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Moblile App for Cardiovascular Risk Assessment: Framingham Heart Age

"Because of your high cholesterol, elevated blood pressure, and smoking, you have the cardiovascular system of a 68 year old man. Let me know if you want address this."

Get STAT Framingham Heart Age on the App Store. 

Seth Bilazarian, MD's insight:

The Framinham Risk Score (FRS) is well known.  the score helps divide risk into high medium and low risk of having a heart attack (myocardial infarction) over the next 10 years.  The developres of teh FRS subsequently develped the Heart age which adds predictionof other cardiovascular risks including congestive herat failure and peripheral arterial disease.  Its useful and hopefully motivating as a fist step for patients who are interested in understanding their risk.

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Mini-Cog Performance: A Novel Marker of Post-Discharge Risk Among Patients Hospitalized for Heart Failure

Mini-Cog Performance: A Novel Marker of Post-Discharge Risk Among Patients Hospitalized for Heart Failure | Heart and Vascular Health | Scoop.it

Congestive Heart Failure (HF) guidelines recommend screening for cognitive impairment (CI) but do not identify how. The Mini-Cog is an ultra-short cognitive 'vital signs' measure that has not been studied in patients hospitalized for HF. 

Methods and Results—We analyzed 720 patients who completed the Mini-Cog as part of routine clinical care during hospitalization for HF. Our primary outcome was time between hospital discharge and first occurrence of readmission or mortality. There was a high prevalence of CI as quantified by Mini-Cog performance (23% of cohort). During a mean follow up time of 6 months, 342 (48%) patients were readmitted, and 24 (3%) died.

Poor Mini-Cog performance was an independent predictor of composite outcome & was identified as most important predictor among 55 variables.

Secondary analysis of initial 30-days post-discharge showed effect modification by venue of discharge, whereby patients with CI discharged to a facility had longer time to outcome as compared with those discharged home.

Conclusions—Mini-Cog performance is a novel marker of post-hospitalization risk. Discharge to facility rather than home may be protective for those HF patients with CI. It is unknown if structured in-home support would yield similar outcomes.

Seth Bilazarian, MD's insight:

The Mini Cog test is a simple test to evaluate patients cognition.  It's brief and easy to administer.  It's online here at:

http://www.alz.org/documents_custom/minicog.pdf

 

The test uses recall of 3 words and a clock drawing test to score for impairment:

3 recalled words = Negative for cognitive impairment
1-2 recalled words + normal CDT = Negative for cognitive impairment
1-2 recalled words + abnormal CDT = Positive for cognitive impairment
0 recalled words = Positive for cognitive impairment.


The authors have successfully correlated cognitive impairment with risk for readmission.  

The ability for patients to manage the tasks of medication adherence, restriction of dietary sodium/ salt & weighing themselves daily may not be able to be successfully achieved in some patients with cognitive impairment.  Senior author Eiran Gorodeski @EiranGorodeski has posted examples of the clock drawing tests (above) from his hospital and asks rhetorically "Will she manage her meds without errors?"

 

 

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TAVR: A Plea to Refer Patients for Consideration

TAVR: A Plea to Refer Patients for Consideration | Heart and Vascular Health | Scoop.it
TAVR or DNR -  For some time, I've been thinking about doing a blog called, "TAVR or DNR." I often see patients being managed by other physicians in our community who aren't referred for even consideration of transcatheter aortic valve replacement (TAVR)—patients who are octogenarians or nonagenarians with severe aortic stenosis, but the patient's internist and cardiologist haven't felt it appropriate or reasonable to send them for a TAVR consultation. These patients then end up having an ST-segment elevation myocardial infarction (STEMI), or they're in the hospital with congestive heart failure and acute pulmonary edema or worse. One patient I saw recently had STEMI with cardiogenic shock. We're asked to perform percutaneous coronary intervention or support in these patients in the setting of a severe aortic stenosis that might have been better managed electively, or they could have at least had a conversation about TAVR.
Seth Bilazarian, MD's insight:

For patient who have severe aortic stenosis - a severe narrowing of the main outlet valve of the heart and want to know more about the option of transcatheter aortic valve replacement (TAVR) the best place to start is at a center approved and doing this procedure in your local area.  There are two aortic valves available on the market in the US  (many more in Europe).  To find a local hospital see:

