Decoding the ACHIEVE Study: A Revelation in Hearing Loss Intervention

In this special episode, Dr. Dave Fabry and Dr. Jamie Hand untangle the intricate findings of the long-awaited ACHIEVE Study that just dropped last week. It revealed a startling 48% reduction in cognitive decline among a specific group, shedding light on the power of intervention. We were excited to discuss how this vital data can be used to empower and educate patients about comorbidities linked to untreated hearing loss. 

We also delve into how the ACHIEVE Study showcases the life-changing impact of hearing loss intervention in reducing feelings of loneliness. The impressive figure of 94% of patients believing their hearing aids were worthwhile after continuous use for three years speaks volumes. Finally, we discussed the importance of monitoring physical and social activity using innovative tools like Starkey's Hear Share app. Are you ready to dive into the fascinating world of hearing health? Let's get started!

Link to full transcript

Transcript

SPEAKER_00 0:01

Welcome to a special edition of Starkey Soundbites Podcast. Joining me today is Dr. Jamie Hand, and we're going to talk a little bit about what's been on everyone's mind, and it's been a long time coming. The first, the initial results of the Achieve study, and Achieve stands for the Aging and Cognitive Health Evaluation in Elder Study. That's a three-year longitudinal prospective study that looks at whether we can finally speak to whether or not hearing loss and untreated uh hearing loss and cognitive decline, whether there's a correlation or maybe whether there's a causative effect. So, Jamie, thank you for joining us today.

SPEAKER_02 0:44

Yeah, happy to be here. Thanks for having me.

SPEAKER_00 0:46

Yeah. Well, what were your impressions when you saw this? I I will admit uh I was traveling earlier this week and I stayed up uh to see the live broadcast because this is, you know, potentially this really helps us shorten the delay for individuals who are on the fence and considering amplification.

SPEAKER_02 1:07

Absolutely. I wasn't as um, I'm not a night owl, but I did wake up at 6 a.m. The first thing I did was roll over in bed and refresh the Achieve Study site and read the abstract. Um, and I think a lot of hearing professionals will agree with me. My first read, I went, oh, oh. You know, but then looking further into it, which I know you'll dive into a little more of that, you know, more unhealthy, as we might say, group, um, really showing that, I mean, that is the big nugget to take from this that I think we can really um use to educate our patients on.

SPEAKER_00 1:40

Yeah, I think you you make a great point. Number one, you know, when people read the headline and they see that the overall effect of this nearly 1,000 patients, participants in this study that were followed over a three-year period, um, that taken in total, use of amplification did not show that it helped uh slow the progression of cognitive decline. Um, and so I know that that was the initial gut punch. But as you said, and during the presentation, Dr. Lin, who presented as the lead uh uh author, uh lead investigator on this multi-center study, said, you know, that was the initial bad news. But then when they dug in a little deeper, they had enough subjects with, you know, 970 some subjects that uh it eclipses any other study that's looked at this relationship. And it's not just a meta-analysis, this was a prospective study where they matched two groups in terms of their ages, and they either did a control where some were not fitted with amplification, but still received some meetings over the time as they would. And then the other that were professionally fit, these were prescriptively fitted devices, followed by a hearing care professional and over that three-year period. And when they broke it down into the subgroups, they had uh one portion that was what they call the de novo subject population, and that's subjects that were recruited by newspaper ad or TV or you know online now. And then the other group that had been participating in a the group is called Eric, the Atherosclerosis Risk in Communities group, four different locations around the country. And this, these individuals have been enrolled since the 80s and been followed and tracked over time. And what they found when they broke out that group from the larger de novo group that was just anyone who met the age requirements and fit into that category, they did find a rather significant and substantial 48% reduction in cognitive decline versus uh those who were in the control group. So that's something we should be celebrating.

SPEAKER_01 4:01

Right.

SPEAKER_00 4:01

Um, because you know, we at Starkey, we've been talking about the importance of comorbidities and not and hearing loss is and hearing care is health care. Um, this is something that I think we really have the opportunity to dig in a little bit.

