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Survey of physicians from around the country attempting to explain why there is a decrease in PCI (angioplasty) volumes. The different explanations and regional variation is fascinating. My views are similar to the New England practioner surveyed. In Massachusets we have the lowest level of uninsured patients in the nation so the economuc factors here are less likely a contributor. Has a hopeful optimist and enthusiast for prevention strategies I favor stain use as the #1 cause. I think the COURAGE trial had no impact at all.
My comment: The FDA prohibits drug or device manufactureres from promoting "off label" use. The requirements to get a label indication is a high bar but is intended to protect the public from marketing that is not backed by good evidence. Is off label promotion free speech or is it more like yelling fire in a crowded theater?
The issue of free speech in prescription drug marketing will get a fresh look when a federal appeals court in San Francisco considers whether a biotech executive committed fraud in touting a lung-disease drug.
Potentially jeopardized in both cases is a set of FDA regulations prohibiting drug companies from off-label marketing, or marketing a medicine for purposes not approved by the agency. Also threatened is the government's extracting of billion-dollar settlements from companies that do just that.
My comment: Should patients be given open access to data from implanted devices such as pacemakers and ICDs? In a world of personalized medicine patients can titrate therir activity and diet and medication use to physiologivc parameters. But who is to blame if it doesnt go well and there is patient harm? Doctors? Device manufacturers? Patients?
The U.S. has strict privacy laws guaranteeing people access to traditional health files. But implants and other new technologies—including smartphone apps and over-the-counter monitors—are testing the very definition of medical records..
My comment: Another vote for moderation. Being sedentary is clearly NOT healthy. But this data suggests that "Chronic extreme exercise appears to cause excessive ‘wear-and-tear’ on the heart,”.
A fast-emerging body of scientific evidence points to a conclusion that’s unsettling, to say the least, for a lot of older athletes: Running can take a toll on the heart that essentially eliminates the benefits of exercise. What the new research suggests is that the benefits of running may come to a hard stop later in life. In a study involving 52,600 people followed for three decades, the runners in the group had a 19% lower death rate than nonrunners, according to the Heart editorial. But among the running cohort, those who ran a lot—more than 20 to 25 miles a week—lost that mortality advantage.
Scientists are studying how to tap the energy naturally created by people's bodies—such as heat, sound and movement—to power medical devices without the need to change batteries...
The task is challenging on a number of fronts. Many biological sources of energy tend to emit very low power and often inconsistently, so the energy needs to be captured and stored, such as with batteries, so it can be used by the device.. Also, energy storage units have to be limited in size if they're going to fit within the body.
An additional hurdle: the devices must not siphon off too much energy, so as to preserve normal body function.
In the work published in the journal Nature Biotechnology, researchers figured out a way to tap a reservoir of energy produced by the inner ear to power a medical device. Scientists have been aware of this source of energy, which we need to use in order to hear properly, for some 60 years, but didn't know how to access it.
The researchers designed tiny electrode sensors that could be implanted in the inner ear and would draw just a small bit of current while maintaining normal hearing.
FDA said it has received reports of 13 deaths since 2008 possibly related to the use of 5-hour Energy shots, a disclosure that could heighten scrutiny of drinks and dietary supplements that promise to deliver an energy..
5-hour Energy, sold in 1.93-ounce plastic bottles, increasingly has become a fixture at check-out counters of convenience stores and drug stores. Its label promises to deliver a boost of energy "in minutes."
In a statement Wednesday, Living Essentials said 5-hour is intended for "busy adults" and that its product is an effective dietary supplement, containing about as much caffeine as a cup of coffee.
It recommends on product labels that consumers don't drink more than two bottles a day, spaced several hours apart, and that consumers sensitive to caffeine should consult with a physician.
"It is important to note that submitting a serious adverse event report to the FDA, according to the agency itself, is not construed by FDA as an admission that the dietary supplement was involved, caused or contributed to the adverse event being reported, or that any person included in the report caused or contributed to the event," the company added in its statement Wednesday.
Living Essentials had about $600 million in sales last year.
My comment: Is the demise of Hostess Brands a leading indicator that Americans are coming around to rational thinking on nutrition and making decisions with food purchases that will have a meaningful impact on obesity and health? I hope so. Joseph Schumpeter might be smiling.
The maker of Wonder Bread and Ding Dongs announced it would close its plants and fire about 18,000 employees after being crippled by a nationwide strike.
Each Twinkie has (had) 150 calories, 2 gm fat, 17 gm sugar.
The company made 500 million of the creme-filled treats every year. The icons have been on shelves since 1930. Supposedly the cakes never go bad. Despite the high amounts of preservatives, Hostess says, Twinkies really only have a 25 day shelf life. President Clinton placed a package in the Millennium Time Capsule in 1999, scheduled to be opened in 2100. We'll see then if if they really do spoil.
