Kathryn Doyle

(Reuters Health) - Older people who break a bone are often receiving medications that can increase the risk of a fracture - and even after a fracture, less than 10 percent of them stop taking those drugs, according to a new study.

"One would expect that a significant health event like a fracture would result in some change in the use of prescription drugs that might have contributed to that event," said lead author Dr. Jeffrey C. Munson of the Geisel School of Medicine at Dartmouth in Lebanon, New Hampshire. "In contrast to this expectation, we observed that for the overwhelming majority of patients we studied, a fragility fracture did not lead to any change in medications that have been linked to fracture risk."

The authors used data on 168,000 Medicare beneficiaries, more than 80 percent of whom were women, on average age 80, who had experienced a hip, shoulder or wrist fracture. They compared these records with retail pharmacy claims to identify which patients had been taking medicines that increase the risk of a fall, decrease bone density or are otherwise tied to an increased risk of fracture.

About 75 percent of fracture patients had been taking one of these medications. While seven percent of people stopped taking the medication after their fracture, a similar number started to take a new medication also tied to fracture risk, the authors reported in JAMA Internal Medicine, online August 22.

"Some drugs affect balance and memory, like the sleeping pills, which can lead to a fall," said Dr. Sarah D. Berry of the Institute for Aging Research at Hebrew SeniorLife in Boston, Massachusetts, who coauthored a linked editorial.

Blood pressure medications cause changes in blood pressure that could lead to a fall. Other drugs, like prednisone or medications for heartburn, increase bone loss which can lead to a fracture, Berry told Reuters Health by email.

"Fractures are the leading cause of death from injury and one of the main reasons for nursing home placement in persons over the age of 65," she said.

"When a patient has a hip, shoulder or wrist fracture, it is important for healthcare providers to examine all the prescription medications he or she is taking, and carefully assess whether there is an opportunity to eliminate those that might cause a future fracture," Munson told Reuters Health by email.

However, he said, "In many cases, the benefits of a drug may outweigh its risks, even when those risks are significant."

Which drugs can be stopped will vary from case to case, Munson noted.

"For many of the drugs we studied, there are alternative drugs that treat the same conditions but with a lower risk of fracture," he said. "In other cases, it may be possible to eliminate a drug altogether."

SOURCE: http://bit.ly/2bc6PIN

JAMA Intern Med 2016.

(c) Copyright Thomson Reuters 2016.

(Reuters Health) - Older people who break a bone are often receiving medications that can increase the risk of a fracture - and even after a fracture, less than 10 percent of them stop taking those drugs, according to a new study.

"One would expect that a significant health event like a fracture would result in some change in the use of prescription drugs that might have contributed to that event," said lead author Dr. Jeffrey C. Munson of the Geisel School of Medicine at Dartmouth in Lebanon, New Hampshire. "In contrast to this expectation, we observed that for the overwhelming majority of patients we studied, a fragility fracture did not lead to any change in medications that have been linked to fracture risk."

The authors used data on 168,000 Medicare beneficiaries, more than 80 percent of whom were women, on average age 80, who had experienced a hip, shoulder or wrist fracture. They compared these records with retail pharmacy claims to identify which patients had been taking medicines that increase the risk of a fall, decrease bone density or are otherwise tied to an increased risk of fracture.

About 75 percent of fracture patients had been taking one of these medications. While seven percent of people stopped taking the medication after their fracture, a similar number started to take a new medication also tied to fracture risk, the authors reported in JAMA Internal Medicine, online August 22.

"Some drugs affect balance and memory, like the sleeping pills, which can lead to a fall," said Dr. Sarah D. Berry of the Institute for Aging Research at Hebrew SeniorLife in Boston, Massachusetts, who coauthored a linked editorial.

Blood pressure medications cause changes in blood pressure that could lead to a fall. Other drugs, like prednisone or medications for heartburn, increase bone loss which can lead to a fracture, Berry told Reuters Health by email.

"Fractures are the leading cause of death from injury and one of the main reasons for nursing home placement in persons over the age of 65," she said.

"When a patient has a hip, shoulder or wrist fracture, it is important for healthcare providers to examine all the prescription medications he or she is taking, and carefully assess whether there is an opportunity to eliminate those that might cause a future fracture," Munson told Reuters Health by email.

However, he said, "In many cases, the benefits of a drug may outweigh its risks, even when those risks are significant."

Which drugs can be stopped will vary from case to case, Munson noted.

"For many of the drugs we studied, there are alternative drugs that treat the same conditions but with a lower risk of fracture," he said. "In other cases, it may be possible to eliminate a drug altogether."

SOURCE: http://bit.ly/2bc6PIN

JAMA Intern Med 2016.

(c) Copyright Thomson Reuters 2016.

(Reuters Health) - Older people who break a bone are often receiving medications that can increase the risk of a fracture - and even after a fracture, less than 10 percent of them stop taking those drugs, according to a new study.

"One would expect that a significant health event like a fracture would result in some change in the use of prescription drugs that might have contributed to that event," said lead author Dr. Jeffrey C. Munson of the Geisel School of Medicine at Dartmouth in Lebanon, New Hampshire. "In contrast to this expectation, we observed that for the overwhelming majority of patients we studied, a fragility fracture did not lead to any change in medications that have been linked to fracture risk."

The authors used data on 168,000 Medicare beneficiaries, more than 80 percent of whom were women, on average age 80, who had experienced a hip, shoulder or wrist fracture. They compared these records with retail pharmacy claims to identify which patients had been taking medicines that increase the risk of a fall, decrease bone density or are otherwise tied to an increased risk of fracture.

About 75 percent of fracture patients had been taking one of these medications. While seven percent of people stopped taking the medication after their fracture, a similar number started to take a new medication also tied to fracture risk, the authors reported in JAMA Internal Medicine, online August 22.

"Some drugs affect balance and memory, like the sleeping pills, which can lead to a fall," said Dr. Sarah D. Berry of the Institute for Aging Research at Hebrew SeniorLife in Boston, Massachusetts, who coauthored a linked editorial.

Blood pressure medications cause changes in blood pressure that could lead to a fall. Other drugs, like prednisone or medications for heartburn, increase bone loss which can lead to a fracture, Berry told Reuters Health by email.

"Fractures are the leading cause of death from injury and one of the main reasons for nursing home placement in persons over the age of 65," she said.

"When a patient has a hip, shoulder or wrist fracture, it is important for healthcare providers to examine all the prescription medications he or she is taking, and carefully assess whether there is an opportunity to eliminate those that might cause a future fracture," Munson told Reuters Health by email.

However, he said, "In many cases, the benefits of a drug may outweigh its risks, even when those risks are significant."

Which drugs can be stopped will vary from case to case, Munson noted.

"For many of the drugs we studied, there are alternative drugs that treat the same conditions but with a lower risk of fracture," he said. "In other cases, it may be possible to eliminate a drug altogether."

SOURCE: http://bit.ly/2bc6PIN

JAMA Intern Med 2016.

(c) Copyright Thomson Reuters 2016.

(Reuters Health) - Patients in the emergency room who don't speak English well are slightly more likely to return within days, suggesting their care the first time was not as good as it could have been, researchers say.

In a study in one New York hospital, about 4 percent of English speakers made an unplanned return to the ER within three days, compared to 5 percent of people with limited English.

Low use of professional translators may partly explain the disparity in care, the researchers report in the Annals of Emergency Medicine.

"There's a necessary but not sufficient step to providing care for people with low English proficiency . . . having a good interpreter or healthcare provider who can speak to them in their language," said Dr. Elizabeth Jacobs of the University of Wisconsin-Madison, who was not part of the new study.

The study team, led by Dr. Ka Ming Ngai of the Icahn School of Medicine at Mount Sinai in New York, analyzed 2012 data from the Mount Sinai emergency department. More than 32,000 adult patients and 45,000 ER visits were included. The study did not include patients with psychiatric or substance-related

complaints, those who were nonverbal or had altered mental status, and those with a history of frequent ER visits.

Almost 3,000 patients had limited English proficiency, and in about half of cases someone served as an interpreter. Usually, this was a family member or an ER staff member. Only 527 visits in this group, 24 percent, involved a professional interpreter.

More than a quarter of patients were admitted to the hospital and 1,380 patients had an unplanned return to the ER within three days.

After accounting for age, sex, insurance, race, ethnicity, triage category and other health problems, having limited English proficiency was not tied to greater risk of being admitted to the hospital.

But those with limited English proficiency were about 24 percent more likely to return to the ER unexpectedly.

Ngai told Reuters Health by email that he has been studying the problem of language barriers for the past six years and over time has seen some improvements.

"New medical students are now routinely educated to use interpreter phones during their clinical simulation . . .however, there are still many barriers including access to interpreters and interpreter phones, time constraints, and (doctors) trying to 'get by' with their own language skills," he said.

Ngai said regulatory bodies require hospitals to make language services available. In New York State, for example, upon a request to the hospital administration by the patient, the patient's family or representative, or the provider of medical care, hospitals must provide translation services in inpatient and outpatient settings within 20 minutes and in emergency settings with 10 minutes.

Most New York Hospitals use an interpreter phone service, he said.

Patients who struggle to speak the local language are "a really important population to study and think about how we can improve their care," Jacobs said.

A 5 percent rather than 4 percent rate of return to the ER is not a large difference, but that could be due to the large number of patients excluded from the study, and because there was no validated measure of English proficiency, Jacobs said.

"That might be why we didn't see large differences, if some people considered low English proficiency actually spoke English well, or were getting good interpretive services," she said. "If you took them out, the difference might be larger."

Patients who do not speak English may struggle in other areas of the health system more than at the ER, she added.

But even having an interpreter at the hospital won't help patients deal with insurance providers, she noted.