SPEAKER_02 4:15

Absolutely. And I think that's where a lot of hearing professionals can really build their muscles in clinic and really practice incorporating those comorbidities. What we've been talking about, like you said, for years and how to have that conversation with patients in clinic. You know, we are talking about the ears, but we know now there's so many studies that point to this same thing. We have the data. Why not talk about it with patients? And I really think it starts with your patient intake form. You know, at any doctor appointment I go to, I have a huge checklist where I have to mark not only what I've experienced in my health, but my parents, my grandparents, et cetera. And really not picking up the, you know, 200-point checklist from a doctor, but especially looking at like the 2020 Lancet report at their nice little infographic and looking at the risk factors of dementia, incorporating those into your intake form, which of these do you have? As we know, it's not going to be, there's likely never going to be a clear study that says, yes, hearing loss, dementia. There's so many other factors people have throughout their entire life, their family history, et cetera, that build towards cognitive decline. So if we can now identify in clinic, now we know if you have risk factors for dementia, you can identify that in the intake form, in the case history, and then use that conversation to say, you know, you may be at an increased risk. I want you to know hearing loss as well adds to that. And that's why we're here today. We're going to look at your hearing and discuss treatment options if you do indeed have a hearing loss.

SPEAKER_00 5:54

Well, let's build on that discussion. There's a lot of great points in there. Um, when I was working at Mayo Clinic, uh I had close relationships with many of the cardiologists there. And in the aging individual, many cardiologists will say that the ear is the overall best barometer of cardiovascular health. Because when you think about that, microvascular feed to the ears and to the eyes, that's one of the reasons. One of the oldest studies that we know looking at comorbidity before even predating cognition was cardiovascular and hearing loss, diabetes, risk of stroke, high blood pressure, uh all of those have a strong comorbidity with hearing loss. And so let's look at then that Eric subgroup, that the group that had atherosclerosis, cardiovascular disease. What issues, to your point, of what could professionals consider having the discussion or having a checklist with their patients, knowing now that this data set suggests that that subject population, who was a little bit older, and the demographics differed slightly. So the locations for the Eric group were in um North Carolina, uh Mississippi, Minnesota, and um Missouri. Uh no, Maryland, excuse me. And so compared with the overall de novo cohort, this group was a little less educated. They were a little bit older, a little bit more ethnically diverse, a higher percentage of uh black population in that that Eric group. But then getting to some of the conditions and the comorbidities you mentioned, they had um uh diabetes at a higher risk, they they were measured and and their diabetes uh in a significant portion of that population, hypertension, they were more likely to be living alone.

SPEAKER_02 7:52

Yes.

SPEAKER_00 7:52

That we'll come back to too. Yeah, uh, because there's some important findings in there, and and a little bit lower household income than in the overall de novo group. But I think in particular, at least having the conversation about whether there's cardiovascular disease, including some of those subconditions, and hearing loss present, now shows that those individuals, if fitted and do doing it sooner, maybe, you know, uh related to that reduction. It's not hearing aids are not going to cure dementia or ultimately. Exactly. But if they can slow that progression and seeing a 40 per 48% decline compared to the control group in that subgroup who had cardiovascular disease, hearing loss, uh, and were fitted with devices is pretty powerful.

SPEAKER_02 8:42

Yeah, and it's incredible. I mean, thinking of it as a public health message as well, the financial burden, not just on that individual, on their family, but on our economy of treating dementia, cognitive decline, all of that, it's estimated to be almost$50,000 a year to care for somebody with cognitive decline versus hearing aids that we all know is a range of investments every few years, you know, is pales in comparison to that. So if we can continue to build on this body of work that's continued to pile up and encourage our public health space to treat hearing loss a little easier through a variety of opportunities, I think is incredible.

SPEAKER_00 9:28

Yeah. For me, my I spent my career, which now is spans 40 years in this industry wishing that hearing loss would be taken seriously by primary care physicians, by the community at large, and raising awareness for the importance of healthy hearing. Well, now we've had this drop in our lap, and really the comorbidity piece is one that we can say, and clinicians can really say, let's emphasize this patient population as one that can significantly benefit from the use of amplification to slow that progression compared with untreated hearing loss. Anything that shortens that seven to ten year time period is a big win for us, and we should recognize that. The other issue that you raised, the Lancet study, not the most current one, but the one where they did the meta-analysis, showed that modifiable risk factors in isolation, hearing loss was the most significant contributor to those modifiable risk factors in midlife.

SPEAKER_01 10:27

Yep.

SPEAKER_00 10:28

Um, the other thing is, is even for that larger cohort, the thousand subjects, in the study that Dr. Lin reported on, and also in the Achieve study publication in Lancet this month, that is available free to individuals. You just have to register, but you don't have to subscribe. Um, I would encourage people to go and read the study for themselves. But they noted they had no adverse effects of fitting people with amplification. Right. There's no harm in fitting the larger population because the caveat and the little ray of hope for that larger population was even in the entire subject population, they're postulating that they may see those declines in the larger population, uh, uh and the differences rather between the control group and those fitted with amplification. It's just saying that maybe three years wasn't enough to study them. They were a little younger, uh, that the overall population may see that decline occur. But we should not be hanging our heads with this, uh, these findings. We should be celebrating them.

