Atrial fibrillation, a rapid, irregular heartbeat that can lead to stroke or sudden death, is three times more common than previously thought, affecting nearly 5% of the population, according to new estimates from UC San Francisco.
A-Fib, as the condition is commonly known, has been on the rise for at least the past decade, driven by the aging of the population, along with increasing rates of hypertension, diabetes and obesity. Earlier projections had estimated that 3.3 million U.S. adults had atrial fibrillation, but these have not been updated in more than two decades.
“Atrial fibrillation doubles the risk of mortality, is one of the most common causes of stroke, increases risks of heart failure, myocardial infarction, chronic kidney disease and dementia, and results in lower quality of life,” said first author Jean Jacques Noubiap, MD, PhD, a postdoctoral scholar at UCSF with a specialty in global cardiovascular health.
“Fortunately, atrial fibrillation is preventable, and early detection and appropriate treatment can substantially reduce its adverse outcomes,” he said.
Rising numbers reflect need for better prevention and treatment
UCSF investigators reviewed the medical records of nearly 30 million adult patients who received some form of acute or procedural care in California from 2005 to 2019. About 2 million of these people had been diagnosed with A-Fib, and the numbers grew over time, rising from 4.49% of the patients treated between 2005 and 2009 to 6.82% of the patients treated between 2015 and 2019.
The data were standardised to reflect the entire country, and researchers estimated the current national prevalence to be at least 10.55 million. They also found that during the study timeframe, A-Fib patients skewed younger, were less likely to be female and more likely to have hypertension and diabetes.
A-Fib has a broad spectrum of complications from shortness of breath and light-headedness to blood clots, stroke and even heart failure. Studies have shown that people with A-Fib are up to five times more likely to have a stroke. The authors said that by outlining the scope of the problem, these new estimates can help guide health care planning, resource allocation and public health interventions.
“Physicians recognise that atrial fibrillation is often encountered in essentially every field of practice,” said senior and corresponding author Gregory M. Marcus, MD, MAS, a cardiologist and electrophysiologist at UCSF Health. “These data provide objective evidence to demonstrate that prior projections severely underestimated how common it truly is.”
Digital technologies may reveal it is even more common than the current analysis indicates.
“With the growing use of consumer wearables designed to detect atrial fibrillation combined with safer and more effective means to treat it, this current prevalence of atrial fibrillation in health care settings may soon be dwarfed by future health care utilisation that will occur due to the disease,” Marcus said.
In a review of 27 different studies, a Johns Hopkins Children’s Center team concludes that some video games created as mental health interventions can be helpful – if modest – tools in improving the mental well-being of children and teens with depression and attention-deficit/hyperactivity disorder (ADHD). They did not significantly help with anxiety, however.
A report on the review of studies from peer-reviewed journals between 2011 and March 20, 2024, was published in JAMA Pediatrics.
“We found literature that suggests that even doubling the number of paediatric mental health providers still wouldn’t meet the need,” says Barry Bryant, MD, a resident in the Department of Psychiatry and Behavioral Sciences in the Johns Hopkins University School of Medicine and first author of the new study.
In a bid to determine if so-called “gamified digital mental health interventions,” or video games designed to treat mental health conditions, benefited those with anxiety, depression and ADHD, the research team analysed their use in randomised clinical trials for children and adolescents.
Bryant and child and adolescent psychologist Joseph McGuire, PhD, identified 27 such trials from the US and around the world. The studies overall included 2911 participants with about half being boys and half being girls, ages six to 17 years old.
The digital mental health interventions varied in content, but were all created with the intent of treating ADHD, depression and anxiety. For example, for ADHD, some of the games involved racing or splitting attention, which required the user to pay attention to more than one activity to be successful in gameplay. For depression and anxiety, some of the interventions taught psychotherapy-oriented concepts in a game format. All games were conducted on technology platforms, such as computers, tablets, video game consoles and smartphones. The video games are available to users in a variety of ways. Some are available online, while others required access through specific research teams involved in the studies.
The research team’s analysis found that video games designed for patients with ADHD and depression provided a modest reduction (both with an effect size of .28) in symptoms related to ADHD and depression, such as improved ability to sustain attention and decreased sadness, based on participant and family feedback from the studies. (An effect size of .28 is consistent with a smaller effect size, where as in-person interventions often produce moderate [.50] to large [.80] effects.) By contrast, video games designed for anxiety did not show meaningful benefits (effect size of .07) for reducing anxiety symptoms for participants, based on participant and family feedback.
Researchers also examined factors that led to improved benefit from digital mental health interventions. Specific factors related to video game delivery (i.e., interventions on computers and those with preset time limits) and participants (i.e., studies that involved more boys) were found to positively influence therapeutic effects. Researchers say these findings suggest potential ways to improve upon the current modest symptom benefit.
