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Developing a Cardiology-Oncology Partnership

Developing a Cardiology-Oncology Partnership

Cardiovascular disease (CVD) and cancer are the most prevalent diseases in the current era, and the rates of these diseases continue to rise. More than 2 million breast cancer survivors in the United States are at risk for cardiotoxicity. Pediatric cancer survivors are two to five times more likely than the general population to develop heart disease. Treatment for cancer has become more effective, but cardiac disease in these patients has in turn become increasingly common. CVD can affect their quality of life as well as the course of cancer treatment. Preventing CVD in Cancer Patients Preventing CVD in cancer patients is important because aggressive cancer therapies are being used in older patients who may have cardiac problems or cardiovascular risk factors. Furthermore, researchers are identifying cardiac toxicities with new cancer therapies. Cardiotoxicity from cancer treatments include heart failure, hypertension, hypotension, arrhythmias, pericarditis, and myocardial ischemia. Radiation to the chest, leukemias, and chest tumors can lead to pericarditis, myocarditis, valve disease, and coronary artery disease.   Diagnosing cardiotoxicity during cancer treatment can be challenging. Symptoms like fatigue, shortness of breath, and edema are common to cardiac problems but are also adverse effects of cancer therapy. When patients present with these symptoms, they should be referred to cardio-oncology programs for further evaluation. Collaborative Care Among Cardiologists & Oncologists At the University of Michigan, cardiologists are collaborating with oncologists to tailor cardiac and cancer therapy to minimize cardiotoxicity. We stratify risk in patients with cardiac disease or CVD risk factors in an effort to optimize these conditions prior to cancer treatment. Cardio-oncology programs: • Provide prevention and early detection of cardiac complications....
ED Care of AF & Hospital Charges

ED Care of AF & Hospital Charges

The initial management of newly recognized atrial fibrillation and atrial flutter (AF) lasting over 48 hours is generally heart rate control along with anticoagulation to prevent future embolic events. Once rate control is achieved by emergency physicians, decisions on the timing of the rhythm control are often left to admission cardiologists. For cases in which AF duration is shorter than 48 hours, patients are often managed similarly. Recent studies, however, show that many of these patients can benefit from ED cardioversion (EDCV) to achieve normal sinus rhythm with discharge from the ED to home. Potential for Significant Savings In a study published in the Western Journal of Emergency Medicine, my colleagues and I examined 300 AF patients who came to the ED for care and were screened for timing of symptom onset. EDCV was considered if nursing or physician notes documented onset of AF symptoms within 48 hours of ED presentation in patients younger than 85. The median charges for EDCV patients were $5,460, compared with $23,202 for those admitted with no attempt at cardioversion. Median charges for patients whose final ED rhythm was normal were $5,641; for those remaining in AF, median charges were $30,299. A surprising finding from our study was that the resource savings produced by simply attempting EDCV, regardless of the results, were also significant. Admitted patients remaining in AF following cardioversion attempts still had hospital charges that were $8,628 lower than those admitted with no EDCV attempt. Efficient & Effective The longer a heart remains in AF, the more the atrium becomes conditioned to accept this rhythm. The sooner after the onset of AF...

Metabolic Syndrome, Catheter Ablation, & AF

Atrial fibrillation (AF) is increasingly being viewed by clinicians as a modern-day epidemic, affecting more than 2.2 million adults in the United States. AF is strongly age-dependent, affecting 4% of people older than 60 and 8% of those older than 80. Alarmingly, about one-quarter of people aged 40 and older are expected to develop AF during their lifetime. Another growing problem is the continued emergence of metabolic syndrome (MS), which is estimated to affect 21% to 24% of U.S. adults. Coexistence of MS and AF is common. Studies suggest that different components of MS, including hypertension, diabetes, dyslipidemia, and obesity, increase the likelihood of AF. Catheter ablation has been a major treatment advance for the condition, offering a new spectrum of options for drug-refractory AF patients. However, this procedure is yet to be a total success in maintaining long-term sinus rhythm, even in the best hands. Little is known about the role of MS on the long-term outcome of AF ablation, such as restoration of sinus rhythm and improvement in quality of life (QOL). Taking a Deeper Look at Atrial Fibrillation In the April 3, 2012 Journal of the American College of Cardiology, we had a study published that prospectively analyzed 1,496 patients with AF who were undergoing a first ablation. About 45% of our study group had long-standing persistent AF, while 29% had paroxysmal AF and 26% had persistent AF. Patients were classified as either having MS or not having MS. They were followed for AF recurrence and QOL at 12 months after their ablation procedure. At follow-up, 39% of patients with MS had experienced arrhythmia recurrence, compared...

Increasing Awareness of Atrial Fibrillation

Research has shown that atrial fibrillation (AFib) is one of the most common sustained heart rhythm abnormalities, affecting an estimated 2.3 million Americans, but other investigations suggest that the condition may affect millions more. “Atrial fibrillation is a potentially serious condition,” says Nassir F. Marrouche, MD. “The irregular heartbeat associated with AFib can cause blood to pool in the atria, which can result in the formation of clots. These blood clots can travel from the heart to the brain, where they can lead to stroke.” According to current estimates, AFib increases the risk of stroke nearly five-fold. About 15% of all strokes in the United States are associated with AFib. Strokes that are associated with AFib are about twice as likely to be fatal or severely disabling as non–AFib-related strokes. In the United States, studies have predicted that as many as 5.6 million American adults will have AFib by 2050. One of the largest demographics to be affected by AFib includes elderly individuals. It has been estimated that 3% to 5% of elderly Americans have AFib, but that number may be larger because symptoms often go unrecognized by patients and physicians alike. Spotting AF Symptoms One of the aspects of AFib that makes it difficult to manage is that the condition is not always accompanied with symptoms. Published studies have shown that several symptoms may be attributable to AFib, including racing or irregular heartbeat, fluttering in the chest, heart palpitations, and shortness of breath. Other symptoms of AFib include chest pain, fatigue when exercising, sweating, and weakness, dizziness, or faintness. “It’s challenging for physicians to identify AFib because the...
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