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Impact of Delay to Reperfusion on Mortality in ST-Segment Elevation Heart Attacks

Impact of Delay to Reperfusion on Mortality in ST-Segment Elevation Heart Attacks | Heart and Vascular Health | Scoop.it

In patients with large anterior myocardial infarction undergoing relatively early reperfusion, longer delays to reperfusion were associated with larger IS and 1-year mortality, but not with reduced reperfusion success.

Seth Bilazarian, MD's insight:

In this trial that made an effort to evaluate the effect delay in treatment has on death in anterior STEMI's (the most serious & deadly of the heart attacks) there was a large difference in survival at 1 year between those that were treated within 3 hours and those that were not.  

The absolute risk reduction for death at 1 year was 5.2%.  That means that every 20 patients that come to the hospital and are treated within 3 hours of their heart attack symptoms there will be one life saved.  Early heart attack education, awareness and action are critical.  

If you have chest pain lasting more than 5 minutes call 911 for the earliest and most effective treatment.

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Healthy Weight Loss

Healthy Weight Loss | Heart and Vascular Health | Scoop.it

There are no magic diets, pills, or operations for long-term, healthy weight loss. A useful approach is to select the best diet that works for you. This is the eating plan you can live with.  A total of 3500 calories equals 1 pound of body weight. This means if you decrease (or increase) your intake by 500 calories daily, you will lose (or gain) 1 pound per week. (500 calories per day × 7 days = 3500 calories.) All foods have carbohydrate, protein, and fat. Carbohydrates provide 4 calories per gram. Proteins provide 4 calories per gram. Fats provide 9 calories per gram. Carbohydrates are either simple or complex. Simple carbohydrates cause more weight gain than complex carbohydrates. Simple carbohydrates include sugar and starches (potatoes, pasta, and rice). Complex carbohydrates include fruits, vegetables, and whole grains.

Seth Bilazarian, MD's insight:

Most useful (and most difficult) line from this JAMA patient page:

To lose weight, you must change your habits. This will happen slowly. Losing 1 to 2 pounds each week is great progress.

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Olivia Perez's curator insight, November 14, 11:21 PM
the best way to lose the weight you want is to do it the right healthy way. For losing weight you don't want to eat more than 3500 calories but you don't want to eat less than 1100. To lose weight way try to eat healthy and work out to 30 minutes to an hour a day.
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Testing for “Silent” Coronary Heart Disease

Testing for “Silent” Coronary Heart Disease | Heart and Vascular Health | Scoop.it

Heart disease is the leading cause of death in the United States. Coronary heart disease refers to heart disease resulting from the buildup of plaque (collection of cholesterol, calcium, and other materials) in the coronary arteries (blood vessels) that supply blood to the heart.

Common symptoms of coronary heart disease include chest pain and trouble breathing, especially with activity. Many people who have coronary heart disease do not have any symptoms and therefore do not know they have problems with their heart. 

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High Blood Pressure Control Infographic

High Blood Pressure Control Infographic | Heart and Vascular Health | Scoop.it
High Blood Pressure Infographic: Make Control Your Goal
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Donovan Baldwin's curator insight, August 25, 9:16 AM

Lowering your blood pressure is good for you. Learn more about your blood pressure at http://nodiet4me.com/health_products/blood_pressure/articles/index.html

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Global Sodium Consumption & Death from Cardiovascular Causes

Global Sodium Consumption & Death from Cardiovascular Causes | Heart and Vascular Health | Scoop.it

High sodium intake increases blood pressure, a risk factor for cardiovascular disease, but the effects of sodium intake on global cardiovascular mortality are uncertain.

In 2010, the estimated mean level of global sodium consumption was 3.95 g/ day, and regional mean levels ranged from 2.18 to 5.51 g/day. Globally, 1.65 million annual deaths from cardiovascular causes were attributed to sodium intake above the reference level; 61.9% of these deaths occurred in men and 38.1% occurred in women. These deaths accounted for nearly 1 of every 10 deaths from cardiovascular causes (9.5%). Four of every 5 deaths (84.3%) occurred in low- and middle-income countries, and 2 of every 5 deaths (40.4%) were premature (before 70 years of age). 

