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High intake of supplemental calcium associated with excess CVD death in men but not women

High intake of supplemental calcium associated with excess CVD death in men but not women | Heart and Vascular Health | Scoop.it

Importance Calcium intake has been promoted because of its proposed benefit on bone health, particularly among the older population. However, concerns have been raised about the potential adverse effect of high calcium intake on cardiovascular health.

 

Objective To investigate whether intake of dietary and supplemental calcium is associated with mortality from total cardiovascular disease (CVD), heart disease, and cerebrovascular diseases.

 

Results During a mean of 12 years of follow-up, 7904 and 3874 CVD deaths in men and women, respectively, were identified. Supplements containing calcium were used by 51% of men and 70% of women. In men, supplemental calcium intake was associated with an elevated risk of CVD death (RR>1000 vs 0 mg/d, 1.20; 95% CI, 1.05-1.36), more specifically with heart disease death (RR, 1.19; 95% CI, 1.03-1.37) but not significantly with cerebrovascular disease death (RR, 1.14; 95% CI, 0.81-1.61). In women, supplemental calcium intake was not associated with CVD death (RR, 1.06; 95% CI, 0.96-1.18), heart disease death (1.05; 0.93-1.18), or cerebrovascular disease death (1.08; 0.87-1.33). Dietary calcium intake was unrelated to CVD death in either men or women.

 

Conclusions and Relevance Our findings suggest that high intake of supplemental calcium is associated with an excess risk of CVD death in men but not in women. Additional studies are needed to investigate the effect of supplemental calcium use beyond bone health.

Seth Bilazarian, MD's insight:

Thre has been concern that the risks of taking calcium supplements may exceed the benefits in some patients. The "hardening of the arteries" that causes vascular problems such as heart attack, stroke and gangrene, is caused by calcium deposits (vascular calcification).  Taking high doses of calcium raises the available calcium in the blood vessles for deposit in the artery wall and the calcium may not be incorporated in the bones which is the goal of treatment.  The recommendation that men consider avoiding calciu supplemetns is reasonable.

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My Life Check - Life's Simple 7 Success Plan

My Life Check - Life's Simple 7 Success Plan | Heart and Vascular Health | Scoop.it

No matter where you stand, it’s never too late to make better choices for your health and we invite you to start a new life resolution now. All you need is a goal, a plan and the desire to live better. That’s why we created My Life Check and the Simple Seven. Thanks to the science and research volunteers of the American Heart Association, we have created a simple tool so you know where you stand on your road to good health. All of us need to practice these seven steps to live a heart-healthy life, and no one achieves heart health by accident.

To find out where you stand with the Simple Seven goals, just take the My Life Check assessment. In a few minutes, you will know how you’re doing with each one of Life’s Simple Seven. You will also get your own personal heart score and life plan. Your results will show you where you stand on the seven recommended areas of focus and will create an action plan that is customized to your lifestyle and health outlook. Your last step is a promise to yourself: a resolution to start making healthy, positive changes for a long, healthy future.

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The Ways to Avoid Feeling Off During Workouts

The Ways to Avoid Feeling Off During Workouts | Heart and Vascular Health | Scoop.it
How to explain a slow day of exercising? It's in how you eat, drink, sleep and think.
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Donovan Baldwin's curator insight, September 3, 7:10 AM

 You always don't feel like you are getting your best from your workout...or doing your best. There can be many reasons for this. One of these might just be a lack of motivation. Check out these Reasons to Exercise, to remind yourself of the many benefits of exercise and have a better workout.

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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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Novel Wireless Devices for Cardiac Monitoring

Novel Wireless Devices for Cardiac Monitoring | Heart and Vascular Health | Scoop.it
It is likely that the cardiac patient of the future, “wired” with a personalized network of biosensors, will be extremely different from the usual patient today. These biosensors will transmit a wealth of data about the patient’s genomic, metabolomics, and clinical responses to daily stimuli to the patient’s smartphone peripheral brain. Once that information is received, the smartphone will process it using sophisticated and personalized modeling software and will direct the patient to take action, for example, to contact his or her physician, to adjust a medication, or to alert emergency medical services of an impending myocardial infarction. These devices have the potential to revolutionize medicine. The eventual integration and study of these devices in the coming years must carefully examine not only the relative safety and efficacy of this technology relative to conventional care but also the impact of this technology on changing the costs of health care by preventing rehospitalization and empowering patients.
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Lyme Disease with cardiac involvement

Lyme Disease with cardiac involvement | Heart and Vascular Health | Scoop.it

Lyme carditis occurs when Lyme disease bacteria enter the tissues of the heart. This can interfere with the normal movement of electrical signals from the heart's upper to lower chambers, a process that coordinates the beating of the heart. The result is something physicians call "heart block," which can be mild, moderate, or severe.

