Heart Health (I)

I was prescribed a nuclear stress test on account of a 157 calcium score* in my widowmaker artery (the LAD) but then I came across this book and reconsidered. My doctor dropped me (and his other patients) two days later as he shifted his practice to being a concierge for $5,000 per year (still researching). Likely unrelated but quite a stressful time right now.

All these factors leave patients feeling overwhelmed and helpless, who land up deferring to physicians and the system to make a choice for them. (page 1)

the majority of diseases can be prevented with diet, exercise, weight control, blood sugar control, and blood pressure control. (page 2)

Treadmills found their early use as a punishment for prisoners in England back in 1818. In later years the practice was abandoned as inhumane. (page 12)

After an abnormal stress test indicates possible blockages in the heart arteries, the patient usually undergoes a more definitive yet invasive procedure called cardiac catherization. In this test, doctors pass a tube through the leg or arm into the heart arteries. They then inject dye directly into the heart arteries and look at the location and extent of blockages. Based on the results, either medications alone, medications with bypass surgery, or medications with angioplasty is recommended as treatment. (page 13)

She was always surprised that in health care the right hand didn’t know what the left hand was doing. (page 19)

“No surgeon performs elective surgeries while a patient is on this blood thinner, because the bleeding could be disastrous. The recommendation is to hold off on any nonemergency surgery for a year. (page 19)

In the 1990s, one in fifty-seven patients receiving a stress test didn’t need it. By the 2000s, this had increases to one in fifteen patients. In some cases, as many as one out of two patients were undergoing unneeded stress tests. (page 20)

Thanks to the ready availability of a stress test with radioactive dye, this technology is used too frequently. In the 1990s, only half of stress tests were performed with radioactive-dye injections. However, by the 2000s close to 90 percent of tests also used radioactive dye. It is estimated that one-third of these te4sts were not medically necessary. All the radiation exposure through these unnecessary tests causes 491 additional cancers per year. In addition, the economic cost of these tests is estimated at about 501 million dollars annually. (page 20)

Therefore, even among patients with a previous heart condition, the stress test does not yield any benefit when there are no symptoms and can instead lead to unnecessary stents or bypasses. (page 21)

Tellingly, the number of stress tests performed decreased only after the reimbursement for these tests decreased in 2005. (page 22)

This is a cognitive error called availability bias, which drives physicians to judge the likelihood of a disease based on how easy it is to recall a particular case. (page 22)

If you have no symptoms, there is very little need for a stress test. The actions that will be taken from the results of the stress test are not going to prolong your life under these circumstances. As a matter of fact, you have more chance of being harmed by the test than being helped by it. (pages 23-4)

Unfortunately, the number of heart attacks recorded over the last few years has not changed. This means heart disease is only as common today as it was in the 1980s and 1990s. However, the number of people who have been tested has increased rapidly. this is an indication that cardiac catherization could be overutilitized. Unlike in the past, we may be applying invasive and expensive tests to people who are unlikely to benefit from it. (page 38)

When patients without symptoms of heart disease undergo testing and blockages are found, treatment with stents or bypasses does not improve longevity. However, in hospitals where unnecessary testing takes place, there is also an increased rate of stent placement or bypass surgery to treat detected blockages, despite the fact that these patients get no benefit and are occasionally even harmed by these treatments. (page 39)

the heart muscle can continue to function normally even with a 50 to 60 percent blockage (except in the left main artery, where anything more than 50 percent blockage is concerning). (page 41)

* My test results from two weeks ago. Back on the Crestor to see if it drops but no stress test for now.

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