Heart and Vascular Health

New healthcare buzzwords are introduced almost daily - can you keep them straight?

Long-term users of warfarin (coumadin, a blood thinner) had difficulty recognizing the clinical severity and urgency of anticoagulation-related situations such as stroke symptoms and medication mismanagement.

69% of patients correctly answered questions about warfarin.  More than 50% of respondents correctly identified four of six urgent risk scenarios: acute chest pain (95%), taking the wrong dose of warfarin for a week or more (79%), head trauma (56%), and sudden headache (87%). Just 25% of respondents, however, recognized the urgency of acute unilateral vision loss as a possible sign of stroke and 20% recognized the urgency of a hit or bump on the head for bleeding risk.

How gaps in medical knowledge affect matters of the heart

The U.S. Preventive Services Task Force has recommended against vitamin D and calcium supplementation in healthy postmenopausal women, citing research showing that such supplementation increases the risk of kidney stones and does not protect against fractures in this population.

Including the amount of physical activity needed to burn off the calories from a meal caused people to order on average 200 calories less in an online survey

After being discharged from the hospital, patients may feel relief—and a false sense of security that they are home free

Instead, studies show, patients are vulnerable to a wide range of adverse health events and complications, and they often end up back in the hospital within weeks. Annually, nearly one-fifth of Medicare patients—about 2.6 million older adults—end up readmitted within 30 days, a problem so costly that the federal health program now penalizes hospitals for any readmission deemed to be preventable for heart attack, pneumonia and heart failure. A New England Journal of Medicine report identified the condition as "post-hospital syndrome" that might derive as much from the physical and emotional stress patients experience in the hospital as from lingering effects of the original illness.

A total of 3691 patients were randomly assigned to undergo PCI at a hospital without on-site cardiac surgery (2774 patients) or at a hospital with on-site cardiac surgery (917 patients). The rates of major adverse cardiac events were 9.5% in hospitals without on-site cardiac surgery and 9.4% in hospitals with on-site cardiac surgery at 30 days (relative risk, 1.00; 95% one-sided upper confidence limit, 1.22; P<0.001 for noninferiority) and 17.3% and 17.8%, respectively, at 12 months (relative risk, 0.98; 95% one-sided upper confidence limit, 1.13; P<0.001 for noninferiority). The rates of death, myocardial infarction, repeat revascularization, and stroke (the components of the primary end point) did not differ significantly between the groups at either time point.

The average physician lost nearly $44,000 over 5 years implementing an electronic health record system, a large pilot study found, but the technology itself was just part of the reason.

Just 27% of practices achieved a positive 5-year return on investment -- a number that would rise to 41% with the addition of federal incentives to use EHRs, the study in the March issue of Health Affairs stated.

Other results from the study include:

38% of practices with six or more physicians achieved a positive return on investment, compared with 26% of practices with one or two physicians55% of practices reported a reduction in the cost of paper medical records after EHR adoption22% of practices reported the most common ongoing cost was additional hours of practice time10% of practices noted improved efficiency, allowing them to see more patients each day18% increased revenue through improved billingPractices with a practice management system in place to help with billing functions before EHR adoption benefited less on average.

Now shown to lower risk of heart disease.

Because for all the talk of jogging, playing basketball on new knees and lacing up skates for late-night ice hockey games, it turns out baby boomers may be in worse shape than the generation that came before. That would be the one that, if urged by an ad to “just do it,” might have replied, “Just do what?”

Writing this month in the journal JAMA Internal Medicine, researchers offered a portrait of boomerdom at odds with its popular portrayal, and perhaps with its sense of itself. They found that boomers were more likely to be obese, more likely to have high blood pressure, high cholesterol and diabetes -- and less likely to be physically active.

 

For years, health officials watched with satisfaction as rates of teen smoking in New York City plummeted, far outpacing the national average. In 2007, the rate dipped to 8.5%. Then it stopped falling.

=> 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."

Processed meats like sausage, ham, and bacon, are linked to premature death, cardiovascular disease and cancer, a new study reports.

If you love sausages, hot dogs, and brats, you might be in for a shorter life, a new study suggests.

 

The study analyzed data from half a million men and women, as a part of the European Prospective Investigation into Cancer and Nutrition. It was published in the journal BMC Medicine [PDF]. They found a link between "processed" meat — which includes all meat products such as ham, bacon, sausages, and minced meat that has been bought as a ready-to-eat product — and cardiovascular disease and cancer, they report.

Spending on basic prescription drugs like cholesterol-lowering pills recorded a rare decline in the U.S.

The slight decrease in traditional-drug spending reflected Express Scripts's success in steering members toward cheaper pills and new generic versions of major drugs like Pfizer Inc.'s cholesterol drug Lipitor and Bristol-Myers Squibb Co.'s anticlotting drug Plavix.

Drugs for inflammatory conditions like rheumatoid arthritis made up the costliest specialty category last year, Express Scripts said, with spending up 23%. This category includes the blockbuster drug Humira from Abbott Laboratories spinoff AbbVie, which posted $9.27 billion in sales last year, a 17% rise.

The liver disease hepatitis C was another area where Express Scripts saw soaring spending—up 33.7%—following the 2011 approval of new drugs from Vertex Pharmaceuticals Inc. and Merck & Co. Express Scripts expects spending in this area, where prescriptions cost nearly $3,300 per month for commercially insured members, to continue growing rapidly.

A diet with lots of olive oil and nuts cuts the risk of stroke and other major cardiovascular problems by 30% among high-risk people, according to a new study. 

There's a large body of research linking a Mediterranean diet—one heavy on fruits, vegetables, fish and beans—to heart health. But this study, published Monday in the New England Journal of Medicine, is significant both for its size—it followed 7,447 people in Spain over almost 5 years—and its scientific rigor. Many previous studies haven't been able to prove direct cause and effect or have assessed the diet's impact only on certain cardiovascular risk factors, like blood pressure or cholesterol.

While the allure of the gym — climate-controlled, convenient and predictable — is obvious, especially in winter, emerging science suggests there are benefits to exercising outdoors that can’t be replicated on a treadmill, a recumbent bicycle or a track.

But the take-away seems to be that moving their routines outside could help reluctant or inconsistent exercisers. “If outdoor activity encourages more activity, then it is a good thing,” After all, “despite the fitness industry boom,”  “we are not seeing changes in national physical activity levels, so gyms are not the answer.”

With the growth of Facebook, public health researchers are exploring the platform’s uses in health care. However, little research has examined the relationship between Facebook and traditional hospital quality measures. The authors conducted an exploratory quantitative analysis of hospitals’ Facebook pages to assess whether Facebook “Likes” were associated with hospital quality and patient satisfaction. The 30-day mortality rates and patient recommendation rates were used to quantify hospital quality and patient satisfaction; these variables were correlated with Facebook data for 40 hospitals near New York, NY. The results showed that Facebook “Likes” have a strong negative association with 30-day mortality rates and are positively associated with patient recommendation. These exploratory findings suggest that the number of Facebook “Likes” for a hospital may serve as an indicator of hospital quality and patient satisfaction. These findings have implications for researchers and hospitals looking for a quick and widely available measure of these traditional indicators.