Nav: Home

ACP issues guideline for testosterone treatment in adult men with age-related low testosterone

January 06, 2020

1. ACP issues guideline for testosterone treatment in adult men with age-related low testosterone

ACP's recommendations include treating for sexual dysfunction only, discontinuing treatment if sexual function does not improve, and not initiating treatment for other reasons

Notes: HD video soundbites of ACP's president discussing the guideline are available to download at http://www.dssimon.com/MM/ACP-testosterone/.

Guideline: http://annals.org/aim/article/doi/10.7326/M19-0882
Evidence Review: http://annals.org/aim/article/doi/10.7326/M19-0830
Editorial: http://annals.org/aim/article/doi/10.7326/M19-3815
URLs go live when the embargo lifts

Physicians should prescribe testosterone for men with age-related low testosterone only to treat sexual dysfunction, the American College of Physicians (ACP) says in a new evidence-based clinical practice guideline. The evidence shows that men with age-related low testosterone may experience slight improvements in sexual and erectile function. The guideline is published in Annals of Internal Medicine.

ACP suggests that physicians consider intramuscular rather than transdermal formulations when initiating testosterone treatment to improve sexual function because the costs are considerably lower for the intramuscular formulation and clinical effectiveness and harms are similar. The annual cost in 2016 per beneficiary for testosterone replacement therapy was $2,135.32 for transdermal and $156.24 for the intramuscular formulation according to paid pharmaceutical claims provided in the 2016 Medicare Part D Drug Claims data. Most men are able to inject the intramuscular formulation at home and do not require a separate clinic or office visit for administration.

Physicians should discuss whether to initiate testosterone treatment in men with age-related low testosterone with sexual dysfunction who want to improve sexual and erectile function based on the potential benefits, harms, costs, and patient preferences. Physicians should reevaluate symptoms within 12 months and periodically thereafter and discontinue testosterone treatment if sexual function does not improve. Testosterone treatment should not be initiated to improve energy, vitality, physical function, or cognition because the evidence indicates testosterone treatment is not effective.

ACP's guideline, endorsed by the American Academy of Family Physicians, applies to adult men with age-related low testosterone. It does not address screening or diagnosis of hypogonadism, or monitoring of testosterone levels.

Media contact: For an embargoed PDF or to talk to an ACP spokesperson, please contact Steve Majewski at SMajewski@acponline.org or 215-351-2514.


2. U.S. health care administration costs four times more per capita than in Canada

Rise in bureaucracy due to surging overhead of private insurers

Abstract: http://annals.org/aim/article/doi/10.7326/M19-2818
URLs go live when the embargo lifts

Health care bureaucracy cost Americans $812 billion in 2017, and represented more than one-third of total expenditures for doctor visits, hospitals, long-term care and health insurance. A study found that cutting U.S. administrative costs to Canadian levels would have saved more than $600 billion. The analysis is published in Annals of Internal Medicine.

Researchers at the City University of New York at Hunter College, Harvard Medical School and the University of Ottawa analyzed thousands of accounting reports that hospitals and other health care providers filed with regulators, as well as census data on employment and wages in the health sector to quantify 2017 spending for administration by insurers and providers. They found that health administration costs were more than four-fold higher per capita in the U.S. than in Canada ($2,479 vs. $551 per person) which implemented a single payer Medicare for All system starting in 1962. Americans spent $844 per person on insurers' overhead while Canadians spent $146. Additionally, doctors, hospitals and other health providers in the U.S. spent far more on administration due to the complexity entailed in billing multiple payers and dealing with the bureaucratic hurdles that insurers impose. As a result, hospital administration cost Americans $933 per capita vs. $196 in Canada, where hospitals are paid lump-sum budgets by the single payer, much as fire departments are funded in the U.S. Physicians' billing costs were also much higher in the U.S., $465 per capita vs. $87 per capita in Canada.

The authors cautioned that their estimates probably understate administrative costs, and particularly the growth since 1999. The same authors conducted a study in 1999 that included administrative spending for some items such as dental care for which no 2017 data were available. They suggest that Medicare for All could save more than $600 billion each year on bureaucracy and repurpose that money to cover America's 30 million uninsured, and eliminate copayments and deductibles for everyone.

