2009 lown forum 3

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MYTHS & FACTS ABOUT AF

MYTH: Patients with AF generally have poor quality of

life and bad prognosis.

FACT: AF is a common condition, especially in older

people. It is a generally benign and manageable clinical

problem.

MYTH: Onset of AF poses a medical emergency

requiring hospital admission.

FACT: Most AF episodes and the vast majority of AF

patients can be treated safely and effectively as

outpatients.

MYTH: AF is generally life threatening.

FACT: Proper anticoagulation (blood thinning) is

effective for stroke prevention, and control of heart

rate alleviates symptoms and prevents potential

complications.

MYTH: Procedures such as ablation are frequently

necessary.

FACT: AF ablation may benefit carefully selected

patients but in our experience this is infrequently

necessary.

historic introduction, in the early 1960s, of direct current

electrical cardioversion, which remains a primary

intervention to restore normal rhythm in AF patients. The

physicians at the Lown Center have managed thousands of

patients with AF. With more than 40 years of experience,

we have developed a unique approach to this condition,

emphasizing medical therapy tailored to the individual

patient, which produces excellent outcomes and good

quality of life in the majority of patients with AF.

Individualized treatmentWe don’t treat AF, but the patient with AF. An effective AF

management plan takes into consideration many factors

unique to each patient, including underlying heart disease,

severity of symptoms, degree of physical activity,

emotional state, compliance with medications and

possible side effects, and, importantly, each patient’s

preferences. For example, patients with infrequent AF

episodes may require only intermittent treatment. By

providing therapy on an as-needed basis, we avoid

unnecessarily exposing them to potential side effects.

Education and reassuranceBeing diagnosed with a cardiac condition can be alarming

and stressful. We take time to help our patients under-

stand their heart health, reassure them that AF is generally

a benign and manageable condition, and affirm that most

people with AF are able to lead full and normal lives.

Maximize non-invasive therapiesThrough careful listening and examination, we identify and

address issues that may co-exist with a person's AF, such

as other medical conditions that can influence its course. A

core principle of the Lown Center's model of cardiac care is

to utilize invasive procedures, such as ablation, only as a

last resort and only in symptomatic patients for whom

other medical alternatives have failed or are not feasible.

In our extensive experience, this is infrequently necessary.

Read the Lown Center patient guide: Atrial fibrillation on page 4.

Atrial fibrillation (AF), an irregular pulse

originating in the upper chambers of the

heart (the atria), is the most common

sustained heart rhythm abnormality

(arrhythmia). Increasingly prevalent, AF

is a significant health issue, currently affecting 2.5 million

adults in the US at an estimated cost of $6.65 billion

annually. About 20% of strokes are due to AF. Most

patients with AF can be treated effectively with

medications. In recent years, however, invasive proceduresfor treating AF have been heavily marketed by specialized

AF centers and related industries.

The Lown Cardiovascular Center has been a pioneer in

researching and treating patients with AF since Dr. Lown’s

Atrial fibrillation: The importance of individualized treatmentShmuel Ravid, MD, MPH

Lown Forum 2 0 0 9 NUMBER 3 T

H

E

LOWN CARDIOVASCULAR RESEARCH FOUNDATION

2 Foundation newsPresident's message

3 Heart Hero Award: Uganda

4 Guide to atrial fibrillation

5 Patient profile: Living with AF I N

S I D

E 5 LCRF anxiety research

6 Question from a patientLown Center N ews b eat

7 Donors celebrate a Lown Center Golden Anniversar

8 Consumer beware: Mobile vascular screenings

8/3/2019 2009 Lown Forum 3


FOUNDATION NEWS

New Lown Center home care projectThe Lown Cardiovascular Center is embarking on a new

demonstration project in which a small group of patients

will be able to communicate with us from their homes via

videoconferencing over the internet. The project's

purpose is to explore how communication technology

might enhance our model of care. Potential benefits of

participation may include receiving quick answers to

simple questions, engaging in face-to-face consultations

without coming into the office, and increasing patients'

peace of mind. We will be recruiting a limited number of

patients for this project. If you are interested and wish to

learn more, contact Jessica Gottsegen at 617-732-1318

x3805 or [email protected].

