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Top Line Results for SAVOR-TIMI-53 Cardiovascular Outcomes Trial of Onglyza (saxagliptin)

Top Line Results for SAVOR-TIMI-53 Cardiovascular Outcomes Trial of Onglyza (saxagliptin) | Heart and Vascular Health | Scoop.it

AstraZeneca and Bristol-Myers Squibb Announce Top Line Results for SAVOR-TIMI-53 Cardiovascular Outcomes Trial of Onglyza(R) (saxagliptin) PRINCETON, N.J. & WILMINGTON, Del., Jun 19, 2013

In this study of adult patients with type 2 diabetes with either a history of established cardiovascular disease or multiple risk factors, Onglyza met the primary safety objective of non-inferiority, and did not meet the primary efficacy objective of superiority, for a composite endpoint of cardiovascular death, non-fatal myocardial infarction or non-fatal ischaemic stroke, when added to a patient’s current standard of care (with or without other anti-diabetic therapies), as compared to placebo. These preliminary SAVOR-TIMI-53 data are being analyzed and the study results will be submitted to the European Society of Cardiology (ESC) for potential presentation at the ESC Congress in September.

Seth Bilazarian, MD's insight:

My comment:  we have struggled to move the ball forward for diabetes care and prevention of heart attacks.  Despite more than a dozen oral drug options that improve blood sugar control, we lack evidence that this approach lowers the risk of strokes and heart attacks.  Blood pressure control and cholesterol treatment are proven strategies for risk reduction, but there remains scant evidence that improving blood sugar control makes a difference.  (It may make a difference on other important issues like diabetic eye and kidney concerns).

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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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Undetectable Troponin T Level in ED & Risk of Myocardial Infarction

Undetectable Troponin T Level in ED & Risk of Myocardial Infarction | Heart and Vascular Health | Scoop.it

Study to evaluate if an undetectable (<5 ng/l) high-sensitivity cardiac troponin T (hs-cTnT) level & ECG without signs of ischemia can rule out myocardial infarction (MI) in the emergency department (ED).

Background  Chest pain is a common symptom often associated with benign conditions, but may be a sign of MI. Because there is no rapid way to rule out MI, many patients are admitted to the hospital.

Methods  All patients who sought medical attention for chest pain and had at least 1 hs-cTnT analyzed during 2 years at the Karolinska University Hospital, Stockholm, Sweden, were included.

Results  14,636 patients. 8,907 (61%) had an initial hs-cTnT of <5 ng/l.

Among patients with a first hs-cTnT level of <5 ng/l, 1,704 (89%) had a second hs-cTnT level measured, which was <5 ng/l in 1,362 (90%) patients. Patients with a first hs-cTnT level of <5 ng/l and no MI within 30 days were admitted to the hospital for a total of 3,262 days, with a mean duration of hospital stay of 1.5 ± 3.0 days; 1,482 (77%) of these patients were discharged on the same or next day. The most common discharge diagnoses in patients with a first hs-cTnT level of <5 ng/l were nonspecific chest pain (50%), atrial fibrillation or supraventricular tachycardia (5.6%), and angina (5.1%).

Conclusions  All patients with chest pain who have an initial hs-cTnT level of <5 ng/l and no signs of ischemia on an ECG have a minimal risk of MI or death within 30 days, and can be safely discharged directly from the ED.

Seth Bilazarian, MD's insight:

The evaluation of chest pain in the emergency department and ability to rapidly evaluate patients, so low risk patients can be released for their comfort &  convenience and for health care cost savings is the "holy grail".  This paper does allot to get us closer. If patients had low level of troponin and a normal EKG there was no heart attack at 30 days in 99.8% and 100% of patients were alive.  Changing protocols in emergency departments will be difficult but achievable.