Media contacts: For an embargoed PDF, please contact Lauren Evans at laevans@acponline.org.

To reach the lead author, David U. Himmelstein, MD, please contact Clare Fauke at clare@pnhp.org.


3. Only 10 percent of eligible primary care providers certified to prescribe buprenorphine

Abstract: http://annals.org/aim/article/doi/10.7326/M19-2403
URLs go live when the embargo lifts

Only 10 percent of eligible primary care providers are certified to prescribe buprenorphine, a number that falls far short of what is needed to address the current opioid epidemic in the United States. Waiver certification has been much faster in areas hardest-hit by the opioid epidemic, but rural communities and communities with lower levels of secondary education are still underserved. A brief research report is published in Annals of Internal Medicine.

Expanded access to medication treatment of opioid use disorder is a critical component of the national response to the opioid crisis. From 2007 to 2017, there was roughly a four-fold increase in providers certified to prescribe buprenorphine. However, how this growth has varied by community characteristics is unclear.

Researchers from RAND Corporation studied Substance Abuse and Mental Health Services Administration and the Drug Enforcement Administration data to examine county-level growth in the number of buprenorphine-waivered prescribers and variation by county characteristics, including rurality, income, and rate of opioid-related overdose deaths in the past year. They found that the number of buprenorphine-waivered clinicians increased substantially between 2007 and 2017 and that growth was much faster in counties with higher rates of opioid-related overdose deaths in the preceding year. However, despite evidence that the opioid crisis has disproportionately affected rural counties that are socioeconomically disadvantaged, prescriber growth was markedly slower in small nonmetropolitan counties than in urban counties and was also slower in communities with lower levels of education, even after adjusting for the severity of the crisis. According to the authors, new models to increase access to care, broader scope of practice laws, and more aggressive training and financial incentives are needed to address a shortage of certified providers who are offering services.

Media contacts: For an embargoed PDF, please contact Lauren Evans at laevans@acponline.org.

To reach the lead author, Ryan McBain, PhD, MPH, please contact him directly at rmcbain@rand.org.


4. Cardiac troponin test cannot safely rule out inducible myocardial ischemia in patients with symptomatic coronary artery disease

Abstract: http://annals.org/aim/article/doi/10.7326/M19-0080
Abstract: http://annals.org/aim/article/doi/10.7326/M19-3731
URLs go live when the embargo lifts

In symptomatic patients with coronary artery disease (CAD), even very low high-sensitivity cardiac troponin (hs-cTn) concentrations, do not generally allow clinicians to safely rule out inducible myocardial ischemia. Findings from a cohort study are published in Annals of Internal Medicine.

Currently, clinical judgement and cardiac stress imaging are used for risk stratification in symptomatic patients with CAD and suspected inducible myocardial ischemia. The optimal noninvasive method for surveillance is unknown, but hs-cTn, a quantitative marker of cardiomyocyte injury, has recently been evaluated as a clinical tool in settings other than the diagnosis of acute myocardial infarction.

Researchers from University Hospital Basel, Switzerland studied 1,896 consecutive symptomatic patients with CAD to apply a novel approach using very low hs-cTnl concentrations less than 2.5 ng/L to determine if it could exclude inducible myocardial ischemia. Including the most sensitive hs-cTnI assay currently available (limit of detection 0.1 ng/l, they used three different assaysto measure hs-cTnI and hs-cTnT in blood samples that had been taken before stress testing and processed by personnel blinded to clinical data. The researchers found that the diagnostic accuracy of hs-cTnI and hs-cTnT to identify inducible myocardial ischemia was low, and no cutoff level achieved the predefined performance characteristics for the safe exclusion of inducible myocardial ischemia.

Media contacts: For an embargoed PDF, please contact Lauren Evans at laevans@acponline.org.

