Campaign promotes fun way to keep an eye on your blood pressure

(NewsUSA) -- Approximately half of U.S. adults have high blood pressure, but many don't know it, according to the American Heart Association. A new public service campaign from the American Heart Association, American Medical Association and Ad Council in partnership with HHS Office of Minority Health and Health Resources & Services Administration encourages all adults to take control by monitoring their blood pressure at home and sharing the numbers with their doctor.

This new campaign is a fun way to get people engaged in monitoring their blood pressure and keeping it under control

The "Get Down with Your Blood Pressure" public service announcement uses catchy music and memorable dance moves to get the attention of people who have and are at increased risk for high blood pressure and negative health consequences associated with it, such as heart attack, stroke and severe complications of COVID-19.

The campaign keeps it simple, and encourages those with high blood pressure to regularly follow four easy steps: "Get It, Slip It, Cuff It, Check It." That means Get the blood pressure cuff, Slip it on, use the band to Cuff your arm, Check your blood pressure with a validated monitor and share the numbers with your doctor. The campaign's detailed instructional videos are available in English and Spanish.

"This new campaign is a fun way to get people engaged in monitoring their blood pressure and keeping it under control -- which can often feel daunting to many patients"-- and is timely given that high blood pressure puts patients at higher risk of severe complications of COVID-19," says American Medical Association president Gerald E. Harmon, M.D. "We are committed to eliminating structural drivers of health inequities that place Black and Brown communities at increasing risk of heart disease," Dr. Harmon adds.

The campaign emphasizes self-monitoring and encourages individuals to work with their doctors to create a personalized plan to manage and treat high blood pressure. Changes to unhealthy eating habits and increases in physical activity may be all it takes to get your blood pressure to a healthy range. However, sometimes it's not that simple. If your doctor prescribes a blood pressure medication, be sure to take it as directed.

"This campaign is part of the American Heart Association's National Hypertension Control Initiative," says Donald M. Lloyd-Jones, M.D., ScM, F.A.H.A., president of the American Heart Association, chair of the Department of Preventive Medicine and Eileen M. Foell Professor of Heart Research and Professor of Preventive Medicine, Medicine, and Pediatrics at Northwestern University Feinberg School of Medicine in Chicago, Illinois. "The initiative encompasses direct education and training on blood pressure measurement and management with health care professionals in community health centers and community-based organizations. We are meeting people where they are with access to blood pressure education and resources to reduce high blood pressure in communities that need it most."

Visit heart.org/hbpcontrol for more information about blood pressure management.

The person who investigates suspicious deaths in your town may not even be a doctor

by Samantha Young
Kaiser Health News

When a group of physicians gathered in Washington state for an annual meeting, one made a startling revelation: If you ever want to know when, how — and where — to kill someone, I can tell you, and you'll get away with it. No problem.

That's because the expertise and availability of coroners, who determine cause of death in criminal and unexplained cases, vary widely across Washington, as they do in many other parts of the country.

Photo: Gerd Altmann/Pixabay

"A coroner doesn't have to ever have taken a science class in their life," said Nancy Belcher, chief executive officer of the King County Medical Society, the group that met that day.

Her colleague's startling comment launched her on a four-year journey to improve the state's archaic death investigation system, she said. "These are the people that go in, look at a homicide scene or death, and say whether there needs to be an autopsy. They're the ultimate decision-maker," Belcher added.

Each state has its own laws governing the investigation of violent and unexplained deaths, and most delegate the task to cities, counties, and regional districts. The job can be held by an elected coroner as young as 18 or a highly trained physician appointed as medical examiner. Some death investigators work for elected sheriffs who try to avoid controversy or owe political favors. Others own funeral homes and direct bodies to their private businesses.

The various titles used by death investigators don't distinguish the discrepancies in their credentials.

Overall, it's a disjointed and chronically underfunded system — with more than 2,000 offices across the country that determine the cause of death in about 600,000 cases a year.

"There are some really egregious conflicts of interest that can arise with coroners," said Justin Feldman, a visiting professor at Harvard University's FXB Center for Health and Human Rights.

Belcher's crusade succeeded in changing some aspects of Washington's coroner system when state lawmakers approved a new law last year, but efforts to reform death investigations in California, Georgia, and Illinois have recently failed.

Rulings on causes of death are often not cut-and-dried and can be controversial, especially in police-involved deaths such as the 2020 killing of George Floyd. In that case, Minnesota's Hennepin County medical examiner ruled Floyd's death a homicide but indicated a heart condition and the presence of fentanyl in his system may have been factors. Pathologists hired by Floyd's family said he died from lack of oxygen when a police officer kneeled on his neck and back.

In a recent California case, the Sacramento County coroner's office ruled that Lori McClintock, the wife of congressman Tom McClintock, died from dehydration and gastroenteritis in December 2021 after ingesting white mulberry leaf, a plant not considered toxic to humans. The ruling triggered questions by scientists, doctors, and pathologists about the decision to link the plant to her cause of death. When asked to explain how he made the connection, Dr. Jason Tovar, the chief forensic pathologist who reports to the coroner, said he reviewed literature about the plant online using WebMD and Verywell Health.

The various titles used by death investigators don't distinguish the discrepancies in their credentials. Some communities rely on coroners, who may be elected or appointed to their offices, and may — or may not — have medical training. Medical examiners, on the other hand, are typically doctors who have completed residencies in forensic pathology.

In 2009, the National Research Council recommended that states replace coroners with medical examiners, describing a system "in need of significant improvement."

Massachusetts was the first state to replace coroners with medical examiners statewide in 1877. As of 2019, 22 states and the District of Columbia had only medical examiners, 14 states had only coroners, and 14 had a mix, according to the Centers for Disease Control and Prevention.

The movement to convert the rest of the country's death investigators from coroners to medical examiners is waning, a casualty of coroners' political might in their communities and the additional costs needed to pay for medical examiners' expertise.

The push is now to better train coroners and give them greater independence from other government agencies.

"When you try to remove them, you run into a political wall," said Dr. Jeffrey Jentzen, a former medical examiner for the city of Milwaukee and the author of "Death Investigation in America: Coroners, Medical Examiners, and the Pursuit of Medical Certainty."

Lawmakers "didn't want their names behind something that will get the sheriffs against them," Collins said.

"You can't kill them, so you have to help train them," he added.

There wouldn't be enough medical examiners to meet demand anyway, in part because of the time and expense it takes to become trained after medical school, said Dr. Kathryn Pinneri, president of the National Association of Medical Examiners. She estimates there are about 750 full-time pathologists nationwide and about 80 job openings. About 40 forensic pathologists are certified in an average year, she said.

"There's a huge shortage," Pinneri said. "People talk about abolishing the coroner system, but it's really not feasible. I think we need to train coroners. That's what will improve the system."

Her association has called for coroners and medical examiners to function independently, without ties to other government or law enforcement agencies. A 2011 survey by the group found that 82% of the forensic pathologists who responded had faced pressure from politicians or the deceased person's relatives to change the reported cause or manner of death in a case.

Dr. Bennet Omalu, a former chief forensic pathologist in California, resigned five years ago over what he described as interference by the San Joaquin County sheriff to protect law enforcement officers.

"California has the most backward system in death investigation, is the most backward in forensic science and in forensic medicine," Omalu testified before the state Senate Governance and Finance Committee in 2018.