LCRF welcomes Jessica GottsegenThe Lown Foundation welcomed Jessica Gottsegen as our

new Foundation assistant in May 2009. Jessica is a 2009

graduate of Brandeis University, where she received

Bachelor of Arts degrees in Psychology

and in Health: Science, Society, and

Policy. At Brandeis, she dedicated a

great deal of time to the Waltham

Group, the university’s community

service program, and was responsible

for managing 16 volunteer programs

with over 400 student volunteers. In

2007 she interned in the Stop TBdepartment of the World Health Organization in Geneva,

Switzerland. She also interned with the American Cancer

Society and volunteered for five years at Camp Sunshine,

a camp for children with life-threatening illnesses.

Jessica works closely with other LCRF staff to support

Foundation activities. Her role includes assisting with

development and fundraising and providing general

administrative support. She is thrilled to be part of the

Lown Foundation team and looks forward to working

with Foundation supporters locally and globally.

Please join us in welcoming Jessica, and feel free to contact

her at 617-732-1318 x3805 or [email protected].

Receive your Lown Forum by emailMembers of the Lown Foundation community can

now receive our quarterly Lown Forum newsletter by

email. If you'd like to receive a PDF of the Forum

rather than a print copy, please send your name and

preferred email address to [email protected] or

call Jessica Gottsegen at 617-732-1318 x3805.

President’s messageVikas Saini, MD, President, Lown Cardiovascular Research Foundation

During a recent presentation in Tokyo, I made the casethat the key to cost containment is reimbursement ofphysicians for spending more time talking with patients,thus reducing premature ordering of multiple procedures

This approach is the core of the Lown Center’s practicestyle and key to its effectiveness. We have completed afirst-phase statistical analysis of our coronary arterydisease project. Results show a mean follow-up time of 13.2years for enrolled patients, and an annualized mortality of3.7%. For those under 80 years, the rate was 3.2%.

Many among this cohort of people originally came to theLown Center for a second opinion. As reported previously(1), our cardiologists determined that most of them did

not require surgery. Our results compare favorably withpeople who undergo bypass surgery: recent Medicareresults indicated that long-term survival after bypasssurgery in northern New England was 4.2% in those under 80 years old.

We have also found other interesting and importantassociations. Exercise duration on treadmill testing wasan important prognostic indicator, reaffirming the valueof maintaining fitness. As discussed by Dr. Blatt on page4, initial anxiety levels were a significant variable inoutcomes, reinforcing our interest in exploring ways toinfluence nontraditional risk factors.

Our next goal is to develop statistical techniques that willallow comparison of our outcomes to those of thegeneral population of patients. This is part of a broad areaof emerging research called “comparative effectiveness,”which has understandably drawn keen interest frompolicy makers in Washington as everyone struggles todelivery quality at affordable cost. Stay tuned.

(1) Long-Term Outcomes of Optimized Medical Management of Outpatients With Stable Coronary Artery Disease (Am J Cardiol2004;93:294–299). Read it on the LCRF website:http://www.lowncenter.org/articles/CAD.pdf

2 L O W N F O R U M

Newpatientappointmentsavailable

Patients of the Lown Cardiovascular Center frequently ask whether--and how--they canrefer friends or relatives to the Center. Newpatient appointments are currently available.Individuals who would like to make anappointment with one of the Lown Center cardiologists should contact Maura Emery,Appointment Coordinator, 617-732-1318 x3315.

8/3/2019 2009 Lown Forum 3


Be Alive With Your Heart Uganda receives ProCor's 2009Louise Lown Heart Hero Award

hand--her mother's obesity and hypertension were

effectively managed, at no cost, through the program.

