You and your cardiologist

Researchers at Harvard have released the following information – Advanced heart failure patients die less frequently when their cardiologists are away at cardiology conferences. Below is from Harvard:

High-risk patients with certain acute heart conditions are more likely to survive than other similar patients if they are admitted to the hospital during national cardiology meetings, when many cardiologists are away from their regular practices.

Sixty percent of patients with cardiac arrest who were admitted to a teaching hospital during the days when cardiologists were at scientific meetings died within 30 days, compared to 70 percent of patients who were admitted on non-meeting days.

That’s a tremendous reduction in mortality, better than most of the medical interventions that exist to treat these conditions,” said study senior author Anupam Jena, assistant professor of health care policy at HMS, internist at Massachusetts General Hospital and faculty research fellow at the National Bureau of Economic Research. There is substantial ambiguity in how medical care is practiced, particularly for these complex patients, he said. “This study may help illuminate some of those gray areas and suggest ways we can provide better care for those high-risk patients.”

The results of the study are published today in JAMA Internal Medicine.

Along with collaborators at the National Institutes of Health, the Leonard D. Schaeffer Center for Health Policy and Economics at the University of Southern California, Los Angeles, and the RAND Corporation, Jena compared similar populations of patients treated at teaching and nonteaching hospitals during American Heart Association and American College of Cardiology meetings and on matched dates immediately surrounding those meetings. They looked at survival rates of high-risk and low-risk patients with heart failure, heart attack and cardiac arrest.

While survival rates at teaching hospitals went up during meetings for high-risk heart failure and for cardiac arrest, there was no difference in mortality between meeting and non-meeting dates for patients with high-risk heart attack or for low-risk patients with any of the conditions studied. There was also no change in mortality rates for any patients for any of the conditions in nonteaching hospitals.

“We don’t have the full set of answers about what works best in these cases, but the evidence suggests that a less is more approach might be best for higher-risk patients with these conditions,” Jena said.

The researchers found that certain intensive procedures were performed less often on the high-risk patients in the study during meeting dates than outside meeting dates.

One explanation for these findings, the researchers said, is that physicians who don’t attend the conferences take a more conservative approach for high-risk patients; another is that the physicians who stayed behind were reluctant to perform intensive procedures on another physician’s patients while that doctor was out of town. Survival rates might be higher because, for high-risk patients with cardiovascular disease, the harms of intensive procedures may unexpectedly outweigh the benefits.

High-risk patients are typically older people with complicated medical histories and clinical profiles that make them especially vulnerable to the illnesses studied and, perhaps, to some of the more intensive methods used to treat these conditions.

Do it yourself Cardiology?

In caring for my patients, I see the heart in three dimensions, for preservation of the heart health, prevention of heart disease, and reversal of chronic disease.

Spiritual Dimension
How the soul and the spirit nurtures the heart and keeps it open and blooming.

Enterohepatic Oxygen Dimension
How the health of the bowel and liver supports oxygen’s energetic, developmental, detox, and detergent functions

Endo Integrity Dimension
How the inner lining cells of blood vessels called endothelium (endo for short) maintains the heart’s health and plugs any leaks in it rapidly.

The first spiritual dimension concerns—through dissolution of anger and hostility—the preservation and restoration of the functions of the autonomic nervous system, which regulates the heart rate, rythm, and strength, as well as maintains normal blood pressure. In my view, this is the single most important aspect of coronary artery disease (CAD).

The second enterohepatic oxygen homeostasis dimension concerns the restoration of the health of the circulating blood. The integrity of the bowel and liver ecosystems is crucial to oxygen homeostasis and the health of the circulating blood. The third endo integrity dimension concerns the restoration of the endothelial structure and function, with subsequent normalization of the structural and functional aspects of subendothelial stroma and muscularis.

This is a radically different from the way it is discerned in the prevailing pharmacologic blockade and interventional cardiology modes. An effective program for physical fitness and optimal choices in the kitchen are critical for success in prevention and reversal of coronary artery disease.

Those issues cannot be separated from the three dynamics of seeing the heart identified above. In the United States today, blocker drugs, stents, and bypass procedures are promoted as the primary therapies for coronary artery disease. With rare exceptions, only lip service is paid to the need for protecting the heart from the baneful effects of anger, oxidized and denatured foods, and physical inactivity. The true strength of the sun-soil model is that it clearly and unequivocally shows the serious error of accepting blocker drugs and coronary stents/bypasses as the primary treatment options. Needless to say, neither blocker drugs nor revascularization procedures address any of the true underlying causes of coronary artery disease.

The three essentials of seeing the heart, seen in light of the Sun-Soil Model of Heart Disease:
In the Sun-Soil Model of Disease, the bowel ecosystem along with the liver and blood ecosystems, represents the “soil-roots unit” of the body—the base of the trio of ecosystems of the body. In integrative medicine, it is essential to have a clear understanding: (1) of the discipline of ecosystem-based toxicology; (2) for assessing health and designing rational and holistic management plans; and (3) for detecting and controlling allergic and immune disorders. For instance, it is critically important not to ignore chronic insidious infections in the oral cavity, urinary tract, and the reproductive systems. The notion of ecosystem-based toxicology might strike gastroenterologists as fanciful, if not an irksome. But it requires careful consideration in view of: (1) progressive chemicalization of human environment; (2) incremental load of toxic species—pesticides, antibiotics, xenobiotics, and others—in the human gut; and (3) deep frustration arising from ongoing suffering.

The three essentials of seeing the heart are also as relevant to the management of hypertension and its sequelae, myocarditis, cardiomyopathy, and other chronic acquired disorders of the heart as they are to coronary artery disease. Some of my statement in this and other tutorials in this course may seem too simplistic or too sweeping to be of practical value.

New or acute chest symptoms may or may not indicate the presence of a heart problem. One needs an experienced doctor to make that determination and prescribe treatment for it. One cannot be one’s own cardiologist under these conditions.

The second episode of chest symptoms after a negative cardiology evaluation may or may not indicate the presence of a heart problem. Again one needs an experienced doctor to make the diagnosis and treat it appropriately.

Shared Responsibility

The recurrence of similar chest symptoms after that creates an option of a different design: responsibility shared between the doctor and the patient. The doctor continues to treat the problem while the patient can become his assistant, an individual who is willing and able to assume the responsibility of preventing future symptoms. She or he can learn about the nature of the problem, detect the triggers that cause the symptoms, and take simple steps to avoid recurrences of symptoms. This is what I call being one’s own doctor—cardiologist in the current context. It can take several weeks to several months. If the above path of shared responsibility is chosen, I suggest a program of learning from the free video encyclopedia of natural healing offered by Ali Academy.

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