“While the benefits are still modest, our research shows that we have some novel tools to help improve children’s mental health – particularly for ADHD and depression – that can be relatively accessible to families,” says Joseph McGuire, Ph.D., an author of the study and an associate professor of psychiatry and behavioural sciences in the school of medicine. “So if you are a paediatrician and you’re having trouble getting your paediatric patient into individual mental health care, there could be some gamified mental health interventions that could be nice first steps for children while waiting to start individual therapy.”
The team cautioned that their review did not indicate why certain video game interventions performed better than others. They also note that some of the trials included in the study used reported outcome measures, and the studies did not uniformly examine the same factors which could have influenced the effects of the treatment. Some of the video games included in the studies are not easily accessible to play.
The researchers also noted that while video game addiction and the amount of screen time can be concerns, those children who played the games studied in a structured, time-limited format tended to do best.
Lung cancer metastasis. Credit: National Cancer Institute
In research published in Nature Communications, scientists have tested a combination of treatments in mice with lung cancer and shown that these allow immunotherapies to target non-responsive tumours.
The study findings, from Francis Crick Institute, in collaboration with Revolution Medicines, show that targeting tumours in different ways simultaneously might increase response to treatments.
The scientists tested a combination of tool compounds in mice with lung cancer. These compounds were used to represent:
Targeted drugs which block a cancer-causing protein called KRAS G12C. These have been approved for use in lung cancer, but often fail to benefit patients in the long term because the tumours develop resistance to these medicines over time.
Immunotherapy drugs. These are designed to stimulate the immune system to fight the tumour, but only 20% of people with lung cancer respond, as tumours often block immune cells from entering.
The researchers combined a newly identified KRAS G12C inhibitor, with a compound that blocks a protein called SHP2, which inhibits cancer cells and can also activate tumor immunity.
These two inhibitors were combined with an immune checkpoint inhibitor, which blocks proteins that help the cancer cells hide from the immune system.
Obstructive sleep apnoea may be a risk factor for developing abdominal aortic aneurysms, according to researchers from the University of Missouri School of Medicine and NextGen Precision Health.
Abdominal aortic aneurysms occur when the aorta swells and potentially ruptures, causing life-threatening internal bleeding. Obstructive sleep apnoea is characterised by episodes of a complete or partial airway collapse with an associated drop in oxygen saturation or arousal from sleep. It can increase the risk of developing cardiovascular problems. Citing studies that indicate a higher prevalence of abdominal aortic aneurysms in patients with obstructive sleep apnoea, MU researchers examined the link between the two using mouse models.
The research team found that intermittent hypoxia caused by obstructive sleep apnoea increased the susceptibility of mice to develop abdominal aortic aneurysms.
“Chronic intermittent hypoxia by itself is not enough to cause abdominal aortic aneurysms, but for a patient with obstructive sleep apnoea who also has additional metabolic problems like obesity, our findings suggest it may help degrade aortic structures and promote aneurysm development,” said Luis Martinez-Lemus, study author and a professor of medical pharmacology and physiology.
Intermittent hypoxia happens during obstructive sleep apnoea when throat muscles relax and block the flow of air into the lungs. According to the research, the loss of oxygen triggers certain enzymes called MMPs. The increased enzyme activity can degrade the extracellular matrix, which acts like a cell scaffolding network, weakening the aorta.
“Patients with abdominal aortic aneurysms usually don’t notice any symptoms, except for some back and belly pain, until the aneurysm bursts. Once that happens, it’s crucial to get the patient to surgery quickly so doctors can repair the aorta,” said Neekun Sharma, the lead author of the study. “Learning how these aneurysms develop can help us find ways to monitor or slow down their progression, especially for patients who have obstructive sleep apnoea.”
Craig Comrie, chairperson of the Health Funders Association
Wednesday, 25 September 2024, The passage of the National Health Insurance (NHI) Bill into an Act of law has set the stage for one of the most significant overhauls of South Africa’s healthcare system. As the government embarks on this ambitious plan, the stakes have never been higher. The NHI Act is more than a mere piece of legislation; it stands as a test of constitutional rights and the nation’s commitment to fostering a more inclusive and equitable society.
The Health Funders Association (HFA) welcomes the meeting between President Cyril Ramaphosa and Business Unity South Africa (BUSA) leadership on Tuesday, 17 September, to discuss the NHI as a positive step.
As a member of BUSA, we find it encouraging that the Minister and Deputy Minister of Health, along with other senior officials, were part of this constructive and forward-looking discussion. We can only hope that these recent discussions will mark the start of a series of engagements with key stakeholders, as the South African government must engage in open dialogue with all stakeholders, including private healthcare providers, medical schemes, and the general public. HFA will provide industry input to BUSA’s presentation to the President to help propose workable solutions to set South Africa’s healthcare train on the right track with inclusive mechanisms that will benefit all.
