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Perioperative AF: Assessing Long-Term Stroke Risks

Perioperative AF: Assessing Long-Term Stroke Risks

Studies have shown that atrial fibrillation (AF) and flutter affect more than 33 million people throughout the world, and the presence of chronic AF has been associated with a three-fold greater risk of stroke. When stroke occurs in patients with AF, these individuals are at greater risk of longer hospital stays, worse disability, and higher mortality. New-onset perioperative AF is one of the most common perioperative arrhythmias, but its incidence ranges widely because studies have included different populations in terms of the type of surgery performed and patient characteristics. “Although it’s well known that AF raises the risk of stroke in general, there is increasing interest to fully understand the clinical burden of perioperative AF,” says Hooman Kamel, MD. “It’s possible that even brief perioperative episodes of AF can increase the risk of stroke.” Studies have shown a strong association between perioperative AF and length of stay, hospital costs, and mortality. Furthermore, the condition has been repeatedly associated with a higher short-term risk of perioperative stroke in the setting of cardiac surgery. However, data are scarce with regard to long-term stroke risks from perioperative AF in patients undergoing other types of surgery. Some research has suggested that perioperative AF may result as a transient response to the physiological stress of surgery itself. Overall, the long-term risks of stroke after patients experience perioperative AF are unclear. Taking a Closer Look Dr. Kamel and colleagues conducted a study to determine the long-term risk of ischemic stroke after perioperative AF of patients undergoing a variety of surgeries. Published in JAMA, the analysis used a population-based sample of more than 1.7 million patients...
The Paucity of Doctor Leaders in Medicine

The Paucity of Doctor Leaders in Medicine

Changes are happening in the healthcare system whether we like it or not, from the ACA to the Physician Quality Reporting System, or PQRS. Many doctors are not happy with these changes. Yet, there are few that lead us to affect change. Many doctors are simply too busy and lack time. Others just do not know how to lead. For years, we are trained to just do what others tell us. We have all served as scut monkeys in our early years of residency. However, this mentality is leading to physician burnout. We can no longer just sit back while non-physician executives and politicians dictate healthcare. How can doctors take back the lead? 1. Attend local meetings at the hospital. Speak up at hospital committees and demand change. Most of us just accept our hospital’s by-laws without even reading them. The vast majority of us oppose MOC, yet if our hospitals are requiring it for us to maintain our privileges, it will never go away. 2. Become active with local medical associations. Many doctors feel the larger ones, such as the AMA, have sold us out to politicians and do not truly represent the physician members. We have more of a chance to make change on a smaller, local lever first. Speak with the representatives and let them know what physicians need and want. 3. Doctors are increasingly frustrated by 3rd party payment hassles. Many sign the participating physician contracts without reading them or knowing what is written in them. This makes it harder for others to negotiate a more reasonable arrangement. Doctors need to stop doing this. We...
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