Category Archives: Heart & Circulation

Patients often win if they appeal a denied health claim

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The health law set national rules for appealing a denied claim, and advocates say consumers should take advantage of them

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Image: sundesigns

By Pauline Bartolone, Capital Public Radio

APR 14, 2014

This KHN story was produced in collaboration with NPR

SACRAMENTO, Calif. — Federal rules ensure that none of the millions of people who signed up for Obamacare can be denied insurance — but there is no guarantee that all health services will be covered.

To help make sure a patient’s claims aren’t improperly denied, the Affordable Care Act creates national standards allowing appeals to the insurer and, if necessary, to a third-party reviewer.

For Tony Simek, a software engineer in El Mirage, Ariz., appealing was the only way he was able to get additional treatment for sleep apnea.  Continue reading

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Cholesterol guidelines could mean statins for half of 40s

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Three red-and-white capsulesBy Richard Knox
MARCH 20TH, 2014

This story was produced in collaboration with 

When sweeping new advice on preventing heart attacks and strokes came out last November, it wasn’t clear how many more Americans should be taking daily statin pills to lower their risk.

new analysis provides an answer: a whole lot. Nearly 13 million more, to be precise.  Continue reading

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Women’s Health — Week 26: Heart Disease

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tacuin womenFrom the Office of Research on Women’s Health

Heart disease is the leading cause of death among American women. The good news is that you can greatly reduce your chances of developing heart disease.

Making healthy changes in daily habits, learning about your personal risk factors, and taking needed medication as prescribed are all important keys to heart health.  Continue reading

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Check your blood pressure, give your contact info away

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By April Dembosky, KQED

Health insurance companies are on the prowl for more customers. There are still three months to go for people to enroll in health plans under the Affordable Care Act, but insurers don’t want to rely solely on state or federal websites to find them.

solohealthSome are finding a path to new customers by partnering with companies that operate health-screening kiosks –- those machines in supermarkets and drug stores where people check their blood pressure or weight.

One of these kiosks sits in aisle 10 of a Safeway grocery store in a city near San Francisco. Sitting down at the machine is like slipping into the cockpit of a 1980s arcade game. Continue reading

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As Washington delays, states move on e-cigarettes

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eBy Jake Grovum
Stateline Staff Writer

Money grab, health concerns, or both? Absent guidance from Washington, states are pressing ahead with their own agendas on electronic cigarettes.

Heading into legislative sessions next year, policymakers, industry representatives, health advocates and tax wonks expect electronic cigarettes — or e-cigarettes for short — to be among the top issues at state capitols.

Legislatures are expected to tackle how to classify, regulate and, perhaps most importantly, tax the relatively new products.

The debates in states come as the federal government considers its own answers to similar questions. The Food and Drug Administration is considering classifying e-cigarettes as “tobacco products,” which would extend its reach and potentially subject e-cigarettes to a host of rules and regulations that apply to tobacco cigarettes.

“States are scrambling to figure out how to deal with this,” Ohio Attorney General Mike DeWine said in an interview. “It’s going to be fought out in 50 states; it’s going to be fought out in one jurisdiction after another.”

DeWine was a lead author of an Oct. 23 letter sent by 40 attorneys general to the FDA pushing for federal rules and for e-cigarettes to be treated as “tobacco products” for regulatory purposes.

So far, Washington hasn’t decided how to proceed with e-cigarettes. A proposed rule, expected to be released for public comment in November, was delayed by the government shutdown and is still pending.

That has left a patchwork of rules, regulations and product definitions across the nation, often at the urging of anti-tobacco advocates. “We think it’s really important that states act,” said Danny McGoldrick, vice president of research at the Campaign for Tobacco-Free Kids.

More than half the states, for example, have banned the sale of e-cigarettes to minors, but others have no restrictions. Currently four states — Utah, North Dakota, Arkansas and New Jersey — have lumped the products in with tobacco under indoor smoking bans, even as research about possible ill-effects from second-hand vapor smoke, if there even are any, remains limited.

Some local governments have taken similar steps on their own, enacting rules for e-cigarettes that sometimes go beyond those in place at the state level.

The intensity of the debate illustrates both the lack of good research on e-cigarettes as well as the money at stake. Often, those considering limits don’t even agree on whether applying tobacco regulations is appropriate, given how different the products are. Like tobacco cigarettes, nicotine levels in the “cartridges” that are loaded into the e-cigarette device can vary widely, complicating efforts to agree on a standard approach to regulation and taxation.

E-cigarettes first appeared about a decade ago, and sales have grown exponentially in recent years. The number of American adults who said they have tried them doubled to one in five in just one year (from 2010 to 2011), according to a Centers for Disease Control survey.

Use among middle and high school students also doubled from 2011 to 2012, according to the CDC, with nearly 1.8 million students saying they’ve used them.

E-Cig Revenue

In an era of revenue-hungry state governments — some still dealing with declining revenue from traditional tobacco taxes and recovering from the Great Recession — taxing e-cigarettes seems likely to get the most attention from state lawmakers in 2014. Questions of advertising limits, health claims and ingredient disclosure will likely remain federal issues.

So far, only Minnesota has put in place a specific state tax policy for e-cigarettes, a decision reached in 2012. The products are subject to a 95 percent tax that functions like a sales tax, tacked onto the wholesale cost of the product.

That generally means they are taxed at a higher rate than traditional cigarettes, which are subject to a $1.29-per-pack levy. The state expects to collect $1.16 billion from all tobacco taxes in the 2014-2015 fiscal year.

For now, most other states apply only a sales tax – if they have one – to e-cigarettes. But at least 30 others are considering e-cigarette taxes of some kind next year.

