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Low-Risk Diet & Lifestyle Habits in the Prevention of Myocardial Infarction

Low-Risk Diet & Lifestyle Habits in the Prevention of Myocardial Infarction | Heart and Vascular Health | Scoop.it

Background  Adherence to a combination of healthy dietary and lifestyle practices may have an impressive impact on the primary prevention of myocardial infarction (MI).

Methods  The population of Swedish men comprised 45- to 79-year-old men who completed a detailed questionnaire on diet and lifestyle at baseline in 1997. In total, 20,721 men with no history of cancer, cardiovascular disease, diabetes, hypertension, or high cholesterol levels were followed through 2009. Low-risk behavior included 5 factors:

1.  healthy diet (top quintile of Recommended Food Score)

2.  moderate alcohol consumption (10 to 30 g/day)

3.  no smoking

4.  being physically active (walking/bicycling ≥40 min/day and exercising ≥1 h/week)

5.  no abdominal adiposity (waist circumference < 37 inches).

Results  During 11 years of follow-up, we ascertained 1,361 incident cases of MI. The low-risk dietary choice together with moderate alcohol consumption was associated with a relative risk of 0.65 compared with men having 0 of 5 low-risk factors. Men having all 5 low-risk factors compared with those with 0 low-risk factors had a relative risk of 0.14. This combination of healthy behaviors, present in 1% of the men, could prevent 79% (95% CI: 34% to 93%) of the MI events on the basis of the study population.

Conclusions  Almost 4 of 5 MIs in men may be preventable with a combined low-risk behavior.

Seth Bilazarian, MD's insight:

The greater the combination of heathy behaviors the greater the benefit in risk reduction for heart attack.  Choosing just two (diet and moderate alcohol) reduces the risk of heart attack by 35%.  Subscribing to all 5 has an impressive 80% reduction in heart attack.

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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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Eat a Healthy Diet and Drink Wisely to Postpone Dying If You Survived a Myocardial Infarction

Eat a Healthy Diet and Drink Wisely to Postpone Dying If You Survived a Myocardial Infarction | Heart and Vascular Health | Scoop.it

The Mediterranean diet as the most likely dietary model to provide protection against CHD.  Increasing adherence to the Mediterranean diet has been consistently beneficial for prevention of major chronic diseases, including fatal and nonfatal CHD, as well as all-cause mortality.

 In 4098 participants in the Nurses’ Health Study who survived an initial MI.  average dietary quality improved only marginally post-MI among the highly educated health professionals

Nevertheless, for participants who increased the diet/nutrition score, there was a 29% reduction in all-cause mortality and a 40% reduction in cardiovascular mortality. The AHEI2010 diet score used includes 11 components: vegetables, fruits, nuts and legumes, red meat and processed meats, sugar-sweetened beverages, alcohol, polyunsaturated fat, trans fat, omega-3 fat, whole grains, and sodium intake.

Many of the recommendations regarding these foods and nutrients are similar to the traditional Mediterranean diet: high consumption of whole grains, fruits, and vegetables; substantial intake of protein from plant sources (nuts and legumes); moderate intake of polyunsaturated fat; fish as a source of omega-3 fatty acids; and alcohol; and a low consumption of trans fat, meat and meat products, and sugar-sweetened beverages.

Seth Bilazarian, MD's insight:

From the Editorial: Patients who survive an MI are likely to receive up-to-date medical care, including cardiac rehabilitation, antiplatelet therapy, statins, angiotensin-converting enzyme inhibitors, and β-blockers. These interventions reduce the chances of a second MI, but a sizable residual risk  persists. The message from this study is that MI survivors should eat a healthy diet and drink wisely to further reduce the risk of subsequent cardiovascular death or simply postpone dying.

