Journal of Gerontological Nursing

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Abstract

Atrial fibrillation (AFib), the most common form of heart arrhythmia, is the subject of a white paper released from a diverse collaboration of health care leaders. The AF StatCall to Action for Atrial Fibrillation was developed to serve as a roadmap for reducing the burden of AFib in the United States. The document outlines critical issues surrounding the management of AFib and recommends priority actions in the areas of policy, management, education, and quality.

The report describes the burden of AFib on Medicare and offers strategies to enhance quality of care, improve patient outcomes, and reduce health care costs associated with the disease. The report was prepared and funded as an outcome of AF Stat, a first-of-its-kind, national initiative that aims to elevate understanding, diagnosis, and management of AFib among all those affected by this increasingly prevalent cardiovascular disease. Twenty-four organizations and individuals representing the advocacy, medical, government, professional, aging, caregiver, employer, payer, and cardiovascular sectors comprise AF Stat, and the recommendations presented in the AF Stat Call to Action were compiled through interviews and meetings with the group. The full report can be downloaded from http://www.afstat.com/AF_Stat_Publications/Call_To_Action.aspx.

The pharmacological aspects of treating AFib were recently documented in an Annals of Internal Medicine article, which found that warfarin (Coumadin®) therapy for patients with AFib appears to be most beneficial for the oldest patients, for those who have had a prior stroke, and for patients with multiple risk factors for stroke.

The study, conducted by Kaiser Permanente and Massachusetts General Hospital researchers as part of the ongoing ATRIA (AnTicoagulation and Risk Factors In Atrial Fibrillation) study, followed 13,559 adults with AFib treated within Kaiser Permanente of Northern California from 1996 to 2003. To evaluate the risks and benefits of warfarin treatment and give patients and physicians quantitative guidance in making therapeutic decisions, the researchers analyzed rates of the two most significant adverse events associated with warfarin therapy: ischemic stroke and intracranial hemorrhage. In patients who did and did not take warfarin, the investigators balanced the reduction in ischemic stroke attributable to treatment against the increase in intracranial bleeding associated with warfarin. Because intracranial hemorrhages usually have worse outcomes than ischemic strokes, bleeding events were given greater weight in the comparison.

While warfarin therapy benefited most AFib patients, the balance of benefits over risks was greatest in those at highest risk of stroke—those with multiple risk factors, those with a history of stroke, and the oldest patients. The benefits of treatment increased dramatically with age, with no clear benefit in the average patient younger than 65 but a reduction of more than two strokes per 100 patients in those age 85 and older.

Sources.“Health Leaders Issue Recommendations to Improve Management of a Common, Costly and Misunderstood Cardiovascular Disease: Atrial Fibrillation.” (2009, September 16). Retrieved October 6, 2009, from http://news.prnewswire.com/DisplayReleaseContent.aspx?ACCT=ind_focus.story&STORY=/www/story/09-16-2009/0005095092&EDATE=.“New Assessment Quantifies Risks and Benefits of Warfarin Treatment for Atrial Fibrillation.” (2009, August 31). Retrieved October 6, 2009, from http://news.prnewswire.com/DisplayReleaseContent.aspx?ACCT=104&STORY=/www/story/08-31-2009/0005085671&EDATE=.

A report in the Archives of Internal Medicine has found that older adults who continue or begin to do any amount of exercise appear to live longer and have a lower risk of disability. The Jerusalem-based study involved 1,861 individuals born in 1920 and 1921. Participants underwent assessments in their homes at ages 70, 78, and 85, during which they were asked about their physical activity levels. Those who performed less than 4 hours per week of physical activity were considered sedentary, while those who exercised approximately 4 hours weekly, performed vigorous activities such as jogging or swimming at least twice weekly, or who engaged in regular physical activity (e.g., walking at least an…

Atrial Fibrillation Highlighted in Report, Warfarin Study

Atrial fibrillation (AFib), the most common form of heart arrhythmia, is the subject of a white paper released from a diverse collaboration of health care leaders. The AF StatCall to Action for Atrial Fibrillation was developed to serve as a roadmap for reducing the burden of AFib in the United States. The document outlines critical issues surrounding the management of AFib and recommends priority actions in the areas of policy, management, education, and quality.

The report describes the burden of AFib on Medicare and offers strategies to enhance quality of care, improve patient outcomes, and reduce health care costs associated with the disease. The report was prepared and funded as an outcome of AF Stat, a first-of-its-kind, national initiative that aims to elevate understanding, diagnosis, and management of AFib among all those affected by this increasingly prevalent cardiovascular disease. Twenty-four organizations and individuals representing the advocacy, medical, government, professional, aging, caregiver, employer, payer, and cardiovascular sectors comprise AF Stat, and the recommendations presented in the AF Stat Call to Action were compiled through interviews and meetings with the group. The full report can be downloaded from http://www.afstat.com/AF_Stat_Publications/Call_To_Action.aspx.

The pharmacological aspects of treating AFib were recently documented in an Annals of Internal Medicine article, which found that warfarin (Coumadin®) therapy for patients with AFib appears to be most beneficial for the oldest patients, for those who have had a prior stroke, and for patients with multiple risk factors for stroke.