“I will be watching to see if more proposals like Minnesota are replicated in the states,” said Scott Drenkard of the Tax Foundation, an anti-tax research group, “But I hope they are not.”

What this is is a money grab.

As tax experts see it, there’s little rationale aside from simply raising revenue for taxing e-cigarettes as traditional cigarettes. Tobacco, they say, is taxed because it produces negative health consequences that cost the public. For now, there’s little research that shows similar effects from e-cigarettes.

“There is zero, emphasis on zero, justification for taxing e-cigarettes right now,” said David Brunori of the group Tax Analysts, a nonprofit tax analysis group that provides insight to private firms and government agencies. “What this is is a money grab. It’s a way of trying to find revenue to replace lost tobacco taxes.”

According to the nonpartisan Tax Policy Center, state and local tax revenues have somewhat leveled off in recent years as smoking has declined. Collections grew from $7.7 billion in 1997 to $15.8 billion in 2007, but reached just $17.6 billion in 2011, the most recent year available.

Tobacco companies that don’t produce e-cigarettes have often pushed tax parity so their own products are not at a disadvantage. In Minnesota’s case, the state simply said that under its laws, the tax must apply.

But the most popular argument is deterrence—higher taxes might make the product less attractive and less affordable to young people looking for nicotine.

“It has nothing to do with revenue,” Ohio’s DeWine said. “It has everything to do with discouraging use.”

An Alternative to Tobacco

Discouraging use, however, is exactly the opposite goal lawmakers should have, said Ray Story of the Tobacco Vapor Electronic Cigarette Association. It’s an opinion shared by some outside of the industry as well, especially with regard to those already smoking.

“Cigarettes are sold everywhere in the world, and we want to make sure that the e-cigarette is sold as a less-harmful alternative right there next to it,” Story said.

“We should expand the use, not restrict it,” he added, saying that if e-cigarettes can greatly reduce cigarette use the industry “will have made the greatest impact on humanity ever.”

The contrasting approach reflects two key differences in thinking about e-cigarettes: as a new recreational product similar to tobacco cigarettes, or as a potentially less-unhealthy alternative that could even help smokers quit entirely.

E-cigarette producers themselves are divided. Some welcome traditional cigarette-style regulations to a degree, content to play by similar rules as tobacco producers, especially if it saves them from more onerous limits applied to drug manufacturers, for example. Others argue that even thinking about e-cigarettes through the same frame of reference as tobacco is a flawed approach.

Federal officials in Washington will likely be the ones to eventually settle the dispute, and that decision could still be months away. Meanwhile, debates in the states over two key issues within their control – taxes and sales to minors – are likely to rage in 2014.

But the eventual decision from the FDA is sure to affect those debates. “If the FDA says these are essentially tobacco products,” said Brunori of Tax Analysts, “that will give all kinds of cover to state politicians.”

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Stateline is a nonpartisan, nonprofit news service of the Pew Center on the States that provides daily reporting and analysis on trends in state policy.

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Randy Dotinga

A freelance writer with a dodgy ticker tells of his hunt for insurance

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Randy Dotinga

Randy Dotinga

I’d like to start a long-term relationship with a health plan, but all I’ve had are flings — seven insurers in the last 13 years. Is it something I said? Nope, it’s something I am: a self-employed, 45-year-old single guy with a heart that beats funny.

Take Cigna. We seemed to click until the company wanted me to pay $11,000 a year in premiums. Another insurer came calling but turned out to be a scam, defrauding me and thousands of others. The high-risk plan in California — my home state — took me on, but I had to cough up $700-plus a month for paltry coverage.

Another couple of government-run plans were supposed to get me through this year with cheaper rates, but a bureaucratic snafu snuffed my coverage.

At least my misery has company. People with pre-existing medical conditions “face every kind of possible hassle,” said Nancy Metcalf, a senior program editor with Consumer Reports. Many can’t find coverage at all.

Now 2014 is fast approaching, and I suddenly have suitors. Six companies are offering me 34 plan options through my state’s marketplace, which was created under the federal health law. Insurance coverage, at last, is guaranteed. And, for now, so is confusion.

It’s A Long Story Involving A Scam, An $11,000 Annual Premium And Relief (Kinda)

My endless insurance drama began in 2001, when my COBRA coverage expired from my previous newspaper job. I needed to find new coverage on the individual market as a self-employed freelance writer who didn’t have access to a guaranteed group health plan. But insurer after insurer rejected me because I had a pre-existing condition: an irregular heartbeat I’d developed in my 20s.

The condition, known as atrial fibrillation, slightly raises my risk of stroke. It also requires occasional cardiologist checkups and costs about $260 in medication each year. That was enough to make me one of the millions of people on the individual market who can’t get coverage because insurers don’t want to risk paying extra for their health problems. (I like to imagine that insurance companies ran screaming into the night when they received my applications).

I needed to find the individual insurance market’s Holy Grail — an insurer who’d take all comers, pre-existing condition or no. I discovered it through a writers’ group that sold an Aetna insurance policy, no health questions asked. But then Aetna spiked its rates, and the group found replacement insurance through a company called Employers Mutual. This did not go well.

The company turned out to be unlicensed and a scam, leaving me and 29,000 other policyholders in the lurch. Employers Mutual reportedly left tens of millions of dollars in medical claims unpaid.

Dotinga Steps 300Coverage through Cigna came next via a firm that provides coverage to members of associations representing artists, performers and writers. But in 2006, when I was 38, I faced a prohibitive increase in my monthly premium from $509 to $928.