To reach the lead author, Christian Mueller, MD, please contact christian.mueller@usb.ch
-end-
Also new in this issue:

Celiac Disease

Joshua Elliott Rubin, MD; Sheila E. Crowe, MD

In The Clinic

Abstract: https://annals.org/aim/article/doi/10.7326/AITC202001070

Annals of Internal Medicine Tip Sheet
@Annalsofim

American College of Physicians

Related Coronary Artery Disease Articles:

A new strategy to counter insulin damage in coronary artery disease
By studying blood vessel tissue from 674 patients, a research team has discovered how insulin contributes to the dysfunction of blood vessels in atherosclerosis, one of the most common chronic health conditions worldwide.
3D fusion imaging improves coronary artery disease diagnosis
A new technique that combines CT and MRI can bolster coronary artery disease diagnosis and help to define appropriate treatment for patients suffering from the disease, according to a new study.
Associations between vaspin levels and coronary artery disease
In a new publication from Cardiovascular Innovations and Applications; DOI https://doi.org/10.15212/CVIA.2019.0565, Lutfu Askin, Okan Tanriverdi, Hakan Tibilli and Serdar Turkmen from the Department of Cardiology, Adiyaman Education and Research Hospital, Adiyaman, Turkey consider associations between vaspin levels and coronary artery disease.
Waist size, not body mass index, may be more predictive of coronary artery disease
For years, women have been told that weight gain could lead to heart disease.
Women with coronary artery wall thickness at risk for heart disease
The thickness of the coronary artery wall as measured by MRI is an independent marker for heart disease in women, according to a new study.
SPIE journal reports advances in use of 3D models in assessing coronary artery disease
In an article published in SPIE's Journal of Medical Imaging (JMI), researchers announce critical advances in the use of 3D-printed coronary phantoms with diagnostic software, further developing a non-invasive diagnostic method for Coronary Artery Disease (CAD) risk assessment.
E-cigarettes linked to heart attacks, coronary artery disease and depression
Concerns about the addictive nature of e-cigarettes -- now used by an estimated 1 out of 20 Americans -- may only be part of the evolving public health story surrounding their use, according to data being presented at the American College of Cardiology's 68th Annual Scientific Session.
Is guideline-recommended therapy for coronary artery disease more likely in Medicare Advantage?
Medicare Advantage is Medicare's managed-care alternative to traditional fee-for-service Medicare.
Early depression diagnosis is deadly serious for patients with coronary artery disease
While clinicians caring for patients with coronary artery disease may not always prioritize depression screening, an early diagnosis could be a matter of life and death.
Analysis of the 9p21.3 sequence associated with coronary artery disease
Before a conclusive link between the SDs and the cardiovascular diseases can be made, further analysis is required on the CAD interval in more patients with coronary artery disease and in the human population, using the TAR cloning technique in combination with qPCR or Droplet digital PCR developed in this work.
More Coronary Artery Disease News and Coronary Artery Disease Current Events

Trending Science News

Current Coronavirus (COVID-19) News

Top Science Podcasts

We have hand picked the top science podcasts of 2020.
Now Playing: TED Radio Hour

Debbie Millman: Designing Our Lives
From prehistoric cave art to today's social media feeds, to design is to be human. This hour, designer Debbie Millman guides us through a world made and remade–and helps us design our own paths.
Now Playing: Science for the People

#574 State of the Heart
This week we focus on heart disease, heart failure, what blood pressure is and why it's bad when it's high. Host Rachelle Saunders talks with physician, clinical researcher, and writer Haider Warraich about his book "State of the Heart: Exploring the History, Science, and Future of Cardiac Disease" and the ails of our hearts.
Now Playing: Radiolab

Insomnia Line
Coronasomnia is a not-so-surprising side-effect of the global pandemic. More and more of us are having trouble falling asleep. We wanted to find a way to get inside that nighttime world, to see why people are awake and what they are thinking about. So what'd Radiolab decide to do?  Open up the phone lines and talk to you. We created an insomnia hotline and on this week's experimental episode, we stayed up all night, taking hundreds of calls, spilling secrets, and at long last, watching the sunrise peek through.   This episode was produced by Lulu Miller with Rachael Cusick, Tracie Hunte, Tobin Low, Sarah Qari, Molly Webster, Pat Walters, Shima Oliaee, and Jonny Moens. Want more Radiolab in your life? Sign up for our newsletter! We share our latest favorites: articles, tv shows, funny Youtube videos, chocolate chip cookie recipes, and more. Support Radiolab by becoming a member today at Radiolab.org/donate.