SPEAKER_02 11:32

Well, and you brought it up earlier, the isolation part of it. And I mean the US Surgeon General now has said, you know, we have uh an epidemic of social isolation, and especially our older adults, and how that is a huge compounding factor for cognitive decline. You know, are we asking patients in clinic what their social activities are? Who do they live with? How often are you getting out of your house? Those kind of questions are really important, not just for cognitive decline, but our treatment of the hearing loss as well. So why aren't we talking about that before the treatment? Again, just at that first appointment and getting that information for every patient.

SPEAKER_00 12:12

I'm I'm really glad you brought up that loneliness piece. Two other tidbits. In the presentation, Dr. Lin talked about the fact that in the study, 94% of the patients who participated agreed that hearing aids were, quotes, very much worth it or quite a lot worth it after three years. Wow. So that's impressive. That's consistent and even exceeds satisfaction with what we're seeing reported in the market track series of data. 94% that were in those top two categories. The other thing, as you alluded, hearing loss intervention has a statistically significant positive effect on reduced loneliness over three years in terms of social network size and in terms of social network diversity. So those are areas we can really sink our teeth into and really emphasize, as you said, with the Surgeon General raising awareness for this and the fact that we know and we've seen other studies highlight this, but this is a large study population to have that positive of uh of patients saying that the hearing aids are very much worth it or quite a lot worth it after three years of wearing them, and then this loneliness piece.

SPEAKER_02 13:20

Yeah, I miss that part. That's that's a great call out, and that's really encouraging. And I mean, I think um with the surgeon general, I was just reading that report again this morning. And, you know, it's not just dementia that loneliness contributes to. It's heart disease, it's stroke, it's what is it, the uh a pack a day kind of habit is the same as as social isolation. Yes. And it's I think um some healthcare professionals, hearing healthcare professionals, excuse me, um are hesitant to discuss this because they don't feel like that is within our scope. You know, the ears are our scope and we shouldn't talk about anything outside of that. And to that, I mean, my dentists, what they bring up to me about cardiovascular health and cognitive help with my teeth. I mean, we have got to use this data to encourage patients to seek help. It is our priority as hearing health care professionals, in my opinion.

SPEAKER_00 14:21

Well, I completely agree with you. If you're in a medical facility, if you're in a private practice, like I said, go to Lancet, register, you can download this paper for free. I would use it as an opportunity to engage or or initiate a conversation with my cardiology colleagues in my medical facility or in the community, go out, share this with them and say, look, we are linked at the hip with cardiovascular disease and hearing loss. And we have been even longer than this issue over the focus of cognition.

SPEAKER_01 14:51

Yep.

SPEAKER_00 14:52

And my parents were more worried about cancer and cardiovascular disease. I'm concerned about cognition. Here, we've been given a great opportunity to engage in more conversations. We have to think of the patient in as a whole, not just a couple of ears that we're doing real ear measurements on, but thinking about that patient's overall health and wellness and really also thinking about that approach avoidance or avoidance-avoidance conflict that first-time hearing aid users are dealing with. And this now provides us with an opportunity for those specifically who have cardiovascular risk factors to say, look, this study showed the sooner you intervene, the more likely that you're going to see a slowing of progression of cognitive decline. That's a powerful statement.

SPEAKER_02 15:39

Right. And having the conversation be a positive conversation, and even before you've even tested a patient's hearing, so they don't feel like it's a fear factor or you're saying you need to do this or you will get dementia. Nobody's saying that. It's important to speak about it factually and make sure you have all of the conditions correct. But we do need to be discussing it with patients, to your point.

SPEAKER_00 16:05

Yeah. And look, like you said, for the last decade when I've gone to see the dentist, they take my blood pressure.

SPEAKER_02 16:11

Yeah.

SPEAKER_00 16:12

What is it that restricts us within our scope of practice for doing a screening blood pressure? These, these, these screening pressure uh monitors, I have one at home. They're low cost, they're high, they're accurate. Um, there's nothing that would prevent us from saying, look, your blood pressure is a little high today. I'm not a physician, but you should consider talking to your primary care doctor or your cardiologist about that. And by the way, did you know the results of the Achieve study? There's lots of opportunity for those of us who are willing to think a little bit outside of the norm in the way that we've always done things with the results of these studies, laying it out for us, those patients who are likely to most benefit from this. One of the things I was um slightly disappointed in the study was that when the cohort started, um they had they were wearing their devices. The median use every day was 10 hours a day. By the end of three years, only seven hours a day. I think we can do better than that. And we're certainly seeing with Genesis, our latest product, people are when I'm working with my patients, people are wearing 12, 14 hours a day or more. And and that to me was was sort of a uh an awareness issue of wow, you know, just seven hours a day was considered successful. Um, to me, that's half my day at best. And uh I want, I want, you know, when people say, what's the best hearing aid? I always say the ones that are worn. And seven hours a day is only a fraction of the day. And I'd I'd like to see follow-up more on that too.

