Do Heart Patients Get Too Many Cholesterol Tests?

Unnecessary screenings contribute to rising U.S. health costs, study suggests

By Steven Reinberg

HealthDay Reporter

MONDAY, July 1 (HealthDay News) -- Many U.S. heart patients may be getting their cholesterol levels checked unnecessarily, a new study suggests.

Statistics on more than 35,000 patients with coronary heart disease treated in a Houston-based Veterans Affairs network suggest this is an area of over-testing that's contributing to the nation's soaring medical costs, the study authors said.

At this one network of seven hospitals, the cost of redundant cholesterol blood tests amounted to more than $200,000 in one year, the study found.

"These results represent health care resource overuse and possibly their waste," said lead researcher Dr. Salim Virani, a cardiologist at the Michael E. DeBakey Veterans Affairs Medical Center in Houston.

The study, published online July 1 in JAMA Internal Medicine, zeroed in on almost 28,000 patients taking statin drugs that were keeping their cholesterol levels in check -- less than 100 milligrams of cholesterol per deciliter of blood.

Over 11 months, repeat tests were ordered for one-third of those patients even though their medication had not been increased, the researchers found.

In all, nearly 13,000 additional tests were performed at about $16 each, bringing the total cost for this one group of hospitals to almost $204,000.

"Apart from the costs associated with these lipid panels, this also carries with it the cost for the patient's time to undergo a repeat blood test and cost for the health care provider's time to follow up on these results after redundant testing and to inform the patient about these results," said Virani.

Most of those who underwent repeat testing had a history of diabetes, high blood pressure and more frequent doctor visits, the research team found. The extra tests likely gave some of these patients a measure of comfort, the study authors noted.

The study drew mixed reactions from other experts.

Current national guidelines recommend that patients with coronary heart disease have their cholesterol checked every four to six months, said Dr. Gregg Fonarow, professor of cardiology at the University of California, Los Angeles and a spokesman for the American Heart Association.

"This new study shows a pattern of lipid testing that is entirely consistent with current guidelines," he said. "Whether less frequent testing and monitoring would result in similar outcomes at lower cost requires more study."

Using statin therapy to achieve and maintain appropriate LDL cholesterol levels remains one of the most cost-effective therapies for preventing recurrent cardiovascular events in men and women with coronary heart disease, he said.

Dr. Joseph Drozda Jr., author of an accompanying journal editorial, said that "seemingly inexpensive tests" really add up when done in large numbers.

"These cholesterol tests were being ordered with no benefit to the patient but cost the VA more than $200,000, and this was only in seven hospitals," said Drozda, from the Center for Innovative Care at Mercy Health in Chesterfield, Mo.

Drozda thinks this is just one example of the overuse of tests. "Most physicians will tell you this is not uncommon. A lot of tests are ordered without direct benefit to the patient and result in this kind of waste," he said.

"We need to be looking for all of these sources of waste and addressing them," he added.

About one of every six adult Americans has high blood cholesterol, putting them at risk of heart disease, according to the U.S. Centers for Disease Control and Prevention.

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Half of People With Hepatitis C Don't Complete Needed Tests: CDC

TUESDAY, May 7 (HealthDay News) -- Only about half of Americans who are infected with hepatitis C undergo follow-up testing to determine if they are still infected, federal officials reported Tuesday.

"Many people who test positive on an initial hepatitis C test are not receiving the necessary follow-up test to know if their body has cleared the virus or if they are still infected," Dr. Tom Frieden, director of the U.S. Centers for Disease Control and Prevention, said in an agency news release.

"Complete testing is critical to ensure that those who are infected receive the care and treatment for hepatitis C that they need in order to prevent liver cancer and other serious and potentially deadly health consequences," Frieden said.

A blood test, called an antibody test, is used to check if a person has ever been infected with hepatitis C. For people who have had a positive result, a follow-up test -- called an RNA test -- can determine if they are still infected so they can receive necessary care and treatment.

Some people's bodies can clear hepatitis C infection on their own, but about 80 percent of people with hepatitis C remain infected and can develop major health problems.

In this study, researchers analyzed data from eight regions across the United States. Only 51 percent of the hepatitis C patients reported in these regions had a follow-up test, according to the Vital Signs report from the CDC.

"Hepatitis C has few noticeable symptoms, and left undiagnosed it threatens the health of far too many Americans -- especially baby boomers," Dr. John Ward, director of the CDC's Division of Viral Hepatitis, said in the news release. "Identifying those who are currently infected is important because new effective treatments can cure the infection better than ever before, as well as eliminate the risk of transmission to others."

