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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*

The Amazing Patient Stories That Keep You Humbled

There are some patients that keep you humbled. Barbara Tate was one of those patients. With a shopping list of chronic conditions a mile long, she was told she could never carry a baby because she had miscarried two during her early 20’s. She suffered the hammer blows of diabetes, high blood pressure, congestive heart failure and asthma.  And it doesn’t stop there. Tate also had a history of two slipped disks, a cellulitis infection and a non-cancerous tumor on her adrenal gland. In fact she was scheduled to have surgery until she discovered she was pregnant at the age of 43. She was strongly encouraged to terminate the pregnancy because of her multiple medical conditions but she didn’t. Tate viewed her pregnancy as a miracle and for all intent purposes, it was. After age 37, there is a rapid decline in the ability to conceive although not impossible.

Her baby was born three months early and it appears that she was unaware of the classic signs of premature labor. On the day of her child’s birth, Read more »

*This blog post was originally published at Dr. Linda Burke-Galloway*

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*

Do Foreign Medical Graduates “Doctor” Better?

Yes, according to a study in today’s Health Affairs. (The full text of the study is available only to subscribers, but Kaiser Health News Daily has a good summary of its findings and links to other news reports.)

The study compares inpatient death rates and lengths of stay for patients with congestive heart failure or acute myocardial infarction when provided by U.S. citizens trained abroad, citizens trained in the United States, and non-citizens trained abroad. Treatment was provided by internists, family physicians, or cardiologists. The differences were striking, according to the authors:

“Our analysis of 244,153 hospitalizations in Pennsylvania found that patients of doctors who graduated from international medical schools and were not U.S. citizens at the time they entered medical school had significantly lower mortality rates than patients cared for by doctors who graduated from U.S. medical schools or who were U.S. citizens and received their degrees abroad.”

Read more »

*This blog post was originally published at The ACP Advocate Blog by Bob Doherty*

The Problem Of Drug Extinction

Doctors are all-familiar with marketing efforts to promote new drugs, but once the new drugs displace older drugs in the medical marketplace, who serves as advocates for the continued manufacturing of older FDA-approved drugs?

In a short answer: No one.

For those of us dealing in cardiac arrhythmia management, this presents difficult challenges for patient care if people are unable to take the newer drugs due to side effects. These patients no longer have a fall-back option to turn to for medical therapy when the older drugs have become extinct on the marketplace. Read more »

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

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IDEA Labs: Medical Students Take The Lead In Healthcare Innovation

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How To Be A Successful Patient: Young Doctors Offer Some Advice

I am proud to be a part of the American Resident Project an initiative that promotes the writing of medical students residents and new physicians as they explore ideas for transforming American health care delivery. I recently had the opportunity to interview three of the writing fellows about how to…

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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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Eat To Save Your Life: Another Half-True Diet Book

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