Your Health Checkup: Hope for People with Heart Failure: Get a Second Opinion
“Your Health Checkup” is our online column by Dr. Douglas Zipes, an internationally acclaimed cardiologist, professor, author, inventor, and authority on pacing and electrophysiology. Dr. Zipes is also a contributor to The Saturday Evening Post print magazine. Subscribe to receive thoughtful articles, new fiction, health and wellness advice, and gems from our archive.
Order Dr. Zipes’ new book, Bear’s Promise, and check out his website www.dougzipes.us.
Last week a friend from long ago asked for advice after he developed heart failure. I told him that such dramatic changes have occurred in the care of patients with heart disease that locating an expert familiar with the new approaches might prolong his life.
- Major advances have transformed treatment of heart valves that have become dysfunctional from either narrowing or leaking. Many of these valve repairs or replacements can be achieved without the need for open heart surgery by using catheters placed in a leg blood vessel and manipulated to treat the abnormal valve. The hospital stay is usually just overnight or even same day discharge in some instances, with prompt resumption of normal activities.
- Key advances in creating stents to prop open clogged arteries to the heart have yielded impressive results for patients with arteriosclerotic heart disease due to cholesterol-related problems. Interventional cardiologists implant these stents to restore blood flow to areas of deprived heart muscle.
- Administration of statins, a new concentrated fish oil medication called icosapent ethyl, and a complex drug called PCSK9 inhibitor have been able to drive abnormal cholesterol (LDL) levels to new lows that might even reverse some arterial obstructions.
- Innovations in treating heart rhythm problems with implantable pacemakers, defibrillators, and monitors have saved hundreds of thousands of lives. Electrophysiologists can pinpoint the precise site of abnormal rhythm activity in the heart and eliminate it by destroying the tissue with a catheter directed to that site. This approach has revolutionized treatment of arrhythmias. Early work indicates that finding and eliminating the abnormal rhythm may soon be accomplished noninvasively.
- We have also made important progress in drug development for treating weakened heart muscle responsible for heart failure. A combination drug, sacubitril/valsartan, has been shown to improve outcomes in patients with heart failure. A revolutionary group of gliflozin drugs called SGLT2 inhibitors that began as treatment for diabetes has had spectacular results in improving heart failure in patients whether or not they have diabetes or kidney disease.
Sir William Osler, a famous Canadian physician and co-founder of Johns Hopkins Hospital, once said that the young physician begins his life using twenty drugs to treat one disease while the old physician concludes his life with one drug to treat twenty diseases. This aphorism is no longer applicable, if it ever was, since the choice for treating most heart problems has expanded beyond the capability of any one drug or even one cardiologist unless they specialize in that particular area. While the choice may not be twenty drugs for one disease, but more than one is often the rule and not the exception.
Thus, my advice to patients questioning their care is to seek a second opinion from a cardiologist specializing in the area of their problem. Do not be afraid of hurting the feelings of your present doctor. Any physician truly interested in your wellbeing values a second opinion from another specialist that may help direct your care.
Finally, do not let the present pandemic prevent you from seeking appropriate medical support. Delaying needed treatment will only adversely affect your health.
Featured image: Oleh Slepchenko / Shutterstock
Your Health Checkup: Creating a “Neighborhood Watch” for Your Heart
“Your Health Checkup” is our online column by Dr. Douglas Zipes, an internationally acclaimed cardiologist, professor, author, inventor, and authority on pacing and electrophysiology. Dr. Zipes is also a contributor to The Saturday Evening Post print magazine. Subscribe to receive thoughtful articles, new fiction, health and wellness advice, and gems from our archive.
Order Dr. Zipes’ new book, Bear’s Promise, and check out his website www.dougzipes.us.
Twenty years ago, when I was president of the American College of Cardiology, I wrote a president’s page commentary about the terrible toll inflicted by out of hospital cardiac arrest (OHCA), still responsible for almost 1,000 deaths daily in the U.S. I envisioned a Neighborhood Heart Watch Program I called Save A Victim Everywhere (SAVE) that would rely on citizen responders to be called and arrive first on the scene to administer lifesaving cardiopulmonary resuscitation (CPR) and/or apply a shock from an automated external defibrillator (AED). These are the two most important approaches to increase the appallingly low survival rate (5-8 percent) from OHCA in most places in the U.S. I also suggested that AEDs be made as available as fire extinguishers and be placed in readily accessible locations.
SAVE is based on the concept of a good-neighbor policy — similar to volunteer firemen and neighborhood watch programs — that could have a major impact on this scourge of modern civilization. I envisioned ordinary citizens trained to perform CPR and apply an AED and suggested that the number of such trainees could be increased if we taught such skills to high school students in public safety or health classes. When a cardiac distress call came into the 911 dispatch center, it would immediately be shunted to both the paramedics (EMS) and the nearest AED-equipped and -trained neighbor. This could increase the number as well as decrease the time-to-application of bystander applied AED shocks, the latter presently occurring in less than 10 percent of OHCAs. If necessary, drones could be used to deliver the AED to the OHCA site.
Such programs exist today in several places. For example, in Denmark, as noted in a recent publication, over a period of one year, citizen responders located about one mile from the OHCA victim were dispatched by cell phone to begin CPR or retrieve and apply an AED. Investigators noted that citizen responders arrived before EMS in 42 percent of 438 cardiac arrests, almost doubling the odds for bystander to begin CPR and more than tripling the odds for bystander application of a shock from the AED. They did not report clinical outcome.
Investigators in Germany compared outcomes for mobile rescuer-initiated CPR (94), EMS-initiated CPR (359), and lay bystander-initiated CPR (277) in 730 OHCAs. They found that mobile rescuers arrived in four minutes versus seven minutes for EMS. Outcome was also better for mobile rescuer responders with higher hospital discharge rate (18 percent) compared with EMS (7 percent). Better neurological outcomes were seen in 11 percent of mobile-rescuer patients compared with 4 percent of EMS patients (not statistically significant).
A recent review of community first responders found that such interventions resulted in increased rates of CPR or AED shocks performed before EMS arrival. However, the authors concluded that it remained uncertain whether this translated into significantly increased rates of overall patient survival and suggested that further study be performed.
Despite that cautious conclusion, since numerous studies have shown that time to first application of CPR and/or application of an AED shock are absolutely critical and that earlier application is associated with improved survival, it would seem to me that if such an outcome could be achieved with a good neighborhood heart watch policy, it would help save lives.
Citizen leaders interested in creating such a program should contact local authorities and, in collaboration with health care leaders, consider crafting SAVE for your neighborhood.
Featured image: Platoo Fotography / Shutterstock