The study, conducted by Kaiser Permanente and Massachusetts General Hospital researchers as part of the ongoing ATRIA (AnTicoagulation and Risk Factors In Atrial Fibrillation) study, followed 13,559 adults with AFib treated within Kaiser Permanente of Northern California from 1996 to 2003. To evaluate the risks and benefits of warfarin treatment and give patients and physicians quantitative guidance in making therapeutic decisions, the researchers analyzed rates of the two most significant adverse events associated with warfarin therapy: ischemic stroke and intracranial hemorrhage. In patients who did and did not take warfarin, the investigators balanced the reduction in ischemic stroke attributable to treatment against the increase in intracranial bleeding associated with warfarin. Because intracranial hemorrhages usually have worse outcomes than ischemic strokes, bleeding events were given greater weight in the comparison.

While warfarin therapy benefited most AFib patients, the balance of benefits over risks was greatest in those at highest risk of stroke—those with multiple risk factors, those with a history of stroke, and the oldest patients. The benefits of treatment increased dramatically with age, with no clear benefit in the average patient younger than 65 but a reduction of more than two strokes per 100 patients in those age 85 and older.

Sources.“Health Leaders Issue Recommendations to Improve Management of a Common, Costly and Misunderstood Cardiovascular Disease: Atrial Fibrillation.” (2009, September 16). Retrieved October 6, 2009, from http://news.prnewswire.com/DisplayReleaseContent.aspx?ACCT=ind_focus.story&STORY=/www/story/09-16-2009/0005095092&EDATE=.“New Assessment Quantifies Risks and Benefits of Warfarin Treatment for Atrial Fibrillation.” (2009, August 31). Retrieved October 6, 2009, from http://news.prnewswire.com/DisplayReleaseContent.aspx?ACCT=104&STORY=/www/story/08-31-2009/0005085671&EDATE=.

Exercise into Older Age Promotes Longevity, Decreases Loneliness

A report in the Archives of Internal Medicine has found that older adults who continue or begin to do any amount of exercise appear to live longer and have a lower risk of disability. The Jerusalem-based study involved 1,861 individuals born in 1920 and 1921. Participants underwent assessments in their homes at ages 70, 78, and 85, during which they were asked about their physical activity levels. Those who performed less than 4 hours per week of physical activity were considered sedentary, while those who exercised approximately 4 hours weekly, performed vigorous activities such as jogging or swimming at least twice weekly, or who engaged in regular physical activity (e.g., walking at least an hour daily) were considered physically active.

The proportion of participants who were physically active was 53.4% at age 70, 76.9% at age 77, and 64% at age 85. When compared with those who were sedentary, individuals who were physically active:

  • Were 12% less likely to die between ages 70 and 78, 15% less likely to die between ages 78 and 85, and 17% less likely to die between ages 85 and 88.
  • Were more likely to remain independent and experienced fewer declines in their ability to perform daily tasks.
  • Reported fewer new instances of loneliness (12.2% versus 22.6% from ages 70 to 78 and 26.5% versus 44.1% from ages 78 to 85) and poor self-rated health (77.3% versus 63.3% from ages 70 to 78 and 63.8% versus 82.6% from ages 78 to 85).

The benefits associated with physical activity were observed not only in those who maintained an existing level of physical activity, but also in those who began exercising between ages 70 and 85.

Source.“Active Older Adults Live Longer, Have Better Functional Status.” (2009, September 10). Retrieved October 6, 2009, from http://www.newswise.com/articles/active-older-adults-live-longer-have-better-functional-status.

Waist-Hip Ratio More Effective than Bmi for Determining Obesity

Body mass index (BMI) may not be a reliable indicator of unhealthy weight levels in older adults—but waist size to hip size is, according to a study published in the Annals of Epidemiology. The study found that after age 70, BMI is a less effective determinant of obesity, as opposed to waist-hip ratio.

For women between ages 70 and 80, every 0.1 increase in the waist-hip ratio was associated with a 28% increase in mortality rate, the research team reported. Therefore, an older woman with 40-inch hips whose waist circumference rose from 32 to 36 inches would have a 28% greater chance of premature death. In older men, the researchers found that the death rate increased by 75% once waist size exceeded hip size. No such link was found between death and waist circumference alone or BMI.

Source.“Waist-Hip Ratio Good Gauge of Obesity in Elderly, Study Shows.” (2009, September 4). Retrieved October 6, 2009, from http://www.nlm.nih.gov/medlineplus/news/fullstory_89004.html.

Cognitive Decline and Socioeconomic Status not Linked

A study of older Americans age 70 and older (mean age = 75) published in the American Journal of Epidemiology has found that the most consistent predictors of faster declines in cognitive functioning were old age and being single, not socioeconomic status. The study was based on data from 6,476 adults born prior to 1924 culled from the Study of Assets and Health Dynamics Among the Oldest Old (AHEAD). Participants were tested five times between 1993 and 2002 on various memory and cognition items, including word recall, the “serial sevens” subtraction test, orientation to time, attention, language, and knowledge of current affairs.

The researchers found that rates of cognitive decline over the 9-year period were similar across socioeconomic and racial and ethnic groups. The findings indicate that disparities in cognitive functioning among older Americans of different groups are almost entirely due to differences in the cognitive peaks they reached earlier in life, not to differences in rates of decline. Evidence of a link between socioeconomic status and cognition was found only at baseline.

Demographic variation in rates of cognitive decline were found in older participants, who declined faster than younger ones, and in widows and widowers and those who never married, who declined faster than married individuals.

Source.“Study Finds No Link Between Cognitive Decline, Socioeconomic Status in Elderly.” (2009, August 6). Retrieved October 6, 2009, from http://newsroom.ucla.edu/portal/ucla/researchers-find-no-link-between-97788.aspx.

10.3928/00989134-20091014-02

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