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Paul Ridker on Inflammation and Residual CV Risk

Paul Ridker on Inflammation and Residual CV Risk | Heart and Vascular Health | Scoop.it

Dr. Bilazarian interviews Dr. Paul Ridker on the inflammation hypothesis and 2 ongoing trials in this area: the National Heart, Lung, and Blood Institute (NHLBI)-funded Cardiovascular Inflammation Reduction Trial (CIRT),[1] which is testing whether taking low-dose methotrexate reduces myocardial infarction (MI), stroke, or death in people with type 2 diabetes or metabolic syndrome who have had a heart attack or have stable coronary artery disease; and the Novartis-sponsored Canakinumab Anti-Inflammatory Thrombosis Outcomes Study (CANTOS),[2] which is assessing whether blocking the proinflammatory cytokine interleukin (IL)-1β with canakinumab, as compared with placebo, can reduce rates of recurrent MI, stroke, and cardiovascular death in patients post-MI with elevated high-sensitivity C-reactive protein (CRP; ≥ 2 mg/L).

Seth Bilazarian, MD's insight:

Paul Ridker provides a great primer for clinicians & patients on the status of trials investigating the links between inflammation and cardiovascular disease. He reviews the background and status of the two large randomized clinical outcomes trials he leads: CANTOS & CIRT.

 

Other resources:

1.  slides from Dr. Ridker at  https://my.americanheart.org/idc/groups/ahamah-public/@wcm/@sop/@scon/documents/downloadable/ucm_426676.pdf

 

2. CIRT trial http://www.thecirt.org/

 

3,  CANTOS trial http://www.thecantos.org/

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Heart-Rhythm Monitoring for Evaluation of Cryptogenic Stroke

Heart-Rhythm Monitoring for Evaluation of Cryptogenic Stroke | Heart and Vascular Health | Scoop.it

Observational studies suggest that we often fail to detect paroxysmal atrial fibrillation as the cause of ischemic stroke. However, owing to the limitations of existing studies, guidelines have yet to endorse specific strategies for detecting atrial fibrillation in patients with a new stroke. The results of two studies published in this issue of the Journal indicate that prolonged monitoring of heart rhythm should now become part of the standard care of patients with cryptogenic stroke.leaving it unclear whether monitoring improves diagnosis as compared with routine follow-up. 

Seth Bilazarian, MD's insight:

Our patients want to avoid stroke because of the debilitating effects it can have on functional status and quality of life.  Efforts to prevent a second stroke are enthusiastically embraced by patients.

Cryptogenic is stroke that a cause cannot be determined (about 1/3 of strokes).  Treatment with anticoagulants in this patient population is not recommended UNLESS the cause of the stroke is from the common irregular heart rhythm atrial fibrillation (AF).  

On the other hand if atrial fibrillation is NOT detected treatment with aspirin or other anti-platelet drugs are used and these drugs are inferior to anticoagulants if AF is the cause.

Two studies in NEJM showed that prolonged monitoring (30 days or 6 months)  increased the detection of AF and allowed more patients to be started on anticoagulants for stroke prevention.

In the trial of 30 days of recording with an external (carried) monitor was 16.1%.

In the trial of the implanted recorder detection of AF was 

at 6 months 8.9%

at 12 months 12%

at 36 months 36%

 The strategy of prolonged monitoring with an external device  for 1 month or 6 months with an implanted device is an unresolved question and adoption of the small subcutaneous device pictured above, will be limited by its cost, until further studies showing stroke reduction can be completed justifying its cost.

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Sex differences in symptoms of Acute Coronary Syndromes (ACS)

Sex differences in symptoms of Acute Coronary Syndromes (ACS) | Heart and Vascular Health | Scoop.it

DeVon et al. evaluated the diagnostic performance of 13 symptoms of ACS by sex in 736 patients admitted to four EDs with suspected acute coronary syndrome. Overall they found there were more similarities than differences between the sexes in the performance of the symptom predictors evaluated. To learn more read their complete report in JAHA http://goo.gl/s6AQro.

Seth Bilazarian, MD's insight:

Shoulder pain, arm pain and shortness of breath are more frequent in females who present with acute coronary syndromes.

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Medscape: Practioner's Corner - Low Value Care in Medicine - a misnomer?