San Joaquin County has since separated its coroner duties from the sheriff's office.

The Golden State is one of three states that allow sheriffs to also serve as coroners, and all but 10 of California's 58 counties combine the offices. Legislative efforts to separate them have failed at least twice, most recently this year.

AB 1608, spearheaded by state Assembly member Mike Gipson (D-Carson), cleared that chamber but failed to get enough votes in the Senate.

"We thought we had a modest proposal. That it was a first step," said Robert Collins, who advocated for the bill and whose 30-year-old stepson, Angelo Quinto, died after being restrained by Antioch police in December 2020.

The Contra Costa County coroner's office, part of the sheriff's department, blamed Quinto's death on "excited delirium," a controversial finding sometimes used to explain deaths in police custody. The finding has been rejected by the American Medical Association and the World Health Organization.

When something like this affects rural areas, if they push back a little bit, we just stop.

Lawmakers "didn't want their names behind something that will get the sheriffs against them," Collins said. "Just having that opposition is enough to scare a lot of politicians."

The influential California State Sheriffs' Association and the California State Coroners Association opposed the bill, describing the "massive costs" to set up stand-alone coroner offices.

Many Illinois counties also said they would shoulder a financial burden under similar legislation introduced last year by state Rep. Maurice West, a Democrat. His more sweeping bill would have replaced coroners with medical examiners.

Rural counties, in particular, complained about their tight budgets and killed his bill before it got a committee hearing, he said.

"When something like this affects rural areas, if they push back a little bit, we just stop," West said.

Proponents of overhauling the system in Washington state — where in small, rural counties, the local prosecutor doubles as the coroner — faced similar hurdles.

The King County Medical Society, which wrote the legislation to divorce the two, said the system created a conflict of interest. But small counties worried they didn't have the money to hire a coroner.

So, lawmakers struck a deal with the counties to allow them to pool their resources and hire shared contract coroners in exchange for ending the dual role for prosecutors by 2025. The bill, HB 1326, signed last year by Democratic Gov. Jay Inslee, also requires more rigorous training for coroners and medical examiners.

"We had some hostile people that we talked to that really just felt that we were gunning for them, and we absolutely were not," Belcher said. "We were just trying to figure out a system that I think anybody would agree needed to be overhauled."

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This story was produced by KHN, which publishes California Healthline, an editorially independent service of the California Health Care Foundation.

KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.

Red Dress Collection Concert kicks off American Heart Month

by The American Heart Association

DALLAS – Powerful players in music, entertainment, fashion and philanthropy joined the American Heart Association, the world’s leading nonprofit organization focused on heart and brain health for all, to celebrate progress towards health equity, while calling for a renewed commitment to investing in women’s heart health in a fashion-forward, musical kickoff to American Heart Month.

The Red Dress Collection® Concert—hosted this year from the Appel Room at Jazz at Lincoln Center in New York City—serves as the American Heart Association’s Go Red for Women national marquee event. Every year, it builds on the iconic tradition of the Red Dress Collection fashion show founded by the National Heart, Lung, and Blood Institute’s The Heart Truth® program, adding musical performances and personal stories of those affected by heart disease and stroke. This year, the event kicks off both American Heart Month, commemorated every February, as well as the Association’s centennial celebration, marking 100 years of service saving and improving lives, and positioning the Association as a change agent for generations to come.

Host Sherri Shepherd wore Ganni on the red carpet and Harbison on the runway. The Daytime Emmy Award-winning talk show host, comedian, actress, and best-selling author began the event by sharing her own connection with cardiovascular disease and spotlighting survivors and women’s health champions in attendance, before introducing the evening’s opening entertainment, GRAMMY-nominated country music star, Mickey Guyton.

The country trailblazer wore Sergio Hudson on the red carpet and Monetre on the runway. Wearing custom RC Caylan for her performance, she opened with “My Side of Country,” and performed hits “Something About You,” “Make It Me,” and “Flowers.”

This year’s concert was headlined by Award-winning musician, actor, advocate and New York Times best-selling author Demi Lovato. The Grammy-nominated artist was introduced on stage by Damar Hamlin, cardiac arrest survivor, Buffalo Bills safety and American Heart Association national ambassador for the Nation of Lifesavers™. The 25-year-old experienced his sudden cardiac arrest on the NFL football field last year and now uses his platform to raise awareness of the need for CPR and AEDs.

Lovato wore a Nicole + Felicia Couture custom gown on the red carpet, and performed wearing a custom Michael Ngo suit. The set started with Lovato singing chart-topper, “Confident,” and continued with hits “Give Your Heart a Break,” “Tell Me You Love Me,” “Sorry Not Sorry,” “Anyone,” “Neon Lights,” “No Promises,” “Skyscraper,” “Heart Attack,” and closed the evening with “Cool for the Summer” alongside all of the Red Dress Collection Concert participants.

Holding true to the Red Dress Collection’s origin in fashion, red haute couture moments were served throughout the show, reclaiming the power of sisterhood and community against the No. 1 killer of women, cardiovascular disease.

Other stars of stage and screen lending their support to the event included: Ana Navarro-Cárdenas (Co-host of ABC’s The View and CNN political commentator) wearing Alexander by Daymor, Bellamy Young (actor, singer and producer; Scandal) wearing Gustavo Cadile on the red carpet and Sachin & Babi on the runway, Brandi Rhodes (Pro wrestling star and founder of Naked Mind Yoga + Pilates) wearing Do Long, Brianne Howey (actress and mother, Ginny & Georgia) wearing Reem Acra, Dominique Jackson (model, actress, author and star of FX's Pose) wearing Coral Castillo, Francia Raísa (actress & entrepreneur) wearing Goddess Exclusive on the red carpet and Maria Lucia Hohan on the runway, Heather Dubrow (actress, author, podcast host and TV personality on Real Housewives of OC) wearing Gattinolli by Marwan on the red carpet and Pamella Roland on the runway, Katherine McNamara (award winning actor, singer, writer, and producer) wearing Mikael D, Madison Marsh (Active Duty Air Force Officer - Second Lieutenant and Miss America 2024) wearing Jovani, Mira Sorvino (Academy Award-winning actress and human rights advocate, Shining Vale and Romy and Michele’s High School Reunion) wearing Dolce and Gabbana, Richa Moorjani (actress and activist, star of Netflix’s Never Have I Ever) wearing Oscar de la Renta, Samira Wiley (Emmy winner for The Handmaid's Tale and producer) wearing Le Thanh Hoa, and Yvonne Orji (actress, comedienne, author; known for the TV show Insecure) wearing House of Emil on the red carpet and Jovana Louis on the runway.

As part of its commitment to supporting women and women's health, KISS USA is proud to support the American Heart Association’s Go Red for Women movement, and the Red Dress Collection Concert.

The Go Red for Women movement, sponsored nationally by CVS Health, exists to increase women’s heart health awareness, and serves as a catalyst for change in the drive to improve the lives of all women. Find resources to support women’s heart health at every age, through every stage of life at GoRedforWomen.org. 

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What's a phone call from your doctor is worth today?

by Julie Appleby
Kaiser Health News

Maybe this has happened to you recently: Your doctor telephoned to check in with you, chatting for 11 to 20 minutes, perhaps answering a question you contacted her office with, or asking how you’re responding to a medication change.

For that, your doctor got paid about $27 if you are on Medicare — maybe a bit more if you have private insurance.

