Heart Health in 2018

The nation's largest killer will be met by multiple technological innovations

Heart disease is the leading cause of death in the United States for both men and women. Fortunately, it’s also one of the most preventable.

Since February is Heart Health Month, it’s a good time to learn about the strategies that are available in the new year for preventing heart disease and encouraging those around you to have their hearts checked and commit to heart-healthy lives.

On October 25, Cleveland Clinic announced the Top 10 Medical Innovations of 2018 at a multimedia presentation during its Medical Innovation Summit. Among those innovations were medications that lower the low-density lipoprotein (“LDL”) cholesterol — better known as bad cholesterol — which brings about fatty deposits that can clog arteries. With certain new drug combinations, LDL levels are reduced by 75 percent.

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According to Cleveland Clinic, a number of trials have been in progress recently testing this theory. So far, the floor has yet to be found.


DID YOU KNOW?

The United Health Foundation reported in December 2017 that cardiovascular deaths were up 2 percent from 2015 and have been identified as one of the fastest-growing health problems in the U.S. In a report they presented, Louisiana ranked in the bottom 10 for the most cardiovascular deaths, citing obesity as a leading risk factor.


New studies reported a 20 percent reduction in the risk of cardiovascular death, myocardial infarction or stroke for patients who took statins combined with a new class of cholesterol-lowering drugs (PCSK9 inhibitors) to reach ultra-low LDL levels.

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“About 20 years ago, we found the bad cholesterol gene and out of that came the human genome project and then the PCSK9 medication which is an antibody that breaks down LDL,” explained Touro Infirmary cardiologist Dr. Frank Wilklow. “The patient gets one injection every two weeks. It’s a great medication — the first to show regression of plaque. While it’s expensive, it’s covered by insurance and it’s optimal for people that don’t have a lot of options.”

Wilklow said he was excited that doctors now have a tool to fight LDL cholesterol.

“Additionally, there is a new medication, Entresto, for the treatment of heart failure,” he said. “It’s really helpful in treating congestive heart failure by aiding in getting rid of the excess fluid. It takes the place of a diuretic.”

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With over 400,000 coronary disease deaths every year and 102 million Americans living with high cholesterol levels, these new medications could make a real difference in 2018.

Also introduced at the Cleveland Clinic summit was the idea of expanding the healthcare environment into the patient’s home and removing geographic barriers to care. The intended result would be quicker, more efficient and more optimal outcomes, as well as significant cost savings. Distance health technologies (known more commonly as telehealth) are part of these efforts as it can enable care for both the physically challenged and those most susceptible to infection.


WHAT'S YOUR RISK?

It depends on where you live.

According to a study, published Nov. 9 in the American Journal of Preventive Medicine, a person’s risk of developing heart disease depends on biological factors, such as their age and gender, but it also tends to vary based on where they live. The new study estimated the risk of heart disease for people in each U.S. state.

Researchers at the Centers for Disease Control and Prevention looked at medical data of nearly 300,000 people ages 30 to 74 to estimate someone’s risk of developing heart disease over the next 10 years. The risk was calculated by looking at a number of factors, including high blood pressure and cholesterol, smoking habits, obesity and low consumption of fruits and vegetables.

The results showed a remarkable variation across states. Those with a higher heart disease risk tended to live in the Southeastern states, and people with a lower risk tended to live in Northwestern states.

The study also found:

14.6% of men and 7.5% of women will develop heart disease over the next 10 years.

For men, the risk ranged from a low of 13.2 percent in Utah to a high of 16.2 percent in Louisiana.

For women, Minnesota had the lowest risk, with 6.3 percent and the risk was highest in Mississippi, with 8.7 percent.


The summit reported that 90 percent of healthcare executives said they have, or are currently building, a telehealth program. Seven million patient users are expected in 2018.

These technologies are also expanding beyond the simple two-way video platform. More patients are now equipped with attachable devices that record and report medical information to doctors to monitor their condition. Over 19 million patients are projected to use these remote monitoring devices in 2018.

“Technological advancements in cardiovascular care continue to rise with the use of telecardiology, new devices and procedures and new methods of treatment,” said Dr. Chris Paris, interventional cardiologist at Cardiovascular Institute of the South (CIS). “In 2018, we plan to continue to grow our Virtual Care Center, which offers a 24/7 on-demand call center, at-home monitoring and CardioConnect, a patient portal and mobile app that gives patients secure access to their health record at their fingertips.”

Dr. Robert Drennan, electrophysiologist at CIS, was the first physician in South Louisiana to implant the Confirm Rx™ Insertable Cardiac Monitor, the world’s first implantable cardiac monitor with Bluetooth wireless technology.  Drennan first implanted the device on Dec. 12, 2017, during a minimally invasive procedure in the electrophysiology lab.

The Confirm Rx cardiac monitor is the first and only system of its kind used to monitor patients who experience unexplained symptoms such as dizziness, chest pain and shortness of breath. The system is also used to diagnose and evaluate conditions such as arrhythmias and atrial fibrillation. Its Bluetooth technology allows for remote monitoring through a patient’s smartphone, eliminating the need for a traditional radio frequency-based bedside transmitter, which can be intrusive and cumbersome, and limits mobility. Through the myMerlin smartphone app, patients are informed of successful device checks and clinic-scheduled transmissions without interrupting their daily lives.

“In the past, if we had a patient that was passing out or getting dizzy for example, we would put a halter device on to monitor them for 24 hours,” Wilklow said. “Within the last year, the technology has emerged where we can inject a chip under a patient’s skin, it lasts for five years, and it will continuously monitor them.”

The monitoring is done via an iPhone app and the information is sent to physicians immediately. “Because of this technology we have been able to find so much information that we would have never found before,” said Wilklow, “like strange arrhythmias.”

Wilklow added that over the last year all ICD and pacemakers have become MRI compatible. “A study conducted last year showed that 75 percent of the population will have an MRI sometime in their lifetime,” he said, “and if you had a pacemaker in the past that was a real issue — you could not have an MRI. That was obviously a problem, so there has been a rapid transition to progress and make this technology available.”

According to Christy Kareokowsky, director of West Jefferson General Hospital’s Cardiac Service Line, the new generation of heart healthcare is about innovative machines and what they can do for the patients.

“The newest technologies, for example, with an ECHO machine allow the doctors to see and view things much clearer and more precise,” she said. “They can make a faster and more accurate diagnosis. The technologies also offer better communication between the doctors so they can easily communicate findings, which in turn enhances overall patient safety and satisfaction. We can now do hand-held echocardiograms, for example, which can be much quicker and less expensive.”


RECAP

Heart Care at Ochsner

2017 was a big year for the John Ochsner Heart and Vascular Institute (JOHVI), home to more than 50 cardiologists providing care at multiple locations throughout New Orleans, Baton Rouge, Kenner, the river parishes, North Shore and bayou regions. 

69th Left Ventricular Assist Device (LVAD) implantation in December

LVADs are devices that help advanced heart failure patients who can no longer rely on earlier stage treatment options.

Became first and only facility to implant HeartMate 3™ LVAD in Louisiana and Mississippi in October

JOHVI became the first facility in Louisiana and Mississippi to implant the HeartMate 3™ LVAD. The device is the latest LVAD design for patients awaiting transplant or experiencing advanced heart failure. The first patients included a 77-year-old and a 16-year-old — both are home and recovering well.

950th Heart Transplant in November

JOHVI performed the first heart transplant in the Gulf South in 1970 and performs approximately 25 transplants every year, making it one of the most experienced heart transplant centers in the country.

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