"There are contextual issues that you may not be able to fully adequately address unless you can understand the nuances," Jacobs said.

"When dealing with immigrant population, it is almost always more than 'just' language," Ngai agreed. There can be cultural issues, too.

In addition, people with low English proficiency may also be less able to take days off of work, and to agree to be admitted to the hospital when necessary, than others, Jacobs said.

We've made tremendous progress in assuring interpreters are more available," in person, over the phone or by video, Jacobs said.

But, she said, "we are very imperfect at getting patients the services they need. It's important for providers to be educated on these issues and to understand how to access these services."

It would be ideal to try to match patients with providers by language and culture, but in the meantime, "language is a good start," Ngai said.

(Reuters Health) - Patients in the emergency room who don't speak English well are slightly more likely to return within days, suggesting their care the first time was not as good as it could have been, researchers say.

In a study in one New York hospital, about 4 percent of English speakers made an unplanned return to the ER within three days, compared to 5 percent of people with limited English.

Low use of professional translators may partly explain the disparity in care, the researchers report in the Annals of Emergency Medicine.

"There's a necessary but not sufficient step to providing care for people with low English proficiency . . . having a good interpreter or healthcare provider who can speak to them in their language," said Dr. Elizabeth Jacobs of the University of Wisconsin-Madison, who was not part of the new study.

The study team, led by Dr. Ka Ming Ngai of the Icahn School of Medicine at Mount Sinai in New York, analyzed 2012 data from the Mount Sinai emergency department. More than 32,000 adult patients and 45,000 ER visits were included. The study did not include patients with psychiatric or substance-related

complaints, those who were nonverbal or had altered mental status, and those with a history of frequent ER visits.

Almost 3,000 patients had limited English proficiency, and in about half of cases someone served as an interpreter. Usually, this was a family member or an ER staff member. Only 527 visits in this group, 24 percent, involved a professional interpreter.

More than a quarter of patients were admitted to the hospital and 1,380 patients had an unplanned return to the ER within three days.

After accounting for age, sex, insurance, race, ethnicity, triage category and other health problems, having limited English proficiency was not tied to greater risk of being admitted to the hospital.

But those with limited English proficiency were about 24 percent more likely to return to the ER unexpectedly.

Ngai told Reuters Health by email that he has been studying the problem of language barriers for the past six years and over time has seen some improvements.

"New medical students are now routinely educated to use interpreter phones during their clinical simulation . . .however, there are still many barriers including access to interpreters and interpreter phones, time constraints, and (doctors) trying to 'get by' with their own language skills," he said.

Ngai said regulatory bodies require hospitals to make language services available. In New York State, for example, upon a request to the hospital administration by the patient, the patient's family or representative, or the provider of medical care, hospitals must provide translation services in inpatient and outpatient settings within 20 minutes and in emergency settings with 10 minutes.

Most New York Hospitals use an interpreter phone service, he said.

Patients who struggle to speak the local language are "a really important population to study and think about how we can improve their care," Jacobs said.

A 5 percent rather than 4 percent rate of return to the ER is not a large difference, but that could be due to the large number of patients excluded from the study, and because there was no validated measure of English proficiency, Jacobs said.

"That might be why we didn't see large differences, if some people considered low English proficiency actually spoke English well, or were getting good interpretive services," she said. "If you took them out, the difference might be larger."

Patients who do not speak English may struggle in other areas of the health system more than at the ER, she added.

But even having an interpreter at the hospital won't help patients deal with insurance providers, she noted.

"There are contextual issues that you may not be able to fully adequately address unless you can understand the nuances," Jacobs said.

"When dealing with immigrant population, it is almost always more than 'just' language," Ngai agreed. There can be cultural issues, too.

In addition, people with low English proficiency may also be less able to take days off of work, and to agree to be admitted to the hospital when necessary, than others, Jacobs said.

We've made tremendous progress in assuring interpreters are more available," in person, over the phone or by video, Jacobs said.

But, she said, "we are very imperfect at getting patients the services they need. It's important for providers to be educated on these issues and to understand how to access these services."

It would be ideal to try to match patients with providers by language and culture, but in the meantime, "language is a good start," Ngai said.

(Reuters Health) - Patients in the emergency room who don't speak English well are slightly more likely to return within days, suggesting their care the first time was not as good as it could have been, researchers say.

In a study in one New York hospital, about 4 percent of English speakers made an unplanned return to the ER within three days, compared to 5 percent of people with limited English.

Low use of professional translators may partly explain the disparity in care, the researchers report in the Annals of Emergency Medicine.

"There's a necessary but not sufficient step to providing care for people with low English proficiency . . . having a good interpreter or healthcare provider who can speak to them in their language," said Dr. Elizabeth Jacobs of the University of Wisconsin-Madison, who was not part of the new study.

The study team, led by Dr. Ka Ming Ngai of the Icahn School of Medicine at Mount Sinai in New York, analyzed 2012 data from the Mount Sinai emergency department. More than 32,000 adult patients and 45,000 ER visits were included. The study did not include patients with psychiatric or substance-related

complaints, those who were nonverbal or had altered mental status, and those with a history of frequent ER visits.

Almost 3,000 patients had limited English proficiency, and in about half of cases someone served as an interpreter. Usually, this was a family member or an ER staff member. Only 527 visits in this group, 24 percent, involved a professional interpreter.

More than a quarter of patients were admitted to the hospital and 1,380 patients had an unplanned return to the ER within three days.

After accounting for age, sex, insurance, race, ethnicity, triage category and other health problems, having limited English proficiency was not tied to greater risk of being admitted to the hospital.

But those with limited English proficiency were about 24 percent more likely to return to the ER unexpectedly.

Ngai told Reuters Health by email that he has been studying the problem of language barriers for the past six years and over time has seen some improvements.

"New medical students are now routinely educated to use interpreter phones during their clinical simulation . . .however, there are still many barriers including access to interpreters and interpreter phones, time constraints, and (doctors) trying to 'get by' with their own language skills," he said.

Ngai said regulatory bodies require hospitals to make language services available. In New York State, for example, upon a request to the hospital administration by the patient, the patient's family or representative, or the provider of medical care, hospitals must provide translation services in inpatient and outpatient settings within 20 minutes and in emergency settings with 10 minutes.

Most New York Hospitals use an interpreter phone service, he said.

Patients who struggle to speak the local language are "a really important population to study and think about how we can improve their care," Jacobs said.

A 5 percent rather than 4 percent rate of return to the ER is not a large difference, but that could be due to the large number of patients excluded from the study, and because there was no validated measure of English proficiency, Jacobs said.

"That might be why we didn't see large differences, if some people considered low English proficiency actually spoke English well, or were getting good interpretive services," she said. "If you took them out, the difference might be larger."

Patients who do not speak English may struggle in other areas of the health system more than at the ER, she added.

But even having an interpreter at the hospital won't help patients deal with insurance providers, she noted.

"There are contextual issues that you may not be able to fully adequately address unless you can understand the nuances," Jacobs said.

"When dealing with immigrant population, it is almost always more than 'just' language," Ngai agreed. There can be cultural issues, too.

In addition, people with low English proficiency may also be less able to take days off of work, and to agree to be admitted to the hospital when necessary, than others, Jacobs said.

We've made tremendous progress in assuring interpreters are more available," in person, over the phone or by video, Jacobs said.

But, she said, "we are very imperfect at getting patients the services they need. It's important for providers to be educated on these issues and to understand how to access these services."

It would be ideal to try to match patients with providers by language and culture, but in the meantime, "language is a good start," Ngai said.

The Centers for Medicare and Medicaid Services has been letting patients grade their hospital experiences, and those "patient experience scores" may give some insight into a hospital's health outcomes, a new study suggests.

Some people have been concerned that patient experience isn't the most important factor to measure, said coauthor Dr. Ashish K. Jha, of the Harvard T. H. Chan School of Public Health in Boston.

"Medicare has been putting a lot of data out for a long time, but the broad consensus has been it's very hard for consumers to use this info," Jha told Reuters Health by phone. "CMS responded by giving out star ratings that consumers can understand easily."

The five-star rating system is based on patients' answers to 27 questions about a recent hospital stay. Questions cover communication with nurses and doctors, the responsiveness of hospital staff, the hospital's cleanliness and quietness, pain management, communication about medicines, discharge

information, and would they recommend the hospital.

The survey is administered to a random sample of adult patients between 48 hours and six weeks after hospital discharge. Consumers can compare their local hospitals online.

For the new study, the researchers compared the CMS patient-experience ratings at more than 3,000 hospitals in October 2015 to data from those hospitals on death or readmission within 30 days of discharge.

Patients in the study had been hospitalized for myocardial infarction, pneumonia or heart failure.

Of the 3,000 hospitals, 125 had five stars, more than 2,000 had three or four stars, 623 had two stars, and 76 had only one star.

Four and five-star hospitals tended to be small rural nonteaching hospitals in the Midwest.

Five-star hospitals had the lowest average patient death rate, 9.8 percent over the 30 days following discharge, while four three and two-star hospitals all had just over 10 percent mortality rates and one-star hospitals had an average 11.2 percent mortality rate, as reported in a research letter online April 10 in JAMA Internal Medicine.

Five-star hospitals also readmitted less than 20 percent of patients over the next month, while other hospitals all readmitted at least that many.

The data only included Medicare patients, who are older andmay not have the same results as younger patients, and there was not much difference between two, three and four-star hospitals, the authors note.

"If you use the star rating you're more likely to end up at a high quality hospital," Jha said. "But I wouldn't use only the star rating to choose a hospital."

"I don't think these data are enough to by themselves to suggest that (patients) should use the star rating as a single guide to choose an institution," agreed Dr. Joshua J. Fenton of the University of California, Davis, who was not part of the new study.

