Saving thousands of lives and reducing health care costs might be a matter of just picking up the phone.Harvard researchers have estimated the likely cost-effectiveness of post-discharge follow-up phone calls to smokers hospitalized with acute heart attacks. In a report in the Archives of Internal Medicine, the researchers suggest that phone calls to these discharged smokers encouraging them to quit would yield significant health and economic gains.“It’s an extremely simply intervention, just some phone calls that make a big impact,” says Harvard’s Joseph Ladapo, a clinical fellow at Harvard Medical School who is completing an internal medicine residency at Beth Israel Deaconess Medical Center.In their analysis, Ladapo and his colleagues considered the likely health and economic benefits gained when nurses phone survivors of acute myocardial infarction (AMI) five times over three months to encourage them to quit smoking.“This is actually an enormous public heath care problem,” says Lapado of the more than 300,000 smokers hospitalized each year in the United States who survive AMI.Smoking is a well-established yet preventable risk factor for heart disease, and Ladapo says most hospitals routinely provide in-hospital smoking cessation counseling to smokers with AMI.But after these patients are discharged, few hospitals follow up on the patients’ smoking habits, even though studies have shown this contact can increase the number of patients who quit. Nonetheless, post-discharge smoking cessation follow-up is still uncommon, and is not considered a quality measure by Medicare, says Ladapo.“Sadly, we know from previous studies that among the survivors, anywhere from 6 to 7 out of 10 of them will still be smoking a year later. And the ones who continue to smoke have much higher rates, not surprisingly, of recurrent heart attacks.“So we decided to look at the problem differently.”With data from a meta-analysis of randomized trials of smoking cessation interventions, Ladapo and his colleagues developed a statistical risk model to project the health and economic outcomes for a hypothetical U.S. cohort of 327,600 smokers who would be admitted for AMI to hospitals this year. The cohort size was the product of the 1.26 million U.S. patients with new or recurrent AMI each year and the reported prevalence of smokers (26 percent) among patients with AMI.The researchers compared the projected 10-year effects of routine care (in-hospital smoking cessation advice) with more supportive care that coupled in-hospital advice with follow-up phone calls to patients after they were discharged.Says Ladapo, “We found that if follow-up phone calls became the standard of care, then among the 300,000 plus smokers who are expected to have a heart attack in a given year, we would get 50,000 more smoking quitters the first year, prevent 1,400 heart attacks, and save about 8,000 lives.”The researchers then calculated for the cohort the projected costs for their reduced hospitalizations, their added care and nonmedical expenditures because of increased longevity, and the subsequent reductions in productivity losses due to premature death. The researchers noted a “net positive value to society of $894 million,” with the program of follow-up intervention costing just $540 per quitter, and yielding a cost-effectiveness value of $5,050 per quality-adjusted life year.Says Ladapo, “The added follow-up intervention is so simple. The nurse calls the patients, literally just picks up the phone and calls each of them five times after they are discharged. Yet we found that if these phone calls were made, if this simple intervention became the standard of care, it would be incredibly cost-effective, especially when you compare it to more expensive medicines and high-tech treatments.”In the study’s conclusion, the researchers suggest that Medicare and other health insurers consider making follow-up phone calls for hospitalized smokers with AMI a quality measure they support.“We have an example of an intervention that can easily be applied for smokers to get them to quit, and it’s not only effective for smoking cessation, but cost-effective,” says study co-author Milton C. Weinstein, the Henry J. Kaiser Professor of Health Policy and Management at the Harvard School of Public Health.“It’s generally the case that almost anything a health professional can do to get someone to quit smoking is going to be worth the money if you can get them to quit.”The study’s other authors are Farouc A. Jaffer of Harvard Medical School and the Cardiology Division at Massachusetts General Hospital, and Erika S. Froelicher of the Department of Epidemiology and Biostatistics at the School of Nursing at the University of California, San Francisco.
By Ryan Clark INDEPENDENCE, Iowa (May 24) – Brian Irvine took the lead on the sixth of 18 laps, then pulled away to a dominant win in the Saturday Showcase for IMCA Sunoco Stock Cars at Independence Motor Speedway.In the first of four installments this season, the Saturday Showcase offers increased prize money once a month to one featured division. It was Irvine’s first win in Independence since May of 2010.Irvine, who started inside row five, raced through traffic and entered a four-car breakaway at the front of the pack with Jarod Weepie, Norman Chesmore and Justin Temeyer. He slipped past Weepie to steal the lead a couple laps before a pair of mid-race cautions. Following the final restart on lap nine, Irvine pulled away from the field to win in convincing fashion and earn the $500 payday. Weepie ran second ahead of Temeyer. Mike Burbridge held the early lead in the 20-lap Performance Bodies IMCA Modified feature. Burbridge ran the low groove of the fast, smooth oval while J.D. Auringer worked into contention from a fourth row starting spot. Auringer cut into Burbridge’s lead and took control on lap 11 while Troy Cordes, Tyler Droste and Scott Hogan raced their way through traffic. Cordes made his way into the runner-up spot shortly after Auringer took the lead and Hogan followed him into the top three just prior to a lap 16 caution. On the restart, Hogan went to work on the top side and pulled even with Auringer a short time later. The two ran in side-by-side formation until Hogan surged ahead as the white flag waved.Hogan led the remainder of the event to score the victory and extend his points lead. Cordes finished second and Auringer was third. Darren Ackerman took the lead on the second lap and then pulled away to the convincing win in the 25-lap IMCA Late Model feature. Ackerman masterfully worked through lapped traffic to take the victory a comfortable margin ahead of Tyler Bruening. Dean Wagner ran third. Jenae Gustin earned her third win in the last four weeks in the Karl Chevrolet Northern SportMod division. From her eighth row starting spot, Gustin quickly worked through the pack and settled into second by the time the caution flag waved on lap six. Gustin took the lead two laps after racing resumed to score the impressive win ahead of Rod McDonald and Danny Dvorak. Shawn Kuennen earned the first win of his career in the IMCA Sunoco Hobby Stock division. Kuennen took charge on the second lap, then held off a hard-charging Benji Irvine in lapped traffic to score the win by half of a car-length. Chad Albert ran third.
THE Achievers Youth and Sports Club romped to an innings and 88-run victory against home team No. 5 Mondderlust due to an all-round effort from skipper Krishndat Ramoo when action continued in the West Berbice Cricket Association (WBCA) Anil Lalsa Construction Company Intermediate Two-Day Cricket Competition.On Saturday (day two), Achievers led by Ramoo were able to bowl out their opponents twice.The off- spinner picked up 11 wickets for 88 runs from 28 overs to lead the charge.On the first day two Saturdays ago, Achievers had posted 390, with Ramoo and Shamal Angel smacking centuries.For the third wicket, the pair put together 243, which took the sail out of their opponents’ bowling. Ramoo struck nine fours and four sixes in his 105, while Angel reached the boundary 14 times, lifting the ball over the ropes six times for a match-high 137. The next best score was by opener Kevin Sinclair, who finished with 49.Bowling for Number 5, Kenjie Sedock spun his way to 6-91 from 21 overs, while A. Bailey supported with 3-113 (21 overs).In their second day, on Saturday last, No.5 were bowled out for 99 with Ramoo picking up 5-52 from 13 overs; Sinclair finished with 3-23. Amernauth Seegobin led the attack for the home side with an unbeaten 35.With a lead of 291, Achievers enforced the follow-on. The home team batted better, but fell for 203. Ramoo finished with 6-36 from 15 overs, while Sinclair picked up 2-54 from 20 overs.R. Estraido led the home team with a solid 73 (11X4s and 2X6s).