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Media, News & Topics on prevention, diagnosis & treatment of cardiovascular disease
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Rosie O'Donnell describes googling about heart attack symptoms

Rosie O'Donnell describes googling about heart attack symptoms | Heart and Vascular Health | Scoop.it

i became nauseous
my skin was clammy
i was very very hot
i threw up

maybe this is a heart attack
i googled womens heart attack symptoms
i had many of them
but really? – i thought – naaaa

i took some bayer aspirin
thank god
saved by a tv commercial
literally

i did not call 911
50% of women having heart attacks never call 911
200,000 women die of heart attacks
every year in the US

by some miracle i was not one of them
the next day i went to a cardiologist
the dr did an EKG and sent me to the hospital
where a stent was put in

my LAD was 99% blocked
they call this type of heart attack
the Widow maker
i am lucky to be here

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Handling inappropriate care appropriately in cardiology

Handling inappropriate care appropriately in cardiology | Heart and Vascular Health | Scoop.it

What do you do when your patient seeks inappropriate care—based on appropriate use and Choosing Wisely guidelines as well as your clinical judgment—from another cardiologist?  How do you then reconcile the situation with the patient?

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Resistant Hypertension: medications & the potential of renal denervation

On our community television program "Matters of the Heart" Hypertension is a term for high blood pressure (BP). Resistant Hypertension is high blood pressure that remains elevated despite the use of medication.

We review BP treatments and a novel and experimental strategy for treatment of resistant hypertension being investigated called renal nerve denervation.

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Profits, Quality, and U.S. Hospitals - Are For-Profits worse?

Profits, Quality, and U.S. Hospitals - Are For-Profits worse? | Heart and Vascular Health | Scoop.it

Ashish Jha – physician, health policy researcher comments on quality  and ratings.  For-profits make up about 20% of all hospitals & many of them are part of large chains (such as HCA). Critics of for-profit hospitals have argued that these institutions sacrifice good patient care in their search for better financial returns. Supporters argue that there is little evidence that their behavior differs substantially from non-profit institutions or that their care is meaningfully worse.

His conclusion "The best part of looking at data is that you get to draw your own conclusions. Here are mine. Public hospitals are struggling on nearly every metric. For-profit hospitals outside of the HCA are a mixed bag – they do worse on patient experience (as we’ve found before), better on processes measures, & somewhat worse on mortality and readmission rates. They are about average on the Leapfrog safety score."

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Obesity data by state - Orange is bad!

Obesity data by state - Orange is bad! | Heart and Vascular Health | Scoop.it

Obesity prevalence in 2011 varies across states and regions
By state, obesity prevalence ranged from 20.7% in Colorado to 34.9% in Mississippi in 2011. No state had a prevalence of obesity less than 20%. 39 states had a prevalence of 25% or more; 12 of these states had a prevalence of 30% or more: Alabama, Arkansas, Indiana, Kentucky, Louisiana, Michigan, Mississippi, Missouri, Oklahoma, South Carolina, Texas, and West Virginia.
The South had the highest prevalence of obesity (29.5%), followed by the Midwest (29.0%), the Northeast (25.3%) and the West (24.3%).

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Does Fanning Help on a Hot Day?

Does Fanning Help on a Hot Day? | Heart and Vascular Health | Scoop.it

Does fanning yourself actually help you cool down on a hot summer day? Or does the energy it takes to fan yourself only increase your body temperature?

 

When you're at rest, perhaps during a sermon in a church with poor ventilation, the amount of energy you're producing is about 100 watts. Waving a fan adds about 1 watt, but it increases the velocity of the air around you significantly and can double your heat loss. For just 1% of extra effort, you can be twice as cool. That's a pretty sweet deal.

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Weight Training Reduces Risk of Type 2 Diabetes Mellitus in Men

Weight Training Reduces Risk of Type 2 Diabetes Mellitus in Men | Heart and Vascular Health | Scoop.it

Take Home Message: Physicians have recommended a MINIMUM of 150 minues of exercise weekly for diabetic risk reduction but the role resistance training or weight lifting is not certain.  In this study, weight training was associated with a significantly lower risk of Type 2 Diabetes (T2DM), independent of aerobic exercise. Combined weight training & aerobic exercise conferred a greater benefit.

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Association of weight training with risk of T2DM in US men & to assess the influence of combining weight training and aerobic exercise, a prospective cohort study of 32 002 men from the Health Professionals Follow-up Study from 1990-2008. Weekly time spent on weight training & aerobic exercise (including brisk walking, jogging, running, bicycling, swimming, tennis, squash, and calisthenics/rowing) was obtained from questionnaires at baseline and biennially during follow-up. 

