Dr Portnay

In US, Hospital Round Trips More Common For Heart Attack Patients

2012-01-05T18:26:00.001-08:00

I found the following story on the NPR iPhone App:
http://www.npr.org/blogs/health/2012/01/04/144674790/in-us-hospital-round-trips-more-common-for-heart-attack-patients?sc=17&f=1128

In US, Hospital Round Trips More Common For Heart Attack Patients
by Richard Knox

- January 4, 2012

If a heart attack sends you to an American hospital, you'll probably go home after only two or three nights. That's faster than virtually anyplace else in the world.

But your chances of needing to go back into the hospital within the next month are also higher than they are for heart attack patients in 16 other countries. That's the finding from a Duke University-led study in this week's JAMA, the Journal of the American Medical Association.

On the face of it, the results suggest that hurry-up hospital care for U.S. heart attack patients may be pushing them home too quickly.

But, not so fast, says Dr. Manesh Patel, a cardiologist and the senior author of the study, which may be the first to compare international rates of hospital readmission after heart attacks.

"We certainly haven't shown in this study that U.S. heart attack patients need to be in the hospital longer," Patel told Shots. Rather, he says, the study triggers a passel of questions about how other countries do post-heart-attack care — both in the hospital and beyond — that results in fewer return stays.

We'll come back to those questions. But first, consider the study's main findings. They involve so-called STEMI heart attacks. The acronym stands for ST-segment Elevation Myocardial Infarction. Around 1 in 3 heart attacks is a STEMI, and they pose the gravest risk to victims.

The study looked at nearly 5,600 heart attack survivors in 17 nations, including the United States, Canada, Australia, New Zealand and 13 European nations.

Everywhere but the U.S., about 10 percent of the survivors had to be readmitted to the hospital within 30 days of their heart attack. But in this country, the readmission rate was 15 percent.

The higher U.S. rate wasn't due to differences in age or the presence of other illnesses.

Some of the higher U.S. readmission rate was from patients who were brought back to the hospital on an non-emergency basis to ream out other clogged arteries discovered at the time of the first admission. Many heart specialists hope that will lessen the chances of a subsequent heart attack, although the evidence for that isn't clear, Patel says.

But even when these elective hospitalizations are taken out, the U.S. still has the highest rate of post-heart attack readmissions.

Since the U.S. has the shortest hospital lengths-of-stay, it would be tempting to conclude that the pressure to cut costs here has compromised quality. Early readmission is considered a marker of poor quality of care.

Readmission also imposes an additional cost burden, so policymakers also consider it a red flag for inefficient care.

But Patel says it's simplistic to blame high U.S. readmission rates on short U.S. lengths-of-stay. As a case in point, he cites Canada — perhaps the closest comparison with U.S. medical culture.

"In the U.S., the 30-day readmission rate was 14.4 percent. In Canada it's in the 5 percent range," Patel notes. "The U.S. length-of-stay is three days, in Canada it's five."

But in all of Canada there are only 45 hospitals that provide the kind of acute heart attack care available in hundreds of U.S. centers — clearing of the clogged coronary artery within hours, followed by placement of a metal stent to keep it open.

"In Canada," Patel says, "patients are often transferred back to the hospital from where they were initially referred, and then they're linked up with their primary care physicians and local cardiologists so their rehabilitation can start."

He says the U.S. often falls down on that post-hospital coordination.

"I think we both do very well from when the patient has chest pain to getting the clogged artery open," Patel says. "But it looks like Canada does better in going from the hospital to home."

That involves things like making sure the patient knows all the things he or she needs to do to prevent a subsequent heart attack, such as stopping smoking; setting up a followup visit with a primary care physician who has access to the hospital records; and ensuring the patient knows what to do if new cardiac symptoms arise.

