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Media, News & Topics on prevention, diagnosis & treatment of cardiovascular disease
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Overdiagnosis: Significant threat to human health

Overdiagnosis: Significant threat to human health | Heart and Vascular Health | Scoop.it

Overdiagnosis occurs when people are diagnosed & treated for conditions that will never cause them harm and there’s growing evidence this is happening increasingly. A large Canadian study found a third of people diagnosed with asthma may not have the condition. One in three screening detected breast cancers may be overdiagnosed.  Some argue osteoporosis treatments do more harm than good in low risk women.

Many factors drive overdiagnosis:

1. commercial & professional vested interests

2. legal incentives & cultural issues

3. sensitive tests capable of detecting tiny “abnormalities”

4. Widening disease definitions

5.  Lowering treatment thresholds

The cost of wasted resources that could be better used to prevent and treat genuine illness is substantal.  The main problem of overdiagnosis lies in a strong cultural belief in early detection, and deep faith in medical technology.

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Half of heart patients don't stick with meds

Half of heart patients don't stick with meds | Heart and Vascular Health | Scoop.it

Take Home Message:  It's known that patients don't always follow doctors' orders and few systems exist  to address this.  In my experience, the best way to stay on track is to have regular (twice annual) follow-up with a physician who is monitoring critical values like cholesterol & blood pressure and reviews the medication list to explain the utility and benefit of continued medication adherence.  It's not sophisticated, doesn't involve technology, but does work.

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Just half of people who are given a prescription to prevent heart disease continue to get their medications refilled over time. And among people who have already had a heart attack, one out of every three fails to continue getting their prescription refilled. The studies looked at seven medications, including aspirin, blood pressure drugs, and cholesterol-lowering statins, typically intended for life-long use. They estimate that 130,000 people die each year because they don't adhere to their prescriptions. 

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Occupy Fitness: Joining the 1%

Occupy Fitness: Joining the 1% | Heart and Vascular Health | Scoop.it

There are 10,080 minutes in a week. Can you spare 150 of them? The American College of Sports Medicine (ACSM) recommends that adults participate in 150 minutes of exercise a week. In essence, it is a bright idea to commit 1% of your week to moderately intense physical activity (o.k., 1.5% is more mathematically accurate, but not as “occupy” movement catchy). It really does not seem like much time.

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Energy drinks: a trigger for heart attacks and stroke?

Energy drinks: a trigger for heart attacks and stroke? | Heart and Vascular Health | Scoop.it

Energy drink consumption has grown exponentially over the past 5 - 10 years. Sales are increasing at double the rate of total carbonated beverage sales.

The drinks are primarily targeted at youth and young adult market with aggressive advertising and marketing. And the potential medical complications of ingesting such drinks are becoming apparent, to both cardiologists and other health specialists.

The combined levels of caffeine in these energy drinks are much higher than a standard cup of coffee. And adverse events and complications from energy drinks largely arise from their caffeine content.

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Sleep tips: How to get more rest

Sleep tips: How to get more rest | Heart and Vascular Health | Scoop.it

Running a sleep deficit, it turns out, can have very real consequences for the balance sheet of life. For instance, research shows that sleeping too little can cause hormones such as leptin and ghrelin to go haywire. They’re prime actors in appetite regulation, and when we fail to get enough rest, cravings for calorie-laden food can be inflamed, sparking weight gain. Follow these simple recommendations. 

 

Or see our video => Good Sleep:Ten Tips

http://www.youtube.com/watch?v=m7Vt5lhNmpo 

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Dodging Medicare's Hidden Traps: Know the basics

Dodging Medicare's Hidden Traps: Know the basics | Heart and Vascular Health | Scoop.it

The Medicare website https://www.medicare.gov/default.aspx

provides the details, but it contains so much information that it can be difficult to navigate. Here is the very least you need to know.

 

Medicare Basics

Part A,  =>  no premium, is hospital insurance. has a deductible of $1,156 that covers hospital stays up to 60 days, copayments of $289/ day for days 61-90, and copayments of $578 a day for days 91-150 days.

 

Part B => optional insurance that covers doctors' bills, labs & outpatient care. The basic premium is $99.90/ month (can be as high as $319.70 for an individual earning > $214,000 annually), and deductible is $140/ year. Copays are 20% of Medicare-approved amounts.

 

Part D,  => covers prescription drugs, has a monthly base premium of $32.34 (high-income consumers pay more), in addition to a premium which varies by a plan. Copayments and deductibles also vary by plan.

 

If you receive Social Security, you will be enrolled automatically in parts A & B when you turn 65. If you aren't yet receiving Social Security, you have to apply for Medicare, (can do online)

 

The enrollment period for Part B and D begins three months before you turn 65 and lasts seven months. If you miss this enrollment window, your coverage will be delayed and your premiums will be higher.