Edwards Life Sciences ($EW) at http://goo.gl/kWgtZP ;

or 

Medtronic ($MDT)  at  http://goo.gl/bxXhoO ;

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High aerobic fitness in late adolescence is associated with reduced risk of heart attack

High aerobic fitness in late adolescence is associated with reduced risk of heart attack | Heart and Vascular Health | Scoop.it

Aims Cardiovascular disease is the leading cause of morbidity and mortality worldwide, and signs of atherosclerosis are present in all large arteries already in adolescence. We investigated the association between high physical fitness in late adolescence and myocardial infarction (MI) later in life.

Methods and results The study cohort comprised 743,498 Swedish men examined at the age of 18 years during conscription 1969–84. Aerobic fitness (Wmax) and muscle strength at conscription were measured. During follow-up period of 34 years, 11,526 MIs were registered in the cohort. After adjusting for age, body mass index (BMI), diseases, education, blood pressure, and socio-economic factors, one standard deviation increase in the level of physical fitness was associated with an 18% decreased risk of later MI.  The beneficial effects of Wmax were significant across all recognized BMI groups, ranging from lean (BMI < 18.5) to obese (BMI > 30) (P < 0.05 for all). However, obese men (BMI > 30) in the highest fourth of Wmax had a higher risk of MI than did lean men (BMI < 18.5) in the highest (HR 4.6, 95% CI 1.9–11.2), and lowest (HR 1.7, 95% CI 1.2–2.6) fourth of Wmax.

Conclusions We report a significant graded association between aerobic fitness in late adolescence and MI later in life in men. However, obese men with a high aerobic fitness had a higher risk of MI than lean men with a low aerobic fitness.

Seth Bilazarian, MD's insight:

The impact of overweight status and fitness status (both aerobic and strength) in 18 yo men,  predicted heart attack over the next 3 decades.  Although both are important, as can be seen in the graphic, the impact of overweight status (fatness) was of greater risk than being "unfit".  Fatness worse than unfitness.

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Jenny Han's curator insight, December 13, 5:55 AM

Graph shows what we should learn.

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Study says a bad marriage could literally break your heart

Study says a bad marriage could literally break your heart | Heart and Vascular Health | Scoop.it
A study found that older couples in bad marriages, especially wives, have a higher risk for heart disease than those who are happily wed.
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Safety Pills's comment, November 27, 1:51 AM
A lot of marriages broke because of libidos loss. Maintain a healthy sex life to avoid marriage break ups. http://www.safetypills.com/mens-health/blue-pill.html
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Dissection of the chest, by Danny Quirk, Medical Illustrator

Dissection of the chest, by Danny Quirk, Medical Illustrator | Heart and Vascular Health | Scoop.it

There is a whole genre called anatomical tattoos. Chris Nuñez, a tattoo artist and judge on Spike’s TV show Ink Master, has said that this style is all about “replicating a direct organ, body part, muscle, tissue, flesh, bone in the most precise way you can.” Danny Quirk, an artist working in Massachusetts, is doing something similar, only his anatomical tattoos are temporary. He creates body paintings with latex, markers and some acrylic that appear as if his models’ skin is peeled back.

The project began in 2012, when Halloween provided the occasion for Quirk to paint his roommate’s face and neck. From there, he made other anatomical paintings on the arms, backs and legs of willing friends, and his photographs went viral.


Read more: http://www.smithsonianmag.com/science-nature/should-we-use-body-painting-to-teach-anatomy-180947826/#HzpSKqA8qIpUel8e.99

 

or 

http://protomag.com/articles/danny-quirk-living-cadavers-art

 

Seth Bilazarian, MD's insight:

Medical Illustrations help understand anatomy.  These dynamic illustrations as body art are fantastic by @DannyArtQuirk.

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Nonobstructive Coronary Artery Disease & MI

Nonobstructive Coronary Artery Disease & MI | Heart and Vascular Health | Scoop.it

Little is known about cardiac adverse events among patients with nonobstructive coronary artery disease (CAD).

Among 37 674 patients, 8384 patients (22.3%) had nonobstructive CAD and 20 899 patients (55.4%) had obstructive CAD. Within 1 year, 845 patients died and 385 were rehospitalized for MI.