To learn more about the NPR iPhone app, go to http://iphone.npr.org/recommendnprnews

Sent from my iPhone

2011-12-21T12:00:00.000-08:00

I am frequently talking with my patients about exercise and its many benefits. One of these benefits is its ability to help with stress and anxiety reduction. Here's a great article I read on everydayhealth.com

How Exercise Eases Anxiety

Studies show that exercise can help manage anxiety. Learn about the best choices to reduce your stress levels.

By Diana Rodriguez

Medically reviewed by Niya Jones, MD, MPH

Anxiety can be overwhelming and cause many physical and emotional side effects. When you can’t stop worrying, you can’t sleep and you may even feel sick to your stomach. While an anxiety disorder should be monitored and treated by a qualified professional, exercise can be part of an effective treatment plan to help manage your anxiety symptoms.

Exercise and Anxiety: What the Research Says

“Exercise won’t cure anxiety or depression, but the physical and psychological benefits can improve the symptoms,” explains Sally R. Connolly, LCSW, a therapist at the Couples Clinic of Louisville in Kentucky. “Research shows that at least 30 minutes of exercise three to five days a week can significantly make a difference.” Some studies have suggested that regular exercise can help alleviate anxiety as much as medications, and the anxiety-relieving effects of exercise may last longer than those of drugs.

Exercise and Anxiety: Who Benefits

While everyone can reap psychological benefits from exercise, research suggests that people who may see the biggest improvements in anxiety symptoms are those who:

Exercise consistently for at least several weeks
Are not already physically active
Have severe anxiety
Do aerobic exercise, such as jogging, swimming, or dancing

Exercise has also been shown to be effective in managing symptoms of depression, which frequently affects people with anxiety disorders.

Exercise and Anxiety: How Exercise Helps

“Anxiety is usually linked to an increased heart rate,” notes Connolly. “Exercise can be very helpful with calming people’s heart rate.”

During exercise, your heart rate shoots up, but over time, as your fitness level improves, your heart begins to work more efficiently. As a result, your resting heart rate between exercise sessions eventually becomes slower. Improved heart and lung function due to regular aerobic activity are often associated with a greater sense of overall well-being, which can help offset feelings of anxiety.

Even short bursts of exercise — just 10 to 15 minutes at a time — can improve your fitness and your mood. Connolly recommends that her patients get a total of 30 minutes of exercise a day, which can be broken into 10-minute blocks if necessary, between six and seven days a week.

Exercise can even help prevent anxiety disorders from beginning in the first place. One study showed that regular exercisers were at a 25 percent reduced risk of depression and anxiety disorders over a five-year period. Not surprisingly, exercise has also been found to improve mental clarity and concentration, both of which may be negatively affected by anxiety. Chemicals released in the brain during exercise may help improve the ability to focus and deal with stressful situations, thereby lessening the risk of anxiety and depression.

Exercise and Anxiety: Anti-Anxiety Workouts

Any exercise can help diminish anxiety, but Connolly says aerobic exercise that really gets your heart rate up will be the most beneficial. Some good aerobic exercises that can help manage anxiety are:

Swimming
Biking
Running
Brisk walking
Tennis
Dancing

“Dancing is a great exercise, and it has a lot of other side benefits. And it’s great when you dance with other people,” notes Connolly, since socializing can also boost your mood.

Though not aerobic, yoga can help offset anxiety symptoms. Yoga combines physical movement with meditation and deep breathing to help calm the mind and alleviate worry.

While weight training and other strengthening exercises are important for your overall health, they don’t seem to offer as much anxiety relief as activities that get your heart rate going.

We all know that exercise is good for the body, and now research shows that it’s also good for the mind. In addition to managing your anxiety with a doctor’s help, exercise is a powerful tool you can use to enhance your physical and mental health.

2011-12-21T11:55:00.001-08:00

I wrote this Monday, December 13, 2010 but its very relevant -- Be smart and healthy this season

I'm always amazed at how much I see people overeating during the holiday season. I read recently that the average American can gain ~ 5lbs over the holiday season. While this seams exaggerated - the New England Journal Of Medicine has reported that the average American can gain 1-2lbs over this season. The really bad news is that many Americans never lose this weight.