Edward reports that the

$2000 award funding will

help the program install

internet services, buy a

secondhand computer to

increase their capacity for

data management, and

expand services to other

parts of the district. He also

hopes that the award's

visibility will help attract

further funding.

ProCor's award review

committee chose the 2009

winner from 20 applications from 15 countries, including

Canada, Ghana, Guatemala, India, Iran, Iraq, Jamaica,

Kenya, Mauritius, Nepal, Philippines, Russia, Saudi Arabia,

Thailand, Uganda, and the US. Special thanks to LCRF

Board member Janet Johnson Bullard and International

Advisory Council member Ruth Bonita for joining the review

committee this year.

Read more about the Heart Hero at www.procor.org.

A few years ago, nutritionist Edward Buzigi and other health

care providers at Uganda Medical Center noticed a striking

increase in the number ofpatients with heart disease, obe-

sity, and hypertension. Data

from the District Health Office

confirmed that chronic diseases

were rapidly increasing: nearly

half of Wakiso District's popula-

tion was hypertensive and nearly

20% were obese.

The Wakiso District is the second

most densely populated district

in Uganda. At the time of thelast census, in 2002, more than

half the population of about 1

million was under 18 years old and 17% of its residents were

orphans. Having lost much of one generation to HIV/AIDS,

the hospital's board and staff decided to develop a program

to prevent the new health threat posed by cardiovascular

disease and its risk factors.

Be Alive With Your Heart encourages a heart-healthy

lifestyle from childhood through old age. Project staff and

volunteer nutrition students from Kyambogo University

provide education on nutrition and physical activity in

schools, homes, public gathering places, and worksites.

They also offer screenings for risk factors like hypertension,

diabetes, and obesity.

"This is a wonderful example of how a small group of

motivated people, with scarce resources, can have a

dramatic and sustainable impact on reducing cardiovascular

disease," commented Dr. Brian Bilchik, ProCor's director.

To address the trend toward fast foods, which Edward

explains is "due to modernization and time saving," the

program encourages schools and households to plant

backyard gardens and farms. Produce that grows well in thedistrict--beans, bananas, tomatoes, avocados, carrots,

cabbage, and green leafy vegetables--is now consumed at

home, at school, and is also made available to others.

As a result of the project's efforts, more than 40 schools

have planted vegetable and fruit gardens in the last two

years, and nearly 200 households in the district have

established backyard vegetable farms.

The program's sole source of funding is Alex Wambi, who

was raised in the district and now lives in the UK. She began

supporting the program after observing the benefits first-

L O W N F O R U M 3

2008 Award recipient featured inleading medical journal

"Making visible what otherwise would

go unnoticed" is, according to Dr.

Bernard Lown, the goal of the Louise

Lown Heart Hero Award. A profile of

last year's recipient, Dr. Toakase

Fakakovikaetau, was published in The

Lancet, a leading international

medical journal, in June 2009. The

profile came about after a Lanceteditor read about ProCor's award, and demonstrates

the award's success in achieving its goal.

"Toakase Fakakovikaetau: pioneering paediatrician in

Tonga" describes Dr. Toa's efforts to screen Tongan

schoolchildren for rheumatic heart disease and provide

early treatment so they can grow up healthy. With 1.8

million registered web users and 30,000 print

subscribers, the Lancet's visibility will help attract

much-needed attention to a health challenge that is

under-recognized and under-addressed.

Read the article online: www.thelancet.com

Education on the benefits of fruits and vegetables is provided byprogram staff and nutrition students from the local university.

8/3/2019 2009 Lown Forum 3


4 L O W N F O R U M

Understanding atrial fibrillationAtrial fibrillation (AF), an abnormal atrial rhythm, is

frequently associated with rapid pulse but may present

with a slow heart rate as well. In some patients, bothvarieties are present. AF might be present intermittently

(paroxysmal) or permanently (persistent or chronic AF).