During 508 332 person-years of follow-up (18 years)

=> 2278 new cases of T2DM

=> dose-response relationship: increasing time spent on weight training or aerobic exercise and lower risk of T2DM (P < .001 for trend)

=> Engaging in weight training or aerobic exercise for at least 150 minutes per week was independently associated with a lower risk of T2DM of 34% (95% CI, 7%-54%) and 52% (95% CI, 45%-58%), respectively.

+> Men who engaged in aerobic exercise & weight training for at least 150 minutes per week had the greatest reduction in T2DM risk (59%; 95% CI, 39%-73%)

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It's official: New Oral Antithrombotic Agents in Nonvalvular AF now in guidelines

It's official: New Oral Antithrombotic Agents in Nonvalvular AF now in guidelines | Heart and Vascular Health | Scoop.it

The new oral anticoagulants (NOAC): dabigatran (Pradaxa) and rivaroxaban (Xarelto), both FDA approved, and apixaban (Eliquis), which has not been approved, can all be considered for stroke prevention in nonvalvular atrial fibrillation, a science advisory from AHA/ ASA stated.

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HAS-BLED Bleeding Risk Score in Atrial Fibrillation treated with Warfarin

HAS-BLED Bleeding Risk Score in Atrial Fibrillation treated with Warfarin | Heart and Vascular Health | Scoop.it

Take Home Message:  In cardiovascular medicine there are several circumstances when it is valuable to give anticoagulant medications (blood thinners). These medicines reduce the chance of clot formation and lower the risk of strokes and heart attacks.  Because it is harder to form clots patient will have a higher risk of bleeding.  In atrial fibrillation, we have good criteria for evaluating the risk of clotting and stroke (CHADS2 and CHADS-VASC) but are in search of a good score to help doctors and patients predict bleeding risk when on the blood thinner coumadin  (warfarin).  The HAS-BLED score http://www.mdcalc.com/has-bled-score-for-major-bleeding-risk/ ;  performed best, but not very well in this analysis except for its ability to predict the most serious type of bleeding called intracranial hemmorhage.

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Free, secure app to remember medications

Free, secure app to remember medications | Heart and Vascular Health | Scoop.it

Free, Secure Mobile App and Website designed to improve adherence to treatment regimens through self-directed reminders to take medications, refill prescriptions, and visit healthcare providers.

Bidirectional app allows patientsd to keep track of adherence and get refill reminders.  Proving that this makes even a modest benefit on medication adherence for patients would have a significant imopact on health outcomes.  See my other scoops on poor adherence for cardiac patients.

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Panel Advises Against Routine Treadmill Stress Tests

Panel Advises Against Routine Treadmill Stress Tests | Heart and Vascular Health | Scoop.it

The United States Preventive Services Task Force joined the call for less routine testing by recommending against screening with electrocardiograms, or EKGs, in people who have no known risk factors or symptoms of heart disease. For people at higher risk of heart disease, the panel found there was “insufficient evidence” to determine the benefits and harms of screening with the EKG test — either at rest or during exercise — and advised that it be considered case by case basis.  They previously recommended against screening PSA & mammograms.

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If You Don’t Buy Health Insurance, Will You Really Pay the Tax?

If You Don’t Buy Health Insurance, Will You Really Pay the Tax? | Heart and Vascular Health | Scoop.it

Here's why not:

1.  Tax is small $95 in 2014

2.  Law requires filers to sel-disclose that they are not covered

3.  Difficult enforcement - IRS must match insurance data with tax retuns.  It could take years.

4.  If owed, IRS has no mechanism to force payment. Law prohibits criminal penalties

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Approval Rules May Be Tied to Drop in Medical Imaging

Approval Rules May Be Tied to Drop in Medical Imaging | Heart and Vascular Health | Scoop.it

There is less medical imaging in the form of CT and MRI and nuclear medicine scans.  There are multuiple factors.  The most recent day i have sen for 2012 suggest that this 20% annual reduction pace is continuing.  Imaging by office based practioners has dranmatically declined, but it has continued to increase in emergency rooms.  Prior authorizaion is effective but not in the best interest of patient care since it invariably delays evaluation and is burdensome.

The "higher cost sharing, prior authorization, reduced reimbursements, and fear of radiation are, for different parts of the population, countering some of the nonmedical incentives to order an imaging study".

