Newscast: Lead Story - Asthma and Minorities
Rand: Welcome to Healthcare 411 for the week of November 7, 2007
Debra: Healthcare 411 is produced by AHRQ, the Agency for Healthcare Research and Quality, part of the U.S. Department of Health and Human Services. I’m Debra James.
Rand: And I’m Rand Gardner.
Debra: Coming up:
Rand: This week’s News and Numbers finds that deaths following hospitalization have declined
Debra: A new review compared coronary bypass surgery with angioplasty
Rand: And our Navigating the Health Care System segment is on asthma and minorities. More after this.
[Begin PSA: Questions to Ask Before Surgery]
Narrator: Every year more than 15 million Americans have surgery. Most operations are not emergencies, which means that you’ll have time to learn about your operation and make certain it’s the best treatment for you. And you’ll have time to work with your surgeon to help make the surgery as safe as possible. Be active in your health care to ensure you receive quality care. To find out more about important questions to ask before surgery, visit ahrq.gov/consumer. A message from the U.S. Agency for Healthcare Research and Quality.
Rand: A new report from AHRQ finds fewer people are dying in hospitals during treatment for serious conditions like heart attacks and major surgeries like heart bypass. The data compare inpatient death rates from 1994 to 2004 for people hospitalized for heart attacks, congestive heart failure, strokes, pneumonia, gastrointestinal bleeding, and hip fractures. Researchers estimate about 136,000 more people survive these conditions now than a decade ago especially those who’ve suffered a heart attack. The report found that for every 1,000 patients admitted for a heart attack, 43 more people survived. For congestive heart failure, pneumonia and stroke, 30 additional inpatients survived each condition. The report also reviewed trends for surgical patients and found inpatient surgical deaths also are declining. For example, between 1994 and 2004, the study found that for every 1,000 operations, deaths from heart bypass surgery decreased from 48 to 28 and deaths from repairing an abdominal aortic aneurysm decreased from 103 to 74. These data are from AHRQ’s Healthcare Cost and Utilization Project.
Debra: Coronary artery disease is the leading cause of death for both men and women. For some of the 15 million Americans affected by this condition, choosing the right treatment is a challenge. But an AHRQ-funded review provides new information about options. Dr. Art Sedrakyan, a health services researcher with AHRQ and a trained cardiac-thoracic surgeon, is with us to discuss the review.
Debra: Dr. Sedrakyan, please tell us about the review’s key findings.
Dr. Sedrakyan: The review found that among patients who needed any intervention, bypass surgery offered important advantages over balloon angioplasty that is performed with or without a stent. With bypass surgery, patients are more likely to get relief from angina, which is a type of chest pain, and less likely to need repeat procedures.
Debra: Are these differences significant?
Dr. Sedrakyan: Only about 4 percent of patients who have bypass surgery need to undergo a repeat procedure within one year of the first procedure. After five years, about 10 percent of those who opted for bypass need a repeat procedure. However, the need is significantly higher among patients who choose angioplasty. After a year, 24 percent will need a repeat procedure. After five years, over 33 percent will need a repeat procedure if they opt for angioplasty.
Debra: What about the chest pain relief?
Dr. Sedrakyan: Patients who chose bypass surgery over angioplasty reported much larger improvements in their angina pain. About 84 percent of patients who have bypass surgery reported that they were free of angina one year after their procedures. Only 75 percent of patients who chose angioplasty reported that they were angina free at one year.
Debra: Do the review’s findings apply to all coronary disease patients?
Dr. Sedrakyan: No, the result of this review applied to only patients without extensive coronary disease. There is a general agreement among clinicians that for extensive coronary disease, bypass surgery offers not only superior relief of angina pain and reduced need for repeat surgery but also offers survival advantages.
Debra: Did the study have any findings regarding survival rates?
Dr. Sedrakyan: Our review suggested that bypass surgery and angioplasty patients actually have about the same survival rate when the disease is not extensive. The odds of surviving either procedure are high. More than 90 percent of patients survive beyond 30 days for both bypass surgery and angioplasty. About 96% of patients live at least one year following both procedures and 90 percent live five years or more. However, more research is needed to establish if surgery can offer survival advantages in this group of patients as well.
Debra: So is this review saying bypass surgery is the better treatment choice?