Among patients with no apparent CAD, the 1-year MI rate was 0.11% (n = 8, 95% CI, 0.10%-0.20%) and increased progressively by number of vessels involved.

Patients with:

1-vessel nonobstructive CAD had a hazard ratio for 1-year MI of 2.0

2-vessel nonobstructive HR, 4.6

3-vessel nonobstructive HR, 4.5

1-vessel obstructive HR, 9.0

2-vessel obstructive HR, 16.5

3-vessel or LM obstructive HR, 19.5

One-year mortality rates were associated with increasing CAD extent, ranging from 1.38% among patients without apparent CAD to 4.30% with 3-vessel or LM obstructive CAD.

Conclusions and Relevance  In this cohort of patients undergoing elective coronary angiography, nonobstructive CAD, compared with no apparent CAD, was associated with a significantly greater 1-year risk of MI and all-cause mortality. These findings suggest clinical importance of nonobstructive CAD and warrant further investigation of interventions to improve outcomes among these patients.

Seth Bilazarian, MD's insight:

The usual definition of coronary artery disease (CAD) severity causes doctors to not "label" the patient with CAD unless stenosis (narrowing) in the coronary artery are greater than 50%.  This paper does a great job bringing attention to the issue that even minor plaques (>20%) predict future heart risk.  As an interventional cardiologist, I am always concerned that patents get the message that they did not have "any significant disease" means that they should not intensify their risk modification efforts like diet, exercise & smoking cessation.  The presence of plaques are important, predictive and an opportunity for doctors to leverage the angiogram pictures we show patients to encourage life stye changes.

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Don't Let Salt sneak Up on You from AHA

Don't Let Salt sneak Up on You from AHA | Heart and Vascular Health | Scoop.it

The American Heart Association wants you to end your love affair with salt! Learn the facts about sodium and take the pledge to live a heart healthy life.

Thinking about ending your love affair with salt? You’ve come to the right place! We’ll show you how extra salt sneaks into your diet and how it hurts your health, and share tips for kissing the excess salt goodbye and starting a healthier relationship with food. And be sure to keep checking our blog, the Salty Scoop, to learn more..

Seth Bilazarian, MD's insight:

Check put Sodium 411 and take the sodium quiz at heart.org/sodium to be sure your basic knowledge about dietary sodium is adequate for life long cardiovascular health

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Action-Related Television Content Increases Food Intake

Action-Related Television Content Increases Food Intake | Heart and Vascular Health | Scoop.it

Television (TV) has generally been blamed for helping make Americans overweight owing to both its distracting influence and its encouragement of a sedentary lifestyle. Indeed, a recent correlational analysis of dinner patterns illustrated that the frequency of TV viewing during dinner was 1 of the 2 largest correlates of adult and child body mass index.

However, the focus to date has been on the medium and not the message. Granted, TV may lead distracted viewers to mindlessly eat past the point at which a person would usually stop. In this, it is not unlike other distracting activities that increase food intake, such as reading, listening to the radio, and interacting with dining companions. However, little is known about whether the content, valence, or pace of content influences how much a viewer eats while watching TV. For instance, how do objective technical characteristics, such as the frequency of visual camera cuts or the variation in sound, influence how much food is eaten?

More distracting TV content appears to increase food consumption: action and sound variation are bad for one’s diet. The more distracting a TV show, the less attention people appear to pay to eating, and the more they eat. Other potential causes, such as increased anxiety, agitation, and stimulation level, should be examined as contributing causes in future research.

While watching the programming, participants were given generous amounts of 4 snacks (M&Ms, cookies, carrots, and grapes) and allowed to eat as much as they wished. Food was weighed before and after the programs to determine the amount eaten by each viewer.

Subjects ate about twice as much watching the action movie compare to the talk show Charlie Rose.

Seth Bilazarian, MD's insight:

The paper does a good job highlighting the impact of distraction on overeating. There is a dose effect. The greater the distraction, the greater the over eating.

The talk show that was used in this trial was the Charlie Rose show. It was less distracting than an action movie and highlights the importance of knowing about distraction as a contributor to overeating.  For motivated patients, avoiding snacks when watching TV or having a limited quantity might reduce the hazard.  Alternatively you could limit your viewing to Charlie Rose.