In this modeling study, 1.65 million deaths from cardiovascular causes that occurred in 2010 were attributed to sodium consumption above a reference level of 2.0 g per day.

Seth Bilazarian, MD's insight:

Nice multimedia presentation of the current data on salt and cardiovascular disease from NEJM editors.

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Varicose Veins

Varicose Veins | Heart and Vascular Health | Scoop.it

Varicose veins are superficial veins that have become abnormally enlarged and cause symptoms or are cosmetically distressing. Types of varicose veins include spider veins, which are reddish-bluish and thread-like; reticular veins, which are bluish and string-like; and true varicose veins, which are large rope- or worm-like veins that feel spongy to the touch and bulge out from the skin surface.

Seth Bilazarian, MD's insight:

Great review on what varicose veins are, how they occur and strategies for prevention and treatment.

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Can You Recognize a Heart Attack or Stroke?

Can You Recognize a Heart Attack or Stroke? | Heart and Vascular Health | Scoop.it
How would you react to a medical emergency? When it comes to heart attack or stroke, every minute counts. Get to know the signs and symptoms of these life-threatening conditions.
Seth Bilazarian, MD's insight:

Last paragraph is the key...

Whether or not you’re trained to offer help, if you see someone having symptoms of a heart attack or stroke, call for help immediately.  If you’re even thinking about calling 9-1-1, you should call,”

 “Yes other conditions can mimic the signs and symptoms of a heart attack or stroke, but let the emergency physician figure that out in the emergency room.” 

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Donovan Baldwin's curator insight, August 6, 9:49 AM

Two years ago, we had a plumbing emergency at our apartment. When it was over, my wife, who had a few health problems, but no heart problem, said, "I don't feel well. I think I may be having a heart attack."


The maintenance man who was there whipped out his phone and called 911. We were kind of embarrassed when the fire truck and the ambulance with the EMT's showed up. My wife wanted to walk out to the ambulance, but they made her get on the gurney. They headed for the hospital, which was four miles away.


I shut the house up, jumped in the car, and went to the emergency room. There I learned that during the short ride to the hospital, my wife had gone into cardiac arrest, and it had taken several attempts to resuscitate her.


She is better now, but still has mental and physical problems as a result of the event. It was fortunate that the maintenance man, Ben, was there, because, as my wife says, "We would have discussed it for several more minutes and the event would have occurred without medical personnel there." Don't mess around. Learn the symptoms and risk the embarrassment. A red face is better than the alternative.

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Hemoglobin A1c in Nondiabetic Patients Predicts Coronary Artery Disease

Hemoglobin A1c in Nondiabetic Patients Predicts Coronary Artery Disease | Heart and Vascular Health | Scoop.it

Objective: To examine the association between hemoglobin A1c (HbA1c) and the presence, severity, and complexity of angiographically proven coronary artery disease (CAD) in nondiabetic patients.
Patients and Methods: We performed a single-center, observational, cross-sectional study of 1141 consecutive nondiabetic patients who underwent coronary angiography from January 1, 2011, through
December 31, 2011. The study population was divided into 4 interquartiles according to HbA1c levels (<5.5%, 5.5%-5.7%, 5.8%-6.1%, and >6.1%).
Results: Patients with higher HbA1c levels tended to be older, overweight, and hypertensive, had higher blood glucose levels, and had lower glomerular filtration rates. Higher HbA1c levels were associated in a graded fashion with the presence of CAD, disease severity (higher number of diseased vessels and presence of left main and/or triple vessel disease), and disease complexity. After adjustment for major conventional cardiovascular risk factors, compared with patients with HbA1c levels less than 5.5%, the odds ratios of occurrence of CAD in the HbA1c quartiles of 5.5% to 5.7%, 5.8% to 6.1%, and greater than 6.1% were 1.8 (95% CI, 1.2-2.7), 3.5 (95% CI, 2.3-5.3), and 4.9 (95% CI, 3.0-8.1), respectively.
Conclusion: The HbA1c level has a linear incremental association with CAD in nondiabetic individuals. The HbA1c level is also independently correlated with disease severity and higher SYNTAX scores. Thus,
HbA1c measurement could be used to improve cardiovascular risk assessment in nondiabetic individuals.