Dr. Sedrakyan: No, patients need to weigh the benefits and the risk of any treatment choice. For instance, our review found that patients who chose bypass surgery had a slightly higher chance of experiencing a stroke within thirty days of procedure. Patients need to talk to their health care providers and see what option is the best for them.
Debra: Thanks for being here today.
Dr. Sedrakyan: My pleasure.
Debra: Dr. Sedrakyan is a researcher with AHRQ’s Effective Health Care program. The report is called Comparative Effectiveness of Percutaneous Coronary Interventions and Coronary Artery Bypass Grafting for Coronary Artery Disease and can be found at effectivehealthcare.ahrq.gov. A summary of the review also posted in the Oct. 15th online version of "Annals of Internal Medicine."
Rand: Coming up: Navigating the Health Care System with Dr. Clancy.
Rand: Asthma is one of the most common chronic medical conditions in the United States. It affects an estimated 1 in 15 Americans approximately 14 million adults and 6 million children and results in two million visits to emergency rooms each year. But asthma doesn’t affect all groups equally. It is far more common among minorities and people with low incomes. Rates of asthma attacks among blacks, for example, are 30 percent higher than among whites. Blacks also are more likely to die from asthma and related complications. With us today to talk about asthma and how to manage it is AHRQ Director Dr. Carolyn Clancy. Welcome, Dr. Clancy. First, please explain, what is asthma?
Dr. Clancy: Asthma is a chronic lung condition that intermittently impairs normal breathing. In fact, a severe asthma attack can cause death. In general, asthma can’t be cured, although some children grow out of it, but the good news is that asthma can be managed, and it can be managed by keeping a close eye on symptoms and using medication to control and prevent those symptoms.
Rand: Didn’t research from AHRQ find that some minority groups are more at risk for asthma?
Dr. Clancy: For the past five years, AHRQ’s National Healthcare Disparities Report has confirmed that blacks, Hispanics and lower income people have poorer quality and worse access to care than whites for many conditions. So this includes access to asthma care and sufficient patient education about managing the condition. In general, Hispanic children are 63 percent more likely than white children to be hospitalized for asthma. And, within the Hispanic community, Puerto Ricans are 80 percent more likely than whites to have asthma. Blacks, on the other hands, are three times as likely to be hospitalized for asthma, and twice as likely to die from asthma as are whites. Similarly, black children have a higher rate of hospitalization for asthma, three times that of white children, and they’re a third less likely than white children to be using daily inhaled anti-inflammatory medications to help control their asthma. Even more alarming, Hispanic children are two-thirds less likely than white children to be using daily medications.
Rand: Do we know why these numbers are so disproportionate?
Dr. Clancy: Blacks are 35 percent more likely than Whites to report communication problems with their and their children’s health care providers. Also, minority groups who live in inner cities have much higher asthma rates than other groups. For example, in East Harlem, New York, has one of the highest asthma hospitalization rates in the country, with a death rate that is a staggering ten times higher than the national average. Especially for people living in inner cities, exposure to such allergic triggers as cockroaches or poor air quality is a major risk factor for developing asthma.
Rand: For people with asthma, what should they be doing to manage the condition?
Dr. Clancy: It’s very important to know that there’s a number of things that people with asthma can do to minimize its effects on their daily lives and minimize the chance that they’ll have to go to the emergency room or be hospitalized. If you have asthma, you need to work with your doctor to create an asthma management plan. You need to eliminate, or at least decrease, your exposure to things that trigger an asthma attack. For some people, that will mean that your entire household has to work together to reduce your exposure, and you need to take your medications properly and as directed even when you’re not having trouble breathing. The bottom line here for asthma and many other conditions is you need to be active in your own health care. Asthma can be managed. It can be managed successfully, but you need to be part of the health care team and follow your management plan.
Rand: Dr. Clancy, thank you for being here.
Dr. Clancy: My pleasure.
Rand: To hear more from this interview with Dr. Clancy on asthma, please go to healthcare411.ahrq.gov.
Debra: That’s it for the week. For more information on these and other health-related stories and topics go to www.ahrq.gov. Healthcare 411 is produced by AHRQ, the Agency for Healthcare Research and Quality, part of the U.S. Department of Health and Human Services. For Rand Gardner, I’m Debra James. Please join us for the next edition of Healthcare 411.