Behind those calls is a four-digit "virtual check-in" billing code created during the pandemic, for phone conversations lasting just within that range, which has drawn outsize interest from physician groups.

It’s part of a much bigger, increasingly heated debate: Should insurers pay for "audio-only" visits? And, if they do, should they pay the same reimbursement rate as when a patient is sitting in a doctor’s office, as has been allowed during the pandemic?

Cutting off or reducing audio-only payments could lead providers to sharply curtail telehealth services, warn some physician groups and other experts. Other stakeholders, including employers who pay for health coverage, fear payment parity for audio-only telehealth visits could lead to overbilling. Will it lead, for example, to a flood of unneeded follow-up calls?

Robert Berenson, an Institute Fellow at the Urban Institute, who has spent much of his career studying payment methods, said if insurers pay too little, doctors — now accustomed to the reimbursement — might no longer make the follow-up calls they might have made for free pre-pandemic.

But, he added, "if you pay what they want, parity with in-person, you’ll have a run on the treasury. The right policy is somewhere in between."

Medicare billing codes, while a dull and arcane topic, draw keen interest from doctors, hospitals, therapists and others because they are the basis for health care charges in the United States. Medicare’s verdict serves as a benchmark and guide for private insurers in setting their own payment policies.

Thousands of codes exist, describing every possible type of treatment. Without a code, there can be no payment. The creation of codes and Medicare’s determination of a reimbursement amount, designed to reflect the amount of work involved, prompt ferocious lobbying by the business interests involved. The American Medical Association derives a chunk of revenue from owning the rights to a specific set of physician billing codes. Other codes are developed by dental groups, as well as the Centers for Medicare & Medicaid Services or state Medicaid agencies.

The idea of a "virtual check-in" code began before the pandemic, in 2019, when Medicare included it to cover five- to 10-minute telephone calls for doctors to respond to established patients. It pays about $14.

When the pandemic hit, Congress and the Trump administration opened the door wider to telehealth, temporarily lifting restrictions — mainly those limiting such services to rural areas.

Meanwhile, CMS this year added a billing code for longer "virtual check-ins" — 11- to 20-minute calls — with payment set at about $27 a pop, with the patient contributing 20% in copayment. Such calls are meant to determine whether a patient needs to come in or otherwise have a longer evaluation visit, or if their health concern can simply be handled over the phone.

And physicians argue that allowing payments for audio-only care is a positive step for them and for their patients.

"I take care of patients who drive from two or three hours away and live in places without broadband access," said Dr. Jack Resneck Jr., a dermatologist and president-elect of the American Medical Association. "For these patients, it’s important to have a backup when the video option doesn’t’ work."

Still, the focus on telephone-only care has raised concerns.

"Here’s an invitation to convert every five-minute call into an 11- to 20-minute call," said Berenson.

The Medicare code allows "other qualified health professionals," such as physician assistants or nurse practitioners, to bill for such calls. Private insurers would set their own rules about whether non-physicians can bill for follow-up calls. It’s not clear how much of a revenue stream dedicating such staff members to make these short, telephone check-ins would create for a medical practice.

To avoid overuse, CMS did set rules: The code can’t be used if the call takes place within seven days of an evaluation visit, either in person or through telemedicine. Nor can a doctor bill for the call if he or she determines the patient needs to come in right away.

When the health emergency ends, however, so do most audio-only payments. The emergency is expected to last at least through the end of the year. Congress or, possibly, CMS could change the rules on audio-only payments, and much more lobbying is expected.

While the virtual check-in codes have been made permanent, physician groups are lobbying for Medicare to retain a host of other telephone-only-visit codes created during the pandemic, including several that allow physicians to bill for telephone-only visits in which the doctor potentially diagnoses a patient’s condition and sets up a treatment plan.

For those, considered "evaluation and management" audio visits, Medicare during the public health emergency has paid about $55 for a five- to 10-minute call and $89 for one that runs 11 to 20 minutes — the same as for an in-office visit.

"Whether we see patients in house, by video or by phone, we need the same coding" and the same payments, because a similar amount of work is involved, said Dr. Ada Stewart, the board chair for the American Academy of Family Physicians.

Many patients like the concept of telehealth, according to Suzanne Delbanco, executive director of Catalyst for Payment Reform, a group representing employers who want payment methods for health care to be overhauled. And, for some patients, it’s the easiest way to see a doctor, especially for those who live far from urban areas or are unable to take time off work or away from home.

But, she said, employers "don’t want to get locked into paying more for it than they have in past, or as much as other [in-person] visits when it’s not truly the same value to the patient."

Young people recover quickly from rare effect caused by COVID-19 vaccine

by American Heart Association

Researchers say future studies should follow patients who have suffered vaccine-associated myocarditis over a longer term, since this study examined only the immediate course of patients and lacks follow-up data.

Most young people under the age of 21 who developed suspected COVID-19 vaccine-related heart muscle inflammation known as myocarditis had mild symptoms that improved quickly, according to new research published today in the American Heart Association’s flagship journal Circulation.

Myocarditis is a rare but serious condition that causes inflammation of the heart muscle. It can weaken the heart and affect the heart’s electrical system, which keeps the heart pumping regularly. It is most often the result of an infection and/or inflammation caused by a virus.

"In June of this year, the U.S. Centers for Disease Control and Prevention (CDC) Advisory Committee on Immunization Practices reported a likely link between mRNA COVID-19 vaccination and myocarditis, particularly in people younger than 39. However, research continues to find COVID-19 vaccine-related cases of myocarditis uncommon and mostly mild," said Donald. M. Lloyd-Jones, M.D., Sc.M., FAHA, president of the American Heart Association, who was not involved in the study. "Overwhelmingly, data continue to indicate that the benefits of COVID-19 vaccination – 91% effective at preventing complications of severe COVID-19 infection including hospitalization and death – far exceed the very rare risks of adverse events, including myocarditis."

"The highest rates of myocarditis following COVID-19 vaccination have been reported among adolescent and young adult males. Past research shows this rare side effect to be associated with some other vaccines, most notably the smallpox vaccine," said the new study’s senior author Jane W. Newburger, M.D., M.P.H., FAHA, associate chair of Academic Affairs in the Department of Cardiology at Boston Children’s Hospital, the Commonwealth Professor of Pediatrics at Harvard Medical School and a member of the American Heart Association’s Council on Lifelong Congenital Heart Disease and Heart Health in the Young. "While current data on symptoms, case severity and short-term outcomes is limited, we set out to examine a large group of suspected cases of this heart condition as it relates to the COVID-19 vaccine in teens and adults younger than 21 in North America."

Using data from 26 pediatric medical centers across the United States and Canada, researchers reviewed the medical records of patients younger than 21 who showed symptoms, lab results or imaging findings indicating myocarditis within one month of receiving a COVID-19 vaccination, prior to July 4, 2021. Cases of suspected vaccine-associated myocarditis were categorized as "probable" or "confirmed" using CDC definitions.

Of the 139 teens and young adults, ranging from 12 to 20 years of age, researchers identified and evaluated:

Most patients were white (66.2%), nine out of 10 (90.6%) were male and median age was 15.8 years.

Nearly every case (97.8%) followed an mRNA vaccine, and 91.4% occurred after the second vaccine dose.

Onset of symptoms occurred at a median of 2 days following vaccine administration.

