4 minute read
HEART HEALTH
It’s really about patient safety and doing what’s best for the patient. We know that patients get over-tested, they have risks when there’s not good information available to their providers, and so this type of system allows for a better quality of care for patients.
— Andrew Hein, Central Florida Health Care
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Florida SHOTS is a free, statewide sys- are barred from any type of information tem that helps healthcare providers and blocking, meaning that they cannot imschools keep track of immunization re- pede the sharing of necessary medical cords in order to ensure that patients of information for proprietary reasons. all ages are receiving the necessary vaccinations to protect them from preventable diseases. Although the global health crisis of COVID-19 has taken up much of the public’s attention for the past year, it is worth CommonWell Health Alliance and noting that the healthcare industry has Carequality are two other systems Cen- been making steady progress in impletral Florida Health Care uses to improve menting the HIE systems. Safer-at-home patient care. They are just a couple of orders and social distancing guidelines the many frameworks have thrust telehealth available to healthcare into the foreground lately, providers to make shar- while the proposed rule ing patient information on information blocking easier and more effiwas quietly rolled out in cient. October. “We have access to those exchanges, and they essentially link us up nationwide to any other participating provider. So if I have a patient who is a snowbird and is coming down The Sequoia Project is the organization selected by the Federal Government in 2019 to coordinate all of the standards and protocols for the successful employment for the winter, and their doctor up north is also ANDREW HEIN of an information exchange system at the naparticipating in a Health tional level. Throughout Information Exchange, I can just click the COVID crisis, The Sequoia Project inside my electronic health record on a has been diligently working to unify the button and instantly have access to their various standards and systems currently records from their doctor up north.” in place to create an effective, universally applicable HIE that will ultimately save Ultimately, the goal is to have one naproviders and their patients time, montionwide exchange that will allow the ey, and – most importantly – lives. disparate systems in use throughout the country to communicate with each “It’s really about patient safety,” Hein other. The 21st Century Cures Act es- explains, “and doing what’s best for tablished the Trusted Exchange Frame- the patient. We know that patients get work and Common Agreement (TEFCA) over-tested, they have risks when there’s to lay out a set of standards to support not good information available to their the development of such a nationwide providers, and so this type of system alexchange. One of the standards is that lows for a better quality of care for paEHR (electronic health records) vendors tients.” HN
HEART
NEWS
Last year, I wrote about heart failure. At that time, I had said that about half the patients admitted with congestive heart failure have normal systolic function. This is true. KOLLAGUNTA SEKHAR, M.D. KSC CARDIOLOGY The most common way to express heart function is by measuring ejection fraction (EF). This is the proportion of the amount of blood in the left ventricle in diastole (after it fills) that is ejected.
So, why would someone have normal function and have heart failure?
Some common reasons would be valve problems, age, obesity, atrial fibrillation, coronary artery disease, etc.
One big explanation is that the ventricle is thickened and stiff. This may not be the only cause, but it is relatively easy to understand. Filling in diastole is impaired. Hypertension is one cause, as are old age and obesity.
The big key many times is in making the diagnosis because these patients have so many other reasons for breathlessness. Also, most of the blood tests and other cardiac tests are not always useful.
So, it is a diagnosis that often is made by cardiologists based on suspicion and the constellation of supportive test data.
How is treatment different compared to patients with decreased function?
For starters, for reduced EF, many treatments are proven to work. For heart failure with preserved function, there are not that many proven therapies. However, there are some treatment goals.
Assessing blockages, good blood pressure and diabetes control, weight loss, exercise and diet control are known to help. Diuretics in patients with fluid overload, treatment of sleep apnea, and restoring normal rhythm are also key.
Some devices like pulmonary artery sensors are useful in monitoring fluid status/preventing fluid buildup and hospitalization. Some medicines have been shown to work especially in preventing admission. Some of these include diuretics like Aldactone and medicines like Entresto. However, unlike in patients with reduced EF, these are useful in only select groups of patients and not all patients with preserved EF. Therefore, it is important to see a specialist who deals with this issue.
This column is sponsored by KSC Cardiology, and the opinions expressed herein may not reflect those of CFHN or of its advertisers. BIO: Dr. Kollagunta Chandrasekhar, better known as Dr. Sekhar (pronounced Shaker) has been practicing cardiology in Winter Haven for 25 years. Dr. Sekhar is the Chief of Staff at Bay Care Winter Haven Hospital as well as the Director of the Heart Function Clinic and the Cardiac Rehabilitation program at Bay Care Winter Haven Hospital and the Chairman of Cardiology at Advent Hospital in Lake Wales. He is a member of the Heart Failure Society of America, the American Heart Association, the American College of Physicians, and the American Society of Nuclear Cardiology. To schedule an appointment, please call (863) 508-1101.