What to do? So many of my patients are constantly reminded of just how hard it is to lose the weight once it has been gained. Therefore, any strategy to keep the weight off in the first place seems to me to be the smartest.

Here are some ideas that I have come across to help my patients during this season of temptation.

Eat smaller portions of food
Eat slowly
Go for a walk after a meal
Off to bring a low calorie dish to the party
Go ahead and mingle - get away from the food
Say "no" to fast food
Be realistic - now is not the time to diet but to maintain

End Of The Road For Pfizer's Lipitor

2011-12-02T18:34:00.001-08:00

End Of The Road For Pfizer's Lipitor

Cardiovascular / Cardiology News From Medical News Today
December 1, 2011 10:00 PM

End Of The Road For Pfizer's Lipitor

The FDA approved today a generic version of Pfizer's Lipitor, one of the world's best selling drugs. Known pharmaceutically as atorvastatin calcium tablets, Lipitor is used to reduce cholesterol. The generic version will be manufactured by Ohm Laboratories in New Brunswick, N.J. Cholesterol itself is not a major problem and is, in fact, an essential nutrient for the body...

Have a Heart-Healthy Holiday

2011-11-16T12:01:00.001-08:00

Dear Edward,

Holiday eating doesn't have to be a high-fat, high-calorie disaster. You can eat smart and still indulge yourself in great food and drink with your friends and loved ones. And we can help.

The American Heart Association's website — www.heart.org — is full of information about heart-healthy eating, including a special Holiday Healthy Eating Guide that addresses issues we face at the holiday table.

Download the guide today and learn how a few simple tips can make your festivities healthier and still be fun. We've even included some great recipes for you to try.

Sincerely,

Gordon F. Tomaselli, M.D.
American Heart Association
President and Volunteer

Updates secondary prevention guidelines

2011-11-04T07:05:00.001-07:00

The guidelines recommend that patients with coronary heart disease and other vascular disease such as stroke and peripheral artery disease:

Stop smoking and avoid exposure to tobacco smoke;
Get at least 30 minutes of exercise 5-7 days a week;
Reduce weight if you are overweight, obese, or have a large waist;
Get an annual flu shot;
Take low-dose aspirin daily unless your doctor prescribes a higher dose or recommends against it because of medical contraindications.

These guidelines may help high-risk people live longer, healthier lives

Healthy habits and optimal medical treatment can improve survival and quality of life for people who have been diagnosed with heart disease, or experienced a heart attack or stroke
For the first time, the guidelines emphasize the importance of participating in a cardiac rehabilitation program after a heart attack or bypass surgery, and of diagnosing and treating depression in heart disease patients.

Weekly Tweets

2011-10-14T13:52:00.001-07:00

drportnay Dr Ted Portnay

New model for transparency: Assessment by two independent groups | theheart.org tinyurl.com/3u3yaw8

18 hours ago

drportnay Dr Ted Portnay

New Blog Posting: Dr Sanjay Gupta's "The Last Heart Attack"bit.ly/qUU0b5

12 Oct

drportnay Dr Ted Portnay

SYNTAX at four years: Death rates diverge but no change in advicetinyurl.com/44xbsau

11 Oct

drportnay Dr Ted Portnay

Statins Protect Brain in Head Trauma tinyurl.com/5rj7ood

11 Oct

drportnay Dr Ted Portnay

Stroke Prevention May Come Coated in Chocolatetinyurl.com/4xuzlrj

10 Oct Favorite Reply Delete

drportnay Dr Ted Portnay

Timing Is Crucial For Family Consent In Brain Dead Organ Donorstinyurl.com/5sqcv3e

9 Oct

Dr Sanjay Gupta's "The Last Heart Attack"