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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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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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Self-monitoring and Self-titration for Hypertension

Self-monitoring and Self-titration for Hypertension | Heart and Vascular Health | Scoop.it

Importance  Self-monitoring of blood pressure with self-titration of antihypertensives (self-management) results in lower blood pressure in patients with hypertension, but there are no data about patients in high-risk groups.

Design, Setting, and Patients  A primary care, unblinded, randomized clinical trial involving 552 patients who were aged at least 35 years with a history of stroke, coronary heart disease, diabetes, or chronic kidney disease and with baseline blood pressure of at least 130/80 mm Hg being treated at 59 UK primary care practices in 2011-13.

Interventions  Self-monitoring of blood pressure combined with an individualized self-titration algorithm. During the study period, the office visit blood pressure measurement target was 130/80 mm Hg and the home measurement target was 120/75 mm Hg. Control patients received usual care consisting of seeing their health care clinician for routine blood pressure measurement and adjustment of medication if necessary.

Results .The mean baseline blood pressure was 143.1/80.5 mm Hg in the intervention group and 143.6/79.5 mm Hg in the control group. After 12 months, the mean blood pressure had decreased to 128.2/73.8 mm Hg in the intervention group and to 137.8/76.3 mm Hg in the control group, a difference of 9.2 mm Hg (95% CI, 5.7-12.7) in systolic and 3.4 mm Hg (95% CI, 1.8-5.0) in diastolic blood pressure following correction for baseline blood pressure. These results were comparable in all subgroups, without excessive adverse events.

Seth Bilazarian, MD's insight:

The illustration is Consumer Reports top rated BP monitors.  Home blood pressure monitoring is extremely valuable in management of hypertension.  From the accompanying editorial:

This trial went beyond monitoring and had patients actively adjust medications based on an algorithm. The patients in the intervention group showed no increase in adverse events compared with patients in the control group.  This trial is an important step toward adaptation of treatment for patients who want to actively take part in their own risk-factor control.  Based on these findings, a “bring it home” blood pressure–lowering strategy appears suitable for patients with hypertension and comorbidities.

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Replacement valves save lives

Replacement valves save lives | Heart and Vascular Health | Scoop.it
The silent nature of heart valve disease presents a major challenge to health services in the UK where the number of people aged over 65 is expected to almost double to 19 million in the next 30 years
Seth Bilazarian, MD's insight:
See my blog: TAVR: A Plea to Refer Patients for Consideration

http://www.medscape.com/viewarticle/831946

 

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Epidemic of the 20th Century: Coronary Heart Disease

Epidemic of the 20th Century: Coronary Heart Disease | Heart and Vascular Health | Scoop.it

1. The increase in coronary heart disease deaths in the 1930s, 1940s and 1950s was due to an increase in coronary atherosclerosis.

2.  A decline in coronary atherosclerosis that began in the late 20th century was associated with decreased smoking and a decrease in cholesterol levels.

3.  Primary and secondary prevention has decreased the incidence of acute myocardial infarction and sudden cardiac deaths from the mid-1960s to the present.

4.  More effective treatment of acute myocardial infarction has  decreased the number of deaths.

Seth Bilazarian, MD's insight:

Most of the decline in coronary heart disease deaths is due to a decrease in deaths due to acute myocardial infarction and to a reduction in sudden cardiac deaths. These deaths have been reduced by primary prevention, which has decreased the incidence of coronary atherosclerosis, and primary and secondary prevention, which have reduced the progression of coronary atherosclerosis to obstructive coronary heart disease. In addition, the remarkable reduction in the case fatality rate of acute myocardial infarction is almost certainly due to more effective emergency treatment and transport of patients who then receive more rapid and effective in-hospital treatment.
The multiple factors that have led to the remarkable decline in coronary heart disease deaths in the US over the
last 50 years less atherosclerosis and better heart attack care 

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Mediterranean diet & telomere length in Nurses’ Health Study

Mediterranean diet & telomere length in Nurses’ Health Study | Heart and Vascular Health | Scoop.it

To examine whether adherence to the Mediterranean diet was associated with longer telomere length, a biomarker of aging.