Either type of AF might be present without an obvious

cause (“lone” AF). AF may manifest with palpitations,

breathlessness, fatigue, lightheadedness or fainting spells,

congestion, and reduced exercise tolerance. Many AF

patients have no symptoms; their AF may be discovered

incidentally during a routine physical exam or EKG test.

Even symptomatic patients with paroxysmal AF

experience many asymptomatic (silent) episodes.

Causes of AFAF may coexist with, be affected by, or contribute to

underlying cardiovascular diseases. The majority of AF

patients are older than 70 and frequently have a history of

hypertension, coronary heart disease, diseases of the heart

valves or muscle, diabetes, or heart failure; some are

“lone” fibrillators without an identifiable cause. Incidence

of AF increases with age. Fewer than 0.5% of adults

younger than 55 experience AF, but it affects about 7% of

adults in their 70s and more than 10% of people in their 80s.

AF is hereditary in a minority of patients. Other causes of

AF, some of which are preventable, include hyperactive

thyroid, sleep disorders, alcohol consumption (even

moderate amounts in sensitive patients), and ingestion of

various stimulants. AF is occasionally triggered by

emotional or physical stress in susceptible individuals.

Adverse outcomes of AFThe most serious complication of AF is stroke, which is

caused by blood clots that originate in the atria and travel

through the circulatory system to the brain (arterial

embolism). Infrequently, embolism from AF blocks other

arteries, potentially causing a heart attack, intestinal

ischemia, or kidney malfunction. Annual incidence of

stroke is about 3-5% in patients older than 70. Weakeningof the heart muscle (cardiomyopathy) and heart failure

due to rapid AF for extended periods of time may occur.

Occasionally, fainting spells result due to slow AF.

TreatmentsTreatment goals for AF are to prevent serious

complications, minimize symptoms, and improve quality

of life. Treatment should be individualized and determined

by medical considerations as well as patients’ preferences

and expectations. Although complications occasionally

occur, AF is generally a benign, non-life threatening

condition, if treated properly with blood thinners and

either restoring normal rhythm (rhythm control) or

slowing the heart rate response to AF (rate control).

Intensive treatment of all coexisting cardiac conditions

and risk factors (high blood pressure, heart failure,

diabetes, etc.) is necessary to reduce recurrence and

complications of AF.

Treatment with Coumadin (warfarin) for patients at high

risk for stroke, especially the elderly and those with heart

failure and/or high blood pressure, effectively lowers the

annual risk of stroke from 3-5% to about 1%. Coumadin

therapy is inconvenient, requiring frequent blood testing

and patient compliance. Patients younger than 75 years

without overt heart disease or high blood pressure may

be safely treated with 325 mg aspirin. Both drugs increase

the risk of bleeding complications, but the benefit of

blood thinning in AF patients is well documented and

outweighs the risks.

Meticulous heart rate control with medications like beta

blockers, calcium channel blockers, or digoxin is a

mainstay for alleviating AF symptoms. Intermittent anti-

arrhythmic drug therapy is effective in restoring normal

rhythm in some patients with infrequent episodes of AF

(“cocktail therapy”), or as long-term treatment for

maintaining normal rhythm in others. However, such

drugs should be used cautiously because of potentiallysignificant side effects.

Electrical cardioversion remains the procedure of choice

to restore normal (sinus) rhythm for persistent AF.

Performed under short-term anesthesia, this outpatient

procedure is effective and safe, and is generally

attempted in most AF patients at least once.

Non-medical interventionsOver the past two decades, various techniques for a

"quick fix" of AF have been developed and promoted by

the industrial medical complex. Radiofrequency ablationof AF is currently the most popular invasive intervention.

