Real World Health Care Blog

Tag Archives: cardio

It’s Not Over Yet: Addressing Part Two of the Door-to-Balloon Time Initiative’s Success

ReillyJohn

John P. Reilly, M.D., FSCAI

From the very first sign of a heart attack, the clock starts ticking in the race to save a patient’s heart muscle and even his or her life.

Thanks to technology and finely tuned systems of heart attack care that are now available in communities throughout the United States, we are getting faster all the time.

But sometimes we still lose the race.

During a heart attack, the heart is deprived of oxygen. The longer the heart goes with too little oxygen, the more muscle is lost, often irreversibly. This is what doctors mean when we say, “Time is muscle.” How quickly a patient receives treatment once heart attack symptoms appear often determines if he or she will make a full recovery, suffer heart muscle damage, or die.

Door to Balloon Signaled Success, or Did It?

This is why, a decade ago, healthcare professionals across the country set out to reduce the time it takes to treat heart attack patients once they arrive at the hospital. Since stopping a heart attack often involves balloon angioplasty to reopen the blocked artery, the effort was called the Door-to-Balloon (D2B) Initiative. This effort has prevented or limited heart damage for countless patients.

The D2B initiative involved making the healthcare system more efficient, more responsive and more effective, starting from the moment a heart attack patient comes to the attention of an emergency medical responder (EMR) answering a 9-1-1 call or presenting in the emergency department.  When D2B began, it often took more than two hours from the time a heart attack patient arrived at the hospital until he or she received life-saving treatment to reopen a blocked artery.

Now, 90 percent of patients who enter hospital doors receive treatment in less than 90 minutes and many are treated within 60, 30, even 15 minutes. [1]

D2B is one of healthcare’s greatest success stories. But, according to a new study [2], reducing D2B times has not been enough to significantly reduce mortality rates among heart attack patients.

What Happens Before the Hospital Door?

There are two sides to the time equation. Unfortunately, the part of the equation that has not improved enough is how long it takes patients to get to the hospital once heart attack symptoms start. Most patients wait two or more hours after heart attack symptoms appear to seek medical help. [3] Many patients are taking too long to call 9-1-1, placing themselves at risk of suffering irreversible heart damage or death.

We must do for Symptom-to-Door (S2D) Time what we have done so successfully for D2B. Revamping a system of care outside the hospital, however, is much different and perhaps more difficult than revamping a system of care within the hospital.

There have been myriad heart attack awareness programs, including online public education programs like SecondsCount.org, for which I am an editor, aimed at helping people understand the risks of heart attack, how to recognize the symptoms and why responding promptly is essential.

We have made progress. An increasing number of people know that chest pain, shortness of breath, nausea, fatigue, dizziness, and pain in the jaw, back or arm are often the first signs of heart attack. While I see more people who identified their symptoms early on, there are also many who remain unaware, are in denial or are just confused. Every day, I see patients who thought their symptoms “weren’t that bad” or explain them away as indigestion or a virus. I also see the toll that lost time takes in hearts damaged and lives lost.

Only 60 percent of patients contact emergency medical responders when experiencing symptoms. About 40 percent arrive at our hospitals on their own. [4] That’s dangerous, whether the patient is driving him- or herself. Or, even if a friend or relative is driving, it still represents a lost opportunity for treatment to begin in the ambulance, or to alert the doctors in the emergency room that a heart attack patient is on the way in.

Let’s Save More Hearts and Lives

To get started, here are a few thoughts on how we might reduce S2D:

  • We need a concerted national effort to reduce S2D time that establishes consistent messages rather than myriad programs offering incomplete or inconsistent information.
  • We must improve regional and statewide systems of care to coordinate heart attack care to ensure everyone gets the most expeditious care.
  • We need to better inform the people who are most at risk for heart attack or other heart issues about what symptoms to look for and what to do if they develop.
  • And, of course, we must continue our educational efforts, helping everyone to understand that if they are concerned they may be having a heart attack, then they should call 9-1-1 without delay and without concern about looking foolish if their symptoms turn out to be something other than a heart attack.  The alternative – sitting at home while having a heart attack, with heart muscle dying as the minutes tick by – would be far worse.

We’ve had remarkable success in reducing D2B times. But it’s not enough. To save hearts and lives, we must take on the other side of the heart attack challenge.

We’ve done it once. We can do it again.

1. Bates ER, Jacobs AK. Time to Treatment in Patients with STEMI. N Engl J Med 2013;369:889-892.
2. Menees DS, Peterson ED, Wang Y, et al. Door-to-balloon time and mortality among patients undergoing primary PCI. N Engl J Med 2013;369:901-9.
3.  Life After a Heart Attack. National Heart, Lung, and Blood Institute.
4.  http://nypress.com/forty-percent-do-not-call-911-survival-rates-show-every-minute-matters/, http://www.nejm.org/doi/full/10.1056/NEJMp1308772

World Heart Day Underscores Why Exercise and Diet Count

This year’s World Heart Day on Sunday, September 29 will focus on raising awareness around changes that individuals – especially women and children – can incorporate into their daily habits to reduce the risk of developing cardiovascular disease (CVD).