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Ten Ways Patients Get Better Medical Treatment - Includes FASTER heart attack care

Ten Ways Patients Get Better Medical Treatment - Includes FASTER heart attack care | Heart and Vascular Health | Scoop.it
From wireless EKGs to customer service, small steps aim to heal the whole person.
Seth Bilazarian, MD's insight:

Health-care innovations aren't limited to drugs and devices. Experts increasingly are adopting new ways to treat patients that studies show are better at healing the sick, preventing disease, improving patients' quality of life and lowering costs. Here are 10 innovations that took root in 2012 and are changing the care patients will get in 2013.The one that is most pertneinet to cardiology = >Heart Attacks Are Being Treated FasterSpeed is of the essence in surviving a heart attack, and in many cities now treatment starts before the patient reaches the hospital. Emergency medical technicians perform electrocardiograms and transmit results wirelessly to the emergency room. New guidelines from the American Heart Association and the American College of Cardiology aim to quickly restore blood flow when an artery is blocked, the most severe type of attack known by the acronym STEMI. Guidelines call for balloon angioplasty and stents as preferred treatments for STEMI, and clot-busting drugs as a stopgap measure. Also recommended: Chilling the patient in cases of cardiac arrest, a practice that reduces subsequent brain injury. In new research, survival rates were higher among cardiac-arrest patients who received CPR longer—a median of 25 minutes versus 16 minutes. For patients, the message is: Don't delay calling 911 when you have symptoms, and avoid going to the hospital in a private car.

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Why Severe Heart Attacks Are Becoming Less Deadly = Stents

Why Severe Heart Attacks Are Becoming Less Deadly = Stents | Heart and Vascular Health | Scoop.it

Severe heart attacks may not be as deadly as they used to be, according to new research.  A new French study demonstrated that patients hospitalized for severe heart attacks – technically known as ST-elevation myocardial infarctions – the chances of dying within 30 days dropped from 13.7% in 1995 to 4.4% in 2010, an improvement of 68%.
Researchers looked at data from nationwide registries in France 1995- 2010 of 6,700 patients who had heart attacks and were admitted to intensive care units. They found that the improvement in survival was likely related to a number of factors, including demographic changes, more timely presentation to hospitals, improvements in medications and treatments, and higher rates of STENTING open up blocked arteries.

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Long-Term Prognosis Following Cardiac Arrest: Role of Angioplasty & Cooling

Long-Term Prognosis Following Cardiac Arrest: Role of Angioplasty & Cooling | Heart and Vascular Health | Scoop.it

Take Home Message: Out of hospital cardiac arrest is still an enormous problem.  Looking at the patients successfully recussitated only 1 in 6 patients survived to discharge.  Best practices of angioplasty and cooling the patient initially resulted in better long term outcomes.

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This study looked at the influence of angioplasty (PCI)  & therapeutic hypothermia (TH) on long-term outcome. It's known that these strategies improve survival to hospital discharge but not much is known about long term outcomes. 

This study looked at adults who had nontraumatic cardiac arrest & discharged alive. Of the 5,958 persons who received EMS-attempted resuscitation

=> 16.8% discharged alive from hospital

=> PCI performed in 38.4%

=> TH performed in 25.6%

Five-year survival:

=> With PCI 78.7% vs. without PCI 54.4%

=> With TH  77.5%  vs. 60.4%  without TH

Conclusions: The effects of acute hospital interventions for post-resuscitation treatment extend beyond hospital survival & influences prognosis to 5 years.

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Emergency Departments Can Identify Low-Risk Cardiac Patients Quickly

Emergency Departments Can Identify Low-Risk Cardiac Patients Quickly | Heart and Vascular Health | Scoop.it

Key Take Away for Patients:

When patients come to the Emergency Room with chest pain the main goal is to assess whether the patient is having a heart attack or at high risk for a heart attack.  In either circumstance the patient will be admitted overnight for treatment and testing.  Identifying low risk patients is a need, but has always been a concern because of the fear of missing someone who MIGHT be at risk and would be at risk for a heart attack or death if discharged.  Strategies to identify lower risk patients who can be discharged home and then seen for out-patient testing is an elusive goal, because there is no certainty.  This study discussed use of TIMI Risk score, EKG and 2 blood tests done 2 hours apart to identify lower risk patients. The negative predictive value of the diagnostic protocol was 99.7%: that means that for every 1000 considered low risk only 3 patients would be miscategorized.

