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Assessing Aspirin Use for CVD Prevention

Assessing Aspirin Use for CVD Prevention

Aspirin is used as a primary strategy to help prevent a first occurrence of cardiovascular disease (CVD). It can also be used as secondary prevention for survivors of heart attacks and strokes to prevent additional cardiovascular events. The American Heart Asso­ciation recommends daily low-dose aspirin for people at high risk of heart attacks and regular use of low-dose aspirin for heart attack survivors. “Preventing CVD events is particularly important,” says Arch G. Mainous, PhD. “Understanding physician recommendations for aspirin therapy is critical to the delivery of quality care.” Few studies, however, have evaluated patient use of aspirin and reported physician recommendations of aspirin therapy for CVD prevention. Suboptimal Use In a study published in the Journal of the American Heart Association, Dr. Mainous and colleagues analyzed data from the National Health and Nutrition Examination Survey, 2011–2012 and examined aspirin use for preventing CVD. The study showed that only about 41% of high-risk individuals reported being told by their physician to take aspirin, and just 79% of these patients actually complied with the recommendation. Among low-risk patients, 26% were told by their physician to take aspirin, with nearly 77% complying. Age, access to a regular source of care, education, and insurance status were identified as significant predictors of a physician recommendation for aspirin use as primary prevention. Among high-risk patients, significant predictors were age, race, and insurance status. Age, education, obesity, and insurance status were significant predictors among low-risk patients. Overall, the analysis indicated that there were persistent problems with access to care. The rates of patients being recommended to take aspirin to prevent CVD are not ideal, says Dr....
Social Support After AMI

Social Support After AMI

Studies have shown that social support is an important prognostic predictor in older people who have suffered an acute myocardial infarction (AMI). Patients with low perceived social support have worse outcomes after their AMI, including higher mortality, more cardiac events, and lower quality of life (QOL). However, most studies have focused on older men, and few analyses have looked at the role of social support in younger AMI patients, especially women. “Younger AMI survivors are at an entirely different stage of life and often have different social connections and support structures,” says Emily M. Bucholz, MD, PhD MPH. “While older people tend to rely on their immediate family for help, younger individuals are more likely to include fewer family members and more friends and coworkers in their support networks. Younger people may also experience more stress from work, raising their family, or social obligations, which can compromise their support structures. As a result, social support may be a particularly important predictor of AMI prognosis in these patients.” Examining Younger AMI Patients In a study published in the Journal of the American Heart Association, Bucholz and colleagues used data from the Variation in Recovery: Role of Gender on Outcomes of Young AMI Patients (VIRGO) study to examine social support in younger patients after they had an AMI, particularly women, from the United States and Spain. VIRGO contains detailed socio-demographic and psychosocial information as well as data on mental health, depression symptoms, and QOL during follow-up. Data from VIRGO were used to investigate both the physical and mental health consequences of low social support after AMI. The investigators evaluated self-reported social...
Anyone Can Become Angry, That’s Easy

Anyone Can Become Angry, That’s Easy

Anyone can become angry—that is easy. But to be angry with the right person, to the right degree, at the right time, for the right purpose, and in the right way—this is not easy.  Aristotle This is a lesson that I have struggled to learn for more than 30 years. I am better than I used to be, but still have a short fuse. There was a time when, as a patient once put it, I was the ‘Bobby Knight of the operating room.’ I didn’t consider it a compliment then and don’t now. Temper tantrums in the OR are destructive to morale and disrupt the flow of an operation. Yelling at the staff doesn’t make them work harder or smarter; it just makes them dislike working with you. I still get loud, curse, and fume, but direct it mainly at myself. I studiously avoid blaming my scrub nurse, tech, or first assistant. The reason a case isn’t going well is seldom their fault in any event. As a mentor once said, “If the operation is hard, you’re doing something wrong.” The flow and pace of the surgery is my responsibility, not theirs. Once my patient is admitted to an inpatient floor, the situation is different. I’m still responsible for the care, but no longer in control. I can’t sit at the bedside 24 hours a day and watch over a patient. So when my orders get screwed up, or when the care is indifferent of incompetent, I look to the nurse caring for the patient to take responsibility for the problem. When this doesn’t happen, I need to...
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