No large hospitals had five stars, and more than half of the five-star facilities didn't have an intensive care unit, Fenton told Reuters Health by phone.

"I can say from practicing in a rural hospital for a few years and we did not have an ICU, when we hospitalized someone with pneumonia or congestive heart failure, we would certainly not have kept them there if we thought it was likely there would be a complication," he said.

Smaller rural hospitals "select" less acute patients, he said. The authors of the new study tried to account for that, but it may still have affected the results.

The Centers for Medicare and Medicaid Services has been letting patients grade their hospital experiences, and those "patient experience scores" may give some insight into a hospital's health outcomes, a new study suggests.

Some people have been concerned that patient experience isn't the most important factor to measure, said coauthor Dr. Ashish K. Jha, of the Harvard T. H. Chan School of Public Health in Boston.

"Medicare has been putting a lot of data out for a long time, but the broad consensus has been it's very hard for consumers to use this info," Jha told Reuters Health by phone. "CMS responded by giving out star ratings that consumers can understand easily."

The five-star rating system is based on patients' answers to 27 questions about a recent hospital stay. Questions cover communication with nurses and doctors, the responsiveness of hospital staff, the hospital's cleanliness and quietness, pain management, communication about medicines, discharge

information, and would they recommend the hospital.

The survey is administered to a random sample of adult patients between 48 hours and six weeks after hospital discharge. Consumers can compare their local hospitals online.

For the new study, the researchers compared the CMS patient-experience ratings at more than 3,000 hospitals in October 2015 to data from those hospitals on death or readmission within 30 days of discharge.

Patients in the study had been hospitalized for myocardial infarction, pneumonia or heart failure.

Of the 3,000 hospitals, 125 had five stars, more than 2,000 had three or four stars, 623 had two stars, and 76 had only one star.

Four and five-star hospitals tended to be small rural nonteaching hospitals in the Midwest.

Five-star hospitals had the lowest average patient death rate, 9.8 percent over the 30 days following discharge, while four three and two-star hospitals all had just over 10 percent mortality rates and one-star hospitals had an average 11.2 percent mortality rate, as reported in a research letter online April 10 in JAMA Internal Medicine.

Five-star hospitals also readmitted less than 20 percent of patients over the next month, while other hospitals all readmitted at least that many.

The data only included Medicare patients, who are older andmay not have the same results as younger patients, and there was not much difference between two, three and four-star hospitals, the authors note.

"If you use the star rating you're more likely to end up at a high quality hospital," Jha said. "But I wouldn't use only the star rating to choose a hospital."

"I don't think these data are enough to by themselves to suggest that (patients) should use the star rating as a single guide to choose an institution," agreed Dr. Joshua J. Fenton of the University of California, Davis, who was not part of the new study.

No large hospitals had five stars, and more than half of the five-star facilities didn't have an intensive care unit, Fenton told Reuters Health by phone.

"I can say from practicing in a rural hospital for a few years and we did not have an ICU, when we hospitalized someone with pneumonia or congestive heart failure, we would certainly not have kept them there if we thought it was likely there would be a complication," he said.

Smaller rural hospitals "select" less acute patients, he said. The authors of the new study tried to account for that, but it may still have affected the results.

The Centers for Medicare and Medicaid Services has been letting patients grade their hospital experiences, and those "patient experience scores" may give some insight into a hospital's health outcomes, a new study suggests.

Some people have been concerned that patient experience isn't the most important factor to measure, said coauthor Dr. Ashish K. Jha, of the Harvard T. H. Chan School of Public Health in Boston.

"Medicare has been putting a lot of data out for a long time, but the broad consensus has been it's very hard for consumers to use this info," Jha told Reuters Health by phone. "CMS responded by giving out star ratings that consumers can understand easily."

The five-star rating system is based on patients' answers to 27 questions about a recent hospital stay. Questions cover communication with nurses and doctors, the responsiveness of hospital staff, the hospital's cleanliness and quietness, pain management, communication about medicines, discharge

information, and would they recommend the hospital.

The survey is administered to a random sample of adult patients between 48 hours and six weeks after hospital discharge. Consumers can compare their local hospitals online.

For the new study, the researchers compared the CMS patient-experience ratings at more than 3,000 hospitals in October 2015 to data from those hospitals on death or readmission within 30 days of discharge.

Patients in the study had been hospitalized for myocardial infarction, pneumonia or heart failure.

Of the 3,000 hospitals, 125 had five stars, more than 2,000 had three or four stars, 623 had two stars, and 76 had only one star.

Four and five-star hospitals tended to be small rural nonteaching hospitals in the Midwest.

Five-star hospitals had the lowest average patient death rate, 9.8 percent over the 30 days following discharge, while four three and two-star hospitals all had just over 10 percent mortality rates and one-star hospitals had an average 11.2 percent mortality rate, as reported in a research letter online April 10 in JAMA Internal Medicine.

Five-star hospitals also readmitted less than 20 percent of patients over the next month, while other hospitals all readmitted at least that many.

The data only included Medicare patients, who are older andmay not have the same results as younger patients, and there was not much difference between two, three and four-star hospitals, the authors note.

"If you use the star rating you're more likely to end up at a high quality hospital," Jha said. "But I wouldn't use only the star rating to choose a hospital."

"I don't think these data are enough to by themselves to suggest that (patients) should use the star rating as a single guide to choose an institution," agreed Dr. Joshua J. Fenton of the University of California, Davis, who was not part of the new study.

No large hospitals had five stars, and more than half of the five-star facilities didn't have an intensive care unit, Fenton told Reuters Health by phone.

"I can say from practicing in a rural hospital for a few years and we did not have an ICU, when we hospitalized someone with pneumonia or congestive heart failure, we would certainly not have kept them there if we thought it was likely there would be a complication," he said.

Smaller rural hospitals "select" less acute patients, he said. The authors of the new study tried to account for that, but it may still have affected the results.

(Reuters Health) - Patients assigned a "nonurgent" status on arrival in the emergency room might still be sick enough to be hospitalized, a new study shows.

Patients deemed by triage nurses to be "nonurgent" often receive diagnostic services and procedures, and some are even admitted to critical care units, researchers found.

Triage was never intended to completely rule out severe illness, only to give patients an estimate of how long they may have to wait to see a doctor, the researchers note.

Dr. Renee Y. Hsia of the University of California, San Francisco and colleagues used a national survey of patient visits to the emergency department (E.D.) between 2009 and 2011, with triage scores assigned by a nurse when the patient arrived. The scores range from one to five, with one through three including immediate, emergency and urgent patients, and four and five being semi-urgent and nonurgent.

They used data on almost 60,000 observations of patients age 18 to 64 collected between 2009 and 2011, which represented 240 million E.D. visits. More than 90 percent had a score of one to

four and were deemed "urgent" visits, while about eight percent had a score of five and were "nonurgent."

Almost half of nonurgent visits involved diagnostic scans, imaging or blood tests, and a third involved procedures like splinting or giving intravenous fluids. For urgent visits, about three-quarters involved diagnostics and half involved procedures.

About four of every 100 non-urgent visits resulted in hospital admission, as reported in JAMA Internal Medicine.

Backache, acute upper respiratory infections, soft-tissue inflammation, and acute sore throat were among the 10 most common diagnoses for both urgent and non-urgent patients.

"Triage is normally done at the very beginning of the visit, usually by a triage nurse," Hsia told Reuters Health by email. "Triaging patients is an extremely difficult task, since patients are what we (as providers) call 'undifferentiated,' since there has not been time to do a full history and physical, and nurses have limited information upon which to base their determination."

"We should not expect triage categorization to be perfect, and one of the goals of this paper is to show that, indeed, triage is not," Hsia said.

Many states have policies that patients with Medicaid insurance who present to the E.D. for "non-urgent" visits will be charged a co-payment, which may keep people from seeking

needed care, even though the triage system is not perfect, she said.

"It is important that we do not blame the patient for going to the E.D. if there were no alternatives that were available in a timely manner," Hsia said.

"Our study cannot distinguish the reasons behind why we found such a high proportion of visits that received diagnostic services or procedures," she said.

Some of the procedures may not have needed to happen in an E.D. setting, but since the patients presented there, they were treated, Hsia added.

(Reuters Health) - Patients assigned a "nonurgent" status on arrival in the emergency room might still be sick enough to be hospitalized, a new study shows.

Patients deemed by triage nurses to be "nonurgent" often receive diagnostic services and procedures, and some are even admitted to critical care units, researchers found.

Triage was never intended to completely rule out severe illness, only to give patients an estimate of how long they may have to wait to see a doctor, the researchers note.

Dr. Renee Y. Hsia of the University of California, San Francisco and colleagues used a national survey of patient visits to the emergency department (E.D.) between 2009 and 2011, with triage scores assigned by a nurse when the patient arrived. The scores range from one to five, with one through three including immediate, emergency and urgent patients, and four and five being semi-urgent and nonurgent.

They used data on almost 60,000 observations of patients age 18 to 64 collected between 2009 and 2011, which represented 240 million E.D. visits. More than 90 percent had a score of one to

four and were deemed "urgent" visits, while about eight percent had a score of five and were "nonurgent."

Almost half of nonurgent visits involved diagnostic scans, imaging or blood tests, and a third involved procedures like splinting or giving intravenous fluids. For urgent visits, about three-quarters involved diagnostics and half involved procedures.

About four of every 100 non-urgent visits resulted in hospital admission, as reported in JAMA Internal Medicine.

Backache, acute upper respiratory infections, soft-tissue inflammation, and acute sore throat were among the 10 most common diagnoses for both urgent and non-urgent patients.