Seth Bilazarian, MD's insight:

The HgbA1c is a blood test that evaluates blood sugar levels over the last 3 months.  Diabetic patients & physicians use the test to evaluate whether diabetes is in good control and value the measure as more useful than one blood sugar measurement to guide recommendations on diet and medication.  The test can also be used for the diagnosis of diabetes (6.5% is the level).

These authors in India found that even below the diabetic level there is significant risk that can be evaluated stepwise in both the presence of blockages in the coronary arteries but also how severe the blockages are that might increase the need for coronary bypass surgery.

The graphic show that starting at 5.5% each 0.5% increase linearly raises the risk.

If validated, this might be one more way to help patients evaluate risk and might find its way in to future risk calculators.

 

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Global Girth Grows to 2.1 billion

Global Girth Grows to 2.1 billion | Heart and Vascular Health | Scoop.it
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Undetectable Troponin T Level in ED & Risk of Myocardial Infarction

Undetectable Troponin T Level in ED & Risk of Myocardial Infarction | Heart and Vascular Health | Scoop.it

Study to evaluate if an undetectable (<5 ng/l) high-sensitivity cardiac troponin T (hs-cTnT) level & ECG without signs of ischemia can rule out myocardial infarction (MI) in the emergency department (ED).

Background  Chest pain is a common symptom often associated with benign conditions, but may be a sign of MI. Because there is no rapid way to rule out MI, many patients are admitted to the hospital.

Methods  All patients who sought medical attention for chest pain and had at least 1 hs-cTnT analyzed during 2 years at the Karolinska University Hospital, Stockholm, Sweden, were included.

Results  14,636 patients. 8,907 (61%) had an initial hs-cTnT of <5 ng/l.

Among patients with a first hs-cTnT level of <5 ng/l, 1,704 (89%) had a second hs-cTnT level measured, which was <5 ng/l in 1,362 (90%) patients. Patients with a first hs-cTnT level of <5 ng/l and no MI within 30 days were admitted to the hospital for a total of 3,262 days, with a mean duration of hospital stay of 1.5 ± 3.0 days; 1,482 (77%) of these patients were discharged on the same or next day. The most common discharge diagnoses in patients with a first hs-cTnT level of <5 ng/l were nonspecific chest pain (50%), atrial fibrillation or supraventricular tachycardia (5.6%), and angina (5.1%).

Conclusions  All patients with chest pain who have an initial hs-cTnT level of <5 ng/l and no signs of ischemia on an ECG have a minimal risk of MI or death within 30 days, and can be safely discharged directly from the ED.

Seth Bilazarian, MD's insight:

The evaluation of chest pain in the emergency department and ability to rapidly evaluate patients, so low risk patients can be released for their comfort &  convenience and for health care cost savings is the "holy grail".  This paper does allot to get us closer. If patients had low level of troponin and a normal EKG there was no heart attack at 30 days in 99.8% and 100% of patients were alive.  Changing protocols in emergency departments will be difficult but achievable.

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Paul Ridker on Inflammation and Residual CV Risk

Paul Ridker on Inflammation and Residual CV Risk | Heart and Vascular Health | Scoop.it

Dr. Bilazarian interviews Dr. Paul Ridker on the inflammation hypothesis and 2 ongoing trials in this area: the National Heart, Lung, and Blood Institute (NHLBI)-funded Cardiovascular Inflammation Reduction Trial (CIRT),[1] which is testing whether taking low-dose methotrexate reduces myocardial infarction (MI), stroke, or death in people with type 2 diabetes or metabolic syndrome who have had a heart attack or have stable coronary artery disease; and the Novartis-sponsored Canakinumab Anti-Inflammatory Thrombosis Outcomes Study (CANTOS),[2] which is assessing whether blocking the proinflammatory cytokine interleukin (IL)-1β with canakinumab, as compared with placebo, can reduce rates of recurrent MI, stroke, and cardiovascular death in patients post-MI with elevated high-sensitivity C-reactive protein (CRP; ≥ 2 mg/L).

Seth Bilazarian, MD's insight:

Paul Ridker provides a great primer for clinicians & patients on the status of trials investigating the links between inflammation and cardiovascular disease. He reviews the background and status of the two large randomized clinical outcomes trials he leads: CANTOS & CIRT.

