Category Archives: women

#GoRedCbus ~ When should you learn about Heart Failure?

BW ARA labcoatThe American Heart Association’s Go Red for Women event February 23, 2017 gave Columbus information about Heart Health for Women, and provided opportunity to support AHA in advocacy, research, and education.

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Left – right, JS, Dr. Albers, Dr. Basuray

Dr Anup Basuray (photo) presented a breakout session on a complex topic. The name Heart Failure does not in fact mean a heart has stopped working (my engineer/math husband is one of many who question the name Heart Failure – but this has been and remains our wording). The term is broad covering symptoms that occur when the heart is not fully functioning – leading to symptoms including shortness of breath, leg swelling, abdominal swelling, fatigue, and/or weight gain or loss. In his presentation, Prevent. Treat. Recover. : Transforming Heart Failure into a Success Story Dr. Basuray highlighted examples of young women patients he has treated. His case presentations illustrated the different ways people get heart failure; some specific to women, for example in the case of problems associated with pregnancy.

Heart Failure is diverse in cause, outcomes, and treatment. The slide here shows ~ 10 causes of Heart Failure, more recently identified is history of cancer treatment, and also included is ‘unknown‘ or doctor-speak, idiopathic. Heart valve disease, genetics (inherited causes), high blood pressure, drugs and alcohol, infection, coronary artery disease, pregnancy related, and irregular heart rate/rhythm can all be causes of Heart Failure.

Heart Failure results in fluid retention by the kidneys, a problem that is worse with high sodium diet. Western diets have high sodium – top sources are Breads and rolls, cold cuts and cured meats, pizza, poultry, soups, sandwiches, cheese, pasta dishes, meat dishes, SNACKS. Reading labels and being aware of sodium is key to heart health in general and to limiting fluid retention in Heart Failure in particular. Knowledge is power when considering what we eat – see here https://hearthealthdocs.com/heart-healthy-diet/  , and for surprising sources of salt https://hearthealthdocs.com/2016/06/08/surprise-sources-of-salt-in-your-diet/

Dr. Basuray addressed the power of prevention and how to stay healthy by knowing the following KEY modifiable risk factors for heart failure

  • High blood pressure
  • Diabetes
  • Obesity
  • High cholesterol

Know your numbers

  • Blood pressure, cholesterol, diabetes (blood glucose) screen
  • Every 4-6 years, as early as age 20

2013 AHA/ACC Heart Failure Guidelines 

So when should you learn about Heart Failure? Now is good. Same with choosing to live a heart healthier life.

Heart Health Docs recommended resources:

https://www.cardiosmart.org/Heart-Conditions/Heart-Failure

Interested in heart health information?

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The Heart Health Doctors site is here to help people improve their heart and circulation health through education.

There is a lot of health information on the internet – a great resource to check for up to date discussions on research is the Topic Archive for the ongoing blog from Women’s Health Research at Yale called ‘Help with the Headlines,’ http://medicine.yale.edu/whr/news/heart/archive/

Topics include diet, exercise, caffeine, stress, and depression and effects on heart health. The format is question & answer, for non-cardiologist readers to learn about their heart health. Check back to the Help with the Headlines site for my comments on an August 2016 study that showed new findings about heart disease risk factors for women.

Each issue can be downloaded – the most recent post looks at whether loneliness and social isolation can lead to heart disease.

http://medicine.yale.edu/whr/news/heart/hearthealth.aspx

Heart Health Doctors Road Trip -> Ohio to Washington DC

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US Capitol building ~ Scaffolding (almost) off

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The American College of Cardiology (ACC) National Legislative Conference offers an opportunity for heart team members to connect with lawmakers regarding issues key to patients’ heart health. Providers including pharmacists, nurses, nurse practitioners, physician assistants, practice administrators, and physicians spend one day learning about the issues and a second day taking our ACC messages to Capitol Hill. ACC also included a focused workshop on leadership for Women in Cardiology this year, held one day before the Legislative Conference. All sessions comprised a busy and high yield 3 days in Washington DC. Key takeaways are:

