Cardiovascular

The meta-analysis published today and an accompanying editorial should serve as a wake-up call for healthcare organizations about the costs of caring for aging populations that have spent much of their lives behind desks and watching TV.

The ACO and Emerging Healthcare Delivery Coalition, an initiative of The American Journal of Managed Care, held its most recent WebEx session this week. Participants discussed new strategies and technologies that both employers and healthcare organizations can use to get patients to take ownership over their own care.

Patients with serious mental illness die 15 to 20 years earlier than those with similar cardiovascular conditions. According to Joseph P. McEvoy, MD, of the Medical College of Georgia, "There's no mystery here." Cognitive deficits, issues, and lack of access can make it hard for these patients to get primary care, and to stick with the instructions they do receive. To help this group, Dr McEvoy believes psychiatrists can gain competency to treat hypertension, diabetes, obesity and to help these patients quit smoking.

This article provides an assessment of the downstream impact of coronary artery calcium scanning on the subsequent treatment patterns of non—high-risk patients.

Two recent policy announcements, one from Medicare and another from the US Preventive Services Task Force, signal a shift toward understanding that America's battle with obesity and diabetes is not only a medical but also a behavioral health problem, and must be treated as such.

Use of dual antiplatelet therapy was modest for patients with existing cardiovascular disease for whom subgroup analysis from a landmark clinical trial suggested benefit in preventing cardiovascular events, and low for patients with multiple risk factors without established cardiovascular disease, for whom increased cardiovascular events were suggested.

For patients with symptomatic severe (>70%) carotid stenosis carotid endarterectomy is highly effective at reducing the risk of subsequent stroke; however few eligible Veterans appear to be receiving this procedure.

Accountable care is forcing providers to develop new capacities and strategies for managing cost and quality trends. Prospectively managing the health of populations requires shifting the focus of care delivery from episodic interventions to continuous population management. As a result, accountable care organizations (ACOs) are dedicating considerable focus to developing the infrastructure and tools needed to help patients manage their chronic conditions. This is a significant departure from traditional care-delivery models and will require provider organizations to develop new partnerships and embrace new methods.

With spending on diagnostics alone for cardiovascular disease likely to be a major challenge for insurers amid the baby boom wave, Aetna is turning to an emerging option as part of a strategy to avoid invasive tests and treatments.

Two articles in Evidence-Based Diabetes Management examine the relationships among stress, diabetes and the brain, and the growing body of research into yoga's positive effects on reducing stress and improving health.