Don’t Let a Failing Heart Relegate You to Endless Doctor and Hospital Visits

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Dr. Ameya Kulkarni is an interventional cardiologist with the Mid-Atlantic Permanente Medical Group.

No one wants to spend their days in a hospital room. For the more than 5 million people in America who live with heart failure, a hospital stay is an unfortunate fact of life. In fact, it is estimated that there are over 1 million hospitalizations for people with this condition every year. The burden on patients, their families and their communities is immense. And the cost of this care is so high that there is a currently a national focus on trying to drive down admissions to the hospital for heart failure.

The Kaiser Permanente Center for Total Health regularly updates the information in our displays in collaboration with our health systems partners in Kaiser Foundation Health Plan and the Permanente Medical Groups. The Q1 2016 update focuses on Quality & Expert medicine, as led and delivered by the Mid-Atlantic Permanente Medical Group.

The Kaiser Permanente Center for Total Health regularly updates the information in our displays in collaboration with our health systems partners in Kaiser Foundation Health Plan and the Permanente Medical Groups. The Q1 2016 update focuses on Quality & Expert medicine, as led and delivered by the Mid-Atlantic Permanente Medical Group.

So far, the ideas on how to solve this problem mostly treaded old paths – exchanging hospitalizations for more doctor office visits. We know that patients end up in the hospital when they fill with fluid. Signs of this fluid buildup (increased weight, decreased activity) usually show up well before the need for a hospitalization. Our solution so far has been to have patients come to the doctor’s office more frequently for weight and activity checks. Although cumbersome for both the patient and the clinical care team, at least coming to the doctor every week keeps these patients out of the hospital.

It does not, however, make patients happier. Although no one wants to be in a hospital, few long for frequent battles with traffic only to pay a copay and wait for a doctor to review their weight and activity and make a small medication adjustment.

The innovation team at the Mid-Atlantic Permanente Medical Group – the independent medical group that exclusively serves Kaiser Permanente members in Washington, D.C., Maryland, and Virginia – has a vision of using 21st century technology to keep a close watch on our patients without the burdens of the traditional face-to-face visit.

We know that an early signal that a patient with congestive heart failure (CHF) will land in a hospital is a decrease in activity or an increase in weight. So we are giving our patients connected monitors that measure these parameters and send them to the care team automatically. We do the rest. When patients are doing fine, we don’t bother them. But when we get a signal that things aren’t going so well, we can reach out to make an adjustment before the fluid retention gets out of hand.

American Heart Month is Here — How’s Yours?

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Here’s an important question: How is your heart?

How about that of your significant other?  Your mom’s and your dad’s?  Your best friend’s?

February is American Heart Month, and considering heart disease is the number one killer of men and women in the United States — causing one in four deaths each year — it’s a topic worth our attention.

Luckily, there’s plenty of great information available on heart health, including this episode of Total Health Radio:  “How’s Your Heart? Understanding Your Risk.”

Looking for more information on how to show your heart some love? Check out this piece on Five Easy Steps for Taking Care of Your Heart. Or this infographic illustrating five ways to be both sweet and healthy on Valentine’s Day.

And finally, if you are looking for ways to promote heart health in your own workplace or organization,’s American Heart Month toolkit may be just what you need.

Let’s take care of our hearts — not just on Valentine’s Day, but all year long.

Total Health Includes CPR Training

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Today, the Center for Total Health team renewed our CPR certification. Most people will never have to preform CPR, but it’s an important skill to have. According the American Heart Association, 70 percent of Americans may feel helpless to act during a cardiac emergency because they either do not know how to administer CPR or their training has significantly lapsed. Add to that the fact that about 88 percent of cardiac arrests occur at home, and you can see why we should all be trained – the life you have to save may well be that of a loved one.

CTH team, recertified

CTH team, recertified

Doubt that CPR can save a life, or that your loved ones will ever need it? Check out this story about a triathlete whose life was saved by CPR during a road race.

If you aren’t CPR certified, or you don’t feel confident that you would know what to do in an emergency, you can find a course here.

Father’s Day Check In and Check Up

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Annual events — birthdays, anniversaries, holidays — are often a time when we take stock of our place in life and progress in dadachieving goals.

