Idea #316 for December 31st, 2009: Out In The Cold or Winter Weather Can Increase Heart Attack Risk

In colder regions of the country, winter weather poses more than just risks of hypothermia. Many people are unaware that risk of heart attack also increases when the temperature drops. In the cold, blood vessels tend to constrict in an effort to conserve body heat. As a result, blood pressure increases and the amount of oxygen that can get to the heart decreases. Couple that with strenuous winter activity — like shoveling snow — and you have a recipe for heart attack in susceptible people. For people at increased risk of of heart disease, experts recommend avoiding strenuous cold-weather activity, and they should be aware of heart attack symptoms to ensure immediate response if one occurs.

Read more about this here.

Idea #278 for November 23rd, 2009: Tag-Team Healthcare or Physicians and Pharmacists Working Together To Improve Patient Outcomes

Under normal circumstances, a physician prescribes a high-blood pressure medication and a pharmacist fills the prescription as written. But when doctor and pharmacist work together, patients with hypertension fare better. New research supports that notion: a study of 400 hypertensive patients showed that patients whose pharmacists and doctors worked together had much better outcomes.

In this case, working together meant that both physician and pharmacist had a say in the medications and dosages the patient received. In the control group, whose patients were prescribed blood pressure medications in the conventional manner, 30% of the patients saw their blood pressure drop to the recommended level within six months. On the other hand, 64% of patients who had the physician/pharmacist team working together reached that level in the same time frame. That’s a remarkable difference.

Methods like this are being employed by some practices in the country already. If the results of the study hold up, it makes sense to expand this type of collaboration. Previous research has shown similar success in treating other conditions like diabetes and high cholesterol with this system as well. The authors of the study think we can encourage more collaboration by employing incentives via Medicare payments for those who setup these partnerships.

Read more about this news here.

Idea #274 for November 19th, 2009: Screening High School Athletes For Heart Conditions

Young athletes who appear to be in excellent physical condition sometimes suffer from undetected heart ailments that lead to their sudden deaths. In fact sudden cardiac death from heart rhythm disturbances kills 1 out of 3000 young adults each year. The rapid onset of these cardiac problems makes treating them almost impossible. Researchers at Johns Hopkins believe that the best approach might be screening healthy young athletes for heart problems.

The researchers screened over 100 high school athletes in Maryland using several tests. They tried to detect cardiac abnormalities using EKG, blood pressure tests, echocardiograms, and listening for murmurs. They found that 36 of the 134 athletes had abnormalities like high and low blood pressure. The researchers contend that using multiple tests is the best way to screen young athletes for heart problems. Although potentially costly, screening athletes could save hundreds or even thousands of lives each year, if heart issues are caught and treated before they lead to sudden cardiac death.

Read more about this in the Baltimore Sun.

Idea #254 for October 30th, 2009: Another Reason To Quit or Smoking a Single Cigarette Can Harden Arteries

A few days ago, this blog dealt with the issue of occasional smokers, and how that particular group is often overlooked by researchers and providers alike. Now there’s more evidence that even the occasional cigarette is indeed harmful. The study found that even one cigarette will temporarily harden the arteries of young adults by 25%.

The study specifically looked at the effects of smoking before exercise and involved subjects between 18-30 years old who smoked about five cigarettes daily as well as non-smokers. Before exercising, both the smokers and non-smokers had the same level of arterial stiffness. Prior to exercise, the smoking group was allowed to smoke a single cigarette, and all participants were assessed on the hardness of their arteries afterward.

In non-smokers, arterial stiffness actually decreased slightly after exercise. In smokers, the stiffness increased by 25%. Even for members of the smoking group who did not have a cigarette before exercise, their arterial stiffness still rose slightly following exercise. The effects of this hardening can make the vascular system less able to deal with physical stress, like running. This is further evidence that occasional smoking — even in young adults — can have quantifiable negative effects on health. Smoking just a few cigarettes a day is a harmful activity, despite what the occasional smoker may believe.

Read more about this issue here.