While a viable option for a select minority of AF patients,

especially younger patients with symptomatic paroxysma

AF, we prefer to use it only as last resort. The procedure is

imperfect, and neither innocuous (about a 1-2% serious

complication rate) nor inexpensive, and in our experience,

is frequently unnecessary.

This Lown Center patient guide summarizes the latest medicalinformation and the Lown Center's unique approach to keycardiovascular issues. We encourage you to contact your cardiologist if you have any questions or concerns.

Lown Center patient guide: Atrial fibrillationShmuel Ravid, MD, MPH

8/3/2019 2009 Lown Forum 3


L O W N F O R U M 5

Seventeen years after we started workon a major research study called "TheCoronary Artery Disease (CAD) Project,"new results offering further insight into

the impact of the psychological state on the the prognosisof patients with CAD have emerged.

As clinicians, every day we see the impact ofanxiety on how a patient will fare. Now wehave solid data to show that the psychologicalstate of anxiety may be as powerful as high

blood pressure, high cholesterol, or even smoking on theoutcome of patients with CAD.

Of course, the question that begs to be answered is: Willtreatment of anxiety with medication, therapy, or both atsome point during the progression of the coronary arterydisease (or, perhaps best, before CAD becomes evident)alter the course of the disease process--perhaps preventinga heart attack or slowing the progression of the disease sobypass surgery, stroke, or even death are avoided?

One might ask, "Why has this study not been done?" Thesimple answer is : It is not as easy as it sounds. A study of

PATIENT PROFILE

Getting my life back with AF

Karen W. was in the middle of preparing for the holidaysin December 2004 when she realized something waswrong. “I was so tired I could barely get through the

shopping," she recalls. "I went to the local walk-in clinicone evening; my problem was diagnosed as ‘stress’ and Iwas given a prescription for Valium.”

But on Christmas Day, she had difficulty preparing dinner.

"I couldn’t lean over to take the food out of the oven. I

was short of breath and coughing. My family was

worried, so I went back to the clinic. They told me I had

atrial fibrillation and to see a cardiologist 'right away.'"

"This was one of the darkest moments in my life," Karen

acknowledges. She has been in the real estate business

for more than 40 years. “Now I couldn’t climb stairs—

imagine a realtor who can’t climb stairs!"

A friend suggested she call the Lown Center. “The day I

met Dr. Ravid was one of the most fortunate days of my

life. He gave me my life back,” she says. "It took a while

to get everything under control, but I could see that he

was confident he was going to get me through this, and I

had complete confidence in him. He started me on

several medications and kept adjusting them. He did a

cardioversion in March 2005 but it only lasted two days.

He performed another cardioversion the following June,

and all of my other miserable symptoms began to

disappear. I was able to climb stairs again and since then I

have been doing well."

Karen encourages other AF patients to follow their

physician’s recommendations. “When Dr. Ravid speaks, I

listen. When he told me to lose 20 pounds, I thought,

‘Okay…' and I did it. I just put food portions I normally

would eat on the plate, and then took half of it off again.

I lost the 20 pounds.” She wishes to impress upon other

patients that “when a physician prescribes medications,

diagnostic testing, or lifestyle changes, the advice is for

your benefit and well being. By following Dr. Ravid’s

advice, I have been able to resume my career."

During busy periods, it is not unusual for Karen to work

more than 60 hours a week, most of which are spent on

her feet. Younger associates envy her energy. "Now

when I am showing a property and reach the top of a

flight or two of stairs without being short of breath," she

concludes, “I silently thank Dr. Ravid.”

this nature is full of pitfalls, and attempts by other institutions to create a cost-effective study design have notbeen fruitful. The Lown Foundation, however, continues toexplore the biology that links a patient's psychologicalstate, and the health of that patient's coronary arteries. Weknow that depression, for example, is associated withinflammation that may give rise to coronary blockage,

angina, and heart attack. We now also note an associationbetween inflammation, the psychological state, and thepropensity to develop atrial fibrillation (AF). Indeed, themore we learn, the more complex, interactive, andmysterious the human biology underlying heart diseaseappears to be.