Heart block from Lyme carditis can progress rapidly.

The cases of three patient who had sudden death has been reported byCDC

 http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6249a1.htm?s_cid=mm6249a1_w

Seth Bilazarian, MD's insight:

Lyme carditis is infrequent but probably under recognized.  I have seen this only once in my career despite living in the part of the country with the highest prevalence.


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Reducing the Risk of Heart Attack and Stroke

Reducing the Risk of Heart Attack and Stroke | Heart and Vascular Health | Scoop.it
Reducing the Risk of Heart Attack and Stroke using The American Heart Association/American College of Cardiology Prevention Guidelines

The authors review use of the ASCVD risk calculator repeatedly over several months to assess risk in a patient and provide positive feedback on the improving risk parameters and lowering of risk through a combination of both lifetstyle changes (diet with weight loss and exercise) and statin therapy.

Seth Bilazarian, MD's insight:

The point is well made that we see with patients who begin to have positive effects on blood pressure, lipids and glucose parameters when they have initial success with weight loss and exercise.  Before patient begin these lifestyle changes they have great skepticism but once patients see the positive impact (especially in fasting glucose) the efforts often intensify and continue.

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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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Donovan Baldwin's curator insight, August 18, 6:13 AM

While it is possible to be healthy and overweight, it improves your health future to not have the excess weight.

Richard Haddad's curator insight, August 18, 4:04 PM

les études sont nombreuses qui montrent le rôle du poids et de l’Obésité sur l'apparition du cancer .Ne pas hésiter  a prendre un peu de ZEN FIT dans 4 yaourts  tout au long de la journée

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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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Banning the Handshake From the Healthcare Setting

Banning the Handshake From the Healthcare Setting | Heart and Vascular Health | Scoop.it

Banning the handshake from the health care environment may require further study to confirm and better describe the link between handshake-related transmission of pathogens and disease. Moreover, given the profound social role of the handshake, a suitable replacement gesture may need to be adopted and then promoted with widespread media and educational programs. Nevertheless, removing the handshake from the health care setting may ultimately become recognized as an important way to protect the health of patients and caregivers, rather than as a personal insult to whoever refuses another’s hand. Given the tremendous social and economic burden of hospital-acquired infections and antimicrobial resistance, and the variable success of current approaches to hand hygiene in the health care environment, it would be a mistake to dismiss, out of hand, such a promising, intuitive, and affordable ban.

Seth Bilazarian, MD's insight:

The fist bump although a challenge for the older generation may be the best alternative, if it became socially accepted and widely adopted.

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DundeeChest's curator insight, August 10, 3:31 AM

Knuckle bump!!!

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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, 6:49 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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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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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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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, 8:43 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, 8:00 AM

thank you Seth:)

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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, 6:16 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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Donating.vs.Death from CDC

Donating.vs.Death from CDC | Heart and Vascular Health | Scoop.it

Where we donate vs. what kill us. 

Seth Bilazarian, MD's insight:

Many inferences can be made about this disparity but one contributor is clearly the notion (incorrectly) that heart disease is a disease of the elderly and therefore inevitable.  A contributor to this was former surgeon general Jocelyn Elders comment the "you have to die of something".   Much of the public has a dim view of the strides that have been made in cardiovascular disease, but its persistence as a problem in young and old alike requires continued research funding.

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When Patients Read What Their Doctors Write

When Patients Read What Their Doctors Write | Heart and Vascular Health | Scoop.it
Patients are more satisfied with their care when doctors share their medical notes. But letting patients see what doctors put in medical records has long been taboo. That's starting to change.
Seth Bilazarian, MD's insight:

The "open notes" enthusiasts often tout that patients have great benefit going from NO access to compete access.  As a clinician, I have no objection to patients having access to any and all their records but without guidance most of the records are unintelligible and patients often grasp on to abnormal testing results which have no clinical significance ("Why was my ALT or BUN 1 point above the upper limit of normal?" .  

After patients are discharged from the hospital I review all the lab and imaging results, page by page, to ensue that they have heard the results and understand the implications of the results.  

Giving patients copies of these reports in addition to all the other (now mandated) discharge paper works is completely useless and almost never reviewed.

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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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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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Average time to get 5 kinds of appointments for new patients

Average time to get 5 kinds of appointments for new patients | Heart and Vascular Health | Scoop.it
A look at the average time to get five kinds of appointments for new patients in 2013, from a survey of 15 metropolitan areas.
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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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