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Women and Heart Disease

Women and Heart Disease | Heart and Vascular Health | Scoop.it

Check out the Women & Heart Disease scoops and posts at

 http://www.scoop.it/t/women-and-heart-disease6  ;

or

blogs and commentary at

http://myheartsisters.org/

or

the Twitter follow @HeartSisters

 

Awarded  "Top 10 online influencers - Making a diference in the fight against heart disease" in 2012.

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Carolyn Thomas's comment, August 5, 2012 6:31 PM
Thanks for the nice plug, Dr. B! :-)
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Artificial Sweeteners - (Nonnutritive): Current Use & Health Perspectives from AHA & ADA

Artificial Sweeteners - (Nonnutritive): Current Use & Health Perspectives from AHA & ADA | Heart and Vascular Health | Scoop.it

Using non-nutritive sweeteners could cut down on added sugars and so have beneficial effects, but there are caveats.

 

Beneficial effects could be undone if people "compensate" for the calorie cuts by eating more high-calorie foods – drinking a diet soda, for example, then having an extra piece of cake later.

 

A high intake of dietary sugars has been shown to contribute to cardiovascular disease and obesity, which can lead to the development of diabetes. The researchers looked at studies of the non-nutritive sweeteners aspartame, acesulfame-K, neotame, saccharin, sucralose, and stevia.

 

At this time, there are insufficient data to determine conclusively
whether the use of NNS to displace caloric sweeteners
in beverages & foods reduces added sugars or carbohydrate
intakes, or benefits appetite, energy balance, body weight, or
cardiometabolic risk factors.

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Massachusetts Health care consumes 43% of planned state budget

Massachusetts Health care consumes 43% of planned state budget | Heart and Vascular Health | Scoop.it

Massachusetts health care policy makers goal was to first provide universal coverage and THEN to rein in costs.  The first goal has been achieved. The second goal will be difficult, painful, uncertain and consequential

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Between the Medicaid program, subsidized insurance under the 2006 health care access reform law, and investments in state employee health insurance and public health programs, health care spending this fiscal year is on pace to rise to 43% of the overall state budget.

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Anticoagulation in AF: Fork in the road or four-way-stop?

Anticoagulation in AF: Fork in the road or four-way-stop? | Heart and Vascular Health | Scoop.it

The FDA's recent decisions on novel anticoagulants in atrial fibrillation have stirred debate and generated some consternation. For the clinical practitioner, how can we efficiently and effectively communicate the issues related to anticoagulation choice to the patient?  Dr Bilazarian proposes -CRABI:

C - Prescription coverage?
R - Normal renal function?
A - Early adopter?
B - GI bleeding?
I - Instability on warfarin?

Download the powerpoint presentation and the comparative Excel sheet.

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HBS Faculty on Supreme Court Health Care Ruling

HBS Faculty on Supreme Court Health Care Ruling | Heart and Vascular Health | Scoop.it

Three Harvard Business School faculty members, all experts in the health care field provide their views on various facets of one of this country's most important and complex problems.

 

Best line: "Americans must take greater responsibility for maintaining their health. In the future they will have a health score, much like their credit score, that is based on well-established metrics that will motivate them to improve their health & will also have to assume greater financial responsibility for cost of their care, abandoning the myth that "health care is free." This will be accomplished through incentives for those who maintain their health, enabling them to pay less, while people who cost the system more will pay a larger proportion of their expenses."

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Pros and cons of being a cardiologist in 2012

Pros and cons of being a cardiologist in 2012 | Heart and Vascular Health | Scoop.it
Private practitioner and theheart.org blogger Dr Seth Bilazarian joins the show to discuss the pros and cons of cardiology in 2012 and express what continues to make his practice enjoyable and fulfilling (despite it all).
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What Really Makes Us Fat

What Really Makes Us Fat | Heart and Vascular Health | Scoop.it

Take Home:  Another review on the comparison of diets.  This is a good read.

Key sentence "the nutrient composition of the diet can trigger the predisposition to get fat, independent of the calories consumed"

Of the 3 diets tested: Low Fat/High Carbohydrate, High Fat/Low Carbohydrate "Atkins",  the best is the Low Glycemic Index for weight loss and long term maintenance and health .  To achieve this many of my patients have implemented Belly Fat Cure by Jorge Cruise.

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The 5 Most Popular Social Media Content Curation Tools

The 5 Most Popular Social Media Content Curation Tools | Heart and Vascular Health | Scoop.it

Kevin K. Lau calls Scoop.it "one of the best sites for curating content right now."

Check out why he thinks Scoop.it is worthy of the number one spot in his article The 5 Most Popular Social Media Content Curation Tools.