(The Cigna rates are even worse now. My annual premium for 2013 if I bought a Cigna point-of-service plan through the same company: $3,028 a month, or $36,336 for the year, plus a $24 service fee.)

A lack of options forced me to enroll in California’s high-risk pool, and it cost me big-time. My monthly premium grew over time and by 2008 it was more than $700 a month for coverage with an annual benefit limit of $75,000 and a lifetime limit of $750,000.

As Metcalf of Consumer Reports puts it, that level of coverage is “terrible.” Indeed, a serious car accident or bout with cancer could wipe that out quickly. I worried that an expensive medical catastrophe would mean bankruptcy for me.

So I paid.

Left In The Lurch Once Again

Fast forward to the Affordable Care Act. For me, it is shaping up to be a blessing — sort of – in my case.

The health law set up a new state insurance plan for high-risk people – the California Pre-Existing Condition Insurance Plan – that offered me the opportunity to get fantastic benefits at less than half the cost of my existing coverage. But I had to go without any insurance for six months to qualify.

So I did, and I survived. But this plan, at an exceptional price of $265 a month, expired in June of this year, forcing me and residents of 16 other states into a six-month transition plan.

That brought more trouble. I’ve been paying the $287 monthly premiums for the transition plan, but a visit to the doctor’s office this month for a flu shot revealed that the feds cancelled my coverage back in August. The system seems to believe I’m eligible for Medicare. Actually, I have another 20 years. Now, I’m working through a bureaucratic maze of phone calls and emails to restore my coverage for the remainder of this year.

That’s just one spot of bother for me to resolve. There’s another: Now I need to wade through 34 insurance options from Covered California, the state’s online health insurance marketplace, which was created as a result of the health law,  and figure out which one to purchase for 2014.

Choices, Choices And More Choices

Fortunately, I live in one of the 14 states that operate their own marketplaces and don’t rely on healthcare.gov, the trouble-prone federal website. Unfortunately, the Covered California website has had its own glitches, including a buggy doctor search feature and shutdowns of the enrollment section for repairs.

So far in my efforts to enroll, which began shortly after the Oct. 1 launch, I’ve faced numerous impediments — blackouts when the site was shut down for scheduled maintenance, a disappearing enrollment section and other technical hiccups, including broken links and HTML coding problems.

Still, I’ve found the website easy to use when it’s actually working. It says 34 plans are available to me ranging in price and particulars from $263 a month for “bronze” level coverage in an exclusive provider organization to $548 a month for a “platinum” level health maintenance organization.

The “metal” levels — bronze, silver, gold and platinum — refer to the level of coverage offered by a plan. They range from platinum plans that cover an average of 90 percent of health care costs to bronze plans, which have significantly cheaper premiums but cover only 60 percent of costs and have higher deductibles. (They pay for 100 percent of costs after a policyholder reaches a set out-of-pocket spending limit.)

The state standardized the four general types of coverage levels so they share the same deductibles and co-pays, said Anthony Wright, executive director of Health Access California, a non-profit advocacy group. “This is a huge benefit for consumers because it creates a situation where people can actually make apple-to-apple comparisons, and it removes the fear of the fine print.”

34 Different Of Apples

But I’ve still got to compare 34 different apples. And it’s not just Granny Smith versus Red Delicious, even with California’s user-friendly modifications.

There are many factors to consider just to choose the best metal level. Platinum plans cover a lot with no deductible and a low, $4,000 maximum out-of-pocket expense for an individual, but they’re mighty pricey and a bad deal if I don’t need much care.

Bronze plans could save me thousands of dollars a year in premiums versus platinum plans, but they don’t cover much and have a higher out-of-pocket maximum — $6,350.

(My income is too high for me to be eligible for subsidies to reduce my premium or costs like co-pays. The Covered California website says I’d get an $11 a month subsidy if I made $45,000 in “Modified Adjusted Gross Income” a year or a whopping $207 monthly subsidy if I made $25,000.)

The Covered California website had a handy feature that asked me how much I typically spend on medical costs annually and then estimated how much I’d spend each year, per plan, on premiums and out-of-pocket costs. But that feature seems to have disappeared for the moment, along with the enrollment section.

Then there are the other factors: HMO, PPO or EPO? If I’d like an HMO, I could go with Kaiser Permanente, which insures 7 million Californians and is well-respected, but would require me to dump my current doctors. HealthNet has by far the cheapest gold-level HMO plan at $347 a month, a savings of $552 a year over the next cheapest one.

But the website’s failure to provide a working database of the physicians covered by the various plans leaves me in the dark about whether HealthNet HMOs include the doctors I’ve seen for a decade or longer.

And I know HealthNet has tried to lower costs to policyholders by sharply limiting the number of doctors who are covered by its plans. So has Blue Shield of California, which will make about half of its doctors off limits to those who buy coverage through the marketplace, the LA Times reported.

Soon, though, I should have coverage set up for 2014 that will be thousands of dollars cheaper a year than what it once was — although more than I’m paying now — and cover much more.

Who knows, maybe an insurer and I will finally start going steady.

Randy Dotinga is a freelance writer based in San Diego.

This article was reprinted from kaiserhealthnews.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.

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The $13 Test That Saved My Baby’s Life. Why Isn’t it Required For Every Newborn?

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by Michael Grabell
ProPublica

On July 10, my wife gave birth to a seemingly healthy baby boy with slate-blue eyes and peach-fuzz hair. The pregnancy was without complications. The delivery itself lasted all of 12 minutes. After a couple of days at Greenwich Hospital in Connecticut, we were packing up when a pediatric cardiologist came into the room.

We would not be going home, she told us. Our son had a narrowing of the aorta and would have to be transferred to the neonatal intensive care unit at NewYork-Presbyterian Hospital at Columbia, where he would need heart surgery.