The Women in Cardiology (WIC) leadership workshop was held at the American College of Cardiology Heart House, now celebrating the 10th year at the DC location. The workshop brought information to attendees – from communication skills to financial ‘well being’ to an overview of current state for women physicians in both academic and community medicine / private practice. The cardiovascular workforce is aging; recruiting a diverse workforce for future cardiovascular team members, in particular women in cardiology, is key to our nation’s heart & vascular health. Presentations from Dr Reshma Jagsi, Dr Robert Harrington, & panel assembled by Dr. Toniya Singh gave attendees perspective on careers in cardiology. ACC Women in Cardiology Section Chair Claire Duvernoy and the WIC leadership council organized a high yield workshop.

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Women in Cardiology Leadership workshop attendees at Heart House

The legislative conference covered key topics for providers including the new payment legislation for Medicare.

Medicare Access & CHIP Reauthorization Act of 2015 (MACRA)

MACRA is not the Affordable Care Act. Sessions including a panel discussion  “MACRA 101” as well as a talk from Jean Moody-Williams, RN, MPP – Deputy Director, Center for Clinical Standards and Quality, Centers for Medicare and Medicaid Services (CMS) representative helped bring the cardiovascular team up to speed on prep for the new law.

Over 400 cardiovascular professionals gathered in Washington DC for the Legislative Conference ~ Ohio was well represented at the meeting.

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Legislative Conference participants from Ohio after first day of the conference ~ prepped for Capitol Hill

This year the conference also included an introduction to Social Media and how to communicate cardiovascular topics to a wide audience ~ Twitter for CV professionals. State based advocacy was also a focus; with key examples for how the cardiology team can work with state legislators to improve cardiovascular health & care delivery. A great example from Ohio includes legislation to bring students education about CPR.

Tuesday visits to Capitol Hill are summarized well by the ACC blog. From a personal standpoint the day was spent in a totally different environment from office practice or the inpatient cardiology service & echo lab.

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Ohio ACC Chapter Governor Dr. Laxmi Mehta & group at the Capitol September 13

Ohio participants divided into groups to visit the Hill; our group included a nurse practitioner, two cardiovascular fellows in training, our ACC Ohio chapter Governor, and myself.  We found our way around the Hill to the offices of Representatives Joyce Beatty, Pat Tiberi, and Warren Davidson, also to Senators Brown and Portman’s offices. Our group took turns talking to legislative aides about legislation to expand patient access to the key secondary prevention program of cardiac rehab, asking for increased funding for heart programs from NIH, FDA , and ensuring congressional oversight for the MACRA roll out & implementation.

We provided first hand education about cardiac rehab – what it offers patients, what’s involved, why the proposed legislation will increase availability for participation, and talked about the impact of medical research on Americans. Having a representative personally thank us for the care a family member received for a potentially devastating heart condition brought home the importance of what we as the cardiology team do everyday in addition to stepping into the advocacy role to ensure providers can continue their practice.

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Ohio Chapter ACC Advocacy ~ Cardiovascular team members meeting with Congressman Warren Davidson, 8th District, Ohio

The 2 days of conferences were made up of more sitting than moving, but Tuesday on Capitol Hill was again a ‘good step’ day with > 15,000 steps by 7pm (is there more credit for walking in the DC sunshine = hot?). Getting to the Mall for a run before Monday’s sessions was not only beautiful at sunrise but also gave an opportunity to exercise.

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Washington Monument & reflection pool Monday September 12 6:30am

 

 

 

#GoRedWearRed ~ Women’s Heart and Vascular Health

BW ARA labcoatThe OhioHealth Women’s Heart & Vascular Conference January 30, 2016 was a great opportunity for healthcare professionals to focus on current research and practice for Women’s Heart Health.

It takes dedicated research and study to understand how best to identify heart risk and heart disease in women and dedicated clinicians who will put the research findings into practice. The American Heart Association Wear Red Day, Go Red for Women campaigns work to educate women about heart and vascular disease ~ 

For Wear Red Day 2016, here are a few conference takeaways:

Dr Alton

Dr Alton

  1. Ischemic heart disease is not a “Man’s” disease ~ in fact heart disease is the leading killer of mothers, wives, aunts, daughters, sisters. Cardiac tests may include radiation exposure; ask about the tests your doctor is recommending – are there alternatives that don’t involve radiation.

