As patients and caregivers… We need to research our heart valve disease. We need to research our surgical options. We need to research surgeons. And, we need to research hospitals.

Why do we do this? Ultimately, I believe this research empowers us to make smart and confident choices that minimize our surgical risk.

On that note, I just read a fascinating report that suggests there is (i) a significant gap in quality among America’s hospitals, and (ii) a corresponding large difference in the rate of patient deaths.

Healthgrades said patients have a 52% percent lower risk of dying in a top-rated hospital than in United States hospitals in general. The study is based on an evaluation of hospital mortality related to 17 procedures and diagnoses at 5,000 non-federal U.S. hospitals. The study’s conclusions came after researchers examined 40 million Medicare hospitalization records from the years 2006, 2007 and 2008.

“The fact is, patients are twice as likely to die at low-rated hospitals than at highly rated hospitals for the same diagnoses and procedures,” Dr. Rick May, an author of the HealthGrades study, said in a statement. “With Washington focused on rewarding high-quality hospitals and empowering patients to make more informed healthcare choices, this information comes at a turning point in the healthcare debate.”

Other findings in the 12th annual “HealthGrades Hospital Quality in America Study” include:

• If all hospitals performed at the level of a five-star rated hospital across 17 procedures and diagnoses studied for mortality rates, 224,537 lives of Medicare patients could potentially have been saved from 2006 through 2008.
• About 57 percent (127,488) of the potentially preventable hospital deaths were associated with four diagnoses: sepsis (44,622); pneumonia (29,251); heart failure (26,374) and respiratory failure (27,241).
• Across all procedures studied, there was a 62% percent lower chance of experiencing one or more inhospital complications in a five-star rated hospital compared to the U.S. hospital average.

So you know…

When I conducted research, prior to my own aortic heart valve replacement, it was studies similar to this one that forced me to consider the best medical centers for cardiac care. For me, it was simple. I wanted a top surgeon. Often, as this study alludes, it is the top hospitals that attract the top surgeons.

Please, please, please conduct the proper diligence before you, or anybody you know, is rolled into an operating room for heart valve surgery.

Keep on tickin!

In the past, we have had several discussions about cardiac depression as a common, patient pitfall after heart valve surgery. Now, it appears there is some new evidence which suggests that treating depression may help treat patients after a cardiac event.

Sarah sent me this very interesting article which was recently featured in The Wall Street Journal.

Patients who develop depression after heart attacks fare worse in the long term than those who don’t. But will treating their depression prevent further heart problems and safe lives? That question plagues medical experts and is a source of fresh contention among cardiologists and behavioral scientists looking for effective strategies to help patients suffering from both conditions.

Depressed people are more likely to have heart attacks, and 15% to 20% of those who have had heart attacks get depressed, according to the American Heart Association. In contrast, 6.7% of adults in the overall U.S. population will be become depressed any given year, according to the National Institute of Mental Health.

Classic-car lover Nicholas Toros says that he couldn’t enjoy his hobby after a heart attack in 1991 led to bouts of depression.

Moreover, depressed heart patients have a greater chance of dying and a worse quality of life compared to those who aren’t depressed. A study published Monday in the Archives of General Psychiatry found that patients who developed severe depression after being hospitalized for a cardiac event, and remain depressed for at least six months, had more than double the risk of dying over the next seven years.

“The bottom line is that depression is important,” says Brett Thombs, assistant professor in psychiatry at McGill University and Jewish General Hospital, Montreal. “The question is what we do about it.”

Remedies for depression in the general population include antidepressant medications, such as Prozac, that have transformed treatment of the condition in the past two decades, and psychotherapy. But there is surprisingly little research examining whether these approaches help prevent deaths or heart attacks among heart patients who also suffer from depression.

In a move that continues to spur debate, the American Heart Association came out with recommendations last year stating that all heart-disease patients should be screened for depression, and those with symptoms should be treated. The guidance, endorsed by the American Psychiatric Association, was issued even though both organizations acknowledged a lack of evidence that such screening improves outcomes in patients with heart disease.

To learn more about cardiac depression as it relates to heart valve surgery, please click these links:

• Behavioral and Emotional Changes After Heart Surgery
  
• How To Care And Support A Heart Valve Surgery Patient?
• Heart Surgery Patients Should Not Feel Alone & Isolated
• Vicodin And Heart Surgery Recovery… Beware!
• Recovery Tip: Go To Cardiac Rehab
• Heart Valve Surgery & Cardiac Depression – My Experience

Keep on tickin!

The University of Michigan Cardiovascular Center just released a rather troubling study about patients who are  diagnosed with mitral regurgitation and do not receive surgical treatment. I guess this is one more reason why second opinions are so valuable. Here are the details:

Overblown fears about (i) surgical risk and (ii) lack of awareness about the risk of not operating are among the reasons only half of eligible patients were referred for mitral valve repair, according to a study by doctors at the University of Michigan Cardiovascular Center.

Mitral Valve Repair (Annuloplasty)

A leaking mitral valve, known as mitral regurgitation or mitral insufficiency, can lead to fatigue, abnormal heart rhythms with irregular heart beats, and congestive heart failure. The longer the leak continues, the more likely there will be permanent heart damage.

Read the rest of this entry »

I give A LOT of credit to patients and caregivers that really, really, really, really do their homework prior to heart valve replacement or heart valve repair surgery. I can immediately tell from the questions you ask me just how diligent you’re being at each phase of the surgical process.

Case in point… Duane Schlosser (55 years of age) from Austin, Texas just sent me two interesting questions about the Ross Procedure and minimally invasive pulmonary valve replacements that I thought you might benefit from. That said, here is what Duane writes:

Duane Schlosser – Heart Valve Replacement Patient

Adam,

Thank you for your heart valve surgery book. It has helped me come to grips with my own situation. I am scheduled for aortic valve replacement in September via the Ross Procedure. I have a two-part question for you.

Read the rest of this entry »

In the past, we have discussed the genetics of heart valve disease. (So you know… I, like my Great Uncle Mooney, suffered from a congenital bicuspid aortic valve which needed to be replaced.)

On the topic of heredity and heart valve disease, a new study was just published in the Journal of the American College of Cardiology which suggests that nearly a third of first-degree relatives (siblings, children or parents) of patients with a bicuspid aortic valve are likely to have enlarged aortas. This was found even in the absence of any abnormalities of the heart valve itself.

According to the study:

Read the rest of this entry »