The leading causes of death for American men are heart disease and cancer, across all races. Certainly those diagnosed with either benefit from early diagnosis, along with good general health.  This Sunday, when you take a minute to call the men in your life to  say “thank you” and “I love you,” remind them that it  might be time for a check up. If you live in the same town as your favorite men, invite them out for a walk, run, or bike ride. Cook them a healthy brunch or dinner. Give them some new exercise gear, a gym membership, or some yoga classes. Or, if your dad is like mine, a few golf lessons and a new 9-iron.

Whatever you do, take this chance to remind the dads (or dads-to-be, or just guys) in your life that their health matters to you because you want them to be around for a long, long time.

And, if you’re a runner in the DC area, you can join other lovers of dads for Georgetown Running Company’s annual Father’s Day 8K. I’ll see you there!



Hypertension and Heart Health: A Q&A with Joseph Young, MD

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Joseph Young, MD

               Joseph Young, MD

As American Heart Month comes to a close, it’s important to acknowledge that heart health should be a priority year-round.  One of the key risk factors of heart attack and stroke is hypertension, and according to the CDC, 1 in 3 U.S. adults has high blood pressure.  The good news?  It’s controllable.  Kaiser Permanente recently published a Q&A with Joseph Young, MD, internal medicine physician and clinical hypertension lead for The Permanente Medical Group – and we’ve included excerpts from that conversation below.

Can you give us a quick ‘Blood Pressure 101’?

Joseph Young, MD:
Blood pressure is just the pressure of blood flowing inside the body’s blood vessels. The top number is the pressure when the heart pumps at its peak. The bottom number is the pressure when the heart is relaxing and filling back up with blood. An ideal blood pressure is 119/79 or lower. A top number between 120 and 139 or a bottom number between 80 and 89 is called ‘prehypertension.’

What is high blood pressure?

If your blood pressure is 140/90 or higher, you have high blood pressure, also known as hypertension. As an aside, in a healthy, active person, what might seem like low blood pressure is often normal. In the United States, 29 percent of the adult population, or roughly 70 million people, has high blood pressure. Being overweight, lack of physical activity, too much salt or alcohol, stress, older age, genetics and family history, and various diseases all can contribute to high blood pressure. The good news is that it is easy to treat high blood pressure with a healthy lifestyle and a number of well-tolerated, once-daily medications.

What are the main guidelines for healthy practices that can reduce risk?

Regular physical activity is very important and helps to lower blood pressure. Pick something you enjoy — that will make it easier to stick with it. And it doesn’t have to be fancy. You could just walk briskly at least 150 minutes a week, for example. Limit salt intake, too, because salt causes fluid retention, which increases blood pressure. Many people don’t realize that most salt doesn’t come out of a salt shaker; it’s from processed and restaurant food. So, cook with unprocessed fresh fruits, vegetables and lean sources of protein at home, and limit how often you eat out to no more than one to two times a week. Don’t drink too much alcohol. If you smoke, quitting is the most important thing above anything else that you could do for your overall health. Smoking does not increase blood pressure, but smoking combined with high blood pressure or with any other risk factor is especially dangerous.

For more information, check out the full article available at Kaiser Permanente’s News Center.

HHS Announces 2012 Hypertension Control Champions

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One year ago, the Department of Health and Human Services, with several key partners, launched the Million Hearts™ national public-private initiative.  Million Hearts aims to prevent 1 million heart attacks and strokes over five years through behavioral changes and clinical interventions.  One of the most significant contributing factors to cardiovascular disease is hypertension, or high blood pressure.  According to the CDC, nearly one in three American adults (67 million) has high blood pressure, and more than half (36 million) don’t have it under control. Additionally, high blood pressure contributes to nearly 1,000 deaths per day and accounts for nearly $131 billion in direct health care costs a year.

Today, the U.S. DHHS Secretary Kathleen Sebelius recognized two health care providers in the United States as 2012 Hypertension Control ChampionsEllsworth (Wis.) Medical Clinic and Kaiser Permanente’s Colorado region.  The designation signifies these two health care providers have had remarkable success controlling hypertension across their patient populations, supported by verifiable data documenting the improvement.  Watch a video of the announcement here.