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Dr. Barac discussing CardioOncology

Dr. Barac discussing CardioOncology

2. Cardio Oncology focuses on heart health in the setting of cancer treatment; either history of cancer treatment or current – the goal is to be sure women can receive the most effective cancer treatments while protecting their heart function ~ As with all heart health, making sure you control risk factors for heart disease (hypertension or high blood pressure for example) also helps the heart stay strong during chemotherapy.

 

Dr Amburgey

Dr Amburgey

3. Consider pregnancy a stress test for your heart  It is important to follow up if you have hypertension in pregnancy, pre-eclampsia, or eclampsia or diabetes in pregnancy because these conditions may improve after delivery but are now included as risk factors for heart disease and stroke for women over the next 30 years.

 

 

Dr. Neff-Massullo

Dr. Neff-Massullo

4. Vascular disease is under-diagnosed in women ~ the role of hormone therapy and venous thrombo-embolism (VTE) or blood clots in veins is significant. While it is not recommended to test everyone who starts hormone therapy, it is important to speak up if you have a family history of blood clots or any signs/symptoms of blood clot (leg swelling, pain) – especially in the first 12 months of hormone therapy.

 

Test of venous disease ~ Doppler showing venous reflux

Test of venous disease ~spectral  Doppler ultrasound showing venous reflux

5. Venous disease can cause leg pain and swelling, over time can be disabling due to skin changes such as ulcers; compression socks and vascular procedures can help.

 

 

 

 

Dr. Rock-Willoughby

Dr. Rock-Willoughby

6. Women suffer from delay seeking treatment AND delay of diagnosis of acute MI (heart attack).    For Women: Don’t wait for symptoms to go away; it might not be chest pain; women can experience fatigue, sweats, shortness of breath, dizziness, nausea or abdominal pain – call 911. For Healthcare Providers : Think Nose to Navel ~ a program designed to reduce the time to EKG evaluation for women.

7. What’s a treatment that reduces risk of death, heart attack, and more heart procedures?  Cardiac Rehab. Why are referrals and enrollment not 100%? Why are both even lower for women? Make time for Cardiac Rehab and for Heart Health; it’s worth the effort.

Dr Albers introducing Dr Amin to discuss Atrial Fibrillation

Dr Albers introducing Dr Amin to discuss Atrial Fibrillation

8. Women are underrepresented in Heart Rhythm Disorders research; we know that being a woman increases stroke risk in atrial fibrillation. Be sure to ask your doctor if you have atrial fibrillation, if you need to be checked for atrial fibrillation, and if you should be taking a medicine to reduce your risk of stroke. Get involved and participate in clinical research.

 

McConnell Heart Health Center

McConnell Heart Health Center

Thanks to conference attendees  ~ the room was at capacity ~ more healthcare professionals learning about the diagnosis and treatment of heart and vascular disease in women.

Hello #HeartMonth

BW ARA labcoatThe OhioHealth Women’s Heart & Vascular Program CME event on Saturday 1/30 was a fabulous kick off to February ~ Heart Month ~ which includes #WearRedGoRed for Women Friday February 5 and the Go Red for Women Luncheon here in Columbus on Thursday February 25 to benefit the American Heart Association.

We appreciate the American Heart Association support for the conference (see registration table photo below) with Red Dress pins, wristbands, and great Know & Go cards for participants.

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The morning event at the McConnell Heart Health Center brought together health care professionals interested in learning about Women’s Heart & Vascular Health; from Heart & Vascular physicians with keynote presentation from Dr. Ana Barac discussing CardioOncology.

Dr. Mary Alton gave a great opening lecture on Women & Heart Disease, including Yentl syndrome.  She covered cardiac testing for women ~ or how can we choose the best way to learn about a woman’s heart function.

Dr. Barac presented current research in how to protect women’s hearts during chemotherapy for cancer; as well as the risk of high blood pressure (hypertension) and other risk factors that weaken a woman’s heart function when going through cancer treatments.