"Triage is normally done at the very beginning of the visit, usually by a triage nurse," Hsia told Reuters Health by email. "Triaging patients is an extremely difficult task, since patients are what we (as providers) call 'undifferentiated,' since there has not been time to do a full history and physical, and nurses have limited information upon which to base their determination."

"We should not expect triage categorization to be perfect, and one of the goals of this paper is to show that, indeed, triage is not," Hsia said.

Many states have policies that patients with Medicaid insurance who present to the E.D. for "non-urgent" visits will be charged a co-payment, which may keep people from seeking

needed care, even though the triage system is not perfect, she said.

"It is important that we do not blame the patient for going to the E.D. if there were no alternatives that were available in a timely manner," Hsia said.

"Our study cannot distinguish the reasons behind why we found such a high proportion of visits that received diagnostic services or procedures," she said.

Some of the procedures may not have needed to happen in an E.D. setting, but since the patients presented there, they were treated, Hsia added.

(Reuters Health) - Patients assigned a "nonurgent" status on arrival in the emergency room might still be sick enough to be hospitalized, a new study shows.

Patients deemed by triage nurses to be "nonurgent" often receive diagnostic services and procedures, and some are even admitted to critical care units, researchers found.

Triage was never intended to completely rule out severe illness, only to give patients an estimate of how long they may have to wait to see a doctor, the researchers note.

Dr. Renee Y. Hsia of the University of California, San Francisco and colleagues used a national survey of patient visits to the emergency department (E.D.) between 2009 and 2011, with triage scores assigned by a nurse when the patient arrived. The scores range from one to five, with one through three including immediate, emergency and urgent patients, and four and five being semi-urgent and nonurgent.

They used data on almost 60,000 observations of patients age 18 to 64 collected between 2009 and 2011, which represented 240 million E.D. visits. More than 90 percent had a score of one to

four and were deemed "urgent" visits, while about eight percent had a score of five and were "nonurgent."

Almost half of nonurgent visits involved diagnostic scans, imaging or blood tests, and a third involved procedures like splinting or giving intravenous fluids. For urgent visits, about three-quarters involved diagnostics and half involved procedures.

About four of every 100 non-urgent visits resulted in hospital admission, as reported in JAMA Internal Medicine.

Backache, acute upper respiratory infections, soft-tissue inflammation, and acute sore throat were among the 10 most common diagnoses for both urgent and non-urgent patients.

"Triage is normally done at the very beginning of the visit, usually by a triage nurse," Hsia told Reuters Health by email. "Triaging patients is an extremely difficult task, since patients are what we (as providers) call 'undifferentiated,' since there has not been time to do a full history and physical, and nurses have limited information upon which to base their determination."

"We should not expect triage categorization to be perfect, and one of the goals of this paper is to show that, indeed, triage is not," Hsia said.

Many states have policies that patients with Medicaid insurance who present to the E.D. for "non-urgent" visits will be charged a co-payment, which may keep people from seeking

needed care, even though the triage system is not perfect, she said.

"It is important that we do not blame the patient for going to the E.D. if there were no alternatives that were available in a timely manner," Hsia said.

"Our study cannot distinguish the reasons behind why we found such a high proportion of visits that received diagnostic services or procedures," she said.

Some of the procedures may not have needed to happen in an E.D. setting, but since the patients presented there, they were treated, Hsia added.

(Reuters Health) - Over the last 40 years, heart disease rates have dropped in the U.S. overall, but the changes varied widely by region, with the highest rates of the disease shifting from the Northeast to the South, researchers say.

"The consistent progression southward over the past few decades suggests that the pattern is not random - and could be attributed to geographic differences in prevention and treatment opportunities," said lead author Michele Casper of the CDC's Division for Heart Disease and Stroke Prevention in Atlanta, Georgia.

"Identifying those counties and regions with the greatest burden of mortality is a necessary first step to target appropriate resources that will ultimately reduce death rates," Casper told Reuters Health by email.

The researchers used data on heart disease deaths among people age 35 and over in the U.S. collected in two year intervals, between 1973 and 2010, from more than 3,000 counties of the 48 contiguous states.

Every county saw a decline in heart disease deaths. The average decline across the U.S. was 61%, but some counties only saw a decline of 9% while others cut heart disease deaths by 83%.

At the beginning of the study, heart disease deaths were most common in the Northeast through Appalachia and into the Midwest. Coastal North Carolina, South Carolina and Georgia also had high rates.

Most counties with the lowest death rates were located in the West, with some low-rate counties also scattered in Alabama, Florida and Mississippi.

By 2010, most high-rate counties were still in the eastern half of the country, but in the South, rather than in the North, with some parts of New England becoming pockets with lower death rates.

Declines were slowest in counties in Alabama, Mississippi, Louisiana, Arkansas, Oklahoma and parts of Texas, the authors reported in a paper scheduled for publication in Circulation.

Since the 1970s, national attention on the dangers of cigarette smoking and uncontrolled high blood pressure has led to a significant decline in deaths from coronary heart disease and myocardial infarction, but "heart disease" includes other conditions, such as heart failure, which have not decreased as much, said Dr. Donald A. Barr of Stanford University School of Medicine in California, who wrote an editorial accompanying the new study.

Comparable data for heart failure (associated with diabetes, obesity and underlying hypertension) has not been coming down as fast, Barr told Reuters Health by phone. He noted that heart failure is projected to increase over the next couple of decades, while coronary heart disease is expected to decline.

Heart failure disproportionately affects low-income Americans and African Americans, he said. "These at-risk populations are found in a somewhat higher proportion in those southeastern states."

"Combining heart failure and coronary heart disease under the global term 'heart disease' combines good news with not so good news," Barr said.

There were still meaningful declines in heart disease deaths in the South, Casper noted.

"Heart disease-related deaths are largely preventable, and with targeted public health efforts, it's possible to alleviate much of the heavy burden of this disease and close the geographic gap in declining heart disease death rates," Casper said.

"With collaboration, government agencies, medical care organizations, community groups, businesses and other organizations can provide more local opportunities for physical activity, as well as access to smoke-free spaces, affordable healthy foods, quality healthcare and social and economic well-being," Casper said.

(Reuters Health) - Over the last 40 years, heart disease rates have dropped in the U.S. overall, but the changes varied widely by region, with the highest rates of the disease shifting from the Northeast to the South, researchers say.

"The consistent progression southward over the past few decades suggests that the pattern is not random - and could be attributed to geographic differences in prevention and treatment opportunities," said lead author Michele Casper of the CDC's Division for Heart Disease and Stroke Prevention in Atlanta, Georgia.

"Identifying those counties and regions with the greatest burden of mortality is a necessary first step to target appropriate resources that will ultimately reduce death rates," Casper told Reuters Health by email.

The researchers used data on heart disease deaths among people age 35 and over in the U.S. collected in two year intervals, between 1973 and 2010, from more than 3,000 counties of the 48 contiguous states.

Every county saw a decline in heart disease deaths. The average decline across the U.S. was 61%, but some counties only saw a decline of 9% while others cut heart disease deaths by 83%.

At the beginning of the study, heart disease deaths were most common in the Northeast through Appalachia and into the Midwest. Coastal North Carolina, South Carolina and Georgia also had high rates.

Most counties with the lowest death rates were located in the West, with some low-rate counties also scattered in Alabama, Florida and Mississippi.

By 2010, most high-rate counties were still in the eastern half of the country, but in the South, rather than in the North, with some parts of New England becoming pockets with lower death rates.

Declines were slowest in counties in Alabama, Mississippi, Louisiana, Arkansas, Oklahoma and parts of Texas, the authors reported in a paper scheduled for publication in Circulation.

Since the 1970s, national attention on the dangers of cigarette smoking and uncontrolled high blood pressure has led to a significant decline in deaths from coronary heart disease and myocardial infarction, but "heart disease" includes other conditions, such as heart failure, which have not decreased as much, said Dr. Donald A. Barr of Stanford University School of Medicine in California, who wrote an editorial accompanying the new study.

Comparable data for heart failure (associated with diabetes, obesity and underlying hypertension) has not been coming down as fast, Barr told Reuters Health by phone. He noted that heart failure is projected to increase over the next couple of decades, while coronary heart disease is expected to decline.

Heart failure disproportionately affects low-income Americans and African Americans, he said. "These at-risk populations are found in a somewhat higher proportion in those southeastern states."

"Combining heart failure and coronary heart disease under the global term 'heart disease' combines good news with not so good news," Barr said.

There were still meaningful declines in heart disease deaths in the South, Casper noted.

"Heart disease-related deaths are largely preventable, and with targeted public health efforts, it's possible to alleviate much of the heavy burden of this disease and close the geographic gap in declining heart disease death rates," Casper said.

"With collaboration, government agencies, medical care organizations, community groups, businesses and other organizations can provide more local opportunities for physical activity, as well as access to smoke-free spaces, affordable healthy foods, quality healthcare and social and economic well-being," Casper said.

(Reuters Health) - Over the last 40 years, heart disease rates have dropped in the U.S. overall, but the changes varied widely by region, with the highest rates of the disease shifting from the Northeast to the South, researchers say.

"The consistent progression southward over the past few decades suggests that the pattern is not random - and could be attributed to geographic differences in prevention and treatment opportunities," said lead author Michele Casper of the CDC's Division for Heart Disease and Stroke Prevention in Atlanta, Georgia.

"Identifying those counties and regions with the greatest burden of mortality is a necessary first step to target appropriate resources that will ultimately reduce death rates," Casper told Reuters Health by email.

The researchers used data on heart disease deaths among people age 35 and over in the U.S. collected in two year intervals, between 1973 and 2010, from more than 3,000 counties of the 48 contiguous states.

