Faith and Heart Health

Faith and Heart Health

HEART HEALTH

Faith and Heart Health

“Spiritual nourishment
is important during times
like this, as is the power
of prayer.”

Growing up, many of us can recall the Sunday mornings spent wrestling into itchy wool sweaters or button-up shirts with a collar. Trying to duck and miss mother’s freshly licked thumb coming our way to wipe food stains from our face while pushing our hair into place. We walked as a family, together, into church those mornings. It’s funny, as an adult, getting ready for church on Sunday morning can still be hectic and rushed, minus mom’s last-minute grooming. The younger version of me would never believe that an older me would attend church from my living room couch. I may have daydreamed about this opportunity in my youth, but sitting in a pew with my brother and sisters between our parents, that idea was pure fiction. Yet, in 2020, this is reality.

I reached out to Rev. Fr. Stepanos Doudoukjian of St. Peter Armenian Church in Watervliet to discuss the connection of faith and heart health. Fr. Stepanos has been serving the community for over 25 years, encouraging young families to embrace the Armenian church and participate on Sunday mornings. He was one of the first people I witnessed adjusting to the challenges of social distancing — moving Sunday Services online with Facebook Live and YouTube videos. “I went into pastoral mode right away,” he recalls. “My family was with me. They like to serve as well; together for about two and a half months, we did services inside the sanctuary. When the weather changed, we were given the okay to move outdoors. We did that for about a month and a half. Most recently, we have met underneath our pavilion where people can meet – physically distanced – and participate in services.”

How church affects heart health

There is plenty of scientific evidence on how regular worship/fellowship attendance is good for the body and soul. Overall, experts have found that people who embrace a religious lifestyle are more likely to take better care of themselves. A study that spanned three decades, following 2,600 California residents who reported weekly religious attendance had strong mental health, increased social relationships, and marital stability – all factors to a long, healthy life. The study’s lead author, Dr. William J. Strawbridge, noted that “the specific mechanisms involved are worth understanding because thee may be broadly generalizable to individual and community health promotion endeavors.” Examples of these would be sponsoring smoking cessation programs, the concept of viewing one’s body with respect, relationship building opportunities, a supportive friendship/community dynamic, a stronger sense of self-control, and increased self-esteem. These good health behaviors intervene “before illness strikes and provide effective self-care treatment strategies when it does.”

Jewish mother and son lighting menorah

Photo by Ksenia Chernaya from Pexels

A Vanderbilt University study explored the old saying, “too blessed to be stressed.” Investigators from the school’s Center for Research on Men’s Health examined the relationship between attending church, stress, and causes of death in middle-aged adults. They found that people who attend worship service reduce their mortality risk by 55%, while those who did not attend church at all were twice as likely to die prematurely. As we have previously reported, one of the secrets of the world’s longest-living people, is a purpose of life and the sense of belonging that comes when attending faith-based services four times a month (no matter the denomination) add up to 14 years of life expectancy. After performing a funeral service for a partitioner who was 101 years old, Fr. Stepanos realized Faith’s evidence in longer life. “We have a lot of elderly, a lot of people who continue to live well in their 80s and 90s. I have always been intrigued that people in our church community tend to live longer.”

The role of spirituality during a pandemic

April has many religious holidays, from Easter to Passover and Ramadan (May 5th), that typically bring parishioners to Sunday services. In years past, sermons and messages would focus on passages of scripture that recount historical times of struggle, oppression, and redemption. The coronavirus pandemic presented real-life situations that left Americans asking for help. Fr. Stepanos recognized the uniqueness of our time when preparing his sermons. “I tapped into my concerns and worries, and also those of our people. I have stayed in contact with them to hear their concerns.”