It turned out that our son was among the first in Connecticut whose lives may have been saved by a new state law that requires all newborns to be screened for congenital heart defects.

It was just by chance that we were in Connecticut to begin with. We live in New York, where such tests will not be required until next year. But our doctors were affiliated with a hospital just over the border, where the law took effect Jan. 1.

As we later learned, congenital heart problems are the most common type of birth defect in the United States. The Centers for Disease Control and Prevention estimate that about one in 555 newborns have a critical congenital heart defect that usually requires surgery in the first year of life.

Many cases are caught in prenatal ultrasounds or routine newborn exams. But as many as 1,500 babies leave American hospitals each year with undetected critical congenital heart defects, the C.D.C. has estimated.

Typically, these babies turn blue and struggle to breathe within the first few weeks of life. They are taken to hospitals, often in poor condition, making it harder to operate on them.

By then, they may have suffered significant damage to the heart or brain. Researchers estimate that dozens of babies die each year because of undiagnosed heart problems.

The new screening is recommended by the United States Department of Health and Human Services, the American Heart Association and the American Academy of Pediatrics. Yet more than a dozen states — including populous ones like Massachusetts, Pennsylvania, Florida, Georgia, Wisconsin and Washington — do not yet require it.

The patchy adoption of the heart screening, known as the pulse oximetry test, highlights larger questions about public health and why good ideas in medicine take so long to spread and when we should legislate clinical practice.

Newborns are already screened for hearing loss and dozens of disorders using blood drawn from the heel. The heart test is even less invasive: light sensors attached to the hand and foot measure oxygen levels in the baby’s blood. This can cost as little as 52 cents per child.

Our son’s heart defect was a coarctation of the aorta, a narrowing of the body’s largest artery. This made it difficult for blood to reach the lower part of his body, which meant that the left side of his heart had to pump harder.

A: Coarctation (narrowing) of the aorta. 1:inferior caval vein, 2:right pulmonary veins, 3: right pulmonary artery, 4:superior caval vein, 5:left pulmonary artery, 6:left pulmonary veins, 7:right ventricle, 8:left ventricle, 9:main pulmonary artery, 10:Aorta.

A: Coarctation (narrowing) of the aorta. 1: inferior caval vein, 2: right pulmonary veins, 3: right pulmonary artery, 4: superior caval vein, 5: left pulmonary artery, 6:left pulmonary veins, 7: right ventricle, 8: left ventricle, 9: main pulmonary artery, 10: aorta. – Source: Wikipedia

In the hospital, though, he appeared completely healthy and normal because of an extra vessel that newborns have to help blood flow in utero. But that vessel closes shortly after birth, sometimes revealing hidden heart problems only after parents bring their babies home.

Depending on the heart defect, the onset of symptoms can be sudden.

This is what happened to Samantha Lyn Stone, who was born in Suffern, N.Y., in 2002. A photograph taken the day before she died shows a wide-eyed baby girl lying next to a stuffed giraffe. The next morning, her mother, Patti, told me, she was wiping Samantha’s face when she heard a gurgle from the baby’s chest.

Before her eyes, Samantha was turning blue. Blood began to spill from her mouth. Ms. Stone dialed 911, and minutes later, a doctor who heard the call over a radio was there performing CPR. Samantha went to one hospital and was flown to another.

But the damage was irreparable. Samantha had gone 45 minutes without oxygen: She lapsed into a coma and died six days later.

It wasn’t until several years later that Ms. Stone learned about the pulse oximetry test. “This could have saved my daughter,” she told me. “There is no parent that should ever have to go through what I went through.”

Pulse oximetry is not a costly, exotic procedure. Most hospitals already have oximeters and use them to monitor infants who suffer complications. You can buy one at Walmart for $29.88.

A recent study in New Jersey, the first state to implement the screening, estimated that the test cost $13.50 in equipment costs and nursing time. If hospitals use reusable sensors similar to those found on blood-pressure cuffs, the test could cost roughly fifty cents.

As medical technology advances, few screenings will be so cheap or simple. Recent years have seen controversy over prostate cancer and mammography screenings. Medical ethicists have to weigh the costs of each program and the agony caused by a false positive against the lives saved.

But with pulse oximetry, the false positive rate is less than 0.2 percent — lower than is seen for screenings newborns already get. The follow-up test is usually a noninvasive echocardiogram, or an ultrasound of the heart. A federal advisory committee came down in favor — three years ago.

“There’s really no question, scientifically, this is a good idea,” said Darshak Sanghavi, a pediatric cardiologist and a fellow at the Brookings Institution. “The issue is, how do we change culture?”

Opposition has taken two forms. One is from doctors who believe policy makers shouldn’t interfere with how medical professionals do their jobs. The other is from smaller hospitals, which worry about access to echocardiograms and the costs of unnecessary transfers.

These concerns can be addressed fairly easily. Nurses in New Jersey and elsewhere have been able to work the test into their normal routines. A rural hospital should already have a protocol to transfer a newborn in serious condition. If Alaska can do it, less remote states can, too.

But this is not simply a rural health care problem. Cardiologists and neonatologists I’ve spoken with said they knew of hospitals in New York City, Boston and metropolitan Atlanta that weren’t screening newborns for heart defects.

“It’s completely the luck of the draw of where you deliver,” said Annamarie Saarinen, who has pushed for the screening since her daughter narrowly avoided leaving the hospital with an undetected heart defect.

Fortunately, our son’s condition was also caught and corrected. The only lasting effects are a three-inch scar on his side and checkups with a cardiologist. He will live a normal life. He will be able to play sports and climb things he’s not supposed to.