 

Other resources:

1.  slides from Dr. Ridker at  https://my.americanheart.org/idc/groups/ahamah-public/@wcm/@sop/@scon/documents/downloadable/ucm_426676.pdf

 

2. CIRT trial http://www.thecirt.org/

 

3,  CANTOS trial http://www.thecantos.org/

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Heart-Rhythm Monitoring for Evaluation of Cryptogenic Stroke

Heart-Rhythm Monitoring for Evaluation of Cryptogenic Stroke | Heart and Vascular Health | Scoop.it

Observational studies suggest that we often fail to detect paroxysmal atrial fibrillation as the cause of ischemic stroke. However, owing to the limitations of existing studies, guidelines have yet to endorse specific strategies for detecting atrial fibrillation in patients with a new stroke. The results of two studies published in this issue of the Journal indicate that prolonged monitoring of heart rhythm should now become part of the standard care of patients with cryptogenic stroke.leaving it unclear whether monitoring improves diagnosis as compared with routine follow-up. 

Seth Bilazarian, MD's insight:

Our patients want to avoid stroke because of the debilitating effects it can have on functional status and quality of life.  Efforts to prevent a second stroke are enthusiastically embraced by patients.

Cryptogenic is stroke that a cause cannot be determined (about 1/3 of strokes).  Treatment with anticoagulants in this patient population is not recommended UNLESS the cause of the stroke is from the common irregular heart rhythm atrial fibrillation (AF).  

On the other hand if atrial fibrillation is NOT detected treatment with aspirin or other anti-platelet drugs are used and these drugs are inferior to anticoagulants if AF is the cause.

Two studies in NEJM showed that prolonged monitoring (30 days or 6 months)  increased the detection of AF and allowed more patients to be started on anticoagulants for stroke prevention.

In the trial of 30 days of recording with an external (carried) monitor was 16.1%.

In the trial of the implanted recorder detection of AF was 

at 6 months 8.9%

at 12 months 12%

at 36 months 36%

 The strategy of prolonged monitoring with an external device  for 1 month or 6 months with an implanted device is an unresolved question and adoption of the small subcutaneous device pictured above, will be limited by its cost, until further studies showing stroke reduction can be completed justifying its cost.

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Diminishing Returns of Modern Medicine - fight to shave minutes in heart attack care

Diminishing Returns of Modern Medicine - fight to shave minutes in heart attack care | Heart and Vascular Health | Scoop.it
In-hospital mortality after an acute heart attack has dropped 10-fold, from 30 percent to 3 percent, since the invention of the modern cardiac care unit in the 1960s. Can shaving a few more minutes off the time it takes to get hospital treatment possibly yield any additional benefit?
Seth Bilazarian, MD's insight:

This is a good account of the problem with advancing medicine.  As we reduce bad outcomes closer to zero OF COURSE there is going to be much greater difficulty (this is the high hanging fruit)..  The author is right that because of the pressure of public reporting on door to balloon time (D2BT) sometimes decisions are rushed and this is an area of concern.

The example he provides of the cardiologist driving 90 mph is not appropriate because that is an example of a system problem that SHOULD be fixed.  Taking 60 minutes to figure out a patient has a heat attack is much to long and not good care.

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Pig or Metal? Aortic Valve Choice for Patients 50 to 69 Years

Pig or Metal? Aortic Valve Choice for Patients 50 to 69 Years | Heart and Vascular Health | Scoop.it

The choice between bioprosthetic and mechanical aortic valve replacement in younger patients is controversial because long-term survival and major morbidity are poorly characterized.

Results  No differences in survival or stroke rates were observed in patients with bioprosthetic compared with mechanical valves.

Actuarial 15-year survival was 60.6% in bioprosthesis vs 62.1% in the mechanical prosthesis group

The 15-year cumulative incidence of stroke was 7.7% vs. 8.6%.

The 15-year cumulative incidence of reoperation was higher in the bioprosthesis group 12.1%  vs. 6.9%

The 15-year cumulative incidence of major bleeding was higher in the mechanical prosthesis group 13.0% vs 6.6%

The 30-day mortality rate was 18.7% after stroke, 9.0% after reoperation, and 13.2% after major bleeding.