Idea #218 for September 24th: Supporting Seniors or Preventing Falls Among The Elderly

Each year, a third of those 65 and older will have an accident where they fall down, and for those over 80, it happens to about half the population. Patients aged 75 with high blood pressure are just as likely to die or get seriously injured falling as they are from a stroke. Falling should not be an inevitable byproduct of growing old, though. Mary Tinetti, a professor from Yale, recently won a MacArthur genius award for her work uncovering the reasons behind falls in the senior population.

Factors like multiple medications, muscle weakness, vision problems, and changes in blood pressure all contribute to falls. Whereas in the past most of the reasons for elderly falls were considered unavoidable, Dr. Tinetti believes the factors should be controllable and can be reduced by 30% if new protocols are implemented. Proper screening for risk factors, she contends, is key to preventing elderly falls. The risk factors are sometimes overlooked because providers may focus on more pressing health matters. Methods like lowering medications, teaching balance, and arranging living spaces to make movement easier can all help prevent falls, and should be considered in elderly patient care.

Read more about this issue in the Wall St Journal and Washington Post.

Idea #203 for September 9th, 2009: Hold The Salt or Cutting Back on Sodium Consumption Could Save Nation Billions

Our nation has a lot of health problems related to the food we consume, and now a study has come up with a dollar estimate of just how much one ingredient is costing our healthcare system. If we cut our collective salt intake down to recommended levels, it’s estimated that we could save $18 billion a year.

Nutritional guidelines recommend that we consume no more than 2,300 mg of sodium per day, but the average American takes in more like 3,300 mg per day — an entire gram of salt more than we should. High sodium consumption is linked to high blood pressure, which in turn leads to heart disease and kidney disorders. Right now, about 70 million Americans have high blood pressure, but that number could be reduced by 11 million if people limited themselves to the recommended 2,300 mg of sodium per day, hence the $18 billion in savings. If we cut our average salt intake to 1,500 mg per day, it’s estimated the savings would rise to $26 billion.

Changing our diets will take some vigilance on the part of the consumers, though. Foods in restaurants aren’t labeled with nutritional information, and most of us probably have no idea how much salt we consume each day. Fast food restaurants could assist the public by making sodium and caloric information more readily available, or by reducing the amount of fat, salt, and sugar in their food. That probably won’t happen, so Americans will have to be more watchful about what they consume.

You can read more about the study here.

Idea #6 for February 24th, 2009: Exercise is Good For Our Wallets or Health Care Cost Cutting

High blood pressure (hypertension) is one of those exponential things: once diagnosed, it is a well into which we pour our health care spending. More troubling still is that in a variety of ways, hypertension has treatments that don’t always have a strong correlation between cost and results. In 2002, the last numbers I had handy, roughly 21% of Americans or 45 million people had been diagnosed with problematic BP. We spend at least $7 billion each year (maybe as high as $15 billion) on medications to control blood pressure, with an average around $350 per patient per year. This does not include the $170 billion economic burden we bear each year as a result of the associated MIs (myocardial infarctions, i.e. heart attacks) and strokes that may have been avoided with better control. Blood pressure medication spending has also been among the leaders in annual cost increases for the last decade, so expect the numbers above to climb. Numerous studies also show that the older diuretic based treatments, which are substantially less expensive than newer therapies, are equally (if not more) effective at treating high BP. I will save the when-older-drugs-are-better-and-cheaper-why-aren’t-doctors-using-them post for a later date.

One thing about hypertension, though, is that it can be readily and well controlled with one simple thing: exercise. There are countless studies that show exercise in combination with drug therapy (or on its own) along with a better diet are excellent ways to control high BP and substantially reduce the risks and costs associated with treating all those MIs and strokes. We need to start thinking out of the box. Using the numbers above, it would actually be cheaper as a nation to pay everyone with high blood pressure $1000 to exercise and control it, or $500 to exercise and cover drug expenses each year, than what the current system is costing Americans. Hypertension is just one example; take a look at cholesterol, diabetes and more and we might just find that we can all stop working and get full time jobs exercising.

Here is some further reading on the subject: http://www.mayoclinic.com/health/high-blood-pressure/HI00024 ; http://www.ajmc.com/Article.cfm?ID=3046 ; http://www.medscape.com/viewarticle/550448_2, and http://jama.ama-assn.org/cgi/reprint/291/15/1850.pdf