Shouldn’t every baby have that chance?

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King County heart attack survival rate hits 57 percent

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From Public Health – Seattle & King County

The survival rate from cardiac arrest in King County has reached an all-time high of 57 percent, according to a new report released today by King County Executive Dow Constantine. Most other parts of the nation have survival rates that hover around 10 percent.

Medic one chart

“People are alive today in King County who would not have survived in most other places in the country,” said Executive Constantine. “Our EMS/Medic One system delivers rapid, high-quality critical care wherever you are.”

The Emergency Medical Services (EMS)/Medic One 2013 Annual Report highlights this achievement and other activities that place this EMS/Medic One system among the world’s best. The Executive has sent the report to the Metropolitan King County Council.

In 2012, the EMS system in King County responded to 172,700 calls to 9-1-1, including 48,010 for Advanced Life Support (ALS), the most serious or life-threatening injuries and illnesses. The average medic unit response time stayed steady at 7.5 minutes.

“Survival from cardiac arrest is the signature of quality for any EMS/Medic One system, and we continue to set the standard,” said Dr. David Fleming, Director and Health Officer for Public Health – Seattle & King County.

King County’s cardiac survival rate has increased from an above-average 27 percent in 2002 to 57 percent today. (Note to editors: graphic showing increases in King County cardiac survival rates is attached.)

The King County EMS/Medic One system is managed by the Emergency Medical Services Division of Public Health – Seattle & King County, and relies on a close partnership of thousands of professionals with fire departments, paramedic agencies, EMS dispatch centers, and hospitals to provide emergency care and save lives.

The full EMS 2013 Annual Report is available at www.kingcounty.gov/health/ems.

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Lifestyle changes can lower heart attack, stroke risk in patients with coronary artery disease

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Salad in BowlBy Sarah Jorgenson, HBNS Contributing Writer
Research Source: American Journal of Preventive Medicine

Lifestyle modification programs that addressed at least two health behaviors lowered the risk of a fatal heart attack or stroke in people with coronary heart disease, finds a new systematic review in the American Journal of Preventive Medicine.

In a meta-analysis of nine studies, with population sample sizes ranging from 57 to 1,621 patients, the researchers found an 18 percent reduction in the risk of death from coronary heart disease in people who participated in healthy lifestyle programs while receiving standard care versus people who received standard care alone.

“When you look at healthy lifestyles, you should be comprehensive in doing it because it is not enough to quit smoking if you have very bad dietary habits. So, the combination of lifestyle interventions could be more beneficial,” said lead author Chiara de Waure, M.D., M.Sc., an assistant professor at the Institute of Public Health at the Catholic University of Sacred Heart in Rome, Italy.

Studies varied in program duration with follow-up periods from one to nineteen years. All of the lifestyle intervention programs included diet and nutrition advice and exercise advice or sessions. A number of the studies also provided smoking cessation advice or programs, while other studies also included stress management.

“These interventions that the authors discuss may also subsequently reduce the risk of cancer, respiratory disease, and diabetes, among other chronic diseases…If anything, they were likely to underestimate the potential benefit of lifestyle change in terms of chronic disease,” commented Barry Franklin, Ph.D., professor of physiology at Wayne State University School of Medicine and director of the cardiac rehabilitation program and exercise laboratories at William Beaumont Hospital in Royal Oak, Michigan.

Franklin added, “The study reiterates that the first line of defense for heart disease, that is, the most proximal risk factors, involves addressing poor diet, physical inactivity and cigarette smoking.”

Researchers found an 18 percent reduction in the risk of death from coronary heart disease in people who participated in healthy lifestyle program.

The review finds that lifestyle interventions are effective even in patients with established coronary heart disease, whether they had symptoms or not, and may lower the risk of non-fatal heart attack and stroke and hospital readmission.

“Sometimes when a patient develops a disease, he may think that his world is over, that there is no way to improve through lifestyles because he has already had the event, but we are showing that healthy lifestyles continue to be important even after the onset of disease,” said de Waure.
Health Behavior News Service is part of the Center for Advancing Health

The Health Behavior News Service disseminates news stories on the latest findings from peer-reviewed research journals. HBNS covers both new studies and systematic reviews of studies on (1) the effects of behavior on health, (2) health disparities data and (3) patient engagement research. The goal of HBNS stories is to present the facts for readers to understand and use for themselves to make informed choices about health and health care.

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This Father’s Day, give your heart a checkup — CDC

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From the Centers for Disease Control and Prevention

HeartHeart disease does not discriminate. It is the leading cause of death for men of most racial and ethnic groups in the United States, including African Americans, American Indians and Alaska Natives, Hispanics, and whites.

For Asian American men, heart disease is second only to cancer among the leading causes of death.

A man’s risk for heart disease begins to rise greatly starting at 45 years of age.

Half of the men who die suddenly of coronary heart disease—the most common kind of heart disease—have no previous symptoms.

Even men who have no symptoms may be at risk.

The good news is that heart disease deaths have been falling steadily over the past few decades. With Father’s Day around the corner, it is a great time for all men to consider what they can do to lower their own risk for heart disease, for themselves and for their loved ones. What better time to start than now?

What are the symptoms of a heart attack?

The five major symptoms of a heart attack are—

  • Pain or discomfort in the jaw, neck, or back.
  • Feeling weak, light-headed, or faint.
  • Chest pain or discomfort.
  • Pain or discomfort in arms or shoulder.
  • Shortness of breath.

A person’s chances of surviving a heart attack increase greatly if the victim receives treatment quickly. Recognizing the signs of a heart attack will help you act fast and call 9–1–1 during a real emergency

Who’s at risk for heart disease?