Conclusions and Relevance  Among propensity-matched patients aged 50 to 69 years who underwent aortic valve replacement with bioprosthetic compared with mechanical valves, there was no significant difference in 15-year survival or stroke. 

Seth Bilazarian, MD's insight:

The answer to the pig vs. metal question has been easy in patients over 70 years old since life expectancy of the valve was considered to be greater than the patient's life expectancy.  For those younger patients the option of a bioprosthetic valve that does not require life long oral anticoagulation with warfarin(Coumadin) is a very good option.

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Fish Oil Supplements

Fish Oil Supplements | Heart and Vascular Health | Scoop.it

Omega-3 polyunsaturated fatty acids can lower high plasma triglycerides, but they have not been shown to decrease the risk of pancreatitis. The results of recent studies do not offer any convincing evidence that fish oil supplements prevent cardiovascular disease.

Seth Bilazarian, MD's insight:

The Medical Letter gives the "bottom line" on fish oil.  It doesn't reduce cardiovascular risk.

Eat fish, don't take fish oil. 

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Wine only protects against CVD in people who exercise

Wine only protects against CVD in people who exercise | Heart and Vascular Health | Scoop.it

Wine only protects against cardiovascular disease (CVD) in people who exercise, according to results from the In Vino Veritas (IVV) study presented at ESC Congress 2014.

IVV is the first long-term, prospective randomised trial comparing the effect of red and white wine on markers of atherosclerosis. The study included 146 people with mild to moderate risk of cardiovascular disease. Participants were randomised to one year of moderate consumption of red (Pinot Noir) or white wine (Chardonnay-Pinot) from the same year and wine region of the Czech Republic.

Moderate consumption was the World Health Organization definition of 0.2 L for women and 0.3 L for men, a maximum of five times a week. The primary endpoint was the level of HDL cholesterol at one year. Participants consumed their usual diet.

The researchers found that there was no difference between HDL cholesterol levels at the beginning of the study compared to one year in either the red or white wine groups. LDL cholesterol was lower in both groups at one year while total cholesterol was lower only in the red wine group.: "The only positive and continuous result was in the subgroup of patients who took more exercise, which means regular exercise at least twice a week, plus the wine consumption. In this group HDL cholesterol increased and LDL and total cholesterol decreased in the

red and white wine groups. There may be some synergy between the low dose of ethyl alcohol in wine and exercise which is protective against CVD."

Seth Bilazarian, MD's insight:

American patients often seize the results of population based dietary studies and often take them out of context.  French populations drink more red wine and have lower rates of cardiovascular events so Americans may add wine to their diet without considering the many other potential contributors to the good outcome.  The French ,in addition to consuming more red wine. also exercise more, eat less processed foods, have lower rates of obesity and eat less fast foods and snack less.  False conclusions are often made also made about fish eating populations such as Eskimos.

The IVV study brings to light these other important added contributors to health.

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Donovan Baldwin's curator insight, September 1, 11:43 AM

Interesting article. I have always said that most of these things, supplements, red wine, massage, weight loss products, diet pills, whatever...would probably only have a significant effect if they were a part of a healthy lifestyle, which includes exercise, nutrition, and rest.

Ellen Diane's curator insight, September 4, 11:00 AM

thank you Seth:)

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Obesity 'linked to 10 cancers'

Obesity 'linked to 10 cancers' | Heart and Vascular Health | Scoop.it

Being overweight and obese puts people at greater risk of developing 10 of the most common cancers, according to research in the Lancet medical journal. Scientists calculated individuals carrying this extra weight could contribute to more than 12,000 cases of cancer in the UK population every year. They warn if obesity levels continue to rise there may be an additional 3,700 cancers diagnosed annually.The study of five million people is the largest to date to confirm the link.

Seth Bilazarian, MD's insight:

Many patients know  the link between obesity and diabetes & heart disease, but the link to cancer is not as well known. This is another reason for urgency to address obesity and overweight for individuals and from a public health standpoint.