Medscape: Practioner's Corner - Low Value Care in Medicine - a misnomer? | Heart and Vascular Health | Scoop.it

Hi. Seth Bilazarian on theheart.org on Medscape, for my Private Practice blog. I want to comment on a paper called "Measuring Low-Value Care in Medicare" that was published in JAMA Internal Medicine on May 12.[1]

I want to give some comments. As a community-based clinical cardiologist, I work in a cardiac cath lab. Those are essentially my disclosures.

I want to comment about what I think is a pendulum swinging from physicians being an integral part of healthcare delivery, and problem-solving in that delivery, to being seen as a major impediment and cost-driver, which I think is a significant detriment. This paper concerns me as a clinical cardiologist in several ways. I am a retail deliverer of cardiology. I don't look at healthcare policy; that is not my profession. I am a practitioner. The discussion in this paper was at a higher level than where I practice, but I think it has important implications and I want to share with the Medscape community and get other physicians to weigh in.

I see this in context with many other initiatives which I will mention. Of course there is (1) appropriate-use criteria, largely directed at physicians; (2) Choosing Wisely®, largely directed at patients, with the idea that physicians discuss these issues with patients; (3) comparative effectiveness, discussing healthcare policy, and then (4) low-value care, which is the topic of this paper.

Seth Bilazarian, MD's insight:

My blog on low value care and the complexity of defining that term as we go forward especially as we move toward "patient-centric" or shared decision models of care and are faced with patient satisfaction as a metric of quality.  Comments welcome on the Medscape site 

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Chief Science Officer ‘sets record straight’ about diet, science, AHA | blog.heart.org

Chief Science Officer ‘sets record straight’ about diet, science, AHA | blog.heart.org | Heart and Vascular Health | Scoop.it

At the American Heart Association, everything we do is based on science. Simply put, we examine the evidence that comes from scientific studies and use it to provide advice to help people get healthier and prevent heart disease and stroke.

That’s why I was so alarmed by the many inaccuracies and misrepresentations of scientific facts in a recent article about our dietary recommendations – and why as the American Heart Association’s Chief Science and Medical Officer I need to set the record straight.

Seth Bilazarian, MD's insight:

For those who want to seriously understand the state of the science on dietary saturated fats this is an excellent refutation of the bad journalism that is being propagated.. I'm personally appreciative of the strong statement by Dr. Robertson denouncing the Daily Beast article's contention that being a Christian disqualifies someone from "thinking scientifically".

"Enlightened scientific discourse can improve our world. But arguments based in falsehoods, questionable allegations and personal attacks serve no purpose but to confuse people. And that is irresponsible."

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Subrata Chakravarty's curator insight, May 31, 10:00 AM

This interview of the Chief Science and Medical Officer of the American Heart Association reveals the deep misconceptions of past nutritional recommendations that have shaped our society today (to its detriment!).  


A whole generation's frustration at being misinformed about their health has led to a nutritional awareness movement that has poked massive holes in the medical interpretation of what good nutrition actually means.  The world of nutrition is being redefined, and hopefully that will lead this world to be a better place.

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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

Richard Haddad's curator insight, August 18, 4:09 PM

Encore une étude qui montre la relation  Obésité/cancer

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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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Trends in Atrial Fibrillation in US, 2000-10

Trends in Atrial Fibrillation in US, 2000-10 | Heart and Vascular Health | Scoop.it

Atrial fibrillation (AF) is one of the most frequently encountered arrhythmias in the hospital. A multidisciplinary approach is required to recognize and treat AF appropriately; to limit the catastrophic consequences such as stroke, heart failure, and dementia; and to decrease the burden on the healthcare system. Hospitalization related to AF is the single largest contributor to overall cost of care in managing AF patients. In this study, we examined the trends of AF hospitalizations in the United States and assessed the effects of patient demographics and comorbid diagnoses on in-hospital mortality, length of stay, and total cost of care. Understanding these factors helps us understand the health economics of AF better. There has been a significant increase in AF hospitalizations over the last decade, with a large contribution from patients >65 years of age, especially among those >80 years of age. The overall length of hospital stay has remained unchanged; however, the cost of inpatient care has increased tremendously, from approximately $2.15 billion in 2001 to $3.46 billion in 2010. To the best of our knowledge, this is the first study to assess the trends of AF-related inpatient care at a national level from the actual hospital discharge database. Such data, although they have inherent limitations, tend to provide more accurate financial trajectory of the problem.