IMG_6674The OhioHealth Women’s Heart & Vascular Pregnancy Predicts Risk Program ~ why was this started & what’s a risk from pregnancy? was introduced by Dr. Laurie Amburgey, Maternal Fetal Medicine, and discussed by Dr. Ashley Chambers, Internal Medicine. Both providers discussed the fact that a woman’s heart risk with pregnancy issues like pre-eclampsia doesn’t stop with delivery of the baby. Dr. Chambers told us about the OhioHealth program to be sure women have appropriate risk factor management in the years after having a pregnancy that predicts Heart Risk.

Dr. Joddi Neff with Riverside Radiology and Interventional Associates gave a great “Ask the Expert” session on Vascular Medicine – (a big topic that could have its own conference) and focused on risk of blood clots with hormone therapy, and management of venous diseases for women.

Faculty & Course Director Clockwise from bottom left: Dr. Alton, Dr. Nicholson, Dr. Amin, Dr. Rock-Willoughby, Dr. Chambers, Dr. Amburgey, Dr. Neff-Massullo, Dr. Barac, Dr. Albers

Women’s Heart & Vascular CME Faculty 
Clockwise from bottom left: Dr. Alton, Dr. Nicholson, Dr. Amin, Dr. Rock-Willoughby, Dr. Chambers, Dr. Amburgey, Dr. Neff-Massullo, Dr. Barac, Dr. Albers (Course Director)

Dr. David Nicholson and Dr. Jayme Rock-Willoughby with OhioHealth presented the session “From ER to CR” highlighting the “Nose to Navel” goal for early EKG for women with symptoms occurring in that anatomical range, and the Women’s Cardiac Rehab programming launched at the McConnell Heart Health Center in 2015 ~ an effort to get more women through Cardiac Rehab.

Dr. Anish Amin, a Heart Rhythm Specialist closed with an excellent talk on Women’s risk for stroke with atrial fibrillation (a heart arrhythmia).

More to come with take home points for patients from the morning sessions.

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Lexie Sines, with OhioHealth CME

#Heart Health for Women; Start here this Valentine’s Day #LoveYourHeart

IMG_2641 ara echoWhat better day to talk about the Heart than Valentine’s Day?

More science is showing the benefit of starting early with habits that promote heart health.  Treatments already available & scientifically proven are UNDERUTILIZED: would you think 20% was a good score?! No. But 80% of people eligible for cardiac rehab DON’T take part in this essential treatment / program.

This post covers TWO topics for Women’s Heart Health:

  • A recent study showing the impact of 20 years of healthy choices for young women 
  • A NEW program to promote the established, effective heart treatment Cardiac Rehab.

Heart month is a great time to bring attention to what we know about preventing heart disease as well as what opportunities are available for managing heart risk.

  • A recent study showing the impact of 20 years of healthy choices for young women 

In 2015 we have learned about healthy habits or behaviors that impact RISK for developing heart disease with PRIMARY prevention. A paper published in the Journal of the American College of Cardiology (JACC) in January reports the impact of 6 habits on the risk of heart disease for women. This study,

Healthy Lifestyle in the Primordial Prevention of Cardiovascular Disease Among Young Women

looked at a group of young women ages 27-44 years old and followed them over 20 years. Can you think of what the 6 healthy behaviors might be? We have covered them here on HeartHealthDoctors – like a lot of heart healthy changes they are available to us NOW. So pick one and START living a healthy lifestyle:

A healthy lifestyle was defined as not smoking, a normal body mass index, physical activity ≥ 2.5 h/week, television viewing ≤ 7 h/week, diet in the top 40% of the Alternative Healthy Eating Index–2010, and 0.1 to 14.9 g/day of alcohol.