TIMI Risk Score is online at http://goo.gl/vCJgh ;

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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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Heart Attack Incidence With Shifts to Daylight Savings Time

Heart Attack Incidence With Shifts to Daylight Savings Time | Heart and Vascular Health | Scoop.it

Modulators of normal bodily functions such as the duration and quality of sleep might transiently influence cardiovascular risk. The transition to daylight savings time (DST) has been associated with a short-term increased incidence of heart attack or acute myocardial infarction (AMI). The present retrospective study examined the incidence of AMIs that presented to Beaumont Hospitals in Michigan the week after DST and after the autumn switch to standard time, October 2006 to April 2012, with specific reference to the AMI type.

The study population (n = 935; 59% men) was obtained from the electronic medical records. Overall, the frequency of AMI was similar in the spring and autumn, 463 (49.5%) and 472 (50.5%), respectively.

The incidence ratio for the first week after the spring shift was 1.17. After the transition from DST in the autumn, the IR for the same period was lower, but not significantly different, 0.99.  Nevertheless, the greatest increase in AMI occurred on the first day (Sunday) after the spring shift to DST (1.71, 95% confidence interval 1.09 to 2.02; p <0.05). Also, a significantly greater incidence was found of non–ST-segment myocardial infarction after the transition to DST in the study group compared with that in the control group (p = 0.022). In conclusion, these data suggest that shifts to and from DST might transiently affect the incidence and type of acute cardiac events, albeit modestly.

Seth Bilazarian, MD's insight:

These investigators have shown the Spring switch to Day Light Savings is of greater hazard to for the incidence of heart attack especially on the first day (Sunday ) after the switch.  The effect is modest but sheds some insights on the impact of sleep and daily body rhythms and their importance in heart and vascular disease..

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William Payne's curator insight, March 15, 9:22 AM

Sleep is critical important to repairing body functions

 

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Relation of Outbursts of Anger and Risk of Heart Attack

Relation of Outbursts of Anger and Risk of Heart Attack | Heart and Vascular Health | Scoop.it

Outbursts of anger are associated with an abrupt increase in cardiovascular events; however, it remains unknown whether greater levels of anger intensity are associated with greater levels of heart attack or muocarcdial infaction (MI) risk or whether potentially modifiable factors can mitigate the short-term risk of AMI.

Analysis of 3,886 participants from the multicenter Determinants of Myocardial Infarction Onset Study, who were interviewed during the index hospitalization for AMI from 1989 to 1996 and compared the observed number and intensity of anger outbursts in the 2 hours preceding MI symptom onset with its expected frequency according to each patient's control information, defined as the number of anger outbursts in the previous year.

Of the 3,886 participants 38% reported outbursts of anger in the previous year. The incidence rate of AMI onset was elevated 2.43-fold within 2 hours of an outburst of anger. The association was consistently stronger with increasing anger intensities (p trend <0.001).

In conclusion, the risk of experiencing MI was more than twofold greater after outbursts of anger compared with at other times, and greater intensities of anger were associated with greater relative risks. Compared with nonusers, regular β-blocker users had a lower susceptibility to heart attacks triggered by anger, suggesting that some drugs might lower the risk from each anger episode.


American Journal of Cardiology, Volume 112, Issue 3, Pages 343-348, 1 August 2013, Authors:Elizabeth Mostofsky, MPH, ScD; Malcolm Maclure, ScD; Geoffrey H. Tofler, MD; James E. Muller, MD; Murray A.

Seth Bilazarian, MD's insight:

The use of beta blocking medications like atenolol, metoprolol and carrvedilol are known to blunt the rise in heart rate and blood pressure with physical and emotional stress.  Tailoring use of these medications to patients with anger issues might be sensible.