Seth Bilazarian, MD's insight:

Atrial fibrillation or AF is the most common heart rhythm abnormality and it is consistently the first or second most common reason for admission at community hospitals.  We have new therapies such as novel oral anticoagulants (Pradaxa, Xarelto, Eliquis) that should increase the ability to manage this problem as an outpatient but changing the practice of physicians & emergency departments will be difficult.

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Testosterone Replacement Therapy

Testosterone Replacement Therapy | Heart and Vascular Health | Scoop.it
Pentucket Medical cardiologist Seth Bilazarian, MD discusses testosterone replacement therapy in men with "low T." What is the risk of heart attack or stroke?
Seth Bilazarian, MD's insight:

Putting the testosterone replacement for "low T" into perspective for our patients.

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Aspirin for Primary Prevention | Pentucket Medical Associates

Aspirin for Primary Prevention | Pentucket Medical Associates | Heart and Vascular Health | Scoop.it
Aspirin is used to prevent cardiac events like heart attack & stroke. Cardiologist Seth Bilazarian, MD explains aspirin use for primary & secondary prevention.
Seth Bilazarian, MD's insight:

The FDA no longer recommends aspirin for primary prevention

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Electronic Cigarettes

Electronic Cigarettes | Heart and Vascular Health | Scoop.it

Electronic cigarettes (E-cigarettes) are devices that deliver nicotine to a user by heating and converting to an aerosol a liquid mixture typically composed of propylene glycol, vegetable glycerin, flavoring chemicals, and nicotine. E-cigarette use doubled in just 1 year among both adults and children, from 3.4% to 6.2% in adults (2010–2011) and 3.3% to 6.8% in youth (2011–2012), with high levels of dual use with tobacco cigarettes.  Although most youth using e-cigarettes are dual users, up to one third of adolescents who tried an e-cigarette have never smoked a conventional cigarette, indicating that some youth are initiating use of the addictive drug nicotine with e-cigarettes.

Smoke-free policies are a critical intervention both to protect nonsmokers and to support smoking cessation attempts. To avoid reversing the effectiveness of these policies, e-cigarettes should not be used anyplace where smoking cigarettes is not allowed (including in homes that are smoke-free). There is no reason to reintroduce toxins into clean indoor air environments.

Seth Bilazarian, MD's insight:

I tell patients who want to use  E-cigarettes that we don't have adequate information to say that these new nicotine drug delivery devices are safer than cigarettes.  For patients who are motivated to quit smoking, use of  E-cigarettes has not been shown to be an effective  aid to end the addiction of smoking.

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Managing Anticoagulation Interruptions

Managing Anticoagulation Interruptions | Heart and Vascular Health | Scoop.it

On the ClotBlog with Dr. Samuel Z. Goldhaber, at theheart.org on Medscape speaking to you from the American College of Cardiology Scientific Symposium in Washington, DC. Today, I have a special guest and a special friend, Dr. Seth Bilazarian. Seth, welcome to the ClotBlog.

Today I wanted to discuss with you a problem that you and I get calls and emails about over and over again, and that is how to safely interrupt anticoagulation. There are several different levels that we can quickly talk about, including cataract surgery and colonoscopy, but then we can go into the more nitty gritty area of what do we do with patients who have mechanical heart valves. Let's start with cataract surgery. Do you ever instruct your patients to interrupt their anticoagulation?

Seth Bilazarian, MD's insight:

Discussion between a leading academic on thrombosis (Dr Goldhaber) and a community based practitioner (me) on the complexity of managing anti-coagulation around the time of a procedure or surgery.

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Thanks for the great plug on twitter : John Mandrola, MD ‏@drjohnm 

Grt discussion on interrupting anticoagulation w/@DrSethdb & Dr Goldhaber http://www.medscape.com/viewarticle/824855?utm_source=twitterfeed&utm_medium=twitter&nbsp;… < Like this topic b/c #judgement critical.

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