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Ever at the Mercy of Well-Intentioned Regulations

Ever at the Mercy of Well-Intentioned Regulations | Heart and Vascular Health | Scoop.it

=> One of the greatest delusions…is hope that the evils in this world are to be cured by legislation - Thomas B. Reed, 1886, speech

=> The greatest dangers to liberty lurk in insidious encroachment by men of zeal, well-meaning, but without understanding. Louis Brandeis, 1928

 

Dr. Joseph Loscalzo, Brigham and Women's Hospital provides an essay about well-intentioned regulations in healthcare and medical reserach:

"I am, however, opposed to regulation for the sake of prevention without evidence of benefit; unnecessarily penalizing the innocent; establishing a tenor of extreme vigilance that assumes professional culpability; and consuming precious time and limited resources with ineffective bureaucratic mandates that could and should be better spent on the practice of our professions."

Seth Bilazarian, MD's insight:

IF YOU HAVE AN INTEREST in American Healthcare or scientific research as a citizen, taxpayer, potential patient or are a current or future professional participant you should read this essay.  I hope that it becomes part of a larger debate in National Newspapers and Think tanks.

 

Key Points:

1. There are more rules and regulations overseen by more regulatory bodies with minimal professional input. HCFA has amassed 130,000 pages of Medicare & Medicaid rules (3x IRS code). Federal cost > $300 billion.

 

2.  There is no evidence regulation is effective: " Does centralized regulation enhance the likelihood that physicians and scientists will consistently act in society’s best interests?  "there is no evidence"

 

3.  We are required to participate in these programs, with lack of participation potentially leading to a loss of clinical privileges or of licensure

 

4.  A recent NIH study reported that an amazing 42% of a researcher’s time is spent on regulatory matters rather than on the research (my comment - no wonder we don't have a cure for AIDS or cancer).

 

5. In clinical medicine estimates suggest that 1 hour of inpatient care generates 36 minutes of required paperwork (my comment - no wonder patients are frustratted by the lack of direct physician - patient intereaction)

 

6. Internet and electronic communication make the implementation of any regulatory requirement extraordinarily simple.

 

7.  Practitioners are now subject to onerous regulation to guard against that rare bad apple at any cost and in the absence of supporting evidence that the regulation makes a clear difference.

 

8.  Issues that need to be considered in the development of an effective regulatory system. include a fundamental cost-effectiveness principle founded on the basis of demonstrable evidence.

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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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Healthy Weight Loss

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

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

Seth Bilazarian, MD's insight:

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

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

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

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

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

Seth Bilazarian, MD's insight:

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

Eat fish, don't take fish oil. 

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Wine only protects against CVD in people who exercise

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

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

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

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

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

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

Seth Bilazarian, MD's insight:

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

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

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

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

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

thank you Seth:)

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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.

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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, 10:10 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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