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Cardiovascular Inflammation Reduction Trial

Cardiovascular Inflammation Reduction Trial | Heart and Vascular Health | Scoop.it

CIRT is a major new randomized trial sponsored by the US National Heart Lung and Blood Institute. CIRT will directly test whether a common anti-inflammatory drug used for the treatment of rheumatoid arthritis (low dose methotrexate) can reduce the risk of heart attack, stroke, and cardiovascular death in patients who have suffered a prior heart attack.

=> Why worry about inflammation? Inflammation plays a major role in heart attack and stroke. While inflammation is as important as cholesterol and high blood pressure, no clinical trial has tested whether reducing inflammation can reduce rates of these life-threatening disorders.

=> Who is eligible for CIRT? Men and women who have suffered a prior heart attack and who have either type 2 diabetes or metabolic syndrome, two conditions associated with a pro-inflammatory response, are eligible to be screened for CIRT.

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Your Car as Your Doctor

Your Car as Your Doctor | Heart and Vascular Health | Scoop.it

Ford is developing a car seat capable of monitoring drivers’ ECG to provide real-time health information and alerts of imminent cardiovascular issues such as a heart attack or arrhythmias.

My comment=> The technology is evolving rapidly.  How this will compete with or integrate with mobile devices and wearable monitoring devices remains to be seen.  The auto industry has had reasonable commercial success integrateing technology for entertainement purposes and also new safety technologies.  This health monitoring approach seems like a commercial gimmick, but might help sell cars.  i can envision the marketing of the speeding car with tachometer and heart rate monitor displayed side by side.

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Restaurant chains have managed to combine quality & cost control and innovation. Can health care?

Restaurant chains have managed to combine quality & cost control and innovation. Can health care? | Heart and Vascular Health | Scoop.it

Atul Gawnde, author and surgeon contrasts successful restaurant chains and their ability to  provide goods and services of greater variety, better quality, and lower cost than what is offered in health care.  It's a great read.

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If you dont read it, here's the best lines.

=>  The theory the country is about to test is that chains will make us better and more efficient. The question is how. To most of us who work in health care, throwing a bunch of administrators and accountants into the mix seems unlikely to help. Good medicine can’t be reduced to a recipe.

=> They watched for waste—wasted food, wasted time, wasted effort. The formula was Business 101: Use the right amount of goods and labor to deliver what customers want and no more. Anything more is waste, and waste is lost profit.

=> But it’s exactly what the new health-care chains are now hoping to do on a mass scale. They want to create Cheesecake Factories for health care. The question is whether the medical counterparts to Mauricio at the broiler station—the clinicians in the operating rooms, in the medical offices, in the intensive-care units—will go along with the plan.

=> The biggest complaint that people have about health care is that no one ever takes responsibility for the total experience of care, for the costs, and for the results.

=> We have no guarantee that Big Medicine will serve the social good. Whatever the industry, an increase in size and control creates the conditions for monopoly, which could do the opposite of what we want: suppress innovation and drive up costs over time.

=>  Our new models come from industries that have learned to increase the capabilities and efficiency of the human beings who work for them. Yet the same industries have also tended to devalue those employees.

=> We’ve let health-care systems provide us with the equivalent of greasy-spoon fare at four-star prices, and the results have been ruinous. The Cheesecake Factory model represents our best prospect for change. Some will see danger in this. Many will see hope. And that’s probably the way it should be.

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Obesity May Hasten Cognitive Decline

Obesity May Hasten Cognitive Decline | Heart and Vascular Health | Scoop.it

People who are obese in middle age and who have high blood pressure and other so-called metabolic risk factors have a speedier cognitive decline as they get older than people of normal weight, according to a large study published Monday in the journal Neurology.

The study, involving 6,401 participants and spanning 10 years, adds to research indicating that obesity increases the risk of dementia later in life.

"In the last 10 years or so, people started suggesting you could be fit and fat—you could be obese and metabolically healthy and have no health risk," said Archana Singh-Manoux, lead author of the study and research director at Inserm, the French National Institute of Health and Medical Research.

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Wider Testing to Head Off Diabetes

Wider Testing to Head Off Diabetes | Heart and Vascular Health | Scoop.it

Take Home Message:  Knowing your numbers including your blood sugar is valuable especially for overweight patients.  Unlike the person profiled in this article I find patients to be very responsive to this early warning sign and generally enthusiastic about efforts to reduce the risk of progresing to diabetes.

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Health-care providers are stepping up efforts to identify the millions of Americans believed to have prediabetes, a condition that can lead to full-blown diabetes, using the HgbA1cto check a greater number of hospital patients.  Prediabetes, typically defined as blood sugar that is higher than normal (over 100)  but not yet in the diabetes range (over 125).  NIH estimates that as many as 79 million Americans age 20 and older—or roughly one in three adults—have prediabetes. That figure dwarfs the 26 million Americans who have Type 2 diabetes, including seven million people believed to have the disease but don't know it.