Chest pain was the most common symptom (99,3%); fever and shortness of breath each occurred in 30.9% and 27.3% of patients, respectively.

About one in five patients (18.7%) was admitted to intensive care, but there were no deaths. Most patients were hospitalized for two or three days.

More than three-fourths (77.3%) of patients who received a cardiac MRI showed evidence of inflammation of or injury to the heart muscle.

Nearly 18.7% had at least mildly decreased left ventricular function (squeeze of the heart) at presentation, but heart function had returned to normal in all who returned for follow-up.

"These data suggest that most cases of suspected COVID-19 vaccine-related myocarditis in people younger than 21 are mild and resolve quickly," said the study’s first author, Dongngan T. Truong, M.D., an associate professor of pediatrics in the division of cardiology at the University of Utah and a pediatric cardiologist at Intermountain Primary Children’s Hospital in Salt Lake City. "We were very happy to see that type of recovery. However, we are awaiting further studies to better understand the long-term outcomes of patients who have had COVID-19 vaccination-related myocarditis. We also need to study the risk factors and mechanisms for this rare complication."

Researchers say future studies should follow patients who have suffered vaccine-associated myocarditis over a longer term, since this study examined only the immediate course of patients and lacks follow-up data. Additionally, there are several important limitations to consider. The study design did not allow scientists to estimate the percentage of those who received the vaccine and who developed this rare complication, nor did it allow for a risk/benefit ratio examination. The patients included in this study were also evaluated at academic medical centers and may have been more seriously ill than other cases found in a community.

"It is important for health care professionals and the public to have information about early signs, symptoms and the time course of recovery of myocarditis, particularly as these vaccines become more widely available to children," Truong said. "Studies to determine long-term outcomes in those who have had myocarditis after COVID-19 vaccination are also planned."

Researchers recommend that health care professionals consider myocarditis in individuals presenting with chest pain after receiving a COVID-19 vaccine, especially in boys and young men in the first week after the second vaccination.

"This study supports what we have been seeing – people identified and treated early and appropriately for COVID-19 vaccine-related myocarditis typically experience mild cases and short recovery times," Lloyd-Jones said. "These findings also support the American Heart Association’s position that COVID-19 vaccines are safe, highly effective and fundamental to saving lives, protecting our families and communities against COVID-19, and ending the pandemic. Please get your child vaccinated as soon as possible."

Magnets in new electronic devices can interfere with implanted defibrillators

by American Heart Association

DALLAS -- Magnet technology is increasingly being used in portable electronic devices, such as the Apple AirPods Pro charging case, the Apple Pencil 2nd Generation and the Microsoft Surface Pen. However, if the devices are carried in pockets near the chest, and the individual has an implanted cardiac device (ICD), the magnets may interfere with the ICD’s ability to help regulate the heart, according to new research published today in Circulation: Arrhythmia and Electrophysiology, a peer-reviewed journal of the American Heart Association.

"If you carry a portable electronic device close to your chest and have a history of tachycardia (rapid heartbeat) with an ICD, strong magnets in these devices could disable your cardioverter defibrillator," said lead study author Corentin Féry, M.Sc., a research engineer at the University of Applied Sciences and Arts Northwestern Switzerland, Institute for Medical Engineering and Medical Informatics in Muttenz, Switzerland. "Heart patients should be aware of these risks, and their doctor should tell them to be careful with these electronic devices with magnets."

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Photo: American Heart Assoc.

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Devices and machinery with magnets exhibit a vector field or area of magnetic influence that can inhibit pulse generators for implanted ICDs and pacemakers. In ICDs, magnets can activate a switch prohibiting the ICD from delivering lifesaving shocks. Newer portable electronic devices equipped with strong magnets can disrupt the ICD operation. Earlier research on the iPhone 12 Pro Max demonstrated that its magnetic field is strong enough to interfere with the normal operation of an implanted pacemaker or ICD when held within an inch.

In this study, researchers tested the magnetic field output of the wireless charging case of the Apple AirPods Pro, the Microsoft Surface Pen and the Apple Pencil 2nd Generation. Their magnetic field strength was measured and compared to the iPhone 12 Pro Max. Using a magnetic mapper with 64 magnetic sensors, researchers measured the magnetic field strength of these products at various distances. The portable electronic devices were also placed closer and closer to five defibrillators from two representative manufacturers until a therapy deactivation occurred. These distances then constitute the minimal safety distance at which an interaction has actually taken place.

The maximum distance for a possible interaction between the portable electronic devices and the implantable cardiac devices was:

around 2 cm (0.78 inches) away for all of the Apple products; and

2.9 cm (1.14 inches) away for the Microsoft Surface Pen.

While the tests results showed the maximum distance for a possible ICD interaction, researchers said for safety the minimal distance is between 0.8 cm (0.31 inches) for the iPhone 12 Pro Max and the Apple Pencil 2nd Generation, and 1.8 cm (0.71 inches) for the Microsoft Surface Pen and the opened charging case of the Apple AirPods Pro .

"The public needs to be aware of the potential risks of portable electronic devices in addition to the iPhone 12 Pro Max that may affect anyone with an ICD," said study co-author Sven Knecht, D.Sc., a research engineer at the Cardiovascular Research Institute Basel at University Hospital Basel, University of Basel in Switzerland. "What is most concerning is that magnets are being used in more and more portable electronic devices, and with so many magnets around us, the risk to cardiac patients is even greater."

"These devices can cause a problem when carried in your shirt or jacket pocket in front of the chest, as well as when you are lying on the couch and resting the electronic device on your chest, or if you fall asleep with the electronic device," Féry added. "The main thing to remember is that any electronic device may be a danger, especially ones with a magnet inside."

In the future, the researchers plan to focus on testing e-cigarettes, other pencils for tablets and other portable electronic devices for their potential magnetic interaction with cardiac devices. "With so many copycat products and accessories available, there may be a problem for the public to know which products pose increased risks," Knecht said.

A major limitation of the study was that it was not conducted on ICDs implanted in patients. "In people with ICDs, the impact of the magnetic interaction will depend on the individual and their overall health," Knecht said. "This research was the first step in identifying the importance of assessing some products for safety. The next step is to confirm these interactions by testing implanted devices in volunteer patients who are at the hospital for routine tests."

The American Heart Association recommends keeping cell phones at least six inches away from ICDs or pacemakers by using it on the ear opposite from the implantation and to avoid keeping the cell phone in a front chest pocket.

"The American Heart Association and the manufacturers of pacemakers and implantable cardioverter defibrillators have long recommended that magnets be kept away from these implanted devices. A recent Journal of the American Heart Association study reported that the magnetic field induced in the receiver coil of the iPhone 12 Pro Max can result in clinically identifiable magnet interference in pacemakers and ICDs," said N.A. Mark A. Estes, M.D., professor of medicine and director of the Clinical Cardiac Electrophysiology Fellowship Program at the Heart and Vascular Institute of the University of Pittsburgh School of Medicine, and an American Heart Association volunteer. "The current study extends observations on magnetic field interactions with even more devices containing magnets. Patients with cardiac electronic implantable devices should be instructed to keep all electronic devices that can generate a magnetic field several inches from their pacemakers or ICDs."