Man praying

Photo by Luis Quintero from Pexels

As researchers and drug companies race to develop a vaccine for COVID-19, many Americans have turned to prayer, seeking intervention from a higher power to deliver relief. “Spiritual nourishment is important during times like this, as is the power of prayer,” Fr. Stepanos reminded his congregation. The Kansas City Heart Rhythm Institute is currently investigating the use of a “universal” prayer offered to hospitalized coronavirus patients by five religious denominations (Christianity, Hinduism, Islam, Judaism, and Buddhism) in addition to health care. The study began in June with a completion date of August 31st. The study’s lead analyst is a cardiologist, Dr. Dhanunjaya Lakkireddy. “I believe in the power of all religions,” he told NPR. Lakkireddy, like many spiritual leaders, believes in miracles. Fr. Stepanos echoed the effect of prayer in medicine. “Faith is important in recovery. The Bible, our Faith, our liturgy, all speak to the fact that God is not separated from us even in the midst of this pandemic. Nothing can do that to those that believe.”

Written by Michael Arce, Host of HeartTalk presented by Capital Cardiology Associates

Reopening Gyms

Reopening Gyms

HEART HEALTH

When will we be able
to workout, again?

“One of the best ways
to prevent getting COVID
is to be strong and have
a healthy body.”

Monday, March 16th, was the day that Jeannine Trimboli’s life changed. “That was the day we received the notice from Governor Cuomo that we would have to close at 8 PM that night,” she recalls. Jeannine is a certified personal trainer and owner of Real Fit Life, a private fitness club in Guilderland. Since that Monday in March, the only contact she has had with her members has been over the phone or online. Like many fitness professionals, Trimboli turned to social media to share workout and motivation videos to viewers, encouraging them to continue to seek safe opportunities for activity and exercise. Almost five months after the pandemic forced her to close her business doors, Trimboli is unsure when she will be able to have contact and resume in-person training sessions with her clients. “I have an inkling that it will be a very long time before we see gyms re-opening.”

Will gyms ever re-open?

Fitness studios, health clubs, and gyms in Massachusetts re-opened in Massachusetts on June 29th under Phase 3. Gov. Charlie Baker encouraged outdoor workouts when re-opening and mandated that gyms operate at 40% maximum capacity. There has been no communication in New York State since Governor Cuomo pulled gyms from Phase 4 of the state’s coronavirus reopening plan. “I was expecting it. I know I’m in the minority of other gym owners who have spoken to the media, I was not anticipating that we would be included,” Trimboli said. All fitness facilities are closed indefinitely as a class-action lawsuit and several individual gym owners are filing legal cases against the governor.

The International Health, Racquet & Sportsclub Association (IHRSA), headquartered in Boston, works with thousands of health club members in the United States and tens of thousands globally. The organization recently sent a letter to every governor, highlighting safety protocols, practices, and standards for reopening facilities. IHRSA also released a coordinated media campaign, “gyms are clean.” The press release points to research that showcases safe facilities. The first example is a Norwegian study — the first and only — to show a randomized trial to test whether people who work out at gyms are at a greater risk of infection of the coronavirus. The results are encouraging because only one coronavirus case was traced from the 3,764 members (ages 18 to 64). That contraction occurred at the member’s workplace, not the gym.

The second example IHRSA referenced are contact tracing numbers from Arkansas, that at the time (June 26), showed 678 new cases reported, of which, .3% visited a gym. On June 26th, Arkansas had reported 18,740 cases. Today (July 16), the number of confirmed cases is 30,297. On the surface, these examples are promising. Still, public health experts rely on evidence-based research when creating recommendations for community health guidelines during a pandemic. This information comes from randomized trials that investigate the virus’ impact in large study populations. That research, as Trimboli suggests, points to gyms opening later, rather than sooner.

What we know about COVID-19

Our nation’s top epidemiologists, scientists, and medical professionals have all pointed out that COVID-19 is a novel virus, meaning this is a new threat to humans, one that we are learning more about the virus every day. Time is a critical resource that science requires to find a vaccine for coronavirus. While proponents for opening fitness centers focus on the “gyms are clean” message, the Centers for Disease Control and Prevention (CDC) points to the risk of contracting the virus in a close setting (within about 6 feet) through respiratory droplets. Trimboli understands how working out, even six feet apart, in a fitness club is different from the potential exposure while grocery shopping. “The longer you stay stagnant in one place, the higher the likelihood of you getting it. Unlike a grocery store where there is constant moving (walking through the store), in a gym, you are in a place where you are spending a lot of time in one space.”