2011-10-12T12:10:00.000-07:00

5 Healthy Reasons To Drink Coffee

2011-10-08T05:21:00.001-07:00

		DELIA LLOYD: 5 Healthy Reasons To Drink Coffee
	Apparently, coffee is now good for you. It holds a host of physical -- not to mention psychological -- benefits which scientists are only now beginning to appreciate.

iSad

2011-10-07T09:17:00.000-07:00

Weekly Tweets

2011-10-07T09:16:00.001-07:00

usedgov US Dept of Education

by drportnay

Hike it! Bike it! I like it! Taking part in Walk to School 2011go.usa.gov/9rX #LetsMove

17 hours ago

drportnay Dr Ted Portnay

Women With PCOS Have Family Heart Disease Linktinyurl.com/6hrlyxf

16 hours ago

drportnay Dr Ted Portnay

PARTNER: Quality of Life Greatly Improved by Transcatheter Valve Procedure tinyurl.com/5ufyzf3

16 hours ago

drportnay Dr Ted Portnay

OBESITY: CVD Risk Cut With Rejected Weight-Loss Drugtinyurl.com/3vwxwnu

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drportnay Dr Ted Portnay

Clinicians Mum on End-of-Life ICD Deactivation tinyurl.com/6glf2de

16 hours ago

drportnay Dr Ted Portnay

New Blog Posting: Sudden Cardiac Arrest Awareness Monthbit.ly/pfzlsv

16 hours ago

drportnay Dr Ted Portnay

New Approach To Keeping Coronary Arteries Open After Angioplasties tinyurl.com/65xnpsg

Sudden Cardiac Arrest Awareness Month

2011-10-06T16:38:00.001-07:00

In the United States, one life is lost to SCA every two minutes.

The 'Next Big Step': Preventing 1 Million Heart Attacks And Strokes

2011-09-13T22:29:00.001-07:00

I found the following story on NPR

http://www.npr.org/blogs/health/2011/09/13/140439893/the-next-big-step-preventing-1-million-heart-attacks-and-strokes?sc=17&f=1128

The 'Next Big Step': Preventing 1 Million Heart Attacks And Strokes
by Richard Knox

- September 13, 2011

They're calling it Million Hearts – a newly launched campaign to put a half-dozen simple and proven public health strategies into wider practice. Federal health officials say it can prevent a million heart attacks and strokes between now and 2016.

Federal officials call it "the next big step" in cardiovascular prevention. There's lots of evidence it's an achievable goal.

First, deaths from cardiovascular disease have already been cut by 60 percent over the past generation. About half of that reduction is due to better diet, smoking cessation and other public health measures. The other half comes from from better medical treatment.

"But we still have a long way to go," Dr. Thomas Frieden, director of the Centers for Disease Control and Prevention, told Shots. "We still have 107 million adults — just about half of all adults — who either have blood pressure out of control, cholesterol out of control, or who smoke."

The campaign has two parts. One aims to change the behavior of doctors and patients. The other aims to change what all of us eat. Both are summed up by the acronym ABCS – which stands for aspirin, blood pressure control, cholesterol control and smoking.

In the realm of doctors and patients, Frieden and a phalanx of other federal officials want to expand by 10 million the number of Americans who have their high blood pressure under control and by 20 million those with controlled blood cholesterol levels.

To get there will require raising blood pressure control from less than half the people with hypertension now to 65 percent. Cholesterol control will have to triple.

The other medical-care strategy is to get people at high risk of heart attacks and strokes to take a baby aspirin every day. Fewer than half now do. The government wants to get that up to 65 percent.

Another goal is to get four million smokers to quit by 2016. That target is more modest – lowering smoking prevalence from 19 percent of adults today to 17 percent five years from now.

The smoking-cessation part of the campaign is part medical, part public health. "Less than a quarter of people who smoke get evidence-based help to quit," Frieden says.