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Sleep Apnea Association With Serious Cardiovascular Events

Sleep Apnea Association With Serious Cardiovascular Events | Heart and Vascular Health | Scoop.it

Take home message: Sleep Apnea stresses the heart and vessels because of the repetitive periods of low oxygen that occur dozens of times each night when the patient has apnea (stops breathing).  Recognition, diagnosis (with a sleep study) & treatment for this problem are very important for cardiovascular health. This meta-analysis syas there is a doubling of stroke risk in men.

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The relationship between obstructive sleep apnea (OSA) and cardiovascular events remains unclear.  Review to determine the incidence of cardiovascular events among patients with OSA showed associated with stroke in a meta-analysis of 5 studies (8435 participants), odds ratio (OR) 2.24; A significant association was seen in studies of men predominantly; OR, 2.87; 95% CI, 1.91–4.31, Data on women were sparse. In the overall analysis of 6 studies (8785 participants), OSA was nonsignificantly associated with ischemic heart disease (OR =1.56)

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Marked Variation in Angioplasty (#PCI) Prices in California

Marked Variation in Angioplasty (#PCI) Prices in California | Heart and Vascular Health | Scoop.it

Prices for the same surgical procedure can be four times higher, depending on where the hospital is located - even if it's in the same city. And often for reasons that are not easily apparent.

For example, hospitals in the San Mateo area charged a median price of $48,000 for a cesarean section in 2010; in San Diego, the same procedure was priced at $20,000. A hip replacement in Alameda County: $133,000; Orange County: $58,000.

Angioplasty
-- Alameda County: $97,000

-- Palm Springs: $87,000

-- Santa Barbara: $19,000

In California, total health care spending in 2009 stood at $230 billion. Hospital costs, at $76.6 billion, account for the biggest slice. In the past 10 years, health care costs in the Golden State have risen 80 percent, and they're still rising.

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U.S.hospitals are scrambling to reduce readmission

U.S.hospitals are scrambling to reduce readmission | Heart and Vascular Health | Scoop.it

Take home message:  Prevention of readmission is good for everyone.  Strategies to reduce readmission involve communication with patients and hosptial & outpatient providers to continue to coordinate care.  These 10 strategies are common sense approaches, but may not be implemented because of cost constraints hosptials are now under.

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Hospitals will be penalized for high 30-day readmission and pneumonia in October. By 2014, hospitals with high rates could lose up to 3% of regular reimbursement.

88% of hospitals have implemented some  practices recommended to reduce preventable readmissions in heart failure and acute MI, but only 12% used eight or more and just 3% used all. The overall average was 4.8.

Here is how the 10 measures are used:

1. Universal tracking of 30-day readmission rate (95%).

2. Setting quality improvement teams to tackle preventable readmissions, (CHF & acute MI)  (87%) 

3. Medication management efforts at discharge, including providing patient education about the purpose of each medication and any changes to their medication list (77%)

4. Patients or caregivers receive an emergency plan (65%)
5.  Regularly called patients after discharge to follow-up (63%)
6.  Usually had patients leave with an outpatient follow-up appointment already arranged (54%)
7.  Monitored how amount of patients with follow-up appointments within 7 days of discharge (32%)
8.  Always sent discharge summary directly to PCP within 48 hours  (26%)
9.   Pharmacy technician primarily responsible for obtaining medication history as part of medication reconciliation process (23%)
10.  Pharmacist usually responsible for conducting medication reconciliation at discharge (10%)

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Global burden of physical inactivity

Global burden of physical inactivity | Heart and Vascular Health | Scoop.it

Study quantifies the effect of physical inactivity on major noncommunicable diseases, Physical inactivity is responsible for nearly 10% of premature deaths worldwide, or more than 5.3 million deaths in 2008. Based on these estimates, physical inactivity is responsible for more premature deaths than smoking.

Dr I-Min Lee said that if all of the inactive people in the world were to suddenly get off the couch and become engaged in just a modest level of physical activity, the estimated gain in life expectancy is 0.68 years.  Lee summed up the benefits: "Everything that gets worse when you grow older gets better when you exercise."

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Deborah Verran's comment, July 19, 2012 6:08 AM
Everyone should read this
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CRP tests for inflammation and gauges risk of cardiovascular disease

CRP tests for inflammation and gauges risk of cardiovascular disease | Heart and Vascular Health | Scoop.it

Blood test for high-sensitivity C-reactive protein (hs-CRP) —a marker for inflammation—is increasingly being used as a routine screening tool for patients who wonder if they are at risk of a heart attack or stroke.  Easily done at the same time as a cholesterol screening & covered by most insurance.  American Heart Association and American College of Cardiology both endorsed use of hs-CRP for "intermediate risk" individuals.

"We know that those with elevated hs-CRP are at high risk even if cholesterol levels are low, and that statin therapy can reduce the risk of heart attack and stroke in this group. While the JUPITER study showed inflammation contributes as much to cardiovascular risk as does high blood pressure or high cholesterol", Dr. Paul Ridker says "the core research question now is whether or not reducing inflammation per se will reduce that risk."