Every county saw a decline in heart disease deaths. The average decline across the U.S. was 61%, but some counties only saw a decline of 9% while others cut heart disease deaths by 83%.

At the beginning of the study, heart disease deaths were most common in the Northeast through Appalachia and into the Midwest. Coastal North Carolina, South Carolina and Georgia also had high rates.

Most counties with the lowest death rates were located in the West, with some low-rate counties also scattered in Alabama, Florida and Mississippi.

By 2010, most high-rate counties were still in the eastern half of the country, but in the South, rather than in the North, with some parts of New England becoming pockets with lower death rates.

Declines were slowest in counties in Alabama, Mississippi, Louisiana, Arkansas, Oklahoma and parts of Texas, the authors reported in a paper scheduled for publication in Circulation.

Since the 1970s, national attention on the dangers of cigarette smoking and uncontrolled high blood pressure has led to a significant decline in deaths from coronary heart disease and myocardial infarction, but "heart disease" includes other conditions, such as heart failure, which have not decreased as much, said Dr. Donald A. Barr of Stanford University School of Medicine in California, who wrote an editorial accompanying the new study.

Comparable data for heart failure (associated with diabetes, obesity and underlying hypertension) has not been coming down as fast, Barr told Reuters Health by phone. He noted that heart failure is projected to increase over the next couple of decades, while coronary heart disease is expected to decline.

Heart failure disproportionately affects low-income Americans and African Americans, he said. "These at-risk populations are found in a somewhat higher proportion in those southeastern states."

"Combining heart failure and coronary heart disease under the global term 'heart disease' combines good news with not so good news," Barr said.

There were still meaningful declines in heart disease deaths in the South, Casper noted.

"Heart disease-related deaths are largely preventable, and with targeted public health efforts, it's possible to alleviate much of the heavy burden of this disease and close the geographic gap in declining heart disease death rates," Casper said.

"With collaboration, government agencies, medical care organizations, community groups, businesses and other organizations can provide more local opportunities for physical activity, as well as access to smoke-free spaces, affordable healthy foods, quality healthcare and social and economic well-being," Casper said.

(Reuters Health) - For people with Alzheimer's disease, having gum disease is tied to faster cognitive decline, according to a new study.

"What we have shown is that regardless of the severity of dementia (within this mild to moderate impaired group) that patients with more severe gum disease are declining more rapidly," said senior author Clive Holmes of the University of Southampton in the UK.

In other studies, Holmes and his coauthors have found that conditions such as chest infections, urinary tract infections, rheumatoid arthritis and diabetes are associated with faster disease progression in Alzheimer's, he said.

"We hadn't previously looked at gum disease because MDs tendto leave this in the hands of dentists but it is an important common low grade chronic infection," Holmes told Reuters Health by email.

The researchers observed 60 people with mild to moderate Alzheimer's disease living at home for six months. The participants did not smoke, had not been treated for gum disease within the previous six months, and had at least 10 teeth.

At the start, each participant completed a cognitive assessment, gave a blood sample, was examined by a dental hygienist and their main caregiver was interviewed to provide a medical and dental history. The same tests and interviews were repeated six months later.

Of the 60 people in the study, 22 had moderate to severe gum disease at the beginning of the study. By six months later, one participant had died, three had withdrawn from the study and three were lost to follow-up.

Cognitive score declined more for those who had periodontitis to begin with than for those who did not, the researchers reported February 24 in PLoS One.

According to one theory, cognitive impairment leads to adverse oral health due to inattention to routine oral hygiene and care, said Dr. James M. Noble of the Taub Institute for Research on Alzheimer's Disease and the Aging Brain at Columbia University Medical Center in New York City, who was not part of the new study.

"The second, and the one I'm most intrigued by, is whether or not periodontal disease has an influence on cognitive outcomes of aging, either as an independent risk factor for (new-onset) cognitive impairment including Alzheimer's disease, or more rapid decline once (Alzheimer's disease) has been diagnosed, as was suggested by this study," Noble told Reuters Health by email.

Gum disease may cause chronic low-grade inflammation in the rest of the body, and inflammation is associated with changes in the brain, he said.

"It is known that gum disease is associated with increased markers of inflammation," Holmes said.

But the new study indicates a connection between gum disease and cognitive decline, not necessarily that one causes the other, he said. Further studies need to assess whether treatingthe gum disease would also slow cognitive decline.

"Periodontitis has been associated with heart disease and stroke among other conditions," Noble said. Based on this and other studies, "it seems to be good advice to brush and floss," Noble said.

(Reuters Health) - For people with Alzheimer's disease, having gum disease is tied to faster cognitive decline, according to a new study.

"What we have shown is that regardless of the severity of dementia (within this mild to moderate impaired group) that patients with more severe gum disease are declining more rapidly," said senior author Clive Holmes of the University of Southampton in the UK.

In other studies, Holmes and his coauthors have found that conditions such as chest infections, urinary tract infections, rheumatoid arthritis and diabetes are associated with faster disease progression in Alzheimer's, he said.

"We hadn't previously looked at gum disease because MDs tendto leave this in the hands of dentists but it is an important common low grade chronic infection," Holmes told Reuters Health by email.

The researchers observed 60 people with mild to moderate Alzheimer's disease living at home for six months. The participants did not smoke, had not been treated for gum disease within the previous six months, and had at least 10 teeth.

At the start, each participant completed a cognitive assessment, gave a blood sample, was examined by a dental hygienist and their main caregiver was interviewed to provide a medical and dental history. The same tests and interviews were repeated six months later.

Of the 60 people in the study, 22 had moderate to severe gum disease at the beginning of the study. By six months later, one participant had died, three had withdrawn from the study and three were lost to follow-up.

Cognitive score declined more for those who had periodontitis to begin with than for those who did not, the researchers reported February 24 in PLoS One.

According to one theory, cognitive impairment leads to adverse oral health due to inattention to routine oral hygiene and care, said Dr. James M. Noble of the Taub Institute for Research on Alzheimer's Disease and the Aging Brain at Columbia University Medical Center in New York City, who was not part of the new study.

"The second, and the one I'm most intrigued by, is whether or not periodontal disease has an influence on cognitive outcomes of aging, either as an independent risk factor for (new-onset) cognitive impairment including Alzheimer's disease, or more rapid decline once (Alzheimer's disease) has been diagnosed, as was suggested by this study," Noble told Reuters Health by email.

Gum disease may cause chronic low-grade inflammation in the rest of the body, and inflammation is associated with changes in the brain, he said.

"It is known that gum disease is associated with increased markers of inflammation," Holmes said.

But the new study indicates a connection between gum disease and cognitive decline, not necessarily that one causes the other, he said. Further studies need to assess whether treatingthe gum disease would also slow cognitive decline.

"Periodontitis has been associated with heart disease and stroke among other conditions," Noble said. Based on this and other studies, "it seems to be good advice to brush and floss," Noble said.

(Reuters Health) - For people with Alzheimer's disease, having gum disease is tied to faster cognitive decline, according to a new study.

"What we have shown is that regardless of the severity of dementia (within this mild to moderate impaired group) that patients with more severe gum disease are declining more rapidly," said senior author Clive Holmes of the University of Southampton in the UK.

In other studies, Holmes and his coauthors have found that conditions such as chest infections, urinary tract infections, rheumatoid arthritis and diabetes are associated with faster disease progression in Alzheimer's, he said.

"We hadn't previously looked at gum disease because MDs tendto leave this in the hands of dentists but it is an important common low grade chronic infection," Holmes told Reuters Health by email.

The researchers observed 60 people with mild to moderate Alzheimer's disease living at home for six months. The participants did not smoke, had not been treated for gum disease within the previous six months, and had at least 10 teeth.

At the start, each participant completed a cognitive assessment, gave a blood sample, was examined by a dental hygienist and their main caregiver was interviewed to provide a medical and dental history. The same tests and interviews were repeated six months later.

Of the 60 people in the study, 22 had moderate to severe gum disease at the beginning of the study. By six months later, one participant had died, three had withdrawn from the study and three were lost to follow-up.

Cognitive score declined more for those who had periodontitis to begin with than for those who did not, the researchers reported February 24 in PLoS One.

According to one theory, cognitive impairment leads to adverse oral health due to inattention to routine oral hygiene and care, said Dr. James M. Noble of the Taub Institute for Research on Alzheimer's Disease and the Aging Brain at Columbia University Medical Center in New York City, who was not part of the new study.

"The second, and the one I'm most intrigued by, is whether or not periodontal disease has an influence on cognitive outcomes of aging, either as an independent risk factor for (new-onset) cognitive impairment including Alzheimer's disease, or more rapid decline once (Alzheimer's disease) has been diagnosed, as was suggested by this study," Noble told Reuters Health by email.

Gum disease may cause chronic low-grade inflammation in the rest of the body, and inflammation is associated with changes in the brain, he said.

"It is known that gum disease is associated with increased markers of inflammation," Holmes said.

But the new study indicates a connection between gum disease and cognitive decline, not necessarily that one causes the other, he said. Further studies need to assess whether treatingthe gum disease would also slow cognitive decline.

"Periodontitis has been associated with heart disease and stroke among other conditions," Noble said. Based on this and other studies, "it seems to be good advice to brush and floss," Noble said.

(Reuters Health) - Having sleep apnea may increase the risk of chronic kidney disease, according to a report from Taiwan.

Researchers analyzed data from 2000 through 2010 on 8,600 adults diagnosed with sleep apnea and four times as many adults of similar age, sex and monthly income without sleep apnea, using Taiwan's National Health Insurance Research Database.

They found 157 new cases of chronic kidney disease among people with sleep apnea and 298 cases in the comparison group, according to Yung-Tai Chen of Taipei City Hospital Heping Fuyou Branch in Taiwan and coauthors.