About 3 million Americans are infected with hepatitis C, and as many as 75 percent do not know they are infected. The study found that 67 percent of all reported cases of current hepatitis C infection were among baby boomers, which includes people born from 1945 through 1965.

All people born in the United States during those years should be tested for hepatitis C, the CDC advised. The agency also recommended testing for other people at increased risk, including injection-drug users and people who received blood transfusions or organ transplants before widespread screening of the blood supply began in 1992.

May is Hepatitis Awareness Month, and May 19 is National Hepatitis Testing Day.

-- Robert Preidt
Copyright © 2013 HealthDay. All rights reserved. SOURCE: U.S. Centers for Disease Control and Prevention, news release, May 7, 2013

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Blood Tests May Predict COPD Flare-Ups

Signs of chronic inflammation in the blood linked to faster deterioration of lung function

By Brenda Goodman

HealthDay Reporter

TUESDAY, June 11 (HealthDay News) -- People with chronic obstructive pulmonary disease (COPD) who have signs of chronic inflammation in their blood are more likely to have flare-ups of the lung disease than those who do not, a large new study shows.

In addition to the slow, steady deterioration in lung function caused by COPD, patients can have sudden, distressing flare-ups. These so-called "exacerbations" are periods of worsening breathing problems that are typically triggered by infections or air pollution.

Patients who experience frequent flare-ups decline more quickly than those who do not; they also tend to have worse quality of life and poorer survival rates than those whose conditions are more stable, according to background information in the study.

Preventing flare-ups is a major goal of COPD treatment, but these episodes can be difficult to predict.

In a study of more than 61,000 people in Denmark, researchers found that COPD patients who had increased levels of certain proteins and cells in their blood were at greater risk for frequent flare-ups.

These particular proteins and cells -- C-reactive protein, fibrinogen and leukocytes -- increase in response to infections, tissue damage and inflammation.

People with higher levels of all three of these "markers" were more likely to experience frequent flare-ups than those with normal levels. That was true regardless of the stage or severity of their COPD.

But the risk was especially pronounced for patients in the study with the worst breathing problems. Among patients who had the highest grade of COPD symptoms, 24 percent with no elevated markers had frequent flare-ups compared to 62 percent of those who had high levels of all three markers.

Patients with frequent exacerbations had two or more flare-ups each year they were followed for the study.

The study is published in the June 12 issue of the Journal of the American Medical Association.

According to Dr. Elizabeth Regan, who is studying the genetics of COPD at National Jewish Health in Denver, the researchers "give compelling evidence that those are useful tests." Regan was not involved with the study.

"These are tests that are readily available. The practicing physician kind of has them at their fingertips. They're not unusual, they're not high-risk," said Regan. "If I were seeing patients, I'd be strongly attracted to doing it."

The price of each test varies, but in general, they're inexpensive, ranging between $10 and $40. Insurance often covers the cost. The only trouble with doing the tests now, Regan said, is that doctors still don't know exactly how to use the information.

"While these tests look like they're strong predictors, we don't have the next piece of this clearly in place," she noted.

The study wasn't able to prove that inflammation causes COPD exacerbations, or that lowering inflammation with medications could head off future flare-ups, Regan explained.

Other studies currently underway are testing whether antibiotics or newer medications can prevent such attacks, she noted.

Until more is known, the researchers say there is still one good reason for COPD patients to get the blood tests.

"Many patients with COPD aren't very adherent to their inhalation medication. Patients don't like to be sick, so they think 'it's doing well now, so let me stop,'" said study author Dr. Borge Nordestgaard, a clinical professor in the department of diagnostic sciences at the University of Copenhagen in Denmark.

"But if you're one of these patients with high biomarkers, then you should be even better at taking your daily inhalation medication," he said. "That's the best advice at present."

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Word Tests May Predict Gains for Kids With Autism

Toddlers' brain responses corresponded with later language, thinking and self-care skills

By Mary Elizabeth Dallas

HealthDay Reporter

WEDNESDAY, May 29 (HealthDay News) -- Early brain responses to words may help predict future abilities in children with autism, a new study suggests.

"We showed that a simple measure of how the brain responds to a familiar word taken at 2 years of age was a strong predictor of children's language, social and cognitive abilities ... at 6 years of age," said study co-author Geraldine Dawson, chief science officer at the advocacy group Autism Speaks.

