Yesterday I posted the four most important questions to ask your doctor. Let’s apply those questions to a typical scenario: Whether or not to take an anticoagulant drug for prevention of stroke in the presence of AF. We need a typical patient. For this example we will pick a typical CHADS-VASC 2 patient. 65 year-old […]
I am seeing an increasing number of patients who did not know they had a choice about taking a medicine or having a procedure. Why did you have that heart cath? A: My doctor said I should. Why are you on that medicine? A: My doctor prescribed it. It’s time we re-review the basic four […]
A large study presented at last month’s American College of Cardiology meeting reported that slightly more than 1 in 10 patients with aortic valve replacements (tissue valve) had small clots on the leaflet of the new valve. The study included 890 patients. The clots, which doctors call “subclinical thrombosis,” cannot be seen on regular echo […]
Fake atrial fibrillation (AF) is a growing problem. This is when the computer-reading on an ECG calls the rhythm AF, but it is not AF. When the doctor does not recognize the faulty read, the patient is misdiagnosed. Here are three pictures from the last month. (I have a stack of these.) Notice the computer-read […]
My Facebook feed has been buzzing with news of a breakthrough in the treatment of sepsis–a deadly condition caused by bacterial infection. Do not be fooled. Please. Resist the urge to be duped. A recent study published in the prestigious journal Chest concluded that a combination of high-dose vitamin C, anti-inflammatory corticosteroids and thiamine given […]
I want to point you to a rebuttal of my last post on healthcare reform. Dr. Rocky Bilhartz is a thoughtful cardiologist and an excellent writer. In a blog post titled Divergent Visions, he offers a completely different view of right care. Go read it. So what if you don’t agree. Christopher Hitchens said in […]
Politicians and policy makers are fighting over new health reform proposals. This debate misses the core problems in US healthcare. Look at this graph from the Our World In Data website: It shows that Americans pay too much for lousy health outcomes. Fixing the problem on that graph should be the focus of reform. I […]
A colleague recently asked me if atrial fibrillation (AF) ablation was overused. Yes it is. AF ablation has become the wild west of electrophysiology. There is essentially no scrutiny of this invasive, expensive and risky procedure. I also include here the add-on “maze-like†procedures done during heart surgery for other conditions. I believe they too […]
I recently served on the faculty of the tenth annual Western AF Symposium in Park City, Utah. Dr. Nassir Marrouche of the University of Utah has grown Western AF into a huge gathering of global experts in atrial fibrillation. During the intense two-day meeting, I took notes and put together a post of top-ten highlights. […]
Three weeks ago I wrote about the growing dominance of the new oral anticoagulant (NOAC) drugs for stroke prevention in patients with atrial fibrillation. (Another common name for these drugs is direct acting oral anticoagulants or DOACs.) The post generated many comments–some privately and some on the blog. Your responses induced me to think a […]
Changing one’s mind is hard. Changing the mind of doctors is even harder. Doctors are supposed to be the medical experts. Often we are. But sometimes I wonder whether our attachments to old ideas gets in the way of seeing the obvious. I am reading Michael Lewis’s book The Undoing Project. Learning how Kahneman and […]