Nurses’ Health Study, an ongoing prospective cohort study of 121 700 nurses enrolled in 1976; in 1989-90 a subset of 32 825 women provided blood samples.

Association between relative telomere lengths in peripheral blood leukocytes measured by quantitative real time polymerase chain reaction and Alternate Mediterranean Diet score calculated from self reported dietary data.

Greater adherence to the Mediterranean diet was associated with longer telomeres after adjustment for potential confounders. Least squares mean telomere length z scores were −0.038 (SE 0.035) for the lowest Mediterranean diet score groups and 0.072 (0.030) for the highest group (P for trend=0.004).

Greater adherence to the Mediterranean diet was associated with longer telomeres. These results further support the benefits of adherence to the Mediterranean diet for promoting health and longevity.

Seth Bilazarian, MD's insight:

What is already known on this topic:
The Mediterranean diet has been consistently linked with health benefits, including reduced mortality and reduced risk of chronic diseases.
No study has examined whether adherence to the Mediterranean diet is associated with longer telomere length, a biomarker of aging.


What this study adds:
Greater adherence to the Mediterranean diet was associated with longer telomeres.
Telomere length variability may be partially explained by lifestyle practices; as accelerated telomere attrition may underlie many chronic diseases, identifying modifiable factors that affect telomere dynamics is important.
The results further support the benefits of adherence to the Mediterranean diet for promoting health and longevity.

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Surgical Treatment of Moderate Ischemic Mitral Regurgitation

Surgical Treatment of Moderate Ischemic Mitral Regurgitation | Heart and Vascular Health | Scoop.it

In patients with moderate ischemic mitral regurgitation, the addition of mitral-valve repair to CABG did not result in a higher degree of left ventricular reverse remodeling. Mitral-valve repair was associated with a reduced prevalence of moderate or severe mitral regurgitation but an increased number of untoward events. Thus, at 1 year, this trial did not show a clinically meaningful advantage of adding mitral-valve repair to CABG. Longer-term follow-up may determine whether the lower prevalence of mitral regurgitation translates into a net clinical benefit.

Seth Bilazarian, MD's insight:

When patient were undergoing open heart surgery for coronary bypass (CABG), the addition of mitral-valve repair for a "leaky valve" was associated with a longer bypass time , longer hospital stay after surgery & more neurologic events.

At one year, moderate or severe mitral regurgitation was less common in the combined-procedure group than in the CABG-alone group (11.2% vs. 31.0%). There were no significant between-group differences in major adverse cardiac or cerebrovascular events, deaths, readmissions, functional status, or quality of life at 1 year.

For now, the best recommendation is to improve heart function with bypass and not "fix" the leaky heart valve.

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Testosterone-Replacement Therapy

Testosterone-Replacement Therapy | Heart and Vascular Health | Scoop.it
Martin is a generally healthy 61-year-old married man who has come to you for his annual physical examination. As you discuss Martin's health concerns, he mentions an interest in receiving a prescription for testosterone.

Which of the following approaches do you think is appropriate for this patient? Base your choice on the published literature, your own experience, recent guidelines, and other sources of information.

1. Recommend testosterone-replacement therapy

2. Recommend against testosterone-replacement therapy

To aid in your decision making, each of these approaches is defended in a short essay by an expert in the field. 

Seth Bilazarian, MD's insight:

Excellent review of the controversial topic of Testosterone replacement.  The controversy is largely driven by a lack of data on safety and longterm hazards vs. small benefits from "Low T " treatment, that might better be achieved with weight loss and exercise.  I voted no.

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In 1964n first angioplasty was called Dotter's Folly

In 1964n first angioplasty was called Dotter's Folly | Heart and Vascular Health | Scoop.it

The first angioplasty procedure was performed 50 years ago. But it was some time before the work of "Crazy Charlie" Dotter caught on.

The patient was an 82-year-old woman whose painful left foot was horribly disfigured by ulcers and gangrene brought on by lack of circulation. Her doctors at what is now Oregon Health & Science University wanted to amputate, but when she objected, she was referred to Charles Dotter, a radiologist at the hospital who was experimenting with new ways to open up narrowed or blocked arteries. At the time, 50 years ago, clearing clogged arteries involved surgery, a long time in the hospital and a high risk of complications. Dotter’s idea was to try unblocking them with catheters—slender, hollow tubes normally used in radiology to prepare for X-rays by injecting contrast dye into blood vessels. 