As part of his announcement on the Phase 4 re-opening guidelines, Gov. Cuomo said that the state is studying whether droplets infected with the coronavirus can be inadvertently spread via air conditioning in crowded indoor spaces. Cuomo mandated that indoor malls, like Crossgates, can re-open if they have this special filtration in their heating, air conditioning, and ventilation systems. Trimboli stated that health clubs do not have the option to install filters with a MERV-13 rating like indoor malls. “Unfortunately, those conversations are not happening,” she commented.

The future for fitness

At every visit with a healthcare provider, we are told about the modifiable risk factors or lifestyle choices we can make to reduce the risk of heart disease, heart attack, and stroke. Two main changes are a heart-healthy diet and at least 30 minutes of daily activity and exercise. As a health professional, Trimboli says she is “in the center of the discussion” on creating safe workout opportunities. For now, she is posting online videos for at-home use or virtual training sessions. But this is not a long-term solution. “I recognize that we will be dealing with this virus, this pandemic for a long time. At some point, we are going to have to figure out how to live our lives.” It is unrealistic to suggest that we all can walk or run outdoors, even during nice weather, when a treadmill or cardio machine at a health club is the only form of exercise that some individuals with mobility restrictions can safely perform.

“We also need to talk about mental health. Many people who deal with depression and or anxiety also use exercise as a way to help deal with their coping mechanisms,” mentioned Trimboli. As science has proven the benefits of exercise for your body, findings have shown that individuals who exercise (for at least 45 minutes) three to five times a week have fewer recorded days of poor mental health than those who do not exercise. In one large US sample, team sports, cycling, and aerobic/gym activities were the three most popular associations. “We’re missing this. If this is going to go on as long as we think it is – we are going to need to find a way for people to pursue their mental and physical health.”

Written by Michael Arce, Host of HeartTalk presented by Capital Cardiology Associates

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Candid Physician Electronic Medical Records and Blood Work

Candid Physician Electronic Medical Records and Blood Work

HEALTH TRENDS

Candid Physician: Medical Records and Testing

Would it surprise you if your doctor shares
some of your healthcare system frustrations?

Stop me if you have thought or heard any of these common healthcare complaints.

There are too many medical record systems. It’s too difficult to make sense of information in an after-visit summary. Why does every health care provider request the same blood work? It feels like my doctor spends more time looking at my charts than talking to me. The way patients are billed is confusing.

Those are five of the most common complaints about the healthcare system. Here is the shocking part: your doctor most likely feels the same way you do when it comes to improving your care quality and the inefficiencies in the healthcare system.

On a recent episode of HeartTalk presented by Capital Cardiology Associates, I had a candid conversation with Dr. Connor Healey, a board-certified cardiologist on the challenges healthcare providers face. I was surprised to learn that a physician shares many of the frustrations of his patients. He was also open to sharing his thoughts and feedback on how we can improve the system. Our talk opened with the after-visit summary (AVS), a paper or electronic document, given to patients after an appointment. As one study found, “the AVS is nearly universal in the United State. However, patients infrequently reference or even retain their AVS, suggesting currently designed documents do not meeting patients’ needs.” The main goal of the AVS was to create a basic report of your doctor’s visit, enabling patients to make better lifestyle choices, while also providing transparency in the care orders. Instead of a standard report that could be freely shared between the patient and their providers, “most of these summaries are inadequate and speak to the inefficient system we have,” stated Dr. Healey. “There is too much medical jargon or information that patients don’t understand, like billing or coding.