After taking other health factors into account, sleep apnea increased the risk of kidney disease by 58%. By comparison, hypertension (a known risk factor for kidney disease) increased the risk by 17%. Diabetes was a stronger predictor than both other factors, more than doubling the risk of kidney disease, the research team reported online February 1 in Respirology.

Intermittent low oxygen levels during the night and fragmented sleep patterns may activate higher blood pressure, which would damage the kidneys and could make individuals more susceptible to chronic kidney disease, said Tetyana Kendzerska of the University of Toronto Institute for Clinical Evaluative Sciences, who was not part of the study in Taiwan.

But, "the findings from this study are limited by lack of information on sleep apnea and chronic kidney disease severity given that these conditions were defined through the health administrative data," Kendzerska said.

Factors like obesity and smoking status are also important for kidney risk but were not included in the assessment, she told Reuters Health by email.

"So, instead of concluding that sleep apnea has the same impact as high blood pressure on the kidney, I would rather conclude that this study suggests that the association between sleep apnea and chronic kidney disease may exist," and should be validated with more powerful studies, she said.

Moderate to severe obstructive sleep apnea can be treated with continuous positive airway pressure (CPAP) at night which may decrease high blood pressure and mitigate kidney risk, Kendzerska said.

"These findings raise the issue of whether the relationship between sleep apnea and chronic kidney disease is unidirectional or bidirectional," she said. "If the importance of sleep apnea and preventive effect of treatment will be confirmed in further studies, sleep apnea should be added to the list of modifiable risk factors considered in (chronic kidney disease) risk assessment."

The authors of the study did not respond to a request for comment.

(Reuters Health) - Having sleep apnea may increase the risk of chronic kidney disease, according to a report from Taiwan.

Researchers analyzed data from 2000 through 2010 on 8,600 adults diagnosed with sleep apnea and four times as many adults of similar age, sex and monthly income without sleep apnea, using Taiwan's National Health Insurance Research Database.

They found 157 new cases of chronic kidney disease among people with sleep apnea and 298 cases in the comparison group, according to Yung-Tai Chen of Taipei City Hospital Heping Fuyou Branch in Taiwan and coauthors.

After taking other health factors into account, sleep apnea increased the risk of kidney disease by 58%. By comparison, hypertension (a known risk factor for kidney disease) increased the risk by 17%. Diabetes was a stronger predictor than both other factors, more than doubling the risk of kidney disease, the research team reported online February 1 in Respirology.

Intermittent low oxygen levels during the night and fragmented sleep patterns may activate higher blood pressure, which would damage the kidneys and could make individuals more susceptible to chronic kidney disease, said Tetyana Kendzerska of the University of Toronto Institute for Clinical Evaluative Sciences, who was not part of the study in Taiwan.

But, "the findings from this study are limited by lack of information on sleep apnea and chronic kidney disease severity given that these conditions were defined through the health administrative data," Kendzerska said.

Factors like obesity and smoking status are also important for kidney risk but were not included in the assessment, she told Reuters Health by email.

"So, instead of concluding that sleep apnea has the same impact as high blood pressure on the kidney, I would rather conclude that this study suggests that the association between sleep apnea and chronic kidney disease may exist," and should be validated with more powerful studies, she said.

Moderate to severe obstructive sleep apnea can be treated with continuous positive airway pressure (CPAP) at night which may decrease high blood pressure and mitigate kidney risk, Kendzerska said.

"These findings raise the issue of whether the relationship between sleep apnea and chronic kidney disease is unidirectional or bidirectional," she said. "If the importance of sleep apnea and preventive effect of treatment will be confirmed in further studies, sleep apnea should be added to the list of modifiable risk factors considered in (chronic kidney disease) risk assessment."

The authors of the study did not respond to a request for comment.

(Reuters Health) - Having sleep apnea may increase the risk of chronic kidney disease, according to a report from Taiwan.

Researchers analyzed data from 2000 through 2010 on 8,600 adults diagnosed with sleep apnea and four times as many adults of similar age, sex and monthly income without sleep apnea, using Taiwan's National Health Insurance Research Database.

They found 157 new cases of chronic kidney disease among people with sleep apnea and 298 cases in the comparison group, according to Yung-Tai Chen of Taipei City Hospital Heping Fuyou Branch in Taiwan and coauthors.

After taking other health factors into account, sleep apnea increased the risk of kidney disease by 58%. By comparison, hypertension (a known risk factor for kidney disease) increased the risk by 17%. Diabetes was a stronger predictor than both other factors, more than doubling the risk of kidney disease, the research team reported online February 1 in Respirology.

Intermittent low oxygen levels during the night and fragmented sleep patterns may activate higher blood pressure, which would damage the kidneys and could make individuals more susceptible to chronic kidney disease, said Tetyana Kendzerska of the University of Toronto Institute for Clinical Evaluative Sciences, who was not part of the study in Taiwan.

But, "the findings from this study are limited by lack of information on sleep apnea and chronic kidney disease severity given that these conditions were defined through the health administrative data," Kendzerska said.

Factors like obesity and smoking status are also important for kidney risk but were not included in the assessment, she told Reuters Health by email.

"So, instead of concluding that sleep apnea has the same impact as high blood pressure on the kidney, I would rather conclude that this study suggests that the association between sleep apnea and chronic kidney disease may exist," and should be validated with more powerful studies, she said.

Moderate to severe obstructive sleep apnea can be treated with continuous positive airway pressure (CPAP) at night which may decrease high blood pressure and mitigate kidney risk, Kendzerska said.

"These findings raise the issue of whether the relationship between sleep apnea and chronic kidney disease is unidirectional or bidirectional," she said. "If the importance of sleep apnea and preventive effect of treatment will be confirmed in further studies, sleep apnea should be added to the list of modifiable risk factors considered in (chronic kidney disease) risk assessment."

The authors of the study did not respond to a request for comment.

When doctors discuss prognosis with advanced cancer patients, those patients have more realistic views of their life expectancy and don't seem to experience a decrease in emotional wellbeing, according to a new study.

"That the vast majority of cancer patients who are dying say that they want to know their prognosis seems surprisingly courageous," said senior author Holly G. Prigerson of Weill Cornell Medical College in New York City.

Every patient needs to know their prognosis, including life expectancy, and expected outcomes of treatment; for example, they should know that chemotherapy cannot cure incurable cancer, Prigerson said.

"Providers often are reluctant to communicate grim news, as anyone would be," she said.

The study included 590 patients with advanced, metastatic cancer who had been treated with at least one round of palliative chemotherapy, which is meant to improve comfort rather than to cure.

Researchers asked the patients whether their oncologist had ever given them a prognosis with a life expectancy estimate, then asked the patients to estimate their own life expectancy and to complete assessments of emotional distress, whether they had advance directives and their end-of-life care preferences.

The patients also described their relationship with their doctors.

Half of the patients survived for less than six months after the study began.

About 70 percent wanted to be told their life expectancy, but only about 18 percent recalled having this discussion with their oncologist.

Half of the patients were willing to estimate their own life expectancy, and those who remembered having a prognosis conversation with their doctor estimated a life expectancy closer to their actual survival than those who did not.

Less than 10 percent of those who remembered having a conversation with their doctor made estimates that were more than five years longer than their actual survival. That compares with 35 percent of those who did not remember having the conversation who overestimated their life expectancy by more than five years.

Remembering a prognostic discussion with a doctor decreased patient estimated life expectancy by about 17 months, when the researchers accounted for other factors, according to the results in the Journal of Clinical Oncology.

Talking to a doctor about life expectancy was not tied to worse doctor-patient relationship, more sadness or higher anxiety, the surveys found.

"It is encouraging that the patients who reported a prognostic disclosure by their oncologist were more realistic in their life-expectancy estimate, more likely to complete a [Do Not Resuscitate] order and to want comfort care," Prigerson said by email.

"There was no emotional fallout that damaged their relationship with their oncologist - as reported by the patient," she said.

Often these conversations should happen, but they do not, for a multitude of reasons, she said. The patient may not be ready to hear bad news, some patients may reject information they are given because they believe a miracle may happen, and other reasons, she said.

"Some patients are not able to hear and process poor prognoses and more harm than good can be done by forcing the situation," Prigerson said. "However, we have found that over 90 percent of patients benefit from prognostic disclosures and it is a minority of patients for religious or personal or social reasons that do not benefit."

When doctors discuss prognosis with advanced cancer patients, those patients have more realistic views of their life expectancy and don't seem to experience a decrease in emotional wellbeing, according to a new study.

"That the vast majority of cancer patients who are dying say that they want to know their prognosis seems surprisingly courageous," said senior author Holly G. Prigerson of Weill Cornell Medical College in New York City.

Every patient needs to know their prognosis, including life expectancy, and expected outcomes of treatment; for example, they should know that chemotherapy cannot cure incurable cancer, Prigerson said.

"Providers often are reluctant to communicate grim news, as anyone would be," she said.

The study included 590 patients with advanced, metastatic cancer who had been treated with at least one round of palliative chemotherapy, which is meant to improve comfort rather than to cure.

Researchers asked the patients whether their oncologist had ever given them a prognosis with a life expectancy estimate, then asked the patients to estimate their own life expectancy and to complete assessments of emotional distress, whether they had advance directives and their end-of-life care preferences.

The patients also described their relationship with their doctors.

Half of the patients survived for less than six months after the study began.

About 70 percent wanted to be told their life expectancy, but only about 18 percent recalled having this discussion with their oncologist.

Half of the patients were willing to estimate their own life expectancy, and those who remembered having a prognosis conversation with their doctor estimated a life expectancy closer to their actual survival than those who did not.

Less than 10 percent of those who remembered having a conversation with their doctor made estimates that were more than five years longer than their actual survival. That compares with 35 percent of those who did not remember having the conversation who overestimated their life expectancy by more than five years.