SPEAKER_02 17:41

I agree. That's I'm glad you pointed that out. And it always reminds me of um Starkey's HearShare app that is still the industry's only caregiver or companion app that you can actually check in on your loved one on how many hours a day they're wearing their hearing aid, as well as their physical and social activity. I mean, Starkey's been thinking about this very many years and providing tools to monitor this and have that discussion. So I think Genesis AI, Livio AI, Evolve AI are devices that have had these sensors and this um capability for years are really going to be important for this new study realization.

SPEAKER_00 18:22

Completely agree. So closing then, what are a couple take-home messages? We've talked about comorbidity, raising that. What's your thoughts on um I think another potential winner out of the study as it's reported right now? And this is really just the beginning. They they cited that there's going to be other publications, further investigation of that de novo group, that larger, younger, slightly younger population, and to see if indeed over time they see the benefits of amplification as they continue to wear them. Other other things, other take-home messages in there that you saw.

SPEAKER_02 18:57

Really, just my what I've discussed with the how to implement this in just day-to-day practice of really looking at your intake form and making sure that you're discussing this with patients. It's I think that's of utmost priority. We we have example ones at Starkey of not only the health intake form, but some examples of questions of how to ask patients about their daily activity, if they live alone, if they live with other people, et cetera. That um if if a hearing professional wants that, we can certainly provide it as an example to use in your own clinic.

SPEAKER_00 19:34

What about screening for mild cognitive impairment? They're pencil and paper measures, their electronic measures. Um I again, I don't think it hurts. And I think it helps bring the discussion into what can be a challenging conversation. Sometimes people are apprehensive about taking tests, especially like I said, boomers like me, we worry. We've spent more time in school uh than our parents did, and we worry about losing it. So sometimes people say, I don't want to know. But I think for me, what gets measured gets done. What's your attitude about uh screening for have you have you done it when you were working clinically?

SPEAKER_02 20:10

I did not, but since then I have taken the ones that are available. And even myself as a 30-something year old female that I think I have all my memory with me, I was nervous taking it. So I can't imagine an older adult. But I think I agree. I think it not only helps bridge the conversation with you and the patient, but helps bridge the conversation with you and other medical professionals in your community. Again, we're not there to tell them, you know, oh, look, you have dementia. We're not there to give any kind of diagnosis, but it is a great tool to your point about blood pressure as well. These tools we can use to then report back to their primary care and say, hey, here's their blood pressure results, here's their hearing test, by the way, here's the article on why I did that. And the please send me any patients like this in the future.

SPEAKER_00 21:04

Completely agree. I think it's a great opportunity to reach out. So, you know, the results overall from the Achieve study add to this growing evidence as we discuss that addressing modifiable risk factors uh for cognitive decline and dementia could be effective in reducing future global burden of dementia. And so, as you said, I would also, in addition to recommending that people go download this latest article from Lancet, go back to look at the 2020 article, look at those modifiable risk factors, be familiar with them, consider the conversation with the patient, think beyond the ears, even hearing, and balance is something people don't think about. This is saying get a little out of your comfort zone. You're not expected to become uh fully versed on all cardiovascular disease, but most people know a little bit, certainly if they've been told that they have high blood pressure, that they have elevated Cholesterol, that they have dem uh diabetes, um, they're aware of it. Open up that conversation. It can be a little uncomfortable at first, but it when it becomes part of your routine, I think now we've been given evidence that there is benefit that we've been given in this study, and I think it's only scratching the surface of what we're gonna see in follow-up.

SPEAKER_02 22:19

Absolutely. Completely agree.

SPEAKER_00 22:21

Well, thanks for the discussion today, and thanks to our listeners uh and viewers of the Soundbites Podcast. We appreciate you. Uh, hopefully this was helpful at unpacking a little bit of the data and the evidence basis in the study. There's going to be more that comes out of this. Uh, if you have other suggestions or ideas for how we deal with this topic or others, we encourage you to send an email to soundbites at Starkey.com. And we appreciate uh, you know, if you subscribe or like this product podcast uh and share it with your friends, your networks, your colleagues, your family members who are concerned about cognitive decline. Thanks so much, and we look forward to hearing and seeing you again soon.