them, or being accused of sexual assault.

“It’s crucial,” Vallabhajosyula said, “that we keep promoting bystander CPR and educating people on when and how to do it.”

More information

The U.S. Centers for Disease Control and Prevention has more on racial disparities in heart disease.

Copyright 2020 HealthDay. All rights reserved.

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‘Green prescriptions’ could cancel mental health benefits for some



So-called “green prescriptions” may end up being counterproductive for people with mental health conditions, researchers say.

Spending time in nature is believed to benefit mental health, so some doctors are beginning to “prescribe” outdoor time for their patients.

That led researchers to investigate whether being in nature helps actually does help people with issues such as anxiety and depression. They collected data from more than 18,000 people in 18 countries.

The takeaway: Time in nature does provide several benefits for people with mental health conditions, but only if they choose on their own to visit green spaces.

While being advised to spend time outdoors can encourage such activity, it can also undermine the potential emotional benefits, according to the authors of the study published this month in the journal Scientific Reports.

The researchers said they were surprised to find that people with depression were spending time in nature as often as folks with no mental health issues, and that people with anxiety were doing so much more often.

While in nature, those with depression and anxiety tended to feel happy and reported low anxiety. But those benefits appeared to be undermined when the visits were done at others’ urging, the investigators found.

The more external pressure people with depression and anxiety felt to visit nature, the less motivated they were to do so and the more anxious they felt.

“These findings are consistent with wider research that suggests that urban natural environments provide spaces for people to relax and recover from stress,” said study leader Michelle Tester-Jones, a postdoctoral research associate at the University of Exeter in the United Kingdom.

But the findings also show that health care practitioners and loved ones should be sensitive about recommending time in nature for people who have mental health issues.

“It could be helpful to encourage them to spend more time in places that people already enjoy visiting, so they feel comfortable and can make the most of the experience,” Tester-Jones said in a university news release.

More information

For more on the benefits of green spaces, go to the National Recreation and Park Association.

Copyright 2020 HealthDay. All rights reserved.

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Study: Nearly half of ‘essential workers’ in U.S. at risk for severe COVID-19



Nov. 9 (UPI) — Nearly half of those classified as “essential workers” in the United States are at increased risk for severe COVID-19, according to an analysis published Monday by JAMA Internal Medicine.

This means that more than 74 million workers and those with whom they live could be at risk for serious illness, based on disease risk guidelines developed by the U.S. Centers for Disease Control and Prevention, the researchers said.

“Many parts of the country face high and rising infection rates, [and] we should not think about work exposure and health risks in isolation, given that workers and persons at increased risk often live in the same households,” study co-author Thomas M. Selden told UPI.

“Insofar as we can reduce the prevalence of COVID-19 in our communities, we can reduce the extent to which policymakers have to choose between the economy and keeping the population safe,” said Selden, an economist with the U.S. Department of Health and Human Services’ Agency for Healthcare Research and Quality.

Since the COVID-19 pandemic spread to the United States in March, states and cities across the country have instituted lockdown measures designed to limit the spread of the disease.

Many of these measures entailed closing schools and non-essential businesses, with only banks, grocery stores, pharmacies and other businesses deemed to provide vital services allowed to stay open.

For this study, Selden and his colleagues analyzed data on the U.S. workforce to examine how many people were in essential jobs, how often they were able to work at home, their risk for severe COVID-19 and the potential health risks for their household members.

Of the more than 157 million workers across the country, 72% are in jobs deemed essential — based on U.S. Department of Homeland Security criteria — and more than three-fourths of all essential workers are unable to work at home, Selden said.

Essential workers include those in the medical and healthcare, telecommunications, information technology systems, defense, food and agriculture, transportation and logistics and energy, water and wastewater industries, as well as those in law enforcement and public works, the DHS criteria stipulates.

The study notes that up to 60% of these workers have underlying health issues, placing them at increased risk for severe COVID-19 if they get infected, as defined by U.S. Centers for Disease Control and Prevention guidelines.

Those with diabetes, heart disease, high blood pressure and chronic respiratory conditions like asthma are considered to be at high risk for serious illness, the CDC says.

Based on these findings, between roughly 57 million and 74 million adults working in on-site essential jobs — and their families — are at increased risk for serious illness, Selden and his colleagues estimated.

“Policymakers face important decisions about how to balance the economic benefits of keeping workers employed and the public health benefits of protecting those with increased risk of severe COVID-19,” Selden said.

“These issues arise in the context of decisions to close segments of the economy and decisions about how to distribute vaccines, which will initially be available only with limited supply, [and] become all the more difficult when the prevalence of infection rises in parts of the country,” he said.

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Study: Hydroxychloroquine no better than placebo for hospitalized COVID-19 patients



Nov. 9 (UPI) — COVID-19 patients treated with hydroxychloroquine showed no signs of significant improvement in “clinical status” compared with those given a placebo, a study published Monday by JAMA found.

Patients given a five-day course of the drug were scored as “category six” based on the World Health Organization’s seven-category COVID Ordinal Outcomes Scale, the same as those given a placebo, the researchers said.

Also, 28 days after they started treatment, 10.4% of those treated with hydroxychloroquine died, just slightly lower than the 10.6% fatality rate in the placebo group.

“The results show that hydroxychloroquine did not help patients recover from COVID-19,” study co-author Dr. Wesley H. Self told UPI.

“In the study, patients treated with hydroxychloroquine and those treated with a placebo had nearly identical outcomes, [so] I do not foresee any role for hydroxychloroquine in acutely ill patients hospitalized with COVID-19,” said Self, an infectious disease specialist at Vanderbilt University Medical Center.

Hydroxychloroquine is an immunosuppressive and anti-parasitic drug that is used to treat malaria.

Early in the COVID-19 pandemic, it was touted by President Donald Trump and others as a potential treatment for the virus, despite the lack of any scientific data supporting its use.

Given its effectiveness helping those sickened with malaria — a mosquito-borne infection — to recover, “there was a strong rationale for why hydroxychloroquine may have been beneficial for patients with COVID-19,” according to Self.

However, in July, the U.S. Food and Drug Administration warned against the drug’s use in the treatment of those infected with the new coronavirus, due to potentially serious heart-related side effects.

For this study, Self and his colleagues treated 433 COVID-19 patients at 34 hospitals across the United States with either the drug or a placebo for a period of five days.

Patients assigned to the hydroxychloroquine group received 400 milligrams of the drug in pill form twice a day for the first two doses and then 200 mg. in pill form twice a day for the next eight doses, for a total of 10 doses over the five days.

All of the patients were then assessed based on the WHO’s COVID Ordinal Outcomes Scale, which categorizes those infected according to disease severity.

Most of the patients in both the hydroxycholorquine group and the placebo group were in “category six,” meaning they were hospitalized and receiving extracorporeal membrane oxygenation or invasive mechanical ventilation to maintain their breathing, the researchers said.

“Our results, especially when combined from other studies conducted in the United Kingdom and Brazil, are good evidence that hydroxychloroquine does not provide benefit for patients hospitalized with COVID-19,” Self said.

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