There are too many medical record systems

It should be noted that one driving factor behind why every healthcare provider in the United States is pushing to provide an AVS is to meet a standard in the Health Information Technology for Economic and Clinical Health (HITECH) Act. This unlocks financial incentives from the Centers for Medicare and Medicaid Services (CMS). The AVS information is also useful for providers and healthcare teams when they are collecting data before a visit or procedure. The AVS is part of the electronic health records (EHR) system outlined in HITECH. “Most patients would know an EHR as a ‘patient portal,'” Dr. Healey pointed out. This component was initially one of the most challenging goals to reach due to the lack of a national medical records system. “More than 50% of affluent countries have a national health records system, according to the World Health Organization (WHO). The United States is not one of them.”

The reason why you must fill out a separate medical records information form at every health provider is due to the fact that there is not an industry-standard EHR. “Number one, there are way too many different EHRs out there. Your primary doctor may use one; we use a different one at Captial Cardiology Associates (CCA), your rheumatologist may use another. None of them are the same as what is used where you receive your hospital care,” added Dr. Healey. According to the National Electronic Health Records Survey of 2017, nearly 9 in 10 (86%) of office-based physicians had adopted an EHR. “None of these systems talk to each other, that is my biggest complaint.”

Blood work and testing

Whether you visit your doctor for your annual physical once a year or have a roster of health care specialist appointments during the year, chances are you have your blood tested. Blood work and testing are two examples of services that could be difficult to understand on an AVS. “What do the results mean,” is a common question asked by patients. The other is, “why do I have to get my blood checked by every doctor?” As we have learned, since most healthcare providers do not have access to the same patient records, this is an inefficiency in the system. Or as Dr. Healey stated, “blood work is probably the number one example of lack of communication between healthcare providers. Ask any patient the number of times they get blood drawn in a year, it’s ridiculous.” In most cases, the tests that are order are the same test. As part of your routine physical, your primary care provider typically checks your kidney functions, electrolytes, vitamin D levels, cholesterol, and other areas depending on your medical history. “When you come to the cardiology office, that’s a lot of what I’m looking at too. I may look at a troponin, which is a blood test for heart damage. I may look at BNP, a blood test that indicates how much MI stretch there is and acts as a surrogate for, ‘hey, do you have too much fluid circulating in your body?’ While most of it is redundant, there are specialty tests that do get ordered, which is why you will need more than one blood test a year. Having said that, there is so much waste on the redundancy of the standard blood tests that the country would save, literally, tens of millions of dollars if we had a better capability of sharing results.”

A better system

As we have transitioned from hand-written notes to electronic records, there are still improvements necessary to upgrade the American healthcare system. A valid point on a Twitter thread stated that EHR’s should be more intuitive. As one doctor tweeted, “As a millennial doc, I still wonder how my older colleagues managed to learn and use. Then read a recent study that EHR is one of the top reasons for physician burnout… and it all makes sense.”

“The goal is to improve the system so that physicians can deliver the highest quality of care at the lowest cost. This starts with a standardized AVS and better connected EMR,” Dr. Healey suggested. Healey visualizes a digital document designed as a standard medical record file, delivering a simple visit summary to the patient, and pertinent information. “Ideally, the solution would be that every patient has a single chart that is unique to them but would accessible by all providers.”

Patient Summary example from Modern Healthcare

A standard patient records system would also improve patient visits. A study released in February of approximately 100 million patient encounters with about 155,000 physicians from 417 health systems, showed that providers spend an average of 16 minutes and 14 seconds per encounter using EHRs. That’s almost a patient visit to review charts, documents, and order tests. Dr. Healey detailed, preparing for a typical patient appointment. “I will get a note that is eight pages long for a single encounter. I have to parse through all of this garbage to find vital signs, physical exam, what was discussed, and the concern or reason why I am seeing this patient. And that’s just one visit! I’m also getting messages from their oncologist, their lung doctor, and in some ways, this is more time consuming that when we used paper charts where we had more control of things.”