Not in your head; protecting yourself from lazy medical diagnoses

RDNE Stock Project/PEXELS

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by Julie Rehmeyer

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You’re a doctor. You have fifteen minutes with your patient, who cries as she ticks off a laundry list of vague symptoms. Depression is very common, you think, and it could explain all of those symptoms. Do you diagnose the patient with depression, noting it in her medical record, or do you begin an expensive, time-consuming investigation?

Now, replay the scenario from the patient’s perspective. You’re Elke Martinez, a veterinary technician, and you’ve developed muscle and joint pain, headaches, fatigue, and gastrointestinal problems. You go to your primary care doctor, part of the Kaiser Permanente healthcare system, and he attributes your symptoms to depression and anxiety. You know that’s not right, since you’re already being treated for those issues, and the treatment works. What do you do?

What Martinez did was humor her doctor. She attended Kaiser’s group cognitive behavioral therapy classes. The classes didn’t improve any of her symptoms, but they did consume a lot of her time and energy. Meanwhile, she saw more doctors to try to figure out what was actually wrong, but every Kaiser-affiliated doctor asked her about the psychiatric diagnosis already in her chart. “You can see on their face that they’re already checked out,” she says. These experiences undermined not only her trust in her doctors, but also in herself: “You get told this enough and you start to believe it and doubt yourself.”

Your odds of having an experience similar to Martinez’s are shockingly high. A 2017 meta-analysis published in The Lancet showed that for every 100 patients seen in primary care, 15 of them will receive a misdiagnosis of depression.

The problem takes a particular toll on patients who are chronically ill. A 2014 survey by the Autoimmune Association found that 51 percent of patients with autoimmune disease report that they had been told that “their disease was imagined or they were overly concerned.” And a 2019 survey of 4,835 patients with postural orthostatic tachycardia syndrome found that before getting a correct diagnosis, 77 percent of them had a physician suggest their symptoms were psychological or psychiatric.

Incorrect psychiatric diagnoses in medical records can cause long-lasting havoc.

In our culture, aspersions against patients with poorly understood chronic illness still run deep. Just a few months ago in OpenMind, we covered longstanding efforts to label as head cases and confabulators individuals with fibromyalgia, myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), persistent symptoms of Lyme disease, and long covid. You can read it here.

Patients affected by rare disorders (those with fewer than 200,000 sufferers in the United States) also suffer enormously from this type of dismissal. According to the National Organization for Rare Diseases, if you initially receive a false psychiatric diagnosis, it takes you 2.5 to 14 times as long to get diagnosed compared to those who were never misdiagnosed, and between 1.25 and 7 times as long as those who received a false non-psychiatric diagnosis.

Even when a patient is in fact depressed or anxious, that might not be the correct explanation for their physical symptoms. The causation may go in the other direction: The patient might have a physical illness that’s causing their psychological distress. Lyme disease patients, for example, are often misdiagnosed as having depression, bipolar disorder, and more. Yet as a 2021 study pointed out, these patients are often depressed precisely because they are ill. Systemic, whole-body or brain infection can cause impaired sleep, attention, memory, and performance, all of which contribute to depression. Targeting those psychological symptoms without effectively treating the underlying infection will never work.

Psychological diagnoses are often the easiest ones for doctors to make, and the hardest ones for patients to shake. Once a psychological diagnosis is entered into a patient’s medical records, it becomes the starting place for every subsequent doctor who reads it. Patients may not even know the diagnosis is there, since they often don’t see their records (although they have a right to — see Tools for Readers, below).

Martinez realized that the only way she was going to get a proper diagnosis of her physical symptoms was by leaving the Kaiser system, so that she could go to a new set of doctors who couldn’t see the psychiatric misdiagnosis in her chart. Thirteen years after her symptoms started, she finally got an explanation: She has Ehlers-Danlos Syndrome, a disorder of the connective tissue that can cause devastating symptoms throughout the body. By the time she received a proper diagnosis, she was disabled and had to give up the career she loved in veterinary work. And she was luckier than many. On average, with a psychiatric misdiagnosis, it typically takes patients 22 years to get diagnosed with Ehlers-Danlos syndrome.

Photo: SHVETS Production/PEXELS

Incorrect psychiatric diagnoses in medical records can cause long-lasting havoc. When one U.S.-based patient I interviewed, who requested anonymity, was erroneously diagnosed with Munchausen’s syndrome — meaning that she was accused of fabricating her illness — she became unable to get medication for her severe pain for several months, while her therapist worked to persuade the psychologist who diagnosed her to remove it from her chart. In the meantime, she resorted to taking large doses of Ibuprofen, which resulted in a stomach ulcer.

Another patient that I interviewed, also in the U.S., told me that her exhaustion led to a diagnosis of depression while she was a medical resident, even though her low energy was sufficiently explained by her autoimmune disease. When she received her medical license, it came with conditions. Due to her diagnosis of mental illness, she was required to receive a high level of supervision, making it impossible for her to practice.

Yet another patient I spoke with lost the ability to digest food, weighing in at 85 pounds at 5’7”, but the local hospital wouldn’t admit her to the emergency room because her medical records diagnosed her problem as psychiatric. Since she lives in a remote area and is too ill to travel, she hasn’t been able to access medical care at all; last I heard, she had not gotten to the bottom of her digestive woes.

Even today, doctors routinely use the term “medically unexplained symptom” to imply a psychological origin for a patient’s physiological reports.

The problem of misdiagnosing physiological illness as psychological is particularly pernicious because it evokes the loaded and sexist aura of the old, discarded term "hysteria." Sigmund Freud claimed, without evidence, that unconscious traumatic memories can be converted into symbolically relevant physical symptoms. In so doing, he gave doctors permission to think of literally any symptom as having a psychological origin, even in the absence of psychological symptoms. This led to the term “conversion disorder,” which has multiplied into endless euphemisms designed to cover over its sexist origins, including somatization disorder, functional disorder, and bodily distress disorder. Specialists sometimes argue over fine distinctions between the terms, but fundamentally, they all imply that looking for physical causes for your symptoms will be fruitless and that you should instead address them psycho-behaviorally.

Even today, doctors routinely use the term “medically unexplained symptom” to imply a psychological origin for a patient’s physiological reports. In UpToDate, a highly respected online guide for evidence-based treatment, a search for “medically unexplained symptoms” reroutes to an entry on somatization in psychiatry. Both the language and the culture of modern medicine systematically nudge some doctors toward the assumption that ambiguous symptoms are psychosomatic; it is a culture we need to change. “As a matter of peculiar pro­fessional fact, there is no term that names diagnostic uncertainty without also naming psychological diagnosis,” bioethicist Diane O’Leary and health psychologist Keith Geraghty state in the Oxford Handbook of Psychotherapy Ethics.

Writing in The American Journal of Bioethics, philosopher Abraham Schwab at Clarkson University notes that psychological diagnoses may be incorrect either because the doctor doesn’t have the knowledge to come to the proper biomedical diagnosis or because the patient has a biological condition that is not yet understood by medical science. “As a result,” he says, “psychogenic diagnoses should carry with them low levels of confidence.”

In practice, though, a psychological diagnosis tends to override other interpretations, making it difficult for doctors to discover a medical explanation for the patient’s symptoms. That’s partly by design: Investigating undiagnosed medical conditions is expensive, and it often doesn’t lead to treatment that relieves the patient's symptoms. The widely used MacLeod’s Clinical Investigation Handbook cautions that “if [patients with medically unexplained symptoms] are not managed effectively, fruitless investigations and harm from unnecessary drugs and procedures may result.” Furthermore, a patient’s very determination to find a medical explanation can be dismissed as “doctor-shopping” and viewed as an indication of somatization.