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Olivia Perez's curator insight, November 14, 1:06 PM
If obesity keeps going on arise there will be an additional 3700 cancers diagnosed each year. Scientist and doctors say that tumor can start to develop on your Kinsey, uterus, cervix, thyroid, and ect. People with more body mass are more likely to develop liver, colon, ovaries, and breast cancer. But scientists she haven't connected of you BMI level is even associated on getting cancer.
Leeza Trainor's comment, November 17, 9:25 AM
That is a whole lot of cancer
Lexie Ruscheinski's comment, November 17, 11:01 PM
This is a huge wake up call and also scary. It shows how big of a problem obesity can be in our country!
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Choosing Wisely for Syncope: Low‐Value Carotid Ultrasound Use

Choosing Wisely for Syncope: Low‐Value Carotid Ultrasound Use | Heart and Vascular Health | Scoop.it
 

The US spends more than $750 billion/ yr  on tests and procedures that do not benefit patients. Although there is no physiological indication for carotid ultrasound in “simple” syncope in the absence of focal neurological signs or symptoms suggestive of stroke, there is concern that this practice remains common for routine syncope workups.

We found that 16.5% of all Medicare beneficiaries with simple syncope underwent carotid imaging and 6.5% of all carotid ultrasounds ordered in 2009 were for this low‐value indication.

For the 15.4% patients with stenosis ≥50%, carotid ultrasound did not yield a causal diagnosis. Only 2% of patients imaged experienced a change in medications after a positive study, and <1% of patients underwent a carotid revascularization procedure.

Seth Bilazarian, MD's insight:

The ultrasound of the carotid artery is often part of the "package" of inappropriate testing that happens with syncope or worse lightheadedness without syncope.  Other commonly ordered tests for syncope are Head CT and echocardiography without signs and symptoms indicating their utility.  Much of the problem comes from emergency room evaluation and hospital admission which leads to accelerated testing to limit patient's length of stay. Most of this would be done better (more effectively and wit greater value)  in the office based assessment by the patient's internist or cardiologist.

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Triumphs and Regrets of an Early Adopter

Triumphs and Regrets of an Early Adopter | Heart and Vascular Health | Scoop.it

I was thinking recently about adoption of new therapies and what I've gotten right and what I've gotten wrong, and what my regrets and triumphs are in this area. I did this exercise in which I spent several hours thinking about my 20 years in practice, and I thought it would be an interesting exercise to share with you. Hopefully others will weigh in on what they have gotten right and wrong.

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The Soup Can Quiz; 60 seconds of nutritional teaching

The Soup Can Quiz; 60 seconds of nutritional teaching | Heart and Vascular Health | Scoop.it
Seth Bilazarian, MD's insight:

For the last several months I have made it a practice to do the "Soup Can Quiz" with my congestive heart failure patients.  I use the can pictured. All the patients acknowledge that they have heard that they should avoid salt, but after that the knowledge deficits rise quickly.

Patients (almost universally) tell me they don't us ANY salt.

 

What I hear from my older patients who need salt restriction:

1.  "Can't read the label - too small"

2.  "Are you promoting it for sale?:

3.  "Salt isn't listed on the nutrition label"

4.  "The can has a heart on it and says "healthy" so it's ok"

5.  Once prompted about sodium on the label - I ask "knowing that you are supposed to limit yourself to 2000 mg of sodium per day, how much sodium is there if you have this can of soup", I hear....

    -  410 mg - I explain that it is not correct since the servings per container is 2.5 so having the can would be closer to 1000 mg for the whole can.

     - some patients say - "so that means I can have 2 cans"

 

Getting patients to understand that the consequences of exceeding salt recommendations has more immediate consequences such as hospitalization for congestive heart failure and is different than not adhering to a diabetic diet, or strategies for weight loss because consequences for those problems are not as immediate or short term.  The effort has been instructive for me and has helped move patients along the health literacy curve a little bit with the hope of reducing CHF admissions and readmissions.