Written by Michael Arce, Host of HeartTalk presented by Capital Cardiology Associates

The Role of Public Health

The Role of Public Health

PATIENT EDUCATION

The Role of Public Health
During a Pandemic

“Public health is interesting
because it is a union between
individual health needs and
community health needs”

In regular times, public health is a large part of our nation’s healthcare system. Public health includes your doctor, who strives to promote wellness in your life, by preventing you from getting sick or developing health issues. Researchers that conduct scientific studies, your child’s school nurse, health inspectors, and advocates that educate the community on the risks of tobacco use or diabetes are all examples of public health. What is public health is a question we posed to Dr. Brion Winston, an interventional cardiologist at Capital Cardiology Associates. He began his medical career as an intern with the New York Department of Health (NYDOH) after graduating from Columbia University with a Masters in Public Health. “Public health is interesting because it is a union between individual health needs and community health needs,” Dr. Winston replied. At the time, he was part of the NYDOH’s Bureau of Tuberculosis Control. He described his role as a contact tracer, “basically determining the contacts that patient with a communicable disease has had as a way of eliminating further exposure.”

In normal times, public health workers cover a wide scope of concerns from childhood vaccinations, to speaking out for smoke-free areas and seatbelt warnings. They are either directly engaged in the community or speaking out for laws to protect the people. But, when disease outbreaks occur, public health’s role becomes even larger as we turn to these officials as a trusted source for health information. These people continue to work in the background to keep us healthy and safe while also combatting an unknown infectious disease.

Who are public health officials and how do they become a trusted source?

It’s a safe bet that most Americans could not identify Dr. Anthony Fauci, Director of the National Institute of Allergy and Infectious Diseases (NIAID), before the COVID-19 pandemic. For two months this year, he became a staple during news briefings as the main scientific voice on the White House Coronavirus Task Force. “In the case of Dr. Fauci, he has a long and storied career in infectious disease and immunology, including his work with the National Institutes of Health. He also had a track record with the HIV/AIDS pandemic,” Dr. Winston shared. Dr. Facui has held his current role (Director of NIAID) since 1984, serving several administrations and congressional leaders. He was awarded the Presidential Medal of Freedom in 2008 by President George W. Bush. “He was a natural choice to head up the COVID response efforts. His tenure through several administrations, making his appointment less political over the years, allows him to be a voice of research and advocate for public health.” And while he never asked for it, there is an online petition pushing to Make Anthony Fauci People Magazine’s Sexiest Man Alive.

Unfortunately, in life, with every blessing comes a curse. “I don’t think you are the one person who gets to make a decision,” Sen. Rand Paul sharply stated at Dr. Fauci during a Senate hearing. The senator was not the only one to challenge Dr. Fauci or other public health officials during the pandemic. Many county health departments across the country found themselves struggling to mount an adequate response to COVID-19 with limited budgets and resources. They were criticized for slow or conflicting policy rollouts. Even with daily press briefings and an endless stream of information being shared in the media, frustrations began to mount as the conversation shifted on social media platforms from public health to personal freedoms and economic fallout. These are two areas that public health workers and officials do not typically address. When you think about it, the same people who remind us to wear our seatbelts are also the ones to layout social distancing guidelines — but they have their limits. While most public health officials are political appointments, they are not “political” figures.

Dr. Winston relayed the attitude he embraces as a physician and public health advocate. “We are used to explaining to patients the areas of their health, providing them with informed consent, but not telling them things they want to hear. This has served me well over the years in my practice, to be honest with patients. There are experts in public health, based on years of experience and keeping abreast of the latest research and developments of physicians in other countries, to build the expertise of managing pandemics. In healthcare, we are constantly examining how we can continue to treat people safely in our hospitals and facilities.”

The role of the individual in public health

While Dr. Fauci is out in front of the cameras sharing evidence-based guidance with the country, the rest of the public health community is working overtime to protect us. “Not just from healthcare workers, but also the essential workforce who have kept our supply chains open. We also saw quite a bit of patience from those who had to sit things out for a while. I think that our response in that sense has been very favorable and that we have reason to be proud,” concluded Dr. Winston. As we strive to be good neighbors and citizens in our daily lives, we must also consider our contribution to community health. There is a valid reason why we are urged to simple things like visiting our doctor at least once a year, get a flu shot, wear a seat belt, or consider eating a heart-healthy diet. We contribute to the health of the population. A healthy lifestyle is the strongest determinant of health. While we thank our public health workers, we also need to listen to them.