Mental health professionals have historically resisted making records available to their patients.

Patients with erroneous psychological records face enormous obstacles since their doctors are discouraged from seeking out the physiological cause of their suffering and further complaints may be met with further suspicion. But there are ways to push back against these challenges, and the place to start is by accessing medical records — and then pushing to get errors fixed.

Mental health professionals have historically resisted making records available to their patients. Common justifications are that patients suffering delusions will become hostile if told in records that their beliefs aren’t correct, or that clinicians will hold back in their note-taking because they’re worried about the reaction of the patient. But some other professionals have argued for encouraging patients to review records, writing in the Journal of the American Medical Association: “The clinician who actively solicits open and ongoing dialogue, including a patient’s opinion about a note’s accuracy, may enhance both clinical precision and the treatment relationship.”

Since 1996 the Health Insurance Portability and Accountability Act (HIPAA) has given patients a legal right to access their medical records. Starting in October of 2022, the 21^st Century Cures Act made it easier to do so. In particular, the Act requires that healthcare providers provide patients access to all the health information in their electronic medical records without delay and without charge. This rule does not include notes from psychotherapy sessions that are not contained within the regular medical record, but it does include any diagnoses made. If a patient believes anything in that record is wrong — such as an incorrect psychiatric diagnosis — they can request that it be changed. See the “Tools” section below for specific guidance on how to purgi falsehoods from your medical record.

Fully fixing the problem of incorrect psychiatric diagnoses, and the array of challenges that result from them, will take a major shift in mindset in the medical profession. It will require a much more nuanced understanding of the complexities of how our mental and physical states affect one another bidirectionally. It will require an acceptance that psychological treatment is an adjunct for physical treatment, rather than a way of getting rid of responsibility for a problematic patient. And it will require a transformation in our healthcare system so that doctors have the time they need to investigate complex patients.

Such changes are beyond what any individual patient can accomplish. But in the meantime, patients can at least ensure that their medical records aren’t making their quest for accurate diagnosis and effective treatment more difficult.

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This story originally appeared on OpenMind, a digital magazine tackling science controversies and deceptions.

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Study finds breastfeeding reduces CVD risk in mothers

by American Heart Association

Women who breastfed for 12 months or longer during their lifetime appeared to be less likely to develop cardiovascular disease than women who did not breastfeed.

DALLAS -- Women who breastfed were less likely to develop heart disease or a stroke, or die from cardiovascular disease than women who did not breastfeed, according to a meta-analysis published today in a pregnancy spotlight issue of the Journal of the American Heart Association (JAHA), an open access, peer-reviewed journal of the American Heart Association.

The special issue, JAHA Spotlight on Pregnancy and Its Impact on Maternal and Offspring Cardiovascular Health, includes about a dozen research articles exploring various cardiovascular considerations during pregnancy for mother and child.

The health benefits of breastfeeding for children are well known. According to the World Health Organization (WHO), it is linked with fewer respiratory infections and lower risk of death from infectious diseases among the children who were breastfed. Breastfeeding also has been linked to maternal health benefits, including lower risk for Type 2 diabetes, ovarian cancer and breast cancer.

"Previous studies have investigated the association between breastfeeding and the risk of cardiovascular disease in the mother; however, the findings were inconsistent on the strength of the association and, specifically, the relationship between different durations of breastfeeding and cardiovascular disease risk. Therefore, it was important to systematically review the available literature and mathematically combine all of the evidence on this topic," said senior author Peter Willeit, M.D., M.Phil., Ph.D., professor of clinical epidemiology at the Medical University of Innsbruck in Innsbruck, Austria.

Researchers reviewed health information from eight studies conducted between 1986 and 2009 in Australia, China, Norway, Japan and the U.S. and one multinational study.

The review included health records for nearly 1.2 million women (average age 25 at first birth) and analyzed the relationship between breastfeeding and the mother’s individual cardiovascular risk.

"We collected information, for instance, on how long women had breastfed during their lifetime, the number of births, age at first birth and whether women had a heart attack or a stroke later in life or not," said first author Lena Tschiderer, Ph.D., a postdoctoral researcher at the Medical University of Innsbruck.

The review found:

82% of the women reported they had breastfed at some time in their life.

Compared to women who never breastfed, women who reported breastfeeding during their lifetime had a 11% decreased risk of developing cardiovascular disease.

Over an average follow-up period of 10 years, women who breastfed at some time in their life were 14% less likely to develop coronary heart disease; 12% less likely to suffer strokes; and 17% less likely to die from cardiovascular disease.

Women who breastfed for 12 months or longer during their lifetime appeared to be less likely to develop cardiovascular disease than women who did not breastfeed.

There were no notable differences in cardiovascular disease risk among women of different ages or according to the number of pregnancies.

Despite recommendations to breastfeed by organizations including the WHO and the U.S. Centers for Disease Control and Prevention (CDC), both of which recommend babies are breastfed exclusively through at least six months of age, only 1 in 4 infants receives only breastmilk for the first six months of life. Black infants in the U.S. are less likely than white infants to be breastfed for any length of time, according to the CDC.

"It’s important for women to be aware of the benefits of breastfeeding for their babies’ health and also their own personal health," Willeit said. "Moreover, these findings from high-quality studies conducted around the world highlight the need to encourage and support breastfeeding, such as breastfeeding-friendly work environments, and breastfeeding education and programs for families before and after giving birth."

The U.S. has the highest maternal death rate among developed countries, and cardiovascular disease is the leading cause, according to the 2021 Call to Action Maternal Health and Saving Mothers policy statement from the American Heart Association. The statement, which outlines public policies that address the racial and ethnic disparities in maternal health, notes that an estimated 2 out of 3 deaths during pregnancy may be preventable.

"While the benefits of breastfeeding for infants and children are well established, mothers should be further encouraged to breastfeed their infants knowing that they are improving the health of their child and improving their own health as well," said Shelley Miyamoto, M.D., FAHA, chair of the American Heart Association’s Council on Lifelong Congenital Heart Disease and Heart Health in the Young (Young Hearts), the Jack Cooper Millisor Chair in Pediatric Heart Disease and director of the Cardiomyopathy Program at Children's Hospital Colorado in Aurora. "Raising awareness regarding the multifaceted benefits of breastfeeding could be particularly helpful to those mothers who are debating breast vs. bottle feeding.

"It should be particularly empowering for a mother to know that by breastfeeding she is providing the optimal nutrition for her baby while simultaneously lowering her personal risk of heart disease."

A limitation of this meta-analysis is that little information was available about women who breastfed for longer than two years. “If we had this additional data, we would have been able to calculate better estimates for the association between lifetime durations of breastfeeding and development of cardiovascular disease in mothers,” Tschiderer said.

Viewpoint |Wildfire smoke signals a growing climate crisis

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“Increasing temperatures and changes in precipitation and snowmelt patterns are increasing the severity and size of wildfires in the West.”

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by Terry Hansen
      Guest Commentary

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Recently, a group of Republican members of Congress sent a letter to the Canadian government, alleging that its poor forest management practices are responsible for out-of-control wildfires and for this summer's air quality problems in the Midwest and Northeast.