The ongoiing CANTOS trial will provide important information.  See my SCOOP IT at   http://www.scoop.it/t/heart-and-vascular-health/p/1559762525/inflammation-statin-therapy-and-hscrp-initial-observations ;

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New iPhone app can detect atrial fibrillation

New iPhone app can detect atrial fibrillation | Heart and Vascular Health | Scoop.it

Take Home: UMass Medical School and WPI have developed an app that can detect atrial fibrillation.  This moves connected and mobile health closer to reality.  The really important development with this approach might allow us to treat patients who have AF intermittently (paroxysmal) differently than we currently do.  Because we are worried about stroke, patients now get blood thinners all the time because we are concerned that they will have recurrences without knowing about it.  With this technology, in the future, we might see validation of a strategy that allows use of blood thinners when patients are in AF only, sometimes called a pill in the pocket.

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Sitting for More than 3 Hours a Day Cuts Life Span

Sitting for More than 3 Hours a Day Cuts Life Span | Heart and Vascular Health | Scoop.it

Sitting down for more than three hours a day can shave a person's life expectancy by two years, even if he or she is physically active and refrains from dangerous habits like smoking, according to a study to be published in the online journal BMJ Open.

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44,000 uninsured Massachusetts residents paid penalty in 2010

44,000 uninsured Massachusetts residents paid penalty in 2010 | Heart and Vascular Health | Scoop.it
Take Home Message: Since Massachusetts is the state laboratory for the national health insurance program (ACA) and its pesonal mandate for insurance, its encouraging to see that the small penalty ($406/yr) MAY play a role as an incentive to encourage more citizens to become insured through the state insurance exchanges ***************************************** About 67,000 people were fined for not having coverage in 2007, the first year of the penalty. That figure dropped to 44,000 in 2010, according to a state report. Since the recession, the state has waived the fine for more people on the grounds that they could not afford health plans available to them, accounting for ome of the decline.
More than half of those who paid the tax penalty were uninsured for the full year, the ­report said. Most were under age 40.
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LifeWatch launches world's first medical smartphone

LifeWatch launches world's first medical smartphone | Heart and Vascular Health | Scoop.it

Take Home Message: Android based system moves mobile and telehealth a little closer to a common place reality.

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Lifewatch has developed a smartphone that has built-in sensors for monitoring heart rate, pulmonary function, blood sugar levels, body temperature and galvanic skin response (which measures psychological pressure), and other physiological variables. The system can also measure blood pressure with an attached sleeve, and can analyze blood samples. 

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Vitamin D — Baseline Status and Effective Dose

Vitamin D — Baseline Status and Effective Dose | Heart and Vascular Health | Scoop.it

Take Home Message: Vitamin Supplements are useful for individuals who are deficient.  For now treatment with Vitamin D supplements to a bood level of Vitamin D-25 greater than 30 is reasonable and recommended. More is not better. It's easy to have the blood level checked.

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An editorial that accompanies a meta anlaysis in NEJM which shows a modest benefit of Vitamin D on fracture risk.  Robert Heaney does an excellent job explaining why we see diiferent results in many vitamin or nutrient trials.

 

Evaluating a certain dose of a Vitamin will not assess the benefit if the patients tested are not deficient.  In the meta analysis the baselinie Vitamin D level in the placebo and different doses of Vitamin D all had a baseline level > 40 (< 30 is deficient)

 

"giving additional amounts of a nutrient to persons who already have enough, or not giving enough to push a person with a deficiency up onto the ascending limb of the response curve, is likely to produce a null response"

 

See the article here http://goo.gl/XG59l (requires subscription)

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Transcatheter Aortic Valve Replacement: What's in a Name?

Transcatheter Aortic Valve Replacement: What's in a Name? | Heart and Vascular Health | Scoop.it

Keeping up with doctor speak can be a full time job (even for doctors).  I blogged about this previously entitled: STEMI, ADHF, MVO, VTE, CSL: The moving target of acronyms in cardiology

http://blogs.theheart.org/private-practice/2010/9/9/stemi-adhf-mvo-vte-csl-the-moving-target-of-acronyms-in-cardiology

The treatment of severely narrowed aortic valves with a catheter rather than surgery had been called Transcather Aortic Vave Implantation (TAVI) since the old valve is not repalced - the new valve is placed or implanted inside the old one.  The cardiology journal JACC decided to rename this TAVR for replacement instead of implant even though there is no replacement.  If you missed this arbitrary switch it's OK since they have decided to switch back.  Sometimes being behind the news curve is more efficient. For now,  we can say TAVR was the old term before we switched back to the older term TAVI.  What's old is new again.

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