Anyone—male and female, young and old, of any race/ethnicity—can develop heart disease. Several medical conditions and lifestyle choices can put people at a higher risk, including—

  • Diabetes.
  • Overweight and obesity.
  • Unhealthy diet.
  • Physical inactivity.
  • Alcohol overuse.

You can help prevent heart disease by making healthy choices and managing any medical conditions you may have.

Start reducing your risk today

There are many good reasons to lower your risk of heart disease. Following these steps will put you well on your way to leading a longer, healthier life and enjoying the benefits of heart health for years to come.

Eat a healthy diet. Fresh fruits and vegetables are especially abundant during the summer. Be sure to eat plenty of them—adults should have at least 5 servings each day.

Eating foods low in saturated fat, trans fat, and cholesterol and high in fiber can help prevent high cholesterol. When grilling, remember healthy meat alternatives, such as fish.

Limiting salt or sodium in your diet also can lower your blood pressure. For more information on healthy diet and nutrition, visit CDC’s Division of Nutrition, Physical Activity, and Obesity Web site or ChooseMyPlate.gov.

  • Maintain a healthy weight. Being overweight or obese can increase your risk for heart disease. To determine whether your weight is in a healthy range, doctors often calculate a number called thebody mass index (BMI). If you know your weight and height, you can calculate your BMI at CDC’s Assessing Your Weight Web page.
  • Exercise regularly. The summer is a good time to get active with family and friends. Physical activity can help you maintain a healthy weight and lower cholesterol and blood pressure. The Surgeon General recommends that adults should engage in moderate exercise for 2 hours and 30 minutes every week. Walk, go for a hike or a bike ride, or head to the local pool for a swim. For more information, seeCDC’s Division of Nutrition, Physical Activity, and Obesity Web site.
  • Monitor your blood pressure. High blood pressure often has no symptoms, so be sure to check it on a regular basis. You can check your blood pressure at home, at a local pharmacy, or at a doctor’s office. Find more information at CDC’s High Blood Pressure Web site.
  • Don’t smoke. Cigarette smoking greatly increases your risk for heart disease. If you don’t smoke, don’t start. If you do smoke, quit as soon as possible. Your doctor can suggest ways to help you quit. For more information about tobacco use and quitting, visit CDC’s Smoking & Tobacco Use Web site and Smokefree.gov.
  • Limit alcohol use. Avoid drinking too much alcohol, which can increase your blood pressure. Men should have no more than two drinks per day (and one per day for women). For more information, visit CDC’s Alcohol and Public Health Web site.
  • Have your cholesterol checked. Your health care provider should test your cholesterol levels at least once every 5 years. Talk with your doctor about this simple blood test. You can find out more from CDC’s Cholesterol Web site.
  • Manage your diabetes. If you have diabetes, monitor your blood sugar levels closely, and talk with your health care team about treatment options. Visit CDC’s Diabetes Public Health Resource for more information.
  • Take your medicine. If you’re taking medication to treat high blood pressure, high cholesterol, or diabetes, follow your doctor’s instructions carefully. Always ask questions if you don’t understand something. Your pharmacist can help if you have questions about taking your medication or about side effects.

More Information

References

  1. Kochanek KD, Xu JQ, Murphy SL, Miniño AM, Kung HC. Deaths: final data for 2009.  [PDF - 3.12MB] National Vital Statistics Reports. 2011;60(3).
  2. Heron M. Deaths: leading causes for 2009  [PDF - 2.56MB]. National Vital Statistics Reports. 2012;61(7).
  3. Go AS, Mozaffarian D, Roger VL, Benjamin EJ, Berry JD, Borden WB, et al. Heart disease and stroke statistics—2013 update: a report from the American Heart Association. Circulation.2013;127:e6–245.
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Should smokers have to pay more for health insurance?

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Cigarette thumbBy Martha Bebinger, WBUR

You’ve heard all the campaigns and statistics: Smoking Kills. It’s the leading cause of preventable death in the U.S. And it’s expensive.

The Centers for Disease Control and Prevention says smoking costs the country $193 billion a year in lost productivity and health care spending. Add another $10 billion for secondhand smoking expenses.

That’s why the federal Affordable Care Act permits insurers to charge smokers up to 50 percent more for coverage than non-smokers.

So, says Jon Hurst, president of the Retailers Association of Massachusetts, why not ask smokers to pay more for health insurance?

“If we’re ever going to control costs, we’ve got to make sure that we don’t over-socialize the system,” Hurst says. ”In other words, we don’t make people pay too much for somebody else’s health care costs.”

Fifty percent more for smokers might be too much, continues Hurst, “but let’s not dismiss outright, the ability for employers to try to incent people to get healthier.”

The debate about whether smokers should pay more for health insurance has created unusual alliances. Tobacco companies are working alongside cancer societies and consumer groups to persuade states they should reject higher charges for smokers.

“First of all there is very little evidence that financial incentives or disincentives through premiums change behavior,” says Amy Whitcomb Slemmer, executive director at Health Care for All, a Massachusetts group that advocates for affordable health care access.

Health Care for All and the group’s allies in the public health world routinely support higher taxes for smokers. But Whitcomb Slemmer says higher insurance premiums could lead many smokers to drop their coverage.

“We were concerned that more would pay the penalty to not be insured,” Whitcomb Slemmer continues. “And, specifically, we’d be concerned that they (smokers) wouldn’t have access to what has been demonstrated to be very effective smoking cessation programming.”

In Massachusetts, Vermont, Rhode Island and the District of Columbia, this public health perspective has won the debate, for now. Insurers will not be allowed to add a surcharge for smokers. California is moving in the same direction.