1) Not smoking

2) Get to GOAL weight which is a normal Body Mass Index (BMI)

3) Move your body through space; physical activity at least 2 1/2 hours per week

4) TV viewing < or equal to 7 hours per week

5) Follow a heart healthy diet 

6) If a woman chooses to drink alcohol, amount of 1 drink per day or 12 oz beer, 4 oz wine, or 1.5 oz liquor correlates to ~14gm

Marlene Busko writes for Medscape about the JACC paper that ” Adoption of six healthy lifestyle behaviors could avert about 73% of coronary heart disease (CHD) cases among women over 20 years, as well as 46% of diabetes, hypertension, and hyperlipidemia, conclude researchers, based on their analysis of about 69 000 participants …”

Key to know with the Nurse’s Health Study findings is that Coronary Heart Disease (CHD) risk was lower for women without AND with heart disease risk factors BOTH groups showed decreased events with more healthy lifestyle habits/behaviors.

  • A NEW program to promote the established, effective heart treatment Cardiac Rehab.

At OhioHealth we have launched a cardiac rehab program for women to help give every opportunity to succeed at SECONDARY prevention and prevent or slow disease progression. To improve the ‘ low test score of 20%’ participation in Cardiac Rehab the OhioHealth Women’s Heart and Vascular Program launched a program for cardiac rehab designed for women. Education and exercise in the company of other women with heart disease offers a new way to help women who have had a heart event (Chest Pain, Heart Attack, Coronary artery Stent, Heart Valve surgery, Coronary artery bypass surgery) and are starting on their SECONDARY prevention journey.

Read more about Cardiac Rehab here; 10TV News did a great story / coverage of the Women’s Cardiac Rehab program (click text to view story and video).

 

 

Wrapping Up #HeartMonth

IMG_9814rtEvery month is Heart Month here at Heart Health Doctors.  That said, February 2014 is the 50th anniversary of American Heart Month.  The Columbus Dispatch 2/23/14 supplement Your Health focuses on Heart Health with tips to use through the coming year & beyond.  In this post I  summarize a few of the articles and have added heart specific information.

Your Health covers the heart health benefits of activity, consideration of medication – from aspirin therapy to high blood pressure medicine, and diet.  There is a great photo of a treadmill desk; these are desks where users can actually walk while using a computer or reading.  As well as standing desks, the treadmill desks offer great alternatives to sitting.  Breaking up sedentary behavior – or encouraging people to just “move more”  will improve heart health. “Sitting is the new smoking” is now a common comment from physicians interested in prevention.

Understanding why you are taking any pill or food is important; we don’t always consider closely what we eat – be it food or medicine – and may lapse in consistency.  The importance of taking medication for high blood pressure is reviewed.

Here is a good video about high blood pressure:

Your Health also writes about, the ‘miracle’ heart drug aspirin.  Aspirin has risks and benefits – with evidence for benefit for healthy men older than 50 years to prevent heart attack and stroke (and colon cancer), but for healthy women that benefit doesn’t outweigh risk of bleeding until age 65 years old.  Any medicine choice is a time to talk to your health care provider; because many different factors are involved.

As outlined here at Heart Health Doctors, your diet is a key part of overall heart health.  But what if you are not at goal weight?  Using different ways to get to goal weight are reviewed with Jennifer Burton RD at the McConnell Heart Health Center who was interviewed for the Your Health Dispatch supplement.

Finally, as winter in central Ohio has shown us, weather and how to prepare for it, can challenge anyone’s best intentions to stay active.  Sports Medicine Physician and athlete Dr. Darrin Bright is interviewed for the article on Exercise Smart.  Cardiologists in particular appreciate the risk of cold weather activity.  The stress of cold temperatures combined with strenuous activity such as, specifically, snow shoveling can be dangerous and a set up for heart attack.

Any consideration of cold weather activity should include asking “have I been active?” and “am I ready for this?”  Don’t ignore symptoms (chest pain, shortness of breath, back pain, shoulder jaw or neck pain, dizziness/lightheadedness among others); proceed gradually.

Dr. Bright’s recommendations to dress according to the temperature help guide anyone wanting to be active during winter.  The recommendations in the article to dress in layers and be prepared for changes in footing apply; I like the message that weather should not stop us from being active year round.

We know the benefits of exercise, but the goal is to be safe – and ready.  Exercise Smart has great information for winter activity; but what Central Ohioans (this one at least!) are definitely ready for this year, is spring.