Since 2008, Kaiser Permanente Colorado’s focus on managing hypertension has resulted in an improvement from an initial member control rate of 61 percent to its current control rate of 82.6 percent.  The average hypertension control rate nationally is around 50 percent.

According to their press release, Kaiser Permanente’s hypertension control strategy has five central components:

  1. Registries: Through data housed within the Kaiser Permanente HealthConnect® electronic medical record, registries are created to identify members with hypertension.
  2. Actionable lists: Kaiser Permanente staff then draft lists to help identify which members did not have their blood pressure under control.
  3. Patient outreach: To reach those newly identified members, Kaiser Permanente nurses and other care team representatives work collaboratively to contact members and encourage them to come into local medical offices for blood pressure checks at least once a year.
  4. Managing blood pressure in the office: Kaiser Permanente primary care teams and clinical pharmacy staff develop long-term medication management programs for members with hypertension.
  5. Eliminating barriers: Members with hypertension are able to receive free blood pressure checks on a walk-in or appointment basis.

In September 2011, shortly after Million Hearts officially launched, Janet Wright, MD, executive director of Million Hearts, joined several other leaders in the heart health space at the Center for Total Health in Washington, D.C., for a summit to address hypertension.  You can see our coverage of that event at these links.

2011 in Review: One-on-One Interviews on Hypertension & Heart Health

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Continuing our “year in review” highlights of programs and content since this blog’s launch earlier this fall, today we have brief one-on-one interviews with three of the expert panelists from the Hypertension & Heart Health Summit held at the Center for Total Health in September. In the first video, you’ll hear thoughts from Janet Wright, who is now executive director of the Million Hearts Initiative — a joint effort co-led by the Centers for Disease Control and Prevention and the Centers for Medicare and Medicaid Services, and sponsored by other federal agencies and private-sector partners.

The next video features Elijah Saunders, MD, with the Association of Black Cardiologists.

Today’s final video is a moment with Ralph Brindis, MD, with Kaiser Permanente.

2011 in Review: Murray Ross on Non-Communicable Diseases

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As 2011 comes to a close, we are revisiting some of the events, programs and topics we’ve highlighted since launching the Center for Total Health blog in September — and bringing new content to you in the process. In today’s post, we have a conversation with Murray Ross, PhD, vice president and director of the Kaiser Permanente Institute for Health Policy. We sat down with Murray in September, shortly before the U.N. High-Level Meeting on Non-Communicable Diseases (and the Hypertension and Heart Health Summit held at the Center for Total Health during Be Well Week). In this interview, Murray shares his thoughts about NCDs and their growing effect — in the United States and globally — on health care costs.

Hypertension and Heart Health: Experts Discuss Prevention, Diagnosis and Management

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September 19 and 20, the United Nations is holding its High-Level Meeting on Non-Communicable Diseases – one of which is cardiovascular disease.  In support of the U.N.’s meeting, the Center for Total Health hosted a summit to address one of the most significant contributing factors to cardiovascular disease: Hypertension.  Held on September 15, the Hypertension and Heart Health Conference featured a panel of experts discussing the challenges of preventing, diagnosing and controlling high blood pressure.

Moderating the conference was Susan Dentzer, editor-in-chief for Health Affairs.  Speaking at the event were Richard McCarthy, MD, Kaiser Permanente’s physician-in-chief for District of Columbia and suburban Maryland, and Nils Daulaire, MD, director of global affairs for the U.S. Department of Health and Human Services.  Panelists included Elijah Saunders, MD, a founding member of the Association of Black Cardiologists; Ralph Brindis, MD, senior advisor for cardiovascular disease at Kaiser Permanente Northern California; and Janet Wright, MD, senior vice president for science and quality at the American College of Cardiology.  Wright was recently named the director of the Million Hearts Initiative – a plan from the DHHS to prevent 1 million heart attacks and strokes over the next five years through behavioral changes and clinical interventions.

Check out highlights of the event in the video below.  And stay tuned for more excerpts  from our conversations with the panelists.