But aides to Massachusetts Gov. Deval Patrick says he’s open to allowing the surcharge in the future — if insurers find accurate ways to determine who smokes and who doesn’t.

The largest insurers in the Bay State are mostly on the sidelines in this controversy. Here’s one reason why: They’ve had the option of hiking premiums for smokers since the state passed its landmark health care act in 2006, and they haven’t done it.

“We try to moderate premiums for the entire market, not seek to target particular populations or individuals because of certain behaviors,” says Eric Linzer, senior vice president at the Massachusetts Association of Health Plans.

The Massachusetts legislature will likely need to amend state law so that a ban on higher charges for smokers takes effect.

And just to make things a little more complicated — it won’t apply to everyone. Large employers, who are self-insured and follow federal insurance rules, will be able to target smokers, if they choose.

This story is part of a partnership that includes WBURNPR and Kaiser Health News. 

This article was reprinted from kaiserhealthnews.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.

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Heart smarts for women

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A Consumer Update from the US Food and Drug Administration

HeartMore women die from heart disease than from any other cause. In fact, one in four women in the United States dies from heart disease, according to the National Heart, Lung and Blood Institute (NHLBI).

“The risk of heart disease increases for everyone as they age,” says cardiologist Shari Targum, M.D., a medical officer at the Food and Drug Administration (FDA). “For women, the risk goes up after menopause, but younger women can also develop heart disease.”

FDA offers many resources to help educate women of all ages about the safe use of FDA-approved drugs and devices for the treatment and prevention of heart disease.

FDA has fact sheets, videos, and other web-based tools on heart disease and conditions like diabetes and high blood pressure that may increase a woman’s risk for heart disease.

FDA created the “Heart Health for Women” site to connect women to FDA resources to support heart-healthy living. Visit the website at: www.fda.gov/womenshearthealth

“I encourage women of all ages to look to FDA for resources to help them reduce their risk for heart disease and make informed decisions about their health,” says Marsha Henderson, director of the Office of Women’s Health at FDA.

Heart Health for Women

When you think about heart disease, you probably imagine heart attacks and chest pain. But women need to know that heart health is about more than just heart attacks. Women need to take steps to reduce their risk for heart disease:

  • Learn to recognize the symptoms of a heart attack in women, including nausea, anxiety, an ache or feeling of tightness in the chest, and pain in the upper body.
  • Use the Nutrition Label to make heart-healthy food choices.
  • Daily use of aspirin is not right for everyone. Talk with a health care professional before you use aspirin as a way to prevent heart attacks.
  • Talk to a health professional about whether you can participate in a clinical trial for a heart medication or procedure. Visit the FDA Patient Network to learn more about clinical trials.

Menopause and Heart Health

“Menopause does not cause heart disease,” says Targum. “But the decline in estrogen after menopause may be one of several factors in the increase in heart disease risk.” Other risks, such as weight gain, may also increase around the time of menopause.

Hormone therapy is used to treat some of the problems women have during menopause. “However, the American Heart Association recommends against using post-menopausal estrogen hormone replacement therapy to prevent heart disease,” says Targum.

Make a Plan, Take Action

Work with your health care team to make a plan for your heart health. Whatever your regimen, make sure to keep a list of your medicines and bring it with you to all of your appointments. Download a medication booklet and visit the FDA website for updates on medicine, nutrition and more.

This article appears on www.fda.gov/ForConsumers/ConsumerUpdates/default.htm FDA’s Consumer Updates page, which features the latest on all FDA-regulated products.

May 23, 2013

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5 tips for raising heart-healthy kids and teens

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Heart

For Valentine’s Day and  National Heart Month, five Seattle Children’s providers share their tips for helping kids and teens build strong, healthy hearts.

Make a heart-healthy resolution for your family this February:

1. Protect young athletes with pre-sport heart screenings

“We’ve all heard stories in the news – the sudden death of a young, competitive athlete due to undetected cardiovascular disease,” says Jack Salerno, MD, director of electrophysiology and pacing services at Seattle Children’s. “It’s every parent’s worst nightmare. One minute your seemingly healthy child is on top of the world competing in a sport they love. The next minute their heart suddenly stops.”

Salerno says parents can help protect their young athletes from sudden cardiac arrest by learning about potential “red flags” before their kids begin competing in sports. “It’s important for student athletes and their parents to work hand-in-hand with physicians to detect any potential risks before the sports season begins.”

The American Heart Association recommends that kids and teens be screened against a 12-point checklist that includes a review of the athlete’s personal and family medical history, and a physical exam by a doctor. The medical history review looks for risk factors like chest pain, elevated blood pressure and unexplained fainting, as well as any family history of heart disease. “

A positive response to one or more items on the checklist could trigger further testing, including an electrocardiogram,” Salerno says.

Salerno is on the medical board for the Nick of Time Foundation, which provides free heart screenings at schools in western Washington. The foundation was started by the family of a 16-year-old football player who died of sudden cardiac arrest in 2004.

2. Help kids eat a heart-healthy diet

Elevated cholesterol is one of many risk factors for heart disease, but sifting through all the information and recommendations can be overwhelming.