Remembering a prognostic discussion with a doctor decreased patient estimated life expectancy by about 17 months, when the researchers accounted for other factors, according to the results in the Journal of Clinical Oncology.

Talking to a doctor about life expectancy was not tied to worse doctor-patient relationship, more sadness or higher anxiety, the surveys found.

"It is encouraging that the patients who reported a prognostic disclosure by their oncologist were more realistic in their life-expectancy estimate, more likely to complete a [Do Not Resuscitate] order and to want comfort care," Prigerson said by email.

"There was no emotional fallout that damaged their relationship with their oncologist - as reported by the patient," she said.

Often these conversations should happen, but they do not, for a multitude of reasons, she said. The patient may not be ready to hear bad news, some patients may reject information they are given because they believe a miracle may happen, and other reasons, she said.

"Some patients are not able to hear and process poor prognoses and more harm than good can be done by forcing the situation," Prigerson said. "However, we have found that over 90 percent of patients benefit from prognostic disclosures and it is a minority of patients for religious or personal or social reasons that do not benefit."

When doctors discuss prognosis with advanced cancer patients, those patients have more realistic views of their life expectancy and don't seem to experience a decrease in emotional wellbeing, according to a new study.

"That the vast majority of cancer patients who are dying say that they want to know their prognosis seems surprisingly courageous," said senior author Holly G. Prigerson of Weill Cornell Medical College in New York City.

Every patient needs to know their prognosis, including life expectancy, and expected outcomes of treatment; for example, they should know that chemotherapy cannot cure incurable cancer, Prigerson said.

"Providers often are reluctant to communicate grim news, as anyone would be," she said.

The study included 590 patients with advanced, metastatic cancer who had been treated with at least one round of palliative chemotherapy, which is meant to improve comfort rather than to cure.

Researchers asked the patients whether their oncologist had ever given them a prognosis with a life expectancy estimate, then asked the patients to estimate their own life expectancy and to complete assessments of emotional distress, whether they had advance directives and their end-of-life care preferences.

The patients also described their relationship with their doctors.

Half of the patients survived for less than six months after the study began.

About 70 percent wanted to be told their life expectancy, but only about 18 percent recalled having this discussion with their oncologist.

Half of the patients were willing to estimate their own life expectancy, and those who remembered having a prognosis conversation with their doctor estimated a life expectancy closer to their actual survival than those who did not.

Less than 10 percent of those who remembered having a conversation with their doctor made estimates that were more than five years longer than their actual survival. That compares with 35 percent of those who did not remember having the conversation who overestimated their life expectancy by more than five years.

Remembering a prognostic discussion with a doctor decreased patient estimated life expectancy by about 17 months, when the researchers accounted for other factors, according to the results in the Journal of Clinical Oncology.

Talking to a doctor about life expectancy was not tied to worse doctor-patient relationship, more sadness or higher anxiety, the surveys found.

"It is encouraging that the patients who reported a prognostic disclosure by their oncologist were more realistic in their life-expectancy estimate, more likely to complete a [Do Not Resuscitate] order and to want comfort care," Prigerson said by email.

"There was no emotional fallout that damaged their relationship with their oncologist - as reported by the patient," she said.

Often these conversations should happen, but they do not, for a multitude of reasons, she said. The patient may not be ready to hear bad news, some patients may reject information they are given because they believe a miracle may happen, and other reasons, she said.

"Some patients are not able to hear and process poor prognoses and more harm than good can be done by forcing the situation," Prigerson said. "However, we have found that over 90 percent of patients benefit from prognostic disclosures and it is a minority of patients for religious or personal or social reasons that do not benefit."

NEW YORK  - Older adults living in long-term care are more than twice as likely as their peers living at home to suffer a fracture, and a new guideline endorsed by the Scientific Advisory Council of Osteoporosis Canada explains how to reduce their risk.

Residents of long-term care tend to be frailer and have more health problems than similar people who live on their own, which explains the higher risk of fractures in long-term care facilities, said lead author Dr. Alexandra Papaioannou of McMaster University and Hamilton Health Sciences in Hamilton, Ontario.

"Up to a third of seniors in long-term care suffer a fracture," often of the hip or spine, she said. For these residents, "long-term care is their home, the nurses know them, and acute care can be a frightening traumatic experience for residents."

The authors developed the new guideline based on input from older people and their families, who most wanted to avoid pain, loss of activity, and hospitalization, Papaioannou said. They also studied published literature on the risks and benefits of strategies to prevent fracture.

The guideline strongly recommends calcium supplementation of 1200 mg or three servings of dairy daily for people older than 70. These calcium levels reduce hip fracture risk and slightly reduce the risk of other fractures, but they may also cause gastrointestinal side effects. For residents who want to avoid these, supplementation may not be a good option, the authors write.

Residents at high risk of fracture, i.e., those with prior fracture of the hip or spine, more than one prior fracture, or one prior fracture and recent use of glucocorticoids, should also take daily vitamin D3 supplements, which are more affordable than vitamin D2, the authors wrote online September 14 in CMAJ.

They also recommend that high-risk residents take alendronate weekly, or risedronate weekly or monthly, as first-line therapy to prevent fractures, as long as they do not have difficulty swallowing and can remain upright for 30 minutes after administration, and they do not have severe renal insufficiency.

For residents who are at high risk of fractures and who have difficulty taking oral medications, they recommend zoledronic acid or denosumab as first-line therapy.

High-risk residents who are mobile should wear hip-protectors, which can protect against fracture in the event of a fall. Low-risk residents who are mobile may wear the devices, depending on their values and preferences.

Balance, strength, and functional exercise can help prevent falls for low-risk residents, and may be useful for high-risk residents, but the exercise itself increases the risk of fall slightly.

Lastly, the authors recommend that all residents have "multifactorial interventions" that are tailored to each individual and include medication reviews, environmental hazard assessment, assistive device use, exercise, and educational interventions for staff.

"Many residents have multiple medical conditions and we need to make sure that they include their lifespan and goals of care in the assessment," Papaioannou said. "The goals of those with short lifespans may be very different from those with longer lifespans."

These recommendations are similar to those for residential care facilities in Australia and the ones made by the Society for Post-Acute and Long-Term Care Medicine in the U.S., the authors point out.

"The document is an excellent guide on how to identify patients at risk, who should be treated and how," said Dr. Gustavo Duque, director of the Musculoskeletal Ageing Research Program at the University of Sydney in Australia.

Doctors often reduce medications for residents who are admitted to nursing homes without realizing that those with osteoporosis or previous fractures are more likely to suffer a fracture at their new residence than in the community, Duque, who was not involved in writing the new guideline, said by email.

"Ceasing osteoporosis treatment has demonstrated to increase the risk of fractures," Duque said. "Unfortunately we see that situation every day."

NEW YORK  - Older adults living in long-term care are more than twice as likely as their peers living at home to suffer a fracture, and a new guideline endorsed by the Scientific Advisory Council of Osteoporosis Canada explains how to reduce their risk.

Residents of long-term care tend to be frailer and have more health problems than similar people who live on their own, which explains the higher risk of fractures in long-term care facilities, said lead author Dr. Alexandra Papaioannou of McMaster University and Hamilton Health Sciences in Hamilton, Ontario.

"Up to a third of seniors in long-term care suffer a fracture," often of the hip or spine, she said. For these residents, "long-term care is their home, the nurses know them, and acute care can be a frightening traumatic experience for residents."

The authors developed the new guideline based on input from older people and their families, who most wanted to avoid pain, loss of activity, and hospitalization, Papaioannou said. They also studied published literature on the risks and benefits of strategies to prevent fracture.

The guideline strongly recommends calcium supplementation of 1200 mg or three servings of dairy daily for people older than 70. These calcium levels reduce hip fracture risk and slightly reduce the risk of other fractures, but they may also cause gastrointestinal side effects. For residents who want to avoid these, supplementation may not be a good option, the authors write.

Residents at high risk of fracture, i.e., those with prior fracture of the hip or spine, more than one prior fracture, or one prior fracture and recent use of glucocorticoids, should also take daily vitamin D3 supplements, which are more affordable than vitamin D2, the authors wrote online September 14 in CMAJ.

They also recommend that high-risk residents take alendronate weekly, or risedronate weekly or monthly, as first-line therapy to prevent fractures, as long as they do not have difficulty swallowing and can remain upright for 30 minutes after administration, and they do not have severe renal insufficiency.

For residents who are at high risk of fractures and who have difficulty taking oral medications, they recommend zoledronic acid or denosumab as first-line therapy.

High-risk residents who are mobile should wear hip-protectors, which can protect against fracture in the event of a fall. Low-risk residents who are mobile may wear the devices, depending on their values and preferences.

Balance, strength, and functional exercise can help prevent falls for low-risk residents, and may be useful for high-risk residents, but the exercise itself increases the risk of fall slightly.

Lastly, the authors recommend that all residents have "multifactorial interventions" that are tailored to each individual and include medication reviews, environmental hazard assessment, assistive device use, exercise, and educational interventions for staff.

"Many residents have multiple medical conditions and we need to make sure that they include their lifespan and goals of care in the assessment," Papaioannou said. "The goals of those with short lifespans may be very different from those with longer lifespans."

These recommendations are similar to those for residential care facilities in Australia and the ones made by the Society for Post-Acute and Long-Term Care Medicine in the U.S., the authors point out.

"The document is an excellent guide on how to identify patients at risk, who should be treated and how," said Dr. Gustavo Duque, director of the Musculoskeletal Ageing Research Program at the University of Sydney in Australia.