My comment: patients with A fib sometimes need a pacemaker because their herat rate slows down to much. THis study helps identify patient groups that are a thigher risk for needing a pacemeker. heart failure was the most important risk factor for needing a pcaemaker.
Symptomatic bradycardia may complicate atrial fibrillation (AF) and necessitate a permanent pacemaker. Study Of the 362 patients, 119 cases had permanent pacemakers implanted for bradycardia after AF diagnosis, and 243 controls were alive without pacemakers.
The follow-up was 4.5 years.
Odds ratios were determined
- age at the time of AF diagnosis (1.02, [CI] 1 to 1.04)
- female gender (1.58, CI 0.95 to 2.63)
- previous heart failure (2.72, 95% CI 1.47 to 5.01)
- African American race (0.33, 95% CI 0.12 to 0.94)
The post hoc model identified permanent AF (odds ratio 2.99, 95% CI 1.61 to 5.57) and atrioventricular nodal blocker use (odds ratio 1.43, 95% CI 0.85 to 2.4).
Conclusion, in patients with AF, heart failure and permanent AF each nearly triple the odds of developing bradycardia requiring a permanent pacemaker; although not statistically significant, our results suggest that women are more likely and African Americans less likely to develop bradycardia requiring pacemaker implantation.
My comment: Best programs don't necessarily deliver best care. Care is delivered by individual caregivers (attending physiicans, fellows, residents, nurses) and they are not all excellent, even at excellent institutions. Implied here is that some "excellent" places that are renown for innovation or caring for certain populations (wealthy, celebrities) actually may not do well on overall quality metrics. On average however institutions have a culture and this affects many aspects of care.
Great picture of the Statue of Christus Consolator under the Johns Hopkins dome, in Baltimore.
A report from Dartmouth offers medical students a glimpse of the kind of doctors they're likely to become, depending where they do their residency. Twenty-three of the country's "top" teaching hospitals were compared on aspects of patient care:
- how they treat patients in their last few months of life
- how many surgical procedures they perform
- what the patient experience is like.
"Understanding variations in the way care is delivered by these institutions is important because it affects residency training and, thus, the way residents in a given program will practice as physicians."
The most prestigious hospitals are not necessarily the ones teaching the most compassionate or even the safest care. Looking at how patients are treated in the last six months of life might seem like an odd way to compare hospitals, much less residency programs, but its actually a good measure of the kind of doctors residents will learn to be, and it speaks to broader aspects of the training program.
The infographic presents different heath devices.
It's supposed to be a foregone conclusion (right?), but one debate at AHA 2012 provided convincing arguments against chest compressions. This could be a major paradigm shift: To compress or not to compress?
The most provocative presentation at AHA 2012 (#AHA12) was presented by Dr. Gust Barty who made a convincing argument that we should at least study whether the use of chest compressions in cardiac arrests is better than prompt use of a defibrillator and no compression at all. He sighted data from Piacenza Italy where this practice is being used. Survival in this community is 34% at 1 year after cardiac arrest. This is in direct opposition to the current recommendations of AHA that chest compression should be done immediately and with minimal interruptions.
My comment: We have new options for patients with atrial fibrillation. These new drugs Pradaxa and Xarelto are under scrutiny because they are new nadn bleeding hazard has been reprted. This study helps us understand that warfarin (coumadin) also has significcant risk and the risk is high in the first week of starting thsi medicine. This early hazard but be an advatage for the newer options.
Rates of serious bleeding among patients taking warfarin are much higher than those found in clinical trials of the drug and are even greater during the first month of use, according to a five-year study of 125,195 seniors with atrial fibrillation.
The findings complicate an already difficult decision-making process for patients with atrial fibrillation (AF) and highlight the importance of careful management of warfarin, especially during the first month of use, experts said. Warfarin is a generic anticoagulant that is marketed under brand names such as Coumadin and Jantoven.
However, during the first month of treatment, the annualized hemorrhage rates were 11.8% in all patients and 16.7% among patients with higher risk of stroke.
My comment: this is one of the great challenges in the practice of cardiovascular medicine. Statins have great results for prevention of stroke and heart attack, but do cause muscle aches in a minority of patients. Sometimes the muscle aches are not from the drug so rechallenging can be helpful to sort this out
Statin myopathy is a generally encountered side effect of statin usage. Both muscle symptoms and a raised serum creatine kinase (CK) are used in case definition, but these are common manifestations of other conditions, which may not be statin related. Statin rechallenge assuming no contraindication in selected cases is an option before considering a different class of lipid-lowering agent.
Patients with statin myopathy constitute 10.2% of our Lipid Clinic workload. They are predominantly female (62.0%), Caucasian (63.9%), with a mean age of 58.3 years and mean BMI of 29.3 kg/m(2). The serum CK and ESR were statistically higher compared to patients with statin intolerances with no muscular component or CK elevations. Secondary causes of statin myopathy were implicated in 2.7% of cases. Following statin myopathy to simvastatin we found no statistical difference between the tolerability rates between atorvastatin, rosuvastatin, pravastatin, and fluvastatin. Fibrates, cholestyramine, and ezetimibe were statistically better tolerated in these patients.