Written by Michael Arce, Marketing Coordinator, Capital Cardiology Associates

How A Drug Is Made

How A Drug Is Made

PATIENT EDUCATION

A Drug’s Journey to
Your Medicine Cabinet

The steps involved to test a new drug for use

The pharmaceutical industry is working quickly to test a wide variety of potential cures for COVID-19. While drug makers have suggested a cure will be available by the end of the year, researchers are setting a timeline of 12 to 18 months to develop a vaccine. We asked, Mohammed Uddin, Albany College of Pharmacy and Health Sciences intern to explore the clinical trials and research development involved in drug development.

Microscope

The journey of an experimental drug from the laboratory into your medicine cabinet takes on average about 15 years. The researcher’s main goal is to find better ways to prevent, detect, and treat diseases. The first 6 to 7 years of drug development consists of researchers discovering a number of molecules that have the potential to become a drug for medical treatment. Once a molecule is identified by a researcher, it first goes through the preclinical testing period to ensure it is safe and effective in the laboratory and in animals.

Prior to testing the molecule in humans, researchers must find out whether the drug molecule has the potential to cause serious harm. If the results of preclinical testing determine the molecule to be safe and effective, researchers will then file an ‘investigational new drug application’ (IND). The IND must be approved by the Food Drug Administration (FDA) and by an institutional review board (IRB). The purpose of the IRB is to protect the safety and well-being of people who will be testing the new drug and to ensure ethical values are met. If the FDA approves the IND, this means the researcher may begin phases of clinical trials. Clinical trials are research studies that involve humans to test the new drug for safety and efficacy, and is typically done in a series of 3 steps:

Phase 1 Trials

This phase takes several months and includes about 20 to 100 healthy volunteers. The goal is to find a safe dose for the new drug, determine how the treatment should be given, and learn how the drug affects the body. If safety is determined, then the drug testing moves to the next phase.

Phase 2 Trials

This phase may take several months and up to 2 years and includes several hundred people with the disease or condition for which the drug is being developed. The goal is to further assess safety, but now also see if the drug actually works. If efficacy is determined, then the drug moves to the next phase.

Phase 3 Trials

This phase may take up to 4 years and may include several thousand people from patient populations for which the medicine is eventually intended to be used. The goal is to further assess if the drug works, but also to look at the long-term side effects of the drug.

If all 3 phases are successfully completed and the trials have shown the drug is safe and effective, then the researcher may file an application known as the “new drug application” or NDA. The purpose of this application is for the FDA to approve the researcher to begin marketing the drug for commercial sale. Reviewing of the NDA by the FDA can take up to 2 years. If the NDA is approved, the drug may be marketed with FDA regulated labeling.

After approval, a phase known as ‘post-marketing monitoring’ begins. Although clinical trials have shown the drug is safe and effective, it is impossible to complete long-term safety information by the time the drug is approved. After the public begins to use the medication, the researcher is responsible to submit safety updates such as side effects and other reports of issues or concerns to the FDA. The FDA will review these reports and may decide to add cautionary statements for use or if side effects are too serious, may withdraw the drug from the market.

New drugs are protected by patents when they are approved for marketing, which means no generic drugs can be manufactured until the patent expires. Although this process may be seemingly long, it is the only way to get the safest drugs to make it to your local pharmacy!

Written by Mohammed Uddin, Pharmacy Intern

References:
Drug Development Process [Internet]. [cited 2020Jun13]. Available from: https://ccts.osu.edu/content/drug-development-process
Learn About Drug and Device Approvals [Internet]. 2018 [cited 2020Jun13]. Available from: https://www.fda.gov/patients/learn-about-drug-and-device-approvals
The Drug Development and Approval Process [Internet]. [cited 2020Jun13]. Available from: https://www.fdareview.org/issues/the-drug-development-and-approval-process/