Doctors often reduce medications for residents who are admitted to nursing homes without realizing that those with osteoporosis or previous fractures are more likely to suffer a fracture at their new residence than in the community, Duque, who was not involved in writing the new guideline, said by email.

"Ceasing osteoporosis treatment has demonstrated to increase the risk of fractures," Duque said. "Unfortunately we see that situation every day."

NEW YORK  - Older adults living in long-term care are more than twice as likely as their peers living at home to suffer a fracture, and a new guideline endorsed by the Scientific Advisory Council of Osteoporosis Canada explains how to reduce their risk.

Residents of long-term care tend to be frailer and have more health problems than similar people who live on their own, which explains the higher risk of fractures in long-term care facilities, said lead author Dr. Alexandra Papaioannou of McMaster University and Hamilton Health Sciences in Hamilton, Ontario.

"Up to a third of seniors in long-term care suffer a fracture," often of the hip or spine, she said. For these residents, "long-term care is their home, the nurses know them, and acute care can be a frightening traumatic experience for residents."

The authors developed the new guideline based on input from older people and their families, who most wanted to avoid pain, loss of activity, and hospitalization, Papaioannou said. They also studied published literature on the risks and benefits of strategies to prevent fracture.

The guideline strongly recommends calcium supplementation of 1200 mg or three servings of dairy daily for people older than 70. These calcium levels reduce hip fracture risk and slightly reduce the risk of other fractures, but they may also cause gastrointestinal side effects. For residents who want to avoid these, supplementation may not be a good option, the authors write.

Residents at high risk of fracture, i.e., those with prior fracture of the hip or spine, more than one prior fracture, or one prior fracture and recent use of glucocorticoids, should also take daily vitamin D3 supplements, which are more affordable than vitamin D2, the authors wrote online September 14 in CMAJ.

They also recommend that high-risk residents take alendronate weekly, or risedronate weekly or monthly, as first-line therapy to prevent fractures, as long as they do not have difficulty swallowing and can remain upright for 30 minutes after administration, and they do not have severe renal insufficiency.

For residents who are at high risk of fractures and who have difficulty taking oral medications, they recommend zoledronic acid or denosumab as first-line therapy.

High-risk residents who are mobile should wear hip-protectors, which can protect against fracture in the event of a fall. Low-risk residents who are mobile may wear the devices, depending on their values and preferences.

Balance, strength, and functional exercise can help prevent falls for low-risk residents, and may be useful for high-risk residents, but the exercise itself increases the risk of fall slightly.

Lastly, the authors recommend that all residents have "multifactorial interventions" that are tailored to each individual and include medication reviews, environmental hazard assessment, assistive device use, exercise, and educational interventions for staff.

"Many residents have multiple medical conditions and we need to make sure that they include their lifespan and goals of care in the assessment," Papaioannou said. "The goals of those with short lifespans may be very different from those with longer lifespans."

These recommendations are similar to those for residential care facilities in Australia and the ones made by the Society for Post-Acute and Long-Term Care Medicine in the U.S., the authors point out.

"The document is an excellent guide on how to identify patients at risk, who should be treated and how," said Dr. Gustavo Duque, director of the Musculoskeletal Ageing Research Program at the University of Sydney in Australia.

Doctors often reduce medications for residents who are admitted to nursing homes without realizing that those with osteoporosis or previous fractures are more likely to suffer a fracture at their new residence than in the community, Duque, who was not involved in writing the new guideline, said by email.

"Ceasing osteoporosis treatment has demonstrated to increase the risk of fractures," Duque said. "Unfortunately we see that situation every day."

Too little sleep, or poor-quality sleep, may be linked to early markers of heart disease in asymptomatic healthy adults, a new study from South Korea suggests.

More than 47,000 men and women completed a sleep questionnaire and underwent assessments of coronary artery calcium and plaque as well as brachial-ankle pulse wave velocity (PWV).

Participants' average sleep duration was 6.4 hours per night, and about 84 percent said their sleep quality was "good," according to Dr. Chan-Won Kim of Kangbuk Samsung Hospital of Sungkyunkwan University School of Medicine in Seoul, South Korea and colleagues.

The researchers considered those who got five hours or less per night to be "short" sleepers, and those who got nine or more hours to be "long" sleepers.

Short sleepers had 50% more coronary artery calcium than those who slept for seven hours per night, according to the results in Arteriosclerosis, Thrombosis and Vascular Biology. Long sleepers had 70% more calcium than those who slept seven hours.

Those who reported poor sleep quality also tended to have more coronary calcium and more arterial stiffness.

In a 2013 study, people who tended to get less than six hours of sleep nightly were more likely to have high blood pressure, high cholesterol, diabetes and to be obese.

"Adults with poor sleep quality have stiffer arteries than those who sleep seven hours a day or had good sleep quality," co-lead author Dr. Yoosoo Chang of the Center for Cohort Studies at Kangbuk Samsung Hospital said in a statement accompanying the study. "Overall, we saw the lowest levels of vascular disease in adults sleeping seven hours a day and reporting good sleep quality."

Short sleepers were more likely than others to be older, have depression, type 2 diabetes or to be smokers.

"The associations of too short or too long sleep duration and of poor sleep quality with early indicators of heart disease, such as coronary calcium and arterial stiffness, provides strong support to the increasing body of evidence that links inadequate sleep with an increased risk of heart attacks," Kim said by email.

"It is still not clear if inadequate sleep is the cause or the consequence of ill health," but good sleep hygiene, including avoiding electronic media at bedtime, should be part of a healthy lifestyle, Kim said.

"For doctors, it can be helpful to evaluate sleep duration and sleep quality when assessing the health status of their patients," Kim said.

Too little sleep, or poor-quality sleep, may be linked to early markers of heart disease in asymptomatic healthy adults, a new study from South Korea suggests.

More than 47,000 men and women completed a sleep questionnaire and underwent assessments of coronary artery calcium and plaque as well as brachial-ankle pulse wave velocity (PWV).

Participants' average sleep duration was 6.4 hours per night, and about 84 percent said their sleep quality was "good," according to Dr. Chan-Won Kim of Kangbuk Samsung Hospital of Sungkyunkwan University School of Medicine in Seoul, South Korea and colleagues.

The researchers considered those who got five hours or less per night to be "short" sleepers, and those who got nine or more hours to be "long" sleepers.

Short sleepers had 50% more coronary artery calcium than those who slept for seven hours per night, according to the results in Arteriosclerosis, Thrombosis and Vascular Biology. Long sleepers had 70% more calcium than those who slept seven hours.

Those who reported poor sleep quality also tended to have more coronary calcium and more arterial stiffness.

In a 2013 study, people who tended to get less than six hours of sleep nightly were more likely to have high blood pressure, high cholesterol, diabetes and to be obese.

"Adults with poor sleep quality have stiffer arteries than those who sleep seven hours a day or had good sleep quality," co-lead author Dr. Yoosoo Chang of the Center for Cohort Studies at Kangbuk Samsung Hospital said in a statement accompanying the study. "Overall, we saw the lowest levels of vascular disease in adults sleeping seven hours a day and reporting good sleep quality."

Short sleepers were more likely than others to be older, have depression, type 2 diabetes or to be smokers.

"The associations of too short or too long sleep duration and of poor sleep quality with early indicators of heart disease, such as coronary calcium and arterial stiffness, provides strong support to the increasing body of evidence that links inadequate sleep with an increased risk of heart attacks," Kim said by email.

"It is still not clear if inadequate sleep is the cause or the consequence of ill health," but good sleep hygiene, including avoiding electronic media at bedtime, should be part of a healthy lifestyle, Kim said.

"For doctors, it can be helpful to evaluate sleep duration and sleep quality when assessing the health status of their patients," Kim said.

Too little sleep, or poor-quality sleep, may be linked to early markers of heart disease in asymptomatic healthy adults, a new study from South Korea suggests.

More than 47,000 men and women completed a sleep questionnaire and underwent assessments of coronary artery calcium and plaque as well as brachial-ankle pulse wave velocity (PWV).

Participants' average sleep duration was 6.4 hours per night, and about 84 percent said their sleep quality was "good," according to Dr. Chan-Won Kim of Kangbuk Samsung Hospital of Sungkyunkwan University School of Medicine in Seoul, South Korea and colleagues.

The researchers considered those who got five hours or less per night to be "short" sleepers, and those who got nine or more hours to be "long" sleepers.

Short sleepers had 50% more coronary artery calcium than those who slept for seven hours per night, according to the results in Arteriosclerosis, Thrombosis and Vascular Biology. Long sleepers had 70% more calcium than those who slept seven hours.

Those who reported poor sleep quality also tended to have more coronary calcium and more arterial stiffness.

In a 2013 study, people who tended to get less than six hours of sleep nightly were more likely to have high blood pressure, high cholesterol, diabetes and to be obese.

"Adults with poor sleep quality have stiffer arteries than those who sleep seven hours a day or had good sleep quality," co-lead author Dr. Yoosoo Chang of the Center for Cohort Studies at Kangbuk Samsung Hospital said in a statement accompanying the study. "Overall, we saw the lowest levels of vascular disease in adults sleeping seven hours a day and reporting good sleep quality."

Short sleepers were more likely than others to be older, have depression, type 2 diabetes or to be smokers.

"The associations of too short or too long sleep duration and of poor sleep quality with early indicators of heart disease, such as coronary calcium and arterial stiffness, provides strong support to the increasing body of evidence that links inadequate sleep with an increased risk of heart attacks," Kim said by email.

"It is still not clear if inadequate sleep is the cause or the consequence of ill health," but good sleep hygiene, including avoiding electronic media at bedtime, should be part of a healthy lifestyle, Kim said.

"For doctors, it can be helpful to evaluate sleep duration and sleep quality when assessing the health status of their patients," Kim said.