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β-Blocker Use & Clinical Outcomes in Stable Outpatients

β-Blocker Use & Clinical Outcomes in Stable Outpatients | Heart and Vascular Health | Scoop.it

My comment: Another icon of medicine is challenged!  If you've had a heart attack (MI), it is the standard of care now to be treated with beta blocker medicines like metoprolol or atenolol indefinitely.  Physicians are graded for their use of beta blockers.  If these are not used with adequate frequency the physician is considered to not be practicing evidence based medicine.  This large study challenges the curent recommendations.  This data suggests no benefit with a history of MI from long ago and possibly harm in patients with only risk factors. How long will it take for guidelines to consider this new data is unknown?

 

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Reduction of Atherothrombosis for Continued Health (REACH) registry who were divided into 3 cohorts: known prior MI (n = 14 043), known CAD without MI (n = 12 012), or those with CAD risk factors only (n = 18 653).  The primary outcome was a composite of cardiovascular death, nonfatal MI, or nonfatal stroke.

Results: Among the 44,708 patients, 21,860 were included in the propensity score–matched analysis. With a median follow-up of 44 months, event rates were not significantly different in patients with β-blocker use compared with those without β-blocker use. In the cohort with CAD risk factors only, the event rates were higher for the primary outcome with β-blocker use.  However, in those with recent MI (≤1 year), β-blocker use was associated with a lower incidence of the secondary outcome.

Conclusion In this observational study of patients with either CAD risk factors only, known prior MI, or known CAD without MI, the use of β-blockers was not associated with a lower risk of composite cardiovascular events.

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Rosie O'Donnell describes googling about heart attack symptoms

Rosie O'Donnell describes googling about heart attack symptoms | Heart and Vascular Health | Scoop.it

i became nauseous
my skin was clammy
i was very very hot
i threw up

maybe this is a heart attack
i googled womens heart attack symptoms
i had many of them
but really? – i thought – naaaa

i took some bayer aspirin
thank god
saved by a tv commercial
literally

i did not call 911
50% of women having heart attacks never call 911
200,000 women die of heart attacks
every year in the US

by some miracle i was not one of them
the next day i went to a cardiologist
the dr did an EKG and sent me to the hospital
where a stent was put in

my LAD was 99% blocked
they call this type of heart attack
the Widow maker
i am lucky to be here

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Credibility of YouTube for Health Information on Heart Attack

Credibility of  YouTube for Health Information on Heart Attack | Heart and Vascular Health | Scoop.it

Take Home Message:  Internet search for health information is growing: 71% of adults in US in 2007.  YouTube is used for health info and this study assessed the credibility of the info for heart attacks (MI).  

Most content (98%) was posted in the last 3 years. Videos from professional societies were the least watched but had the most thorough content coverage (symptoms, physiology, prevention & treatment).  The other sources (94% of content) from personal experience, news reports & pharmaceutical industry  had seven times greater number of views. But these were not thorough.  Only 7% urged immediate treatment for a heart attack - the most important of all public messages.  Prevention was mentioned in 17% of videos. Caveat Emptor.  (Caveat Spectator)  With Web 2.0, its better to trust trusted sources.

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Systems of Care for Heart Attack => ST-Segment–Elevation MI from AHA

Systems of Care for Heart Attack => ST-Segment–Elevation MI from AHA | Heart and Vascular Health | Scoop.it

Key take away for patients:

This paper was a survey of over 300 hospitals that take care of the sickest type of heart attack called the STEMI.  Best practices to improve care by reducing the time to open up the artery (called door to balloon time (D2B)) were identified. 

 

These practices are:

1.  accepting patients at a PCI hospital regardless of bed availability

2.  single phone call activation of cath lab

3.  emergency department physician activation
of lab without cardiology consultation

4.  national data registry participation

5.  Prehospital activation of the catheterization laboratory by paramedics & transferring physicians.

 

The most commonly reported barriers to system
implementation were hospital and cardiology group
competition and EMS transport and finances.

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