X-rays showed that the woman’s leg had a narrowing in the femoral artery, which supplies blood to the lower extremities. That made her a perfect first candidate for Dotter’s scalpel-free artery repair. On January 16, 1964, he inserted a guide wire into the patient’s femoral artery and threaded it to the narrowed area. He then passed a catheter along the guide wire, followed by another, wider catheter. The procedure caused the artery to expand, and blood flow quickly returned to the woman’s foot. Several of her badly damaged toes eventually fell off, but the woman was able to walk out of the hospital on her own, living free of foot pain until she died two and a half years later. 

Seth Bilazarian, MD's insight:

Dotter’s innovation, 50 years ago was the beginning of the fields of interventional cardiology and radiology.

Dotter’s ideas, like his personality, were bold enough that many physicians in the United States dismissed him as “Crazy Charlie” and long ignored the procedure he eventually called percutaneous transluminal angioplasty (PTA). Dotter’s approach to clearing arteries had a better reception in Europe. In 1977, German-born physician Andreas Gruentzig introduced the balloon-tipped catheter, which uses tiny inflatable pouches to dilate narrowed coronary arteries. Today, angioplasty is performed on more than a million patients each year.  

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Recent Trends in Employer-Sponsored Insurance

Recent Trends in Employer-Sponsored Insurance | Heart and Vascular Health | Scoop.it
News from JAMA — Recent Trends in Employer-Sponsored Insurance
Seth Bilazarian, MD's insight:

Premium increase of $7000 and deductible increase of $1000 over 8 years for families

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TIA for the Patient

TIA for the Patient | Heart and Vascular Health | Scoop.it

The definition of TIA is changing. Previously, TIA was defined as a focal cerebral ischemic event with symptoms lasting < 24 hours. As computed tomography and magnetic resonance imaging have become more widely used, up to one-third of patients with TIA have radiological evidence of acute infarction. Therefore, the definition of TIA is moving from time-based to tissue-based, as “a transient episode of neurological dysfunction caused by central nervous system ischemia without acute infarction.” Unilateral weakness and speech disturbances are the most common manifestations of TIA. Unilateral weakness (face, arm, or leg) and speech disturbance (aphasia or dysarthria) are seen in approximately 31%-54% and 25%-42% of TIAs, respectively.

Short-term risk of stroke increases after TIA. The risk of stroke in the days and months after TIA can be estimated using the ABCD2 score.

Seth Bilazarian, MD's insight:

TIA, sometimes called by patients "mini-strokes" ,are often warning signs before a stroke.  Evaluating how much risk there is of a completed stroke with permanent disability can be estimated using the ABCD2 score pictured.  Converting the score to the risk as seen in the figure can help match the level of intensity by patients & doctors to evaluate and treat the TIA, with the goal of reducing the stroke risk.

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Depression Treatment in Acute Coronary Syndromes

Depression Treatment in Acute Coronary Syndromes | Heart and Vascular Health | Scoop.it
The Coronary Psychosocial Evaluation Studies trial demonstrated promising results for enhanced depression treatment to reduce cardiovascular risk of patients with acute coronary syndrome and comorbid depression, but the long-term effectiveness of this intervention is unclear.

During the 6-month treatment period, death or hospitalization for myocardial infarction/unstable angina occurred in 3 participants (4%) in the treatment group compared with 11 participants (14%) in the usual care group, During 12 months of additional observational follow-up, 11 participants (14%) in the treatment group experienced the composite outcome of death or hospitalization for myocardial infarction/unstable angina compared with 3 participants (4%) in the usual care group.

Seth Bilazarian, MD's insight:

Although this is a small study, there was a 10% absolute risk reduction in death or heart attack in patients with depression who were treated.  Using the NNT, there would be one death or hospitalization prevented for every 10 patients treated. 

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Prognostic Value of Exercise Capacity

Prognostic Value of Exercise Capacity | Heart and Vascular Health | Scoop.it
To examine the prognostic value of exercise capacity in patients with nonrevascularized and revascularized coronary artery disease (CAD) seen in routine clinical practice.Conclusion

Exercise capacity was a strong predictor of mortality, MI, and downstream revascularizations in this cohort. Furthermore, patients with similar exercise capacities had an equivalent mortality risk, irrespective of baseline revascularization status.