Constitutional rights and freedom of choice
The critical questions about the Act’s constitutional validity, economic feasibility, and potential impact on both public and private healthcare sectors, specifically the role of medical schemes, remain unanswered.
Recently, during a Q&A session, the President reaffirmed his belief that the Act is constitutionally sound but he declined to share specifics on how this conclusion was reached. In response, the Health Funders Association (HFA) will test various aspects of the NHI’s constitutionality, which is crucial for establishing a stable healthcare framework that delivers quality health services for all South Africans.
This is a critical juncture for politicians, policymakers and every South African who relies on the nation’s healthcare services – private and public sectors alike. Against this background, the HFA is seeking to strike a balance between much-needed healthcare reforms and the hard-hitting risks of the NHI Act that demand amendments.
Government has been adamant about the NHI’s transformative potential to address inequalities in healthcare access, contending that the NHI is aligned with Section 27(1) of the Constitution, which guarantees the right to access healthcare services, including reproductive healthcare.
On the other hand, this part of the Act cannot be read without the consideration of Section 36 which indicates that existing rights should not be compromised if there are alternative ways to achieve, in this case, universal health coverage. This is a key part of responding to the President’s invitation for alternative proposals that stand a more realistic chance of achieving a partnership with the private sector for improving healthcare for consumers.
Any alternative proposals provided by the private sector will come with the need to amend the current. The Act, if left unchallenged in its current form, can be likened to letting the healthcare train run on a single track of public sector inefficiency. By adding the private sector as a parallel track – both heading in the same direction towards universal healthcare coverage, we can stabilise and accelerate the journey.
The medical scheme sector effectively provides funding to the majority of services in the private sector with less than 10% of health consumers paying for services out of pocket in the private sector. This population group serves a significant portion of the taxpaying population, yet its role in the new system remains ambiguous. Will private healthcare consumers be forced to rely solely on centrally procured services, or will there be room for a coexistence that stands a better chance of laying the track towards a successful healthcare future that can benefit all South Africans?
Transparency and collaboration are essential in addressing the questions surrounding the NHI’s financial viability, human resource capacity, and broader economic impact. The future of South Africa’s healthcare system hinges on finding a balanced approach that ensures quality, accessibility, and economic sustainability for all citizens.
The government proposes funding the NHI through general taxes and mandatory payroll contributions. However, this plan has been met with scepticism as it raises considerable questions about the economic burden on taxpayers, particularly given the country’s high unemployment rate of 33.5% and sluggish economic growth rates of around 0.4% in the second quarter of this year. Critics argue that increasing tax rates to fund the NHI could backfire, reducing overall tax revenue, as highlighted by the Laffer Curve, which suggests that higher taxes can lead to lower revenue if they exceed an optimal rate.
Where will the healthcare professionals come from?
The public healthcare sector faces its own set of challenges. Reports indicate that the quality of care in public health facilities is often subpar, with systemic inefficiencies and resource constraints leading to poor health outcomes. The sector is grappling with high vacancy rates for healthcare professionals, exacerbating the strain on an already overburdened system. As it is, South Africa is already facing a severe shortage of medical personnel, with the vacancy rate for doctors ranging from 22.4% in the Free State to 5.5% in the Western Cape, while the national average vacancy rate for nurses stands at 14.7%.
The current system is struggling to fill thousands of vacancies for doctors, nurses and allied healthcare professionals, with over 2 000 unfunded vacant posts for medical doctors across nine provinces requiring an estimated R2.4 billion to fill them. Many provinces report alarming doctor vacancy rates: 18.5% in Mpumalanga, 17.6% in Limpopo, and 11.3% in KwaZulu-Natal, among others. The shortage is not just a numbers game; it affects the quality of healthcare that can be delivered. These figures raise serious concerns about the system’s capacity to deliver reliable and accessible healthcare services hampered by corruption and lack of proper leadership and management.
We must consider the strain this places on those simply trying to cope with the current healthcare demand from a growing population. The NHI aims to provide universal health coverage, but where will the necessary healthcare professionals come from?
The way forward
The NHI is not the only solution to South Africa’s healthcare challenges and is certainly not a panacea in its current form. The government must take a more collaborative approach, engaging with all stakeholders, including the private healthcare sector, medical schemes and the general public. Open dialogue is crucial to finding sustainable solutions that work for everyone. Critical decisions must be made, and these should not be taken behind closed doors. The nation’s healthcare needs are too important to be dictated by a select few without broader consultation.
The government has a constitutional obligation to ensure every South African has access to quality healthcare services. However, this must not come at the expense of freedom of choice, job losses and economic stability.
I urge President Cyril Ramaphosa to protect the constitutional rights of all South Africans and engage in meaningful dialogue with all stakeholders. The future of South Africa’s healthcare system depends on our collective ability to find innovative and inclusive solutions.