Aaron Owens, clinical pediatric dietitian at Seattle Children’s, says now is the time for parents to help their kids develop heart-healthy habits when it comes to food. The trick, she says, is knowing how to read a nutrition label:

  • Know your cholesterols. Only animal products, like meat, egg yolks and dairy products, contain cholesterol. LDL, or low-density lipoprotein cholesterol, is known as “bad” cholesterol. High levels of LDL increase the risk of heart disease. HDL, or high-density lipoprotein cholesterol, is the good kind, and can help protect against heart disease. Just remember, “Low you want low” and “high you want high.”
  • Substitute unsaturated fats for saturated fats. Saturated fats are primarily found in meat and dairy products, as well as tropical oils like coconut and palm oils. Saturated fats can increase LDL, so limit them in your kids’ diets. Unsaturated fats, on the other hand, can help increase HDL, so use them in place of saturated fats when you can. Unsaturated fats are found in nuts, avocados and oils like olive and canola.
  • Limit processed foods. Processed foods, like crackers and doughnuts, contain hydrogenated oils and are high in trans fats that can increase LDL. Trans fats are especially bad for hearts, and should be avoided when possible.
  • Add fiber-rich foods. Fiber is a must-have for heart-healthy diets. Soluble fiber binds to LDL cholesterol and helps flush it out of the body. You can add oats, beans and lentils to your kids’ diets to help increase their fiber levels.

“A heart-healthy diet includes lean meats, fruits, vegetables, low-fat dairy products and whole grains,” Owens says. “If a food has a label, check to make sure that any fats are the unsaturated kind.”

3. Encourage ‘active play every day’

“Anything that gets the heart rate up – even a little bit – is good for the heart!” says Mollie Grow, MD, MPH, a pediatrician at Seattle Children’s, and the daughter of a cardiologist. “My motto for young children is ‘active play every day.’ Kids naturally love to play and we can teach them from a young age how to enjoy being active.”

Being active on a regular basis helps strengthen our hearts, Grow explains. Stronger hearts pump blood more efficiently, which can help lower blood pressure.

Grow offers five simple tips parents can use to help their kids develop a love of activity:

  1. Be your kid’s playmate. Kids are more active if they have people to be active with, so plan family activities like walking to the park, bike riding, playing tag, or dancing. Simple games are often the most fun, Grow says.
  2. Get outdoors. Outdoor activity is a great way for kids to stay active, and most kids don’t get enough outdoor playtime on a regular basis. Make it your goal to get outside once a day, and don’t let cold weather deter you. Grow suggests searching used clothing stores for rain suits and boots so the whole family can be comfortable outside.
  3. Add to your indoor repertoire. Create a list of go-to indoor activities, like dancing or tossing a ball, to keep your kids engaged. Brainstorm with other parents or browse local parenting blogs and magazines for indoor play areas. For instance, says Grow, many community centers offer open gyms and toddler play zones.
  4. Plan for it. Set aside dedicated time for play in the evenings and on weekends when families are together. Sign up for structured activities that your kids enjoy, like swim or karate lessons.
  5. Look for “activity opportunities.” Grow suggests building in “little bits of activity” throughout the day, whether it’s taking the stairs at the mall, walking your kids to school, or taking an evening walk to the grocery store rather than driving. “It’s so true that when it comes to activity, everything counts,” Grow says.

4. Talk to your teens about the dangers of smoking

The health risks associated with tobacco – including heart disease – are well documented. The good news for parents is that teens’ tobacco use has decreased significantly in recent years, from a high of 39 percent of U.S. teens smoking cigarettes in 1976, to a low of 19 percent in 2012.

However, parents still need to make sure their teens are aware of the dangers of smoking, says Leslie Walker, MD, chief of Seattle Children’s adolescent medicine division.

Walker says one concerning trend is the increased use of hookahs, or water pipes, for smoking tobacco. In fact, it’s the only type of tobacco use that’s increased in recent years among teens.

“Teens may perceive this as a healthier, tastier and more social way to ingest tobacco,” says Walker. “But hookahs still deliver the same addictive nicotine and toxins as cigarettes, and there is no regulation or quality control of what is actually being smoked.”

In addition to increased risks for cancer and other infectious diseases, the Centers for Disease Control and Prevention warn that hookah smokers may take in higher concentrations of the toxins found in cigarette smoke – toxins that are known to clog arteries and cause heart disease.

If you know or suspect your teen is smoking, Walker recommends beginning by asking questions, listening, and sharing basic facts about tobacco. She also encourages parents to set family rules about drug and alcohol use, and make sure teens are aware of expectations and consequences.

“It’s essential for parents to keep lines of communication open with their children throughout the teen years,” Walker says. “Parents are the primary influence on teenagers’ behavior, even if it doesn’t seem that way.”

5. Express your love and gratitude

Valentine’s Day is a great opportunity for parents to write a love note to their kids, says Cora Breuner, MD, MPH, of Seattle Children’s orthopedics and sports medicine and adolescent medicine divisions. For a different kind of heart health, parents can model an attitude of gratitude in their family.

“Valentine’s Day is a reminder that we have hearts, which can be filled with tenderness and love, especially for our children,” Breuner says. She encourages parents to use Valentine’s Day to start a practice of intentionally expressing love and gratitude to their kids. It doesn’t need to be a big gesture; a simple sentiment can mean a lot to a child, she says.

“I like to write ten ‘gratitudes’ to my kids,” Breuner says. For instance, “You like my cooking despite the fact that it usually involves pasta and pesto. You empty the dishwasher even when I don’t ask you. You like to snuggle with our dog. You have a wonderful smile.”

Parenting can be a challenge, and Breuner says it’s important for parents to let their kids know they’re proud of them.

“When we take pen to paper or even fingers to text, we take a feeling and put it into words,” Breuner says. “When we write them down, feelings become real and tangible, thoughtful and strong. And sometimes sharp anger can change to soft love, resentment to forgiveness and bitterness to compassion.”

This article first appeared on the Seattle Children’s On the Pulse webpage.

Additional resources for parents:

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