Paul DeMiglio

Paul DeMiglio

Created in 2000 by the World Heart Federation (WHF) to highlight heart disease and stroke as the world’s leading causes of death claiming 17.3 million lives each year, advocates will educate the public about prevention strategies through talks and screenings, walks and runs, concerts and sporting events.

It is expected that by 2030, 23 million people will die of CVD, more than the entire population of Australia. Together with its members, WHF reports that 80 percent of premature deaths from CVD could be reduced if individuals take the following actions:

  • Reduce or discontinue use of tobacco
  • Eat healthfully
  • Engage in physical activity

CVD can affect people of all ages and population groups, including women and children, as illustrated in WHF’s infographic that also shares practical tips on how to eat more healthfully and exercise more frequently. To teach children about healthy heart living, WHF also created a leaflet along with a character, “Superheart,” that encourages:

  • Playing outdoor games
  • Cycling
  • Eating a diet rich in fruits and vegetables

The American Heart Association (AHA) recommends increasing daily servings of mostly plant-based foods to help improve cardio health, acknowledging that “many studies have shown that vegetarians seem to have a lower risk of obesity, coronary heart disease (which causes heart attack), high blood pressure, diabetes mellitus and some forms of cancer.”

To support better coronary health outcomes, AHA created five goals for healthy eating that encourage individuals to:

  • Eat more fruits and vegetables.
  • Consume more whole grain foods.
  • Use liquid vegetable oils such olive, canola, corn or safflower as your main kitchen fat.
  • Eat more chicken, fish and beans than other meats.
  • Read food labels to help you choose the healthiest option.

AHA also published an info sheet about the warning signs of a heart attack, which often starts slowly and usually goes unnoticed. This is especially true among women, whose symptoms can often mimic those of the flu. Additionally, it is common among women to put others first, especially their children, and so they usually do not recognize symptoms until it is too late. To address this public health challenge, AHA initiated the Go Red for Women campaign to empower women to know their risk, live more healthfully and share their stories.

The primary warning signs of a heart attack remain the same regardless of gender, however:

  • Chest discomfort
  • Discomfort in other areas of the upper body
  • Shortness of breath
  • Breaking out in a cold sweat, nausea or light headedness

Now tell us your story. Do you know anyone who experienced a heart attack or other heart condition? Are you aware of your own risk level? What could you, your friends or loved ones do differently to live more healthfully?

Turning DASH Strategy into Reality for Improved Cardio Wellness Outcomes: Part II

As part of their health & wellness program, the largest health insurer sent me a refrigerator magnet highlighting the National Institutes of Health’s (NIH) Dietary Approach to Stop Hypertension Diet (DASH).  In their accompanying letter, the company stated that the refrigerator magnet is a “tool to help you manage your blood pressure.”

Shawn J. Green

Shawn J. Green

The DASH Eating Plan refrigerator magnet was a nice gesture to remind clients to consume less sodium and incorporate more vegetables and fruits into their diet to lower blood pressure.  However, is this the most effective wellness tool to engage and motivate individuals to change their eating habits?

As we learned in last week’s post, plant-based diets – especially those rich in leafy greens, such as spinach and arugula – elevate cardio-protective nitric oxide.  For many pre-hypertensive individuals, staying with a plant-based diet is a critical driver to prevent elevated blood pressure and the diseases associated with hypertension.

Yet many Americans continue to fall far short of eating recommended daily servings of vegetables that elevate natural nitric oxide levels in our body.

A new model is needed to drive behavioral change. So how do we consistently integrate cardio-protective plant-based diets into our daily dietary lifestyle?

Berkeley Test may be a start.

Berkeley Test’s Saliva Nitric Oxide Test Strips and its iPhone Cardio Diet Tracker are designed to break bad habits and empower folks from various walks of life to incorporate plant-based foods into their daily diets.  These engaging tools provide a model to influence dietary change on a personal level that supports lasting compliance with measurable outcomes.

Designed to detect nitric oxide status in the body throughout the day, Berkeley Test developed the next generation proprietary nitric oxide test strip; for less than 70-cents, an easy-to-use, 1-minute saliva test strip enables consumers to make immediate and real-time dietary lifestyle adjustments.

Once users finish the strip test, they can use Berkeley Test’s Cardio Diet Tracker App to compare their results to a color-coded indicator showing whether nitric oxide levels are on target. After 2-3 hours, the user is alerted to check their nitric oxide status.  Users can leverage the Cardio Diet Tracker App to more effectively adhere to plant-based diets by tracking nitric oxide status in conjunction with the type, frequency, and amount of nitric oxide-potent foods eaten to sustain their levels.

