These findings from the ASCERT study, which was presented at the Annual Meeting of The Society of Thoracic Surgeons, are similar to those demonstrated in other recent major clinical trials.

We can improve outcomes while
lowering costs.

For the longest time, people thought surgery and percutaneous coronary intervention (PCI) were comparable or competing against each other. Based on these recent studies, we have learned that the procedures are not competitive.

Take-home message

People with complex coronary artery disease, especially those with diabetes or multi-vessel disease, who undergo surgery vs PCI:

• have shown better survival.
• report a better quality of life.
• have fewer future heart attacks.
• have a lower need for repeat revascularization.

Better outcomes, lower cost

These benefits also equate to lower healthcare cost savings in the long run. We can improve outcomes while lowering costs. This is a benefit for both patients and the overall healthcare system.

The study results demonstrate how important it is for patients to be well informed. And it’s important to seek a place for treatment that has both cardiac surgeons and cardiologists on the team.

Cleveland Clinic’s Umesh Khot, MD, vice chair of the Robert and Suzanne Tomsich Department of Cardiovascular Medicine, says hospitals and physicians are always looking for ways to reduce readmissions. “It’s not easy to find strategies that make a profound difference,” he says, “but we keep trying.”

Good communication between caregivers and patients is key.

He stresses that one of the best strategies is good communication between caregivers and patients upon discharge. One of the most common problems is patients not knowing what medications to take, or taking them incorrectly.

Dr. Khot’s tips to reduce risk of readmission

As a patient – or the loved one of a patient – you have an important role to play in preventing readmission. Dr. Khot urges people to follow these tips while at the hospital:

1. Know your medications and take them as prescribed. “The most important thing patients can do to prevent readmission is to have a clear understanding of the medicines they need to take and to make sure they take them as prescribed,” Dr. Khot says.

2. Speak up about how you’re feeling before being discharged from the hospital. While some signs of possible readmission can be monitored (such as blood pressure), patients need to alert their doctors to things such as light-headedness or trouble breathing before leaving. 

3. Ask what’s expected after discharge and make proper follow-up appointments. “Patients should know when and with whom to follow up with in the outpatient clinic,” Dr. Khot says, emphasizing that follow-up appointments are important to adjust medications and therapy as the patient recovers. In addition, participating in cardiac rehabilitation saves lives and includes valuable information for individuals living with heart disease.  

4. Two sets of ears are better than one. Try to have a relative or friend with you to listen to your discharge instructions.

5. Get it in writing. Written instructions regarding your medications and any other treatment or follow-up exam information are great resources to carry with you.

6. Make the pharmacy a priority. Get your prescriptions filled as soon as possible after leaving the hospital, so there is no lapse in starting your new regimen.

7. Consider home healthcare services, at least for the short term, after discharge. A visiting nurse may help you get started on the right medication routine and any other changes you need to make once you’re home. 

Always call your healthcare provider if you get home and cannot remember or do not understand your discharge instructions. Cleveland Clinic Heart and Vascular Institute patients have access to a nurse 24/7 to answer questions after they leave the hospital.

Cleveland Clinic’s Leo Pozuelo, MD, Section Head of Consultation Psychiatry, explains why.

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Answers to those questions are given by Michael Rocco, MD, medical director of Cardiac Rehabilitation and Stress Testing at Cleveland Clinic, in this whiteboard session.

Find out what’s good, average and “needs improvement” through medications in this whiteboard session lead by Michael Rocco, MD, Medical director of Cardiac Rehabilitation and Stress Testing at Cleveland Clinic.

EECP is a non-invasive therapy provided on an outpatient basis that does not require the use of any medications.

More than 7 million people in the U.S. are estimated to suffer from angina according to the American Heart Association. These patients suffer from ischemia, which means that there is a restriction in the blood supply to body tissues. This causes a shortage of oxygen, and EECP therapy can help.

What Exactly Is EECP?

Enhanced External Counterpulsation is an outpatient therapy that mechanically increases blood flow to improve chest pain symptoms and quality of life.