Getting doctors to urge patients to quit "doubles the likelihood of a successful quit attempt," Frieden and Dr. Donald Berwick, the chief of Medicare and Medicaid, write in an article posted Tuesday by the New England Journal of Medicine. Prescribing one of the seven approved smoking-cessation drugs further increases quit rates.

The public health part of the stop-smoking initiative is familiar. A year from now it'll be stepped up by graphic new warnings on all cigarette packs – unless the industry gets courts to block them.

All these strategies "could save more than 100,000 lives a year," Frieden and Berwick claim. Over five years that adds up to half the Million Hearts goal.

The rest is supposed to come from two big changes in what Americans eat. Federal officials want to cut average daily salt intake by 20 percent.

But this doesn't mean throwing away the saltshaker, Frieden says. "Most Americans eat about twice as much sodium as we should get," he says. "About 80 percent of that comes in restaurant and packaged foods — it's not what you add at the table.

"What the studies show," he adds, "is that if you take half of the salt out of food and tell people 'put as much salt on as you want,' they only put back about 20 percent of what got taken out."

So the Food and Drug Administration plans to work with the food industry to cut back on the salt that's already in food when it gets on the plate. Other agencies will press for reduced salt in food the government pays for and will try to raise consumer awareness.

Similarly, the government wants to eliminate artificial trans fat in purchased foods — chemicals that raise levels of bad cholesterol and lower good cholesterol. Already, Americans' consumption of trans fat has been reduced by half; going the rest of the way could save 50,000 lives a year, according to Frieden and Berwick.

This is the public face of the campaign. Behind the scenes, one driving force of Million Hearts is the realization that with more doctors using electronic medical records and adopting new medical information technology systems, improving cardiovascular preventive care is "the best place to start," Frieden says.

"Most of us get reminders from our dentists or auto mechanics or our vet if our teeth or car or pet needs maintenance," Frieden says. "But we rarely get a reminder from our doctor."

An Immune System Trained to Kill Cancer

2011-09-12T22:39:00.001-07:00

While not specifically cardiology related, this is a wonderful article on a major medical breakthrough. It deserves to be read and shared.

"A closer look at what was done to cure two patients of chronic lymphocytic leukemia with a novel gene therapy — which may be useful against other cancers. http://nyti.ms/ps9o4b"

Weekly Tweets

2011-09-09T10:21:00.000-07:00

drportnay Dr Ted Portnay

Bariatric Surgery Gets High Marks for CVD Risk Reductiontinyurl.com/3ato6v4

6 minutes ago

drportnay Dr Ted Portnay

Anybody ever try to eat only a "plant based diet"? I'm intrigued by the potential benefits. How hard is it to adhere to? #vegan @esselstyn

14 hours ago

drportnay Dr Ted Portnay

'Legs For Life' Screening Available During National PAD Awareness Month; Exercise, Intervention May Help Individuals 'Go The Distance' http:

8 Sep

drportnay Dr Ted Portnay

Weight Watchers doubles weight loss compared with GPstinyurl.com/3cf2dvv

7 Sep

drportnay Dr Ted Portnay

Lifestyle factors that cut diabetes risk pack bigger punch togethertinyurl.com/3g63e3u

7 Sep

drportnay Dr Ted Portnay

FDA Reviewers Recommend Complete Response Letter for Rivaroxaban tinyurl.com/3s7av6u

6 Sep

drportnay Dr Ted Portnay

Pedal you waist line into submission bit.ly/q0vcMH

5 Sep

drportnay Dr Ted Portnay

Bedtime Blood Pressure Best CVD Risk Factortinyurl.com/4y2msus

5 Sep

drportnay Dr Ted Portnay

ESC: TAVI Safe in Lower-Risk Patients tinyurl.com/3tg2leu

5 Sep

drportnay Dr Ted Portnay

Coronary Artery Calcium Beats C-Reactive Protein In Predicting Who Might Benefit From Statins tinyurl.com/3sh9crj