Michael Greger, M.D., of NutritionFacts.org, suggests that Berkeley Test may offer hope by bringing plant-based foods into our dietary lifestyle in an engaging fashion. At the very least, it will remind us to eat our greens on a more frequent basis, he says.

Berkeley’s strip-app bundled technologies demonstrate that self-assessing, analyzing, and fine-tuning wellness outcomes with a shared, open, interactive community can be a catalyst to sustain plant-based cardio-protective diets in our daily lifestyle. The value of Berkeley Test’s model is not only demonstrated in how it equips consumers to make healthier dietary choices, but also in its ability to connect users by allowing them to share dietary successes with their Facebook friends.  In today’s society, wellness outcomes and fitness is highly social and valued.

Individuals – who range from Olympians seeking to boost their physical endurance to baby boomers looking for an easier way to eat healthfully and prevent high blood pressure – are embracing these innovations.  As more people turn to Berkeley’s strip and mobile App to improve adherence to plant-based diets, such as DASH and Ornish, natural communities of mutual support are growing.  These networks offer a unique venue to share experiences, provide strategies for success and a forum to discuss common challenges, refine approaches and achieve desired outcomes.

A dynamically open community to share new knowledge about wellness and create a model for achieving and maintaining healthy living and eating is what we hope Berkeley’s ‘health biomarker’ test strips (such as nitric oxide and mobile App combo) provides.

So, what is your nitric oxide level, today?

More Patients DASH to New Solution to Reduce High Blood Pressure: Part I

Shawn_J_Green

Shawn J. Green

What’s the solution to reversing the tide of hypertension, the most commonly diagnosed condition in the United States?  More evidence indicates that the answer begins with the food choices we make every day.

An underlying cause of heart attacks, strokes and kidney disease, one in three American adults now experiences high blood pressure – the single-largest contributor to death worldwide. It is also becoming more resistant to the pharmaceutical drugs used to lower it. In fact, blood pressure remains elevated in nearly one-third of all treated hypertensive patients on pharmaceutical drugs.

Instead of relying on prescriptions, more patients are turning to a healthier eating approach: Keeping sodium intake low and making consumption of nitric oxide-rich vegetables and leafy greens high. This cardio-protective daily diet, known as the DASH (Dietary Approach to Stop Hypertension) Eating Plan, is emerging as an effective way to delay or prevent high blood pressure altogether.

The value of nitric oxide was spotlighted when the Nobel Prize was awarded in 1998 for discovery of this naturally produced cardio-protective factor. A string of clinical studies underscored that vegetables (like red beet roots) and leafy greens (such as spinach and arugula) are replete with nitric oxide.

Diets known for promoting heart health and lowering rates of diabetes and obesity – like Japanese diets, Mediterranean diets and plant-based diets, such as DASH, among others including TLC, Ornish, and Pritikin – incorporate these natural whole foods. The need to consume more nitric oxide-potent vegetables and leafy greens becomes even more critical as we age because our bodies are less able to synthesize this natural hypertensive-fighting factor.

Reducing hypertension would not only improve health outcomes for individual patients, but would also benefit the health system as a whole. Although the percentage of resistance to antihypertensive drugs is relatively lower in the U.S., elevated blood pressure among a rapidly growing number of baby boomers will mean more challenges for health care in the long run unless we identify tools that work and make them as accessible and user-friendly to the public as possible.

DASH holds great promise to fuel compliance – a critical driver to prevent elevated blood pressure – among those living with hypertension. But a healthful eating strategy alone will not mean better outcomes for patients without a model to help them break bad habits and support dietary changes on a personal level, one day at a time.

So how do we get there?

Join us here next Thursday for the second post in our two-part series. Discover what innovative tools can empower patients to make the DASH Diet a part of their arsenal in the fight against hypertension.

Meditation Found to Cut Risk in Half of Death, Heart Attack, or Stroke in African Americans

Here’s an idea that every person alive can do, costs nothing, and takes as little as 20 minutes a day: Meditate.

A recent peer reviewed, published study shows why:

“Meditation is usually thought of as a practice of healthy, well-off white people and Asians. But newly published research suggests it can produce hugely significant health benefits in a very different demographic group: African Americans with heart disease.

“A study that followed 201 African Americans for an average of five years found those who meditated regularly were far more likely to avoid three extremely unwelcome outcomes. Compared to peers participating in a health-education program, meditators were, in that period, 48 percent less likely to die, have a heart attack, or suffer a stroke.

Read more about the research here, and to access information regarding the technique of Transcendental Meditation as well as evidence-based benefits, you can visit this website.

What are ways we can encourage more people to meditate? We’d love to hear more about what works, what doesn’t when it comes to meditation to improve health outcomes.  Please share links to any evidence-based findings!