Autism is a neurodevelopmental disorder characterized by impaired communication, difficulty with social interactions and repetitive behaviors. The U.S. Centers for Disease Control and Prevention estimates that one in 88 U.S. children has some form of autism, which can range from mild to severe.

"In this study, we were interested in understanding why some children with autism make rapid progress whereas others progress more slowly," Dawson said. "For example, many children with autism are able to develop spoken language, whereas about 20 percent to 30 percent remain minimally verbal or nonverbal.

"Recent studies have shown that nonverbal children can be helped to develop spoken language if they are given special alternative devices -- such as an iPad or other speech-generating device -- as part of their early intervention program," Dawson added. "But we don't know how to identify which children are likely to need extra help."

The study, published May 29 in the journal PLoS ONE, involved 44 children, all of whom were 2 years old. Twenty-four had autism and 20 did not. The children were asked to listen to a mix of familiar and unfamiliar words while wearing sensors, which measured their brain responses.

The children with autism were divided into two groups based on the level of their social impairment. The brain responses of the children with autism with milder symptoms were similar to the brain responses of the children who did not have autism, the researchers found. These children had a strong response to known words in a specific area of the left side of the brain called the temporal parietal region, which is responsible for language.

This suggests that children with less severe symptoms can process words in much the same way as typically developing children, the study authors said.

Children with more severe social impairments, however, showed brain responses more broadly over the right hemisphere. The researchers said this is not usually seen in healthy children of any age.

The children's language skills, thinking abilities and social and emotional development also were assessed at age 2 and again at ages 4 and 6.

Over time and with intensive treatment, the children with autism improved on the behavioral tests, but individual gains varied widely, the researchers found. The more the autistic children's brain responses resembled those of typically developing children, the greater the improvement in their skills by age 6.

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Medical Groups Warn About Unnecessary Tests

Dozens of types of tests and treatments are too often recommended by doctors when patients don't need them, according to a warning issued Thursday by a coalition of leading medical groups in the United States.

This unnecessary care wastes time and money and sometimes causes harm to patients, according to the organizations that represent more than 350,000 doctors, the Associated Press reported.

The Choosing Wisely Coalition said patients need to ask their doctors, "Do I really need that?". The coalition was formed by the American Board of Internal Medicine Foundation.

Too many people "think that more is better, that more treatment, more testing somehow results in better health care," Dr. Glen Stream, former president of the American Academy of Family Physicians, told the AP. "That really is not true."

The academy contributed to this year's list of 90 examples of potentially needless care, which adds to 45 examples included on last year's list. Among the newly-added warnings:

Don't screen for a clogged neck artery in healthy people with no stroke signs. It could lead to risky surgery for a blockage that would cause no harm.Don't try feeding tubes in people with advanced dementia. Helping them eat is a better approach.Don't routinely give heartburn medicine to infants with reflux. This treatment hasn't been proven effective in babies and could cause side effects.Don't prescribe opioid painkillers for migraines except as a last resort. Opioids can carry the risk of addiction and can actually worsen migraines. Instead, use more migraine-specific drugs.Don't induce labor if a pregnant woman misses her due date and both mother and baby are doing fine.

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Multiple Tests Needed to Spot Infections in Newborns: Study

Title: Multiple Tests Needed to Spot Infections in Newborns: Study
Category: Health News
Created: 2/20/2013 6:36:00 PM
Last Editorial Review: 2/21/2013 12:00:00 AM

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Which Cancer Tests Do You Really Need?

Feb. 1, 2013 -- Not all cancer screening tests are helpful, and some are potentially harmful, according to a new Consumer Reports rating.

In the new report, Consumer Reports recommends only three of 11 common cancer screening tests, and then only for certain age groups.

Screenings for cervical, colon, and breast cancer are recommended.

Screenings for cancers affecting the bladder, lungs, skin, mouth, prostate, ovaries, pancreas, and testicles are not.

"The science of prevention and screening has changed," says John Santa, MD, MPH, director of the Consumer Reports Health Ratings Center. He oversaw the project.

"Consumers need to know that some screening tests are terrific, some are not good, and some can harm you," Santa says.

"We are not talking about people at high risk," he says. "And of course they are not symptomatic. We're not talking about what you should do if you have a mole that is changing or if you feel a breast lump."

The full report is in the March issue of Consumer Reports.