The long-term nature of our study provides a uniquelyvaluable perspective. Although the importance of theemotional state to good cardiac health is obvious on thesurface, we will continue to explore beneath the surface inan effort to find more effective means of caring for patientswth heart disease.

LCRF data offers insight into effects of anxiety on the heartCharles M. Blatt, MD

Anxiety may be as powerful as high blood

pressure, high cholesterol, or even smoking.

8/3/2019 2009 Lown Forum 3


6 L O W N F O R U M

LOWN CARDIOVASCULAR CENTER

N e w s B e a t

Drs.BrianBilchikand VikasSainiare co-authors ofMadurai Area Physicians Cardiovascular Health EvaluationSurvey (MAPCHES)--an alarming status, published in theCanadian Journal of Cardiology (Vol 25, No 5, May 2009).The study demonstrated an alarmingly high incidence ofCVD risk factors and stroke among a cohort of 4000physicians in southern Tamilnadu, India.

Dr.BernardLown delivered thecommencement address and received anhonorary degree at the University of NewEngland College of OsteopathicMedicine's graduation on June 6, 2009 inPortland, Maine.

Dr.FredMamuya co-authored SCCT guidelines for performance of coronary computed tomographicangiography: A report of the Society of Cardiovascular Computed Tomography Guidelines Committee, published inthe Journal of Cardiovascular Computed Tomography(2009; 3:190-24). He also chaired two sessions at theAnnual Scientific Meeting of the Society of Cardiovascular Computed Tomography in Florida on July 16-17, 2009.

Dr.TomGraboys, President Emeritus ofthe Lown Foundation, and his wife,Vicki, discussed his memoir, Life in theBalance, for an audience of nearly 500

physicians, medical students, and thepublic at the Semel Institute for Neuroscience and Human Behavior at

UCLA on June 2, 2009....Dr. Graboys spoke about hispersonal journey from cardiologist to patient with Lewybody dementia with Parkinson's disease on WRNI in May2009. The interview is available online:http://www.wrni.org/content/doctor-becomes-patient

Dr.BrianBilchik was appointed to theChronic and Cardiovascular DiseasesWorking Group of Harvard Institute ofGlobal Health (HIGH), which organized

a conference, "Cardiovascular Diseasein Developing Countries--MovingForward," on July 22, 2009.

Dr.VikasSaini participated in the 7th Teikyo-HarvardSymposium in Tokyo, Japan from June 26-28,2009. Hispresentation, "Hospitals, workers, and communities: timefor a new paradigm," focused on the relevance of theLown Center's recent research findings to health caresystem reform, particularly costs of overtreatment andthe role of the doctor-patient relationship in creatingviable solutions.

Question from a patientVikas Saini, MD

Should I take fish oil capsules?

The evidence suggests that omega 3 fatty acids

are good for heart health. In prehistoric times,we consumed many times more of these

essential fats than we do now. Since researchers first

noticed the seeming benefits of omega-3 fatty acids in

studies of diet and heart disease in large populations, the

evidence has grown enormously.

Omega-3s are a distinct group of dietary fats which are

part of the larger class of polyunsaturated fatty acids

(PUFAs). Omega-3s are found in fish in the form of

docosahexaenoic acid (DHA) and eicosapentaenoic acid

(EPA), and in vegetable sources in the form of alpha-

linolenic acid (ALA).

If your diet is rich in omega-3s, you probably don’t need to

take supplements.

It is well-known that fish contains these oils--but not all

fish. The best fish sources are cold-water fish, such as

sardines, mackerel, salmon, and tuna. Cod and haddock

have much less, while tilapia has very little. There are

vegetarian sources as well. The highest content is in flax

oil. Cooking with canola, soy, peanut, or mustard oil will

also contribute. Walnuts and pumpkin seeds are good

snack sources of omega-3s.