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E-Cigarettes: What to Tell Patients

E-Cigarettes: What to Tell Patients | Heart and Vascular Health | Scoop.it
Channeling Donald Rumsfeld, Dr. Bilazarian outlines both the known and unknown unknowns about e-cigarettes.
Seth Bilazarian, MD's insight:

E-cigarette use has really grown pretty significantly. It does an estimated $1.7 billion in sales and it's currently expected that it will exceed revenue from cigarettes in about 10 years. They're marketed as healthier, as potential quitting aids, and they allow smoking anywhere. The marketing is briefly summarized as "e-cigarettes are healthier, cleaner, and cheaper." Much is not known about these new nicotine delivery devices, but counseling of patients about the hazards is important.

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Average Emergency Department Wait Time

Average Emergency Department Wait Time | Heart and Vascular Health | Scoop.it

30 minutes is the national median wait time to be treated in the emergency department, according to the National Hospital Ambulatory Medical Care Survey in 2010-11. The shortest median wait time: 12 minutes for patients with an immediate need to be seen. As for median treatment time, the clock ticked to slightly more than 90 minutes. 

Source: McCraig LF, et al. MMWR. 2014;63:439

Seth Bilazarian, MD's insight:

For cardiology patients, long wait times in the ED are a hazard because patients with chest pain sometimes say they don't want to go for emergency evaluation because it will take many hours to be evaluated and discharged.  Not going to the ED delays diagnosis for heart attack and delays treatment that can be life saving.

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Trends in Atrial Fibrillation in US, 2000-10

Trends in Atrial Fibrillation in US, 2000-10 | Heart and Vascular Health | Scoop.it

Atrial fibrillation (AF) is one of the most frequently encountered arrhythmias in the hospital. A multidisciplinary approach is required to recognize and treat AF appropriately; to limit the catastrophic consequences such as stroke, heart failure, and dementia; and to decrease the burden on the healthcare system. Hospitalization related to AF is the single largest contributor to overall cost of care in managing AF patients. In this study, we examined the trends of AF hospitalizations in the United States and assessed the effects of patient demographics and comorbid diagnoses on in-hospital mortality, length of stay, and total cost of care. Understanding these factors helps us understand the health economics of AF better. There has been a significant increase in AF hospitalizations over the last decade, with a large contribution from patients >65 years of age, especially among those >80 years of age. The overall length of hospital stay has remained unchanged; however, the cost of inpatient care has increased tremendously, from approximately $2.15 billion in 2001 to $3.46 billion in 2010. To the best of our knowledge, this is the first study to assess the trends of AF-related inpatient care at a national level from the actual hospital discharge database. Such data, although they have inherent limitations, tend to provide more accurate financial trajectory of the problem.

Seth Bilazarian, MD's insight:

Atrial fibrillation or AF is the most common heart rhythm abnormality and it is consistently the first or second most common reason for admission at community hospitals.  We have new therapies such as novel oral anticoagulants (Pradaxa, Xarelto, Eliquis) that should increase the ability to manage this problem as an outpatient but changing the practice of physicians & emergency departments will be difficult.

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Testosterone Replacement Therapy

Testosterone Replacement Therapy | Heart and Vascular Health | Scoop.it
Pentucket Medical cardiologist Seth Bilazarian, MD discusses testosterone replacement therapy in men with "low T." What is the risk of heart attack or stroke?
Seth Bilazarian, MD's insight:

Putting the testosterone replacement for "low T" into perspective for our patients.

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A Patient’s Guide to Recovery After Deep Vein Thrombosis or Pulmonary Embolism

A Patient’s Guide to Recovery After Deep Vein Thrombosis or Pulmonary Embolism | Heart and Vascular Health | Scoop.it

When a blood clot forms in the deep veins of the body, it is called deep vein thrombosis (DVT). DVT occurs most commonly in the leg; however, it can occur anywhere in the body, such as the veins in the arm, abdomen, pelvis, and around the brain. A complication of DVT in legs and arms is pulmonary embolism (PE). A PE occurs when a blood clot breaks off from a DVT and travels through the blood stream, traversing the right atrium and right ventricle, and lodging in the lung.

Seth Bilazarian, MD's insight:

Nice summary for patients wanting to have more information about PE and DVT.   The FAQs adressed are:

How Long Will I Need Treatment With an Anticoagulant? Which Anticoagulant Will I Receive? When Will My Clot and Pain Go Away? How Soon Can I Be Physically Active? What Kind of Doctor Do I Need?

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