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Media, News & Topics on prevention, diagnosis & treatment of cardiovascular disease
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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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Subclinical Hyperthyroidism Linked to Heart-Failure Deaths

Subclinical Hyperthyroidism Linked to Heart-Failure Deaths | Heart and Vascular Health | Scoop.it

Subclinical hyperthyroidism is associated with a 20% increased risk for cardiovascular mortality, primarily driven by heart-failure deaths, according to a large study in more than half a million individuals from general practice in Denmark, reported at the 2013 European Congress on Endocrinology.

"The main finding is a 20% increased risk of mortality in all levels of hyperthyroidism, including overt and subclinical but also high-normal, euthyroid patients, those lying in the lower range of the normal thyroid-stimulating hormone [TSH],"

"The take-home message is that if a person has a family history with any thyroid problem or has any signs of thyroid problems, they should go for a checkup. Their family doctors need to be aware that any sign of thyroid abnormality can affect cardiovascular health, and they should act accordingly."

 The link between overt hyperthyroidism and cardiovascular mortality is quite well established, he said, but the finding of an association with subclinical hyperthyroid disease is much more novel.

Of 574,595 included individuals (mean age, 48.7 years; 39.1% male), 95.9% were euthyroid, 1603 (0.3%) had overt hypothyroidism, 11,834 (2.1%) had subclinical hypothyroidism, 3967 (0.7%) had overt hyperthyroidism, and 6264 (1.1%) had subclinical hyperthyroidism.

Seth Bilazarian, MD's insight:

Symptoms of hyperthyroidism are not evident in patients who have sub-clinical hyperthyroidism.  The levels are abnormal but their are no symptoms.  In this very large study, the risk of death was 20% higher.  testing the thyroid level is very simple and is performed on a non fasting blood test.

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Dr. KGM BIYABANI's comment, May 3, 2013 9:45 AM
THANK YOU DR. BILAZARIAN FOR THE INSIGHT..
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Why do Congestive Heart Failure (CHF) patient's not take their medications?

Why do Congestive Heart Failure (CHF) patient's not take their medications? | Heart and Vascular Health | Scoop.it

Key Takeaways:

Medications in CHF have been shown to reduce death and hospitalization rates.

Not reliably taking medications (nonadherence) rates are high. The factors predicting nonadherence remain unclear.  These authors identified 3 factors that more than doubled the likelihood of patients not "staying with the program"

1.  lapses in attention OR = 2.65

2.  excessive daytime sleepiness OR = 2.51

3.  Two or more medication dosings daily OR= 2.59

 

Adherence averaged about 84%, dosing adherence averaged 77%, and timing adherence averaged 63%.

Several factors anticipated to predict adherence were not significant predictors. Practical support for self-care, income, cost of medications, minor depression were all not predictors of adherence. The most likely reason for the difference between these results and past reports might be that most prior studies measured adherence using self-reportong.

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National Trends in Patient Safety for Heart Attack, CHF, pneumonia or surgery 2005–2011

National Trends in Patient Safety for Heart Attack, CHF, pneumonia or surgery 2005–2011 | Heart and Vascular Health | Scoop.it

Patient safety poses serious challenges to the health care system in the United States. Since 2001, nationwide efforts have focused on reducing in-hospital adverse events over the past decade.  Extensive nationwide efforts have focused on improving care processes and outcomes, starting with Medicare patients with acute myocardial infarction (AMI), in 1992, . The cardiovascular care community, in particular, has embraced quality improvements for patients hospitalized with acute myocardial infarction or congestive heart failure by launching national registries, developing performance measures and appropriate-use criteria, and initiating national quality-improvement campaigns.

The study included 61,523 patients hospitalized for heart attack (AMI)  (19%), congestive heart failure (25%), pneumonia (30%), and conditions requiring surgery (27%). From 2005 through 2011, among patients with acute myocardial infarction (AMI), the rate of occurrence of adverse events declined from 5.0% to 3.7%..  Among patients with congestive heart failure (CHF) the rate of occurrence of adverse events declined from 3.7% to 2.7%. . Patients with pneumonia and those with conditions requiring surgery had no significant declines in adverse-event rates.

 From 2005 through 2011, adverse-event rates declined substantially among patients hospitalized for acute myocardial infarction or congestive heart failure but not among those hospitalized for pneumonia or conditions requiring surgery.
Seth Bilazarian, MD's insight:

Good news from CMS on improvement in patient safety for two of the most common reasons for hospitalization in the cardiology realm.  Adverse events in patients admitted with heart attack and congestive heart failure are declining.  Why this has occurred might be due to the attention being given to this important issue by cardiology societies.

One area of heart attack care that increased during the interval studied is injury to the kidney after cardiac catheterization (contrast-induced nephropathy), This problem increased significantly among patients with acute myocardial infarction, but has been an area of significant attention and increased efforts to identify patients at risk and reduce this problem.

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Implementing home telemanagement of congestive heart failure using Xbox gaming platform.

Implementing home telemanagement of congestive heart failure using Xbox gaming platform. | Heart and Vascular Health | Scoop.it

Take Home Message:  many innovators are trying to use readily available consumer products like smart phones and in this case home gaming systems to bridge the gap in telemedicine. The benefits are cost, conveninience availability and ease of use.  The concerns for all these approaches are relaibility and privacy securiity.

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