How does this translate into real life? Use canola oil for

cooking as much as possible. Try to eat 2-3 servings of the

fish mentioned above each week, and two or more

servings per week of a vegetable source like walnuts,

pumpkin seeds, or crushed flax seeds.

If your diet doesn’t contain enough omega-3, then taking

supplements is a good idea.

• Fishoil: 1200 mg /day of the combination of EPA and

DHA is a reasonable dose. Some preparations have a

slightly fishy odor. Others, especially "pharmaceutical

grade," have been processed to remove the smell and

are even available with lemon or orange flavorings.

• Flaxoil: 5-7 gms (1-2 tablespoons) should be enough.

However, unlike fish oil, the benefit of flax oil can be

blocked if you are eating too much other fat, even if it is

a healthy fat like safflower or corn oil.

Send your suggestions for the Lown Forum's "Question from apatient" column to Catherine Coleman, Editor, at 617-732-1318x3332 or [email protected].

8/3/2019 2009 Lown Forum 3


Foundation donors celebrate their LownCenter "Golden Anniversary"Fifty years ago, James Bickman was unable to find a

cardiologist who could diagnose and treat his heart

condition, so he consulted the "up and coming" Dr.

Bernard Lown. Since then, "Through all these years,through thick and thin, from here to the other end of the

earth, the Lown Center's physicians have been there for

us," notes his wife, Ada. "We call this our Golden

Anniversary with the Lown Center."

Mr. and Mrs. Bickman are among the Lown Cardiovascular

Research Foundation's longest-standing supporters. "The

Foundation's research is constantly looking for new ways to

help people with cardiovascular disease," Mrs. Bickman

explains.

Mr. Bickman is committed to supporting the style of

cardiac care that is the cornerstone of the Lown Center.

"These days, everything is measured by seconds and

minutes. But life isn't that measurable," he notes. "We

support the idea of passing along to young physicians theimportance of listening to patients, asking a lot of good

questions, taking time, and making patients feel at home.

It will do younger doctors a lot of good to learn these

methods. I wish the Lown Center's approach would

expand across the health care industry."

Gifts to the Lown Foundation are vital in order to continue our cardiovascular research, patient care, medical education, andglobal outreach. Donations may be made online atwww.lownfoundation.org or may be mailed to LownFoundation, 21 Longwood Avenue, Brookline MA 02446.

L O W N F O R U M

BoardofDirectors

Nassib ChamounChairman of the Board

Vikas Saini, MDPresident

Bernard Lown, MDChairman Emeritus

Thomas B. Graboys, MDPresident Emeritus

Patricia AslanisCharles M. Blatt, MDJoseph Brain, SDJanet Johnson Bullard

Carole Anne McLeodC. Bruce Metzler Barbara H. Roberts, MDRonald ShaichRobert F. Weis

AdvisoryBoardMartha CrowninshieldHerbert EngelhardtEdward FinkelsteinWilliam E. FordRenee Gelman, MDGeorge GraboysBarbara GreenbergMilton LownJohn R. MonskyJeffrey I. Sussman

David L. Weltman

"In an ever-changing healthcare system that is

in desperate need of reform, I will forever

value the philosophy of the Lown Center to

treat each patient holistically as an individual,

taking into equal account a patient’sexpectations, environment, and goals of care.

During a recent hospital rotation, I often

thought of my training experience at the

Lown Center and asked myself how a

diagnostic test or procedure would change a

patient's care and management. I witnessed

first-hand the ways in which the side effects of

too many, often gratuitous, interventions

adversely affected patient outcomes. A morethorough history taking could readily have

eliminated the need for many of those tests.