Notably, the letter fails to mention climate change. However, although fire-management practices can play a role in these megafires, climate change also has a profound impact. In the words of Natural Resources Canada:

"Warmer-than-average temperatures, decreased levels of snowpack, low soil moisture and elevated drought conditions are indicators that climate change is impacting the frequency, size and range of wildland fires in Canada. For example, the number of over-wintering fires is increasing."

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During the three preceding decades, human-caused climate change doubled the area affected by forest fires in the western United States.

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It’s also important to take note of a 2015 issue of the U.S. Forest Service’s journal, Fire Management Today, titled “Climate Change: The Future Is Here.” This publication states, “Increasing temperatures and changes in precipitation and snowmelt patterns are increasing the severity and size of wildfires in the West.” Concern is also expressed about the “occurrence of fire that is outside the range of our existing experience” and the danger this poses to firefighters and communities.

Moreover, a 2016 study in the Proceedings of the National Academy of Sciences concluded that during the three preceding decades, human-caused climate change doubled the area affected by forest fires in the western United States.

The reason is that hotter temperatures evaporate soil moisture and dry vegetation, making it more likely to burn. According to physicist Phillip B. Duffy, "What would have been a fire easily extinguished now just grows very quickly and becomes out of control.”

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We are experiencing these impacts before Earth's warming has reached the 1.5°C (2.7°F) threshold climate scientists have long warned about.

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In addition, their letter emphasizes, "Our constituents have been limited in their ability to go outside and safely breathe due to the dangerous air quality the wildfire smoke has created."

Significantly, 184 medical and public health groups, including the American Medical Association, the American Heart Association and the American Lung Association, have released a statement declaring: "Climate change is one of the greatest threats to health America has ever faced — it is a true public health emergency."

These organizations cite extreme heat, floods and year-round wildfires, as well as air pollution caused by fossil fuel burning and the spread of mosquito and tick-borne diseases.

Even more troubling, we are experiencing these impacts before Earth's warming has reached the 1.5°C (2.7°F) threshold climate scientists have long warned about. Consider that a recent report by the United Nations concludes that, without a greater commitment to reduce emissions, the Earth will warm by about 3.1° C above pre-industrial levels by 2100. What's more, the increase in global heating is expected to continue beyond the end of the century.

In order to deal with climate-driven threats, we must first recognize them. Urgently reducing greenhouse gas emissions and funding adaptation should be top priorities for every politician who cares about public health and the future we all share.

Terry Hansen is a retired educator who writes frequently about climate change. He lives in Milwaukee.

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Heart disease is a risk for women transitioning through menopause

by The American Heart Association

DALLAS — Medical experts note that hormone and body composition changes during the transition to menopause can increase the risk of developing heart disease after menopause.^[1] The American Heart Association, a global force for healthier lives for all, offers tips to support women’s heart health during this transition.

“More women in the U.S. are living longer, and a significant portion of them will spend up to 40% of their lives postmenopausal,” said Brooke Aggarwal, Ed.D., M.S., F.A.H.A., assistant professor of medical sciences in Cardiology at Columbia University Medical Center and a volunteer for the American Heart Association’s Go Red for Women™ movement.

As women grow and change so does their risk for cardiovascular disease. Go Red for Women, the Association’s premier women’s movement, addresses awareness and clinical care gaps of women’s greatest health threat, and is a trusted source for health and well-being at every age, stage and season.

“Navigating through menopause isn’t one-size-fits-all, and neither is the journey to good heart health,” she added. “This makes it even more important to focus on heart and brain health at all stages of life.”

The best defense against menopause-related changes is working with your doctor to make sure your key health numbers are in a healthy range, and understanding which healthy habits you can fine tune to boost your heart health. These tips can help:

1. Health by the numbers: Blood pressure, blood sugar and body mass index should be monitored yearly. More often if your numbers are out of range. Cholesterol level is also important, and healthy numbers are more individualized based on your other risk factors. Your doctor can help you figure this one out.
2. The best way to eat: No single food is a miracle-worker for health. Instead, look at your overall pattern of eating. Experts at the American Heart Association rated 10 popular eating patterns and the DASH-style and Mediterranean-style way of eating rose to the top as having the most heart-healthy elements: high in vegetables, fruit, whole grains, healthy fat and lean protein; and low in salt, sugar, alcohol and processed foods.
3. Exercise that does double-duty: Strength and resistance training is one of the four types of exercise in a general workout routine along with endurance, balance and flexibility. Strength and resistance have the added benefit of increasing bone strength and muscle mass. As women enter menopause, bone density may take a hit and body composition tends to shift to lower muscle mass. Strength training at least twice a week can help your bones and muscles maintain strength and density.
4. Protect your sleep time: Healthy sleep is part of the 8 essential elements of heart health called Life’s Essential 8, but the transition to menopause comes with myriad interruptions to a good night’s rest – nightly restroom trips, night sweats, insomnia. Do whatever it takes to get your Z’s because better sleep has great health benefits: stronger immune system, better mood, more energy, clearer thinking and lower risk of chronic diseases. A few habit changes can improve sleep, like setting a notification or alarm to remind you it’s time to wind down, then shutting down electronic devices at that time. For stubborn sleep problems your doctor may be able to help.

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AHA agrees with CDC guidelines, recommends Covid-19 booster

(Amreican Heart Association) -- As the Omicron variant spreads, COVID-19 vaccination is more important than ever. The American Heart Association continues to align with expert guidance from the U.S. Centers for Disease Control and Prevention (CDC) – the nation’s infectious disease experts - regarding COVID-19 vaccinations and booster shots.

Recently, the CDC extended recommendations for a booster dose of COVID-19 vaccines to all adults ages 18 and older, including the allowance to "mix & match" the types of COVID-19 vaccines for the booster dose. According to the CDC, the additional COVID-19 vaccine dose may be from any of the three COVID-19 vaccines authorized or approved in the U.S. – either the Pfizer-BioNTech, Moderna or Johnson & Johnson COVID-19 vaccines. The mix & match regimen is available only for booster doses of the COVID-19 vaccines, not for the primary vaccination series, which still requires the same, initial two doses of either the Pfizer-BioNTech or Moderna COVID-19 vaccine.

The CDC recommends a booster of either the Moderna or Pfizer-BioNTech COVID-19 vaccine (mRNA vaccines) for all adults at least 6 months after receiving two-doses of the same mRNA COVID-19 vaccine. Adults ages 18 and older who previously received one dose of the Johnson & Johnson COVID-19 vaccine (an adenovirus vector vaccine) are eligible for a booster dose two months after the initial dose. They may select a second dose of the Johnson & Johnson COVID-19 vaccine or a booster dose of either the Pfizer-BioNTech or Moderna COVID-19 vaccines.

The American Heart Association/American Stroke Association, a global force for longer, healthier lives for all, affirms the CDC’s guidance on COVID-19 vaccines.

The Association remains concerned about the continuing gaps in COVID-19 vaccination among people from all eligible age groups in the U.S. including people from diverse racial and ethnic groups and among pregnant women, especially in light of the Omicron variant. Therefore, it continues to urge all adults and children ages 5 and older in the U.S. to receive all COVID-19 vaccines as soon as they are eligible, as recommended by the CDC and fully approved or authorized for emergency use by the FDA.