While undergoing EECP, the patient lies on a comfortable table and is strapped with treatment cuffs that inflate along the legs from the calves to the thighs and buttocks. This external pulsation helps to increase blood supply to the heart muscle and decrease the amount of work it has to do. Throughout the procedure, heart rate and rhythm are monitored to make sure the patient is responding well.

Studies using stress tests have shown that EECP relieves angina and the degree to which a person suffers from ischemia. This non-invasive therapy is provided on an outpatient basis and does not require the use of any medications.

Limitations of EECP

Cleveland Clinic’s Stephen Ellis, MD, section head of Interventional Cardiology, says there are still many reasons that medication and surgical interventions remain the gold standard in heart treatment.

“EECP is not for everyone,” he says. “Some arrhythmias and other cardiovascular conditions preclude EECP, and it takes several treatments to see lasting results—so, the time commitment is great.”

He adds that about half of patients who try EECP relapse after one or two years. In addition, the treatments are not always covered by insurance.

“For some patients, it may be a good option,” says Dr. Ellis, “especially for those who are intolerant of medications or who suffer from persistent angina.”

Is EECP right for you?

The decision to try EECP begins with talking to your physician. EECP has been shown to help patients who:

• Are no longer getting relief from the use of medications.
• Have returning symptoms after heart surgery and interventions.
• Have other health concerns that disqualify them for another procedure.

Learn more about EECP therapy offered at Cleveland Clinic

Image of TS3 EECP® Therapy System compliments of Vasomedical.

Medical director of Cardiac Rehabilitation and Stress Testing at Cleveland Clinic, Michael Rocco, MD, shows us the components of a lipid profile and what this important fasting blood test measures. Get a better understanding of your numbers by watching this whiteboard session.

In this whiteboard session, Michael Rocco, MD, medical director of Cardiac Rehabilitation and Stress Testing at Cleveland Clinic, shares how HDL cholesterol works to your heart’s benefit.

In this whiteboard session, Michael Rocco, MD, medical director of Cardiac Rehabilitation and Stress Testing at Cleveland Clinic, explains how LDL cholesterol works and what treatments can control it.

“Keeping mom’s heart healthy is especially critical since we know that heart disease is the number one cause of death for women,” says Leslie Cho, MD, Director of Cleveland Clinic’s Women’s Cardiovascular Center. “After menopause, a woman’s risk for heart disease increases dramatically, and the average age for menopause is 51.4 years old.”

As estrogen levels decrease at menopause, the risk for heart disease risk increases because estrogren is a hormone that helps to regulate cholesterol levels. Dr. Cho recommends these four tips to help keep mom healthy.

1. Have regular checkups. As mothers work and take care of the house and family, they often forget about their own health. Make sure Mom takes the time to have an annual checkup to monitor her blood pressure and  cholesterol levels. For Mother’s Day, make your mom an appointment at a center such as the Women’s Cardiovascular Center, which focuses on women and their special needs.

2. Exercise most days of the week. Decreased ability to exercise can be a sign of heart disease. If your mom is becoming a lot less active as she ages, make sure she sees a doctor to rule out any health issues. Then get her moving! If exercise is new for your mom, start by going for a walk with her a few times a week. Encourage her to increase her stamina.

3. Stay away from smoking. Smoking increases blood pressure and heart rate and contributes to hardening of the arteries. If your mom smokes, talk to her about the dangers of it especially as she ages. Even one or two cigarettes a day greatly increases the risk of heart attack, stroke and other serious health issues. It is never too late to add years to your life by quitting.

4. Eat moderately and eat heart healthy. As we age, we need just as many nutrients, but fewer calories to avoid weight gain. This is why it is so important for mom to choose her calories wisely. Her heart-healthy diet should be rich in fruits, vegetables, whole grains, low-fat dairy, lean meats, fish, beans and nuts. She should limit saturated fats and sodium and make sure she is getting enough calcium and B12.

“Talk to her about these key health indicators,” says Dr. Cho. “When you can, be healthy with her! There is nothing better than showing by example.” Spend a little quality time with her to focus on diet and exercise – it will be good for both of you!