To develop the ratings, Santa and his team looked at medical research, consulted medical experts, surveyed more than 10,000 readers, and talked with patients about screening tests.

They looked closely at recommendations of the U.S. Preventive Services Task Force. This independent panel provides guidelines on health care based on evidence. Much of Consumer Reports' recommendations follow the task force guidelines to the letter.  But, their recommendations sometimes differ from those of organizations such as the American Cancer Society (ACS). Here, details on the three recommended tests:

Cervical cancer . Women 21 to 30 should have a Pap smear to test for cervical cancer every three years. Women 30 to 65 can wait five years if they have had testing for human papillomavirus (HPV), the virus that causes the cancer. Those 65-plus can skip screening if they were screened regularly earlier. Those under 21 can also skip the test, as experts know the cancer is not common at those ages. Colon cancer. Those 50 to 75 should get screened regularly, and older people should discuss the pros and cons with their doctor and decide. Options include a colonoscopy, which examines the entire colon, every 10 years, or a sigmoidoscopy, which looks at the lower third, every five years plus a stool test every three years, or an annual stool test. As far as other guidelines, no groups suggest screening younger than 50 unless high risk. The ACS also doesn't say to specifically stop at age 75.Breast cancer. Women 50 to 75 need a mammogram every two years. Those 40 to 49 or 75 andolder should talk with their doctor about pros and cons. These guidelines do split with those of the ACS, though. The cancer society recommends yearly mammograms after age 40 and as long as healthy.

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Pap Tests Often Given When Not Needed

Dec. 3, 2012 -- Against clinical guidelines, many women are still getting Pap smears (a test that’s meant to find cancer of the cervix) even after they've had a total hysterectomy, which removes the uterus and cervix, according to a new government report.

The cervix is the “neck-like” lower part of the uterus. A Pap test uses cells scraped from the cervix to check for early changes that may indicate cervical cancer or precancer. The new report, from the CDC, looked at trends in Pap testing in U.S. women from 2000 to 2010.

In telephone surveys of thousands of women, about 60% of those over age 30 who said they’d had a hysterectomy also reported having a recent Pap smear in 2010.

Even though that number was down about 15 percentage points since 2000, researchers said it was still too high.

“Some of these women would need continued screening, for various reasons, but that’s a small percentage,” says researcher Meg Watson, MPH, an epidemiologist with the CDC’s Division of Cancer Prevention and Control. “We wouldn’t think it would be 60%.”

A hysterectomy is an operation that removes all or part of the uterus. The most common kind of hysterectomy is a total hysterectomy, or an operation that removes both uterus and cervix.

Even after the cervix has been removed, doctors can scrape cells from an area called the vaginal cuff. And in the past, Watson says, many doctors continued to perform the test even after a total hysterectomy to check for signs of vaginal cancers.

“But vaginal cancer rates are quite low,” Watson says, and subsequent studies have shown that using Pap smears to find vaginal cancers isn’t an effective strategy.

Experts who were not involved in the research agree.

“It doesn’t really make a lot of sense,” says Virginia Moyer, MD, MPH, a pediatrician and chair of the U.S. Preventive Services Task Force, a panel of expert advisors that makes recommendations about tests and treatments that are meant to prevent disease.

Last year, the panel said most healthy women only need Pap smears every three years, and it advised women who’d had total hysterectomies for reasons other than cancer to skip the test altogether.

The American College of Obstetricians and Gynecologists and the American Cancer Society also recommended against routine Pap smears after a total hysterectomy.

“The only thing I can sort of speculate is that people get in the habit of doing them and just keep doing them without really thinking about it, which is regrettable,” Moyer says.

The Pap test is one of the great success stories in medicine. Before it was introduced, in the 1950s, cervical cancer was a leading cause of cancer death in women. The test is credited with helping cut the rates of cervical cancer deaths by 60% between 1955 and 1992.

But like many cancer screening tests, Pap tests can be harmful as well as helpful.  

Watson says studies have shown that for every 100 abnormal Pap tests, only one woman will actually turn out to have cervical cancer. But all 100 women would need additional testing and sometimes invasive procedures to rule out cancer. That can cause significant anxiety and stress.

In cases where a woman has her cervix or uterus removed after cervical cancer, she would need to continue to get a regular Pap smear to check for cancer recurrence, Watson says.

But about 90% of hysterectomies are performed for non-cancerous conditions, like uterine fibroids.

“Obviously the large majority of that group would be people who had an unnecessary Pap smear,” Moyer says.

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