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Study Finds 31% of Doctors Shun Medicaid

Study Finds 31% of Doctors Shun Medicaid | Heart and Vascular Health | Scoop.it

Take Home Message:  The rates physiocians are paid for Medicaid challenges the financial sustainability of practices.  many physicians see Medicaid patietns but consciosuly or unconsciously limit the portion of Medicaid in their pracitces.  This study syas 31% are not accepting Medicaid at all but many more limit the portion in their practice all of which will be a substantial drag on teh ACA's success in getting more citizns medical care. 

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About one in three doctors across the country doesn't accept new patients who are covered by Medicaid, the federal-state insurance program that is supposed to enroll millions more low-income Americans as part of the Obama administration's health overhaul, according to a new government study. By contrast, 18% of the doctors said they weren't taking new patients with private insurance, and 17% said they weren't taking new patients who had coverage through Medicare, the federal program for the elderly. 

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Why running slow isn't bad

Why running slow isn't bad | Heart and Vascular Health | Scoop.it

Boston Globe blogger counters arguments that runnng slow is useless and how this criticism and negative comments previously discouraged her from running at all,  Get Moving!

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Tweeting for Student Health Care Coverage

Tweeting for Student Health Care Coverage | Heart and Vascular Health | Scoop.it
An Arizona graduate student with advanced colon cancer turned to Twitter when his insurance company stopped covering his medical bills. Surprisingly, the insurance company's chief executive tweeted back.

Ultimately the student with colon cancer who uses the Twitter handle @poop_strong engaged Aetna & the Aetna CEO, Mark Bertolini in twitterverse and won changes in coverage limits for himself and other students at his school.

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The Clatter of the Hospital Room

The Clatter of the Hospital Room | Heart and Vascular Health | Scoop.it

Take Home message: We've come a long way from decades ago, when patients would check in to the hospital for rest.  The noise and alarms are nerve wracking and fatiguing to physicans and nurses and certainly unsettling to patients.  

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Initiatives are under way to reduce noise in hospitals, and while it's too early to tell whether they will prove successful, it has become clear that patient complaints about noise and lack of sleep are critical to quality of care.

Patient quote:

“It’s because I can’t get better here, with all those alarms and people waking me up to give me pills and take my blood pressure and get my blood.” She stopped for a moment to catch her breath, then started crying. “I feel like I get sicker in the hospital because I can’t get any sleep!”

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Medicare Prepayment audits to start Aug. 27 in 7 states

Medicare Prepayment audits to start Aug. 27 in 7 states | Heart and Vascular Health | Scoop.it

Take Home Message - Prepayment review has not been done before by CMS.  Previously this was reported to be for cardiac procedures such as angioplasty and defibrillators.

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The Centers for Medicare & Medicaid Services finally gave the official word on when hospitals should brace themselves for prepayment audits--Aug. 27, the agency quietly announced on its website.

The official launch date of Aug. 27 provides the timeline as to when CMS will target hospitals in states with high volumes of fraud or error-prone providers (Florida, California, Michigan, Texas, New York, Louisiana, Illinois) or many short inpatient stays (Pennsylvania, Ohio, North Carolina, Missouri).

The goal is to cut improper payments before they even happen. Shifting away from the pay-and-chase method, Medicare Recovery Auditors (RAC) will review claims before payment to ensure that providers comply with all Medicare payment rules.

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Smart phone app that checks your symptoms

Smart phone app that checks your symptoms | Heart and Vascular Health | Scoop.it

I tested it as

1.  a 55 yo with chest pain and sweats and it did a good job with diagnostic possibilites and then recommended emergency evaluaiton for possible heart attack. 

2.  a 60 yo with palpitations and lightheadedness with similar outcomes.

Links to google maps for local emergency rooms

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Called Symcat, (symptoms-based, computer-assisted triage) the app allows the user to enter in various ailments such as a fever, cough, swelling etc. and receive an instant diagnosis.

The app is currently available through their website, or can be accessed via an Android beta app. A version for the iPhone and other Apple products is said to be in the works.

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Want a 9% Raise? Hit the Gym

Want a 9% Raise? Hit the Gym | Heart and Vascular Health | Scoop.it

Workers who exercise regularly earn 9% higher pay on average than those who don't.  Is it appearance?  Is it better mental focus and energy and mood at work?

 

see video or blog at 

http://blogs.smartmoney.com/advice/2012/06/06/want-a-9-raise-hit-the-gym/

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