Seth Bilazarian, MD's insight:

Authors from the FIT Project have put together beautifully the data and summarized it in this one image on the benefits of being fit or "in shape" and the benefits of having arteries "fixed" with angioplasty (PCI or stents) or bypass surgery (CABG), for patients who have coronary artery disease.

What the slide means:

The top row looks at mortality (death).  The term METS refers to the amount of energy spent and  roughly correlates with the number of minutes on the treadmill using the standard exercise protocol called the Bruce protocol.  Looking across the top row you can see that death rate falls as the amount of exercise increases.  The hazard of death falls by 75% for those who can exercise more than 12 minutes compared to those who exercise less than 6 minutes.

In the second & third rows the reduction of heart attacks (MIs) and need for future angioplasty or bypass surgery is effected by revascularization.  Patients that are "fixed" have lower rates of heart attack and needing to be fixed compared to those that haven't been fixed.

For coronary disease patients revascularization with stents or bypass and being fit based on exercise capacity provides the best prognosis

TAKE HOME MESSAGE - It's best to be ""fixed" and fit.

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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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Influenza Vaccine

Influenza Vaccine | Heart and Vascular Health | Scoop.it
WHAT IS INFLUENZA?

Influenza, also called “the flu,” is caused by the influenza virus. It affects the lungs and can cause symptoms such as fever and trouble breathing. Most people recover from the flu on their own. But, in some people who are older or have long-term medical problems, the flu can be a serious or even deadly illness.

Influenza is a seasonal illness and affects most people during the winter months. In the United States, January and February tend to be the worst months for flu, but people can get the flu as early as October and as late as May. Each year the virus changes slightly, and the resulting different types of viruses are called strains. Some strains cause more serious illness than others. These strains are sometimes given special names, such as “swine flu” (H1N1) or “avian flu” (H5N1 and H7N9).

Seth Bilazarian, MD's insight:

The season for influenza vaccine is upon us.  Its never been easier to get a "flu shot" - available at pharmacies, senior & community centers and docotr's offices.  Get one today (if your over 6 months old).

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Consumer Updates > Blood Pressure Monitoring Kiosks Aren't for Everyone

Consumer Updates > Blood Pressure Monitoring Kiosks Aren't for Everyone | Heart and Vascular Health | Scoop.it
Correct cuff size is critical in measuring blood pressure. FDA is advising consumers that the cuffs on blood pressure kiosks in stores, pharmacies, gyms and other locations don't fit everyone and might not be accurate for all users.
Seth Bilazarian, MD's insight:

Measurement by a trained professional  (doctor, nurse or other trained person) is the best approach with blood pressure measurement in both arms. The cuff size is critical.  A cuff too large will cause blood pressure to be measured artificially lower than is accurate.  A cuff too small will give a falsely elevated reading.  Good quality home machines are an excellent option.  Added confidence is gained by validating the results on a home machine.   Bringing your device  to the physicin's office to confirm that the equipment and your use of the machine results in an accurate blood pressure measurement is easy and effective.

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Donovan Baldwin's curator insight, October 5, 1:57 PM

I do not have huge arms, but, they are larger than the recommended size for most blood pressure cuffs. I have found that asking for a larger cuff brings my blood pressure readings down. Kiosks that measure blood pressure automatically raise my readings dramatically.

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What We Don't Know About Heart Disease Can Kill Us

What We Don't Know About Heart Disease Can Kill Us | Heart and Vascular Health | Scoop.it
People in the United Kingdom failed big time when they took a poll on risk factors for heart disease. Think you're more up to speed? Try our quickie quiz and find out.
Seth Bilazarian, MD's insight:

Are you smarter than a Brit?

Four simple questions to test your knowledge about risk factors and their relation to stroke and heart disease.

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Donovan Baldwin's curator insight, September 30, 11:15 AM

Heart disease is a major killer in the U.S. and the UK. Heart health starts with knowledge, followed by action...in more ways than one. Regular, moderate exercise is one of our major defenses against heart disease.