"With the Omicron variant spreading, we urge everyone 5 and older to get vaccinated against COVID-19 and get the booster when they are eligible. The booster shots are particularly important for adults ages 50 and older who have underlying medical conditions or any adult living in a long-term care facility," said American Heart Association volunteer President Donald M. Lloyd-Jones, M.D., Sc.M., FAHA, who is also the Eileen M. Foell Professor of Heart Research, professor of preventive medicine, medicine and pediatrics, and chair of the department of preventive medicine at Northwestern University’s Feinberg School of Medicine in Chicago.

"As cited by the CDC, recently published research indicates a COVID-19 vaccine booster dose provides increased protection against COVID-19 infection, severe complications and death. Breakthrough cases of COVID-19 infection after vaccination are possible, however, serious side effects and needing hospitalization among people who are vaccinated continue to be rare and mild. The benefits of the vaccine and boosters far outweigh the very limited risk."

The Association also supports the CDC’s ongoing safety recommendations: mask wearing for all people regardless of vaccination status when indoors, frequent handwashing and social distancing. Along with COVID-19 vaccination, these safety protocols are essential to minimizing the spread of the COVID-19 virus and reducing the risk of infection, hospitalization and death.

"As the COVID-19 pandemic impacts our families and communities for a second winter and holiday season, we encourage everyone to remain vigilant against the COVID-19 virus. The COVID-19 vaccines are paramount to saving lives, protecting our families and loved ones against COVID-19 infection, severe illness and death. We urge everyone to get vaccinated as soon as possible so that it is a winter filled with joyous memories," urged Lloyd-Jones.

Emergency assessment needed even when stroke symptoms disappear

by American Heart Association

Dallas - Stroke symptoms that disappear in under an hour, known as a transient ischemic attack (TIA), need emergency assessment to help prevent a full-blown stroke, according to a new American Heart Association scientific statement published today in the Association’s journal Stroke. The statement offers a standardized approach to evaluating people with suspected TIA, with guidance specifically for hospitals in rural areas that may not have access to advanced imaging or an on-site neurologist.

Photo courtesy American Heart Assoc.

TIA is a temporary blockage of blood flow to the brain. Each year, about 240,000 people in the U.S. experience a TIA, although this estimate may represent underreporting of TIA because symptoms tend to go away within an hour. While the TIA itself doesn’t cause permanent damage, nearly 1 in 5 of those who have a TIA will have a full-blown stroke within three months after the TIA, almost half of which will happen within two days. For this reason, a TIA is more accurately described as a warning stroke rather than a “mini-stroke,” as it’s often called.

TIA symptoms are the same as stroke symptoms, only temporary. They begin suddenly and may have any or all of these characteristics:

• Symptoms begin strong then fade;
• Symptoms typically last less than an hour;
• Facial droop;
• Weakness on one side of the body;
• Numbness on one side of the body;
• Trouble finding the right words/slurred speech; or
• Dizziness, vision loss or trouble walking.

The F.A.S.T. acronym for stroke symptoms can be used to identify a TIA: F ― Face drooping or numbness; A ― Arm weakness; S ― Speech difficulty; T ― Time to call 9-1-1, even if the symptoms go away.

“Confidently diagnosing a TIA is difficult since most patients are back to normal function by the time they arrive at the emergency room,” said Hardik P. Amin, M.D., chair of the scientific statement writing committee and associate professor of neurology and medical stroke director at Yale New Haven Hospital, St. Raphael Campus in New Haven, Connecticut. “There also is variability across the country in the workup that TIA patients may receive. This may be due to geographic factors, limited resources at health care centers or varying levels of comfort and experience among medical professionals.”

For example, Amin said, “Someone with a TIA who goes to an emergency room with limited resources may not get the same evaluation that they would at a certified stroke center. This statement was written with those emergency room physicians or internists in mind – professionals in resource-limited areas who may not have immediate access to a vascular neurologist and must make challenging evaluation and treatment decisions.”

The statement also includes guidance to help health care professionals tell the difference between a TIA and a “TIA mimic” – a condition that shares some signs with TIA but is due to other medical conditions such as low blood sugar, a seizure or a migraine. Symptoms of a TIA mimic tend to spread to other parts of the body and build in intensity over time.

Who is at risk for a TIA?

People with cardiovascular risk factors, such as high blood pressure, diabetes, obesity, high cholesterol and smoking, are at high risk for stroke and TIA. Other conditions that increase risk of a TIA include peripheral artery disease, atrial fibrillation, obstructive sleep apnea and coronary artery disease. In addition, a person who has had a prior stroke is at high risk for TIA.

Which tests come first once in the emergency room?

Blood work should be completed in the emergency department to rule out other conditions

After assessing for symptoms and medical history, imaging of the blood vessels in the head and neck is an important first assessment. A non-contrast head CT should be done initially in the emergency department to rule out intracerebral hemorrhage and TIA mimics. CT angiography may be done as well to look for signs of narrowing in the arteries leading to the brain. Nearly half of people with TIA symptoms have narrowing of the large arteries that lead to the brain.

A magnetic resonance imaging (MRI) scan is the preferred way to rule out brain injury (i.e., a stroke), ideally done within 24 hours of when symptoms began. About 40% of patients presenting in the ER with TIA symptoms will actually be diagnosed with a  stroke based on MRI results. Some emergency rooms may not have access to an MRI scanner, and they may admit the patient to the hospital for MRI or transfer them to a center with rapid access to one.

Blood work should be completed in the emergency department to rule out other conditions that may cause TIA-like symptoms, such as low blood sugar or infection, and to check for cardiovascular risk factors like diabetes and high cholesterol.

Once TIA is diagnosed, a cardiac work-up is advised due to the potential for heart-related factors to cause a TIA. Ideally, this assessment is done in the emergency department, however, it could be coordinated as a follow-up visit with the appropriate specialist, preferably within a week of having a TIA. An electrocardiogram to assess heart rhythm is suggested to screen for atrial fibrillation, which is detected in up to 7% of people with a stroke or TIA. The American Heart Association recommends that long-term heart monitoring within six months of a TIA is reasonable if the initial evaluation suggests a heart rhythm-related issue as the cause of a TIA or stroke.

Early neurology consultation, either in-person or via telemedicine, is associated with lower death rates after a TIA. If consultation isn’t possible during the emergency visit, the statement suggests following up with a neurologist ideally within 48 hours but not longer than one week after a TIA, given the high risk of stroke in the days after a TIA. The statement cites research that about 43% of people who had an ischemic stroke (caused by a blood clot) had a TIA within the week before their stroke.

Assessing stroke risk after TIA

A rapid way to assess a patient’s risk of future stroke after TIA is the 7-point ABCD2 score, which stratifies patients into low, medium and high risk based on Age, Blood pressure, Clinical features (symptoms), Duration of symptoms (less than or greater than 60 minutes) and Diabetes. A score of 0-3 indicates low risk, 4-5 is moderate risk and 6-7 is high risk. Patients with moderate to high ABCD2 scores may be considered for hospitalization.

Collaboration among emergency room professionals, neurologists and primary care professionals is critical to ensure the patient receives a comprehensive evaluation and a well-communicated outpatient plan for future stroke prevention at discharge.

“Incorporating these steps for people with suspected TIA may help identify which patients would benefit from hospital admission, versus those who might be safely discharged from the emergency room with close follow-up,” Amin said. “This guidance empowers physicians at both rural and urban academic settings with information to help reduce the risk of future stroke.”