Thank you!" Fatima Akrouh, 4th year Harvard

Medical School student

TheLownCardiovascularResearchFoundation

promotesahumaneandcost-effectivemodelof

cardiaccarethatadvocatespreventionover

costly,invasivetreatmentsandrestoresthe

relationshipbetweendoctorandpatient.CONTACTUS

LownCardiovascularResearchFoundation21 Longwood AvenueBrookline MA 02446(617) 732-1318info@lownfoundation.orgwww.lownfoundation.orgwww.procor.org

LownCardiovascularCenter

Brian Z. Bilchik, MD

Charles M. Blatt, MDWilfred Mamuya, MD, PhDShmuel Ravid, MD, MPHVikas Saini, MDCraig S. Vinch, MD

LownForum

EditorCatherine Coleman

EditorialsupportClaudia KenneyJessica Gottsegen

c2009 Lown FoundationPrinted on recycled paper with soy-

based ink.

"We support the idea of passing along toyoung physicians the importance of listening to patients," say James and AdaBickman, longstanding supporters of the

Lown Foundation.

8/3/2019 2009 Lown Forum 3


Lown Cardiovascular Research Foundation21 Longwood AvenueBrookline, Massachusetts 02446-5239

Nonprofit Org.

US PostagePAID

Boston, MAPermit No. 53936

8 L O W N F O R U M

Health consumer bewar e: Mobile vascular scr eenings--scan or scam?

Shopping in a mall last winter, Elizabeth M. spotted a

big sign: "Beware of silent killer diseases like stroke."

The sign advertised three screenings for $75. The

price seemed reasonable for peace of mind.

After signing a waiver, her neck, legs, and abdomen

were scanned with portable ultrasound equipment. A

few weeks later, she was notified that she had

significant carotid disease and should contact her

doctor.

"We spoke on the phone at great length. She was

devastated and ready to fly back to Boston to see

me," recalls Dr. Brian Bilchik. "I had seen her recently,

and assured her that there was no need for urgent

action." When she eventually returned to Boston, Dr.

Bilchik repeated the test in the Lown Center'svascular lab and confirmed that no intervention was

required. "But despite my continued reassurance, she

remained very anxious for a very long time," he said.

According to Dr. Fred Mamuya, Director of the Lown

Center's vascular lab, "These mobile screenings are

abbreviated tests which do not tell the full story. The

studies are incomplete, so results are not sufficient or

useful from a diagnostic or management standpoint."

In addition to not being useful, the tests are often

harmful for patients---producing either a false sense

of security, unnecessary alarm and stress, or inaccurate results that can lead to repeat testing,

unnecessary medications, or interventions. According

to the US Preventive Services Task Force (USPSTF),

an independent panel of experts, the potential harm

outweighs the benefits of these tests.

Q&A with Dr. Fred MamuyaDirector, Lown Cardiovascular Center Vascular Lab

When is vascular scanning appropriate?

Routine screening for carotid artery

and peripheral arterial disease is not

recommended in patients who do not

have any symptoms. The only recommended screening is

abdominal ultrasound to exclude aortic aneurysm in men

between 65 and 75 years old with a prior history of

smoking; or men and women over 65 years old with a

family history of abdominal aortic aneurysms. Moreover,

any vascular scanning should be performed in an

accredited facility with credentialed technologists and a

high level of quality assurance.

You should tell your physician if you have symptoms such

as leg pain while walking, transitory neurological

symptoms that appear without any warning (transient

ischemic attack), or abdominal pain following a meal.

Sudden difficulty in controlling your blood pressure may

also suggest the need for a vascular examination.

Moreover, your physician is able to discern potential

problems following a complete physical examination.

I see ads for screenings everywhere. Why are they popular?

Companies that do screenings make a lot of money, then

move on to the next church or senior center. One of my

patients described it as "a traveling circus." The tests are

marketed to capitalize on people's fears about their health.

My friends are having these tests and say I should too...

Discuss your questions or concerns with your cardiologist.

Become familiar with the facts and don't give in to peer

pressure. If it's a topic of dinner conversation, you might

want to share what you know with others.

2009 lown forum 3

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