CONCLUSIONS: Statin rechallenge is a real treatment option in patients with statin myopathy. Detailed history and examination is required to exclude muscle diseases unrelated to statin usage. In patients developing statin myopathy on simvastatin, we did not find any statistical difference between subsequent tolerability rates to rosuvastatin, pravastatin, and fluvastatin.
Patients with heart disease frequently assume that medication is enough to forestall a repeat heart attack or stroke, but a large new study shows the preventive power of a healthy diet. The findings from a report looked at the impact of diet in addition to the medicines routinely used to treat cardiovascular disease. Although it is widely accepted that healthy diets are powerful tools to prevent cardiovascular disease, less is known about the impact of diet on people who already have the disease. People with the healthiest diets—those with the highest intakes of fruit, vegetables, whole grains, nuts, and a higher intake of fish relative to meat poultry and eggs—were 35% less likely to die from a repeat heart attack or stroke during the length of the study, compared with those with the least healthy diets, according to the five-year study of 32,000 people in 40 countries.
Recommended by The American Heart Association advises:
=> Fish: At least two servings of fish each week are recommended in a study of healthy diets.
=> Vegetables: More than four cups of fruits and vegetables are suggested for daily intake.
=> Nuts: Four servings of nuts or seeds a week are considered part of a healthy diet.
=> Diet Colors: eating vegetables of various colors.
Could a car that knows when you are stressed or ill save you from having an accident? Auto makers are stepping up efforts to find out.
A number of big car manufacturers are accelerating research into equipping vehicles with so-called biometric sensors that would keep tabs on a driver's vital health signs, including pulse, breathing and "skin conductance," aka sweaty palms. When that information is fed into the computers that manage a car's safety systems, it could enable a vehicle to better react to whatever challenges the road and traffic dish out.
Many of the body’s processes follow a natural daily rhythm or so-called circadian clock. There are certain times of the day when a person is most alert, when blood pressure is highest, and when the heart is most efficient. Several rare gene mutations have been found that can adjust this clock in humans, responsible for entire families in which people wake up at 3 a.m. or 4 a.m. and cannot stay up much after 8 at night. Now new research has, for the first time, identified a common gene variant that affects virtually the entire population, and which is responsible for up to an hour a day of your tendency to be an early riser or night owl.
urthermore, this new discovery not only demonstrates this common polymorphism influences the rhythms of people’s day-to-day lives -- it also finds this genetic variant helps determine the time of day a person is most likely to die.
My comment: There is significant concen about the safety of Chantix. I explain to my patients that the risk of this drug has to be balanced against the risk of continued smoking (heart disease, stroke, cancer, erectile dysfunction) since this is the most effective strategy we have to help people succeed at qutitting their addiction to niocotine.
Danish registry of 35,000 patients comparing the safety of quitting smoking with Chantix (varenicline) comared to Wellbutrin or Zyban (bupropion) on safety of cardiovascular events.
At 6 months the rates were 0.69% vs. 7.1%. This study found no increased risk of major cardiovascular events associated with use of varenicline compared with bupropion for smoking cessation.
Sleep deprivation can cause serious health and cognitive problems in humans. In short, it can make us fat, sick and stupid. But why do humans need so much sleep? PBS Science correspondent Miles O'Brien talks to scientists on the cutting edge of sleep research and asks if there's any way humans might evolve into getting by with less.
For those who want a new option for tracking activity. A new option with great promise. It can even be used to track activity while swimming (don't try that with your smart phone). It's about the size of 3 stacked quarters. It's iPhone compatible and synchs with the iPhone by laying it on the screen. No wireless, no cables. How they do that?
This new technology is for those looking for connected health #cHealth that is seamless (hence wearable) and provides meaningful data that can be used to track health and fitness parameters longitudinally.
More good news for "coffee achievers". I think we already knew this.
(Relaxnews) - Is a strong cup of coffee a happiness elixir? New research finds that caffeine may take the negative edge off of the world, and focus your mind on positivity.
20 years ago today the SPINAF trial was published. This was one of the last studies to compare warfarin to placebo in atrial fibrillation (Afib) for the prevention of stroke. For the lsat 20 years warfarin has been the standard of care. Anticoagulants (blood thinners) prevent stroke in Afib. After this there were only a few more studues that were done comparing warfarin to placebo or aspirin (SPAF-II in 1994) because it was felt to not be ethical since the benefits of warfarin are so clear for stroke prevnetion.
AIn teh US, we've had only warfarin (coumadin) until 2 years ago (10/2010) when the first of the novel oral anticoagulants (NOACs) were introduced. Pradaxa (dabigatran) and Xarelto (rivaroxaban) are now available in the US. We expext Eliquis (apixiban) in 2013 with others to follow.