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Women At Higher Risk Of Having A Stroke With Afib

You don’t want this…

When it comes to the risk of stroke in atrial fibrillation, it pays to be a boy. Sorry, ladies.

An important question came up on my recent post on AF and stroke.

Why does being female give you an automatic point on CHADS2-VASc?  I keep seeing it, but I don’t see why that is.

It doesn’t seem intuitive that female AF patients should have more strokes. Why? AF should equal AF.

But it does matter. When it comes to AF and stroke, women are very different.

Here are three references that support the fact that female gender increases the risk of stroke in AF.

–First: Read more »

*This blog post was originally published at Dr John M*

Atrial Fibrillation: 3 Notable Studies, 3 Important Questions

In treating atrial fibrillation (AF), this year has witnessed some real excitement. And not all the good news has to do with new pills. Recently, there has been a flurry of encouraging and objective news on ablating AF. Here are some comments on three notable studies that address three important questions:

1. What are the “long-term” success rates of AF ablation? 

On this important question comes an American Heart Association (AHA) abstract from the highly-regarded lab of Dr. Karl-Heinz Kuck in Hamburg. They report on a relatively young cohort of 161 patients who underwent AF ablation (using standard pulmonary vein isolation techniques) in 2003-2004. At an average of five years of follow up, more than 80 percent were either AF-free or “clinically improved.”

Real-world impression: Although late recurrences of AF years after successful ablation have been reported, my impression (having started with AF ablation in 2004) is that most who are AF-free off drugs after one year have remained AF-free thus far. Read more »

*This blog post was originally published at Dr John M*

Sex And Your Defibrillator

Have a defibrillator and feel like getting frisky? For the first time that I can recall, there’s a very helpful article published in Circulation addresses the concerns of implantable cardiac defibrillator (ICD) patients and sexual activity. There’s all kinds of helpful tidbits, like this one:

A study of 1,774 patients who had experienced an acute myocardial infarction showed that sexual activity was a likely contributor in fewer than 1 percent of cases. In fact, regular physical exertion, such as that associated with sexual activity, was associated with a decreased risk of cardiac events in patients.

Now that’s helpful!

Recall that defibrillators are designed to detect rapid, potentially life-threatening arrhythmias. Most of the time, sexual activity does not lead to heart rates at a level that ICD’s would consider elevated during intercourse. (This, of course is patient specific). While your doctor can tell you the rate cut-off at which your ICD might possibly fire, watching your heart rate rise with a monitor during those moments might be a bit of a, shall we say, turn-off. Read more »

*This blog post was originally published at Dr. Wes*

Is Red Meat Hazardous To Your Health?

Red meat consumption has been linked to diabetes, cardiovascular disease, and several types of cancer (breast, colorectal, stomach, bladder, prostate, and lymphoma).

There are plausible mechanisms: Meat is a source of carcinogens, iron that may increase oxidative damage, and saturated fat. But correlation and plausibility are not enough to establish causation.

Is red meat really dangerous? If so, how great is the risk? A couple of recent studies have tried to shed light on these questions, but they have raised more questions than they have answered. Read more »

*This blog post was originally published at Science-Based Medicine*

How Much Does A Heart Attack Cost?

Money HeartHow much would a heart attack cost you? Quite a bit, according to CBS

According to an article from the National Business Group on Health, the average total [editor's note: lifetime] cost of a severe heart attack -– including direct and indirect costs -– is about $1 million. Direct [lifetime] costs include charges for hospitals, doctors and prescription drugs, while indirect costs include lost productivity and time away from work. The average [lifetime] cost of a less-severe heart attack is about $760,000. Amortized over 20 years, that’s $50,000 per year for a severe heart attack and $38,000 per year for a less-severe heart attack.

I’m all for maintaining a healthy lifestyle, but before we get all hot and bothered about performing more testing to “prevent” a heart attack as a means to save healthcare costs going forward, remember the lessons we learned from the Tim Russert fallout. Read more »

*This blog post was originally published at Dr. Wes*

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The Spirit Of The Place: Samuel Shem’s New Book May Depress You

When I was in medical school I read Samuel Shem s House Of God as a right of passage. At the time I found it to be a cynical yet eerily accurate portrayal of the underbelly of academic medicine. I gained comfort from its gallows humor and it made me…

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