5 Sep

drportnay Dr Ted Portnay

No Evidence Of Improved Survival Rates With Heart Ultrasound Before Elective Surgery tinyurl.com/3m9upxq

5 Sep

drportnay Dr Ted Portnay

Vegan Diet Makes Bill Clinton "Feel Good", "Have More Energy"tinyurl.com/3e72ote

5 Sep Favorite Reply Delete

drportnay Dr Ted Portnay

Study Confirms Home Blood Pressure Monitoring More Accurate, Affordable tinyurl.com/3semmce

5 Sep

Weekly Tweets

2011-09-02T13:20:00.000-07:00

drportnay Dr Ted Portnay

It's Official Chocolate Linked To Heart Health tinyurl.com/43lpy4p

2 minutes ago Favorite Reply Delete

drportnay Dr Ted Portnay

Cycling Fast, Vigorous Daily Exercise Recommended For A Longer Life tinyurl.com/3bqm7sz

2 minutes ago

drportnay Dr Ted Portnay

Discontinuation Of Smokeless Tobacco After Myocardial Infarction Linked To Improved Survival tinyurl.com/3vbbqt4

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drportnay Dr Ted Portnay

Lower Rate Of Stent Thrombosis Found With Second-Generation Drug-Eluting Stent Than With Bare Metal Stent tinyurl.com/3cxkcaq

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drportnay Dr Ted Portnay

Door-to-Balloon Time Closing In On One Hour tinyurl.com/3ussguc

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drportnay Dr Ted Portnay

Cardiac Rehab Patients Do Not Gain From Increased Amount Of Resistance Training tinyurl.com/3tv876v

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drportnay Dr Ted Portnay

SATURN Statin Trial a Dead Heat tinyurl.com/3vphqzr

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drportnay Dr Ted Portnay

ESC: Afib Registry Shows High-Risk Patients Undertreatedtinyurl.com/3lzxy8x

Increase Your Physical Activity by Joining a Heart Walk in Your Area Today

2011-08-31T18:51:00.001-07:00

Dear Edward,

Thank you for your past support of the American Heart Association and American Stroke Association. I'd like to take this opportunity to provide you with a few tips that you and your family can use to build a healthy lifestyle.

As you may know, cardiovascular diseases are the leading cause of death and disability in the U.S. Research shows that even moderate exercise such as walking can reduce your incidence of heart disease; however, only 15 percent of American adults achieve the American Heart Association's recommended levels of physical activity. Walking vigorously for as little as 30 minutes a day, most days of the week, can promote weight loss, decrease the risk of coronary heart disease, and lower blood pressure and cholesterol levels.

Here are a few ways to incorporate physical activity into your lifestyle:

Track your physical activity and daily nutrition at www.startwalkingnow.org. Record your walking distance, outline map routes and locate nearby American Heart Association-designated Walking Paths.
Sign a pledge to lead a healthier life at your local American Heart Association Heart Walk. Keep motivated by putting your pledge card on your refrigerator to remind yourself of your promise to live heart healthy. For more information, visit www.heartwalk.org.
Join your company team or start a team of your own. Either way, you can help make a difference in people's lives - including your own. Visit www.heartwalk.org to join a team.
Keeping a record of your progress can also help keep you motivated and AHA has some great tools to help you keep your physical activity program on the move. To document your weight, blood pressure and get more information on heart disease sign up today at www.heart360.org
Get your personal heart score a custom plan with the seven simple steps you need to live better. Visit www.mylifecheck.org for more information.
Keep track of how much you move with our pedometer, great for the office, home, or running errands! Find this and other great products that can help you stay in step with heart health at shop.heart.org.

As an online donor, you've helped the American Heart Association advance our mission through your generosity. Funding from donors has helped to create walking paths in your community and across the country, as well as provided people with online resources such as exercise plans and other ways to get active and stay active. Thank you again for your gift and for helping us build healthier lives, free of cardiovascular diseases and stroke!

With appreciation,


Nancy Brown
CEO
American Heart Association