Heart & Stroke

HEART & STROKE MAY 2019 | FUTUREOFPERSONALHEALTH.COM

An Independent Supplement by Mediaplanet to USA Today

Howie Mandel

shares his advice on managing heart health and high cholesterol

Explore the steps you need to take when seeking treatment for AFib Discover the new technologies that are helping stroke patients walk again

Putting Your Heart Into Stroke Prevention Adopting a heart-healthy lifestyle is not only beneficial for promoting positive cardiovascular health, but is essential in reducing stroke risk, as well.

In May we observe National Stroke Awareness Month. This year’s focus revolves around prevention tactics and increasing awareness in adults who may not suspect they are at risk. Preexisting heart conditions and lifestyle choices can put a person at higher risk for having a stroke, including modifiable risk factors such as high blood pressure, smoking status, lack of physical activity, or high cholesterol. Atrial fibrillation, an irregular heart rhythm, can also

increase risk for stroke, and may not always be recognized by patients.

Minutes matter The good news is that 4 out of 5 strokes can be prevented, thanks to advances in medical care and access to more timely treatment. Time matters most during a stroke, since brain damage can occur in a matter of minutes. Watch for symptoms such as severe headache, trouble speaking, vision changes, loss of balance, or sudden numbness in the face, leg, or arm. If you suspect you or a loved one are having a stroke, calling 9-1-1 is the most important thing you can do.

If you are at risk for a stroke, it’s important to take steps to lower that

Richard Kovacs M.D., FACC, President, American College of Cardiology risk. Keeping your blood pressure and cholesterol in a healthy range can reduce risk, along with eating a healthy diet, reducing salt intake, quitting smoking, staying active, and maintaining a healthy weight.

Aspirin regimens It’s long been thought that an aspirin a day can “keep the cardiologist away” by

helping to prevent heart attacks and strokes. But newer data has shown that’s not always the case.

The American College of Cardiology and American Heart Association’s 2019 Primary Prevention of Cardiovascular Disease Guideline recommends that aspirin should rarely be used to prevent heart attack or stroke in people without heart or blood vessel disease. Aspirin thins the blood to help it flow more easily through your body and reduce the possibility of blood clots forming. However, due to the blood thinning, aspirin can also result in bruising and gastrointestinal bleeding.

If you have already had a heart attack or stroke, taking one aspirin each

day is often prescribed to prevent a second, potentially deadly recurrence.

In this situation, the benefits can often outweigh the risk of bleeding. If you’re considering changing your medication, be sure to talk with your care team first.

By adopting healthier choices, you’re doing both your heart and brain a favor. It can be difficult to know where to begin in your health journey, so keep an eye on any modifiable risk factors and set realistic goals for your day-to-day life. By starting a conversation with your care team about how to prioritize healthier living, you’re on your way to building the foundation for a healthy mind and heart. n

Publisher Fernando Isaacs Business Developer Mac Harris Managing Director Luciana Olson Designers Tiffany Pryor, Marie Coons Copy Editor Juliana Burkhart Director of Sales Shannon Ruggiero Director of Business Development Jourdan Snyder Director of Product Faye Godfrey Lead Editor Mina Fanous Production Manager Josh Rosman Content Strategist Vanessa Rodriguez Cover Photo Take Cholesterol to Heart Campaign All photos are credited to Getty Images unless otherwise specified. This section was created by Mediaplanet and did not involve USA Today.

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What Patients With Atrial Fibrillation Need to Know About Treating Their Condition SPONSORED

When catheter ablation is successful, patients may be able to stop taking or reduce the amount of medication they’re taking to control their heart rate or rhythm.

AFib has been brought into the spotlight recently with Apple Watch’s ability to detect AFib, and with the diagnosis of reality star Eddie Judge of “Real Housewives of Orange County,” who was diagnosed with AFib 18 months ago.

A personal trainer and gym owner, Judge is passionate about fitness. His AFib affected his quality of life greatly, as it occurred when he was doing something he loved — exercising.

“I would walk or jog but it felt like I was sprinting as fast as I could,” he explains. “It really held me back. It felt like someone was squeezing my heart.

I wasn’t able to breathe.”

Patients with AFib, like Judge, want relief from their condition.

PHOTO: EDDIE JUDGE

Over 5.5 million Americans have atrial fibrillation (AFib), an irregular heartbeat that can lead to stroke, blood clots, heart failure, and other complications.

Here are some steps they should take: 1. Don’t wait to get diagnosed It’s essential to get diagnosed so you can get treatment as soon as possible. AFib is a progressive disease that gets harder to treat as symptoms get worse. “It’s crucial to get checked right away,” according to Andrea Natale M.D., an international expert on the treatment of AFib and leading electrophysiologist, “since the data is in favor of early intervention.”

2. Learn about your condition AFib is the leading cause of strokes in the United States and increases a patient’s risk for stroke by five times.

“AFib affects people differently, with symptoms ranging from ‘fluttering’ in the chest and irregular heartbeat to more subtle symptoms like fatigue, weakness, or sweating,” says Uri Yaron, Ph.D., worldwide president of Biosense Webster, Inc., a global leader in the science of diagnosing and treating heart rhythm disorders.

3. See an electrophysiologist While AFib patients may get diagnosed by their primary care doctor or a cardiologist, it’s important for patients to see an electrophysiologist (known as an EP), a doctor who specializes in the heart’s electrical system and treats heart arrhythmias.

4. Know your treatment options Your doctor may prescribe drug therapy to help minimize symptoms and reduce your risk of stroke from an AFib-related blood clot. But not all AFib patients can manage their condition with drug therapy, as the medicine can cause unwanted side effects. An electrophysiologist may suggest a catheter ablation procedure to treat AFib and which may reduce the risk of stroke.

“Most patients who receive catheter ablation treatment experience a long-term reduction in the number of episodes of arrhythmia and the severity of symptoms,” says Yaron. “Many achieve a permanent return to normal heart rhythm.”

5. Get back to living your life normally “The most important benefit from catheter ablation is better quality of life coming from the freedom of arrhythmia” says Natale. “Your quality of life should be better after an ablation which is a huge benefit for patients living with the fear of AFib and stroke.”

“After my procedure, I’m exercising again,” says Judge, who advises other patients to see a specialist and never give up. “I’m back to living my regular life and I feel normal again.”

Get Smart About AFib, an AFib patient community, hosts a Facebook Live event every month with an electrophysiologist for an informative question-and-answer session with the AFib community. The next event will be held on June 5th on their Facebook page. To learn more, or to find an electrophysiologist near you, visit GetSmartAbout Afib.com. n Kristen Castillo

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Work With a Healthcare Team to Prevent Secondary Stroke Strokes can occur even in young, healthy people. Not all strokes are preventable, but knowing the signs and acting fast can save your life.

O

Underlying cause “I had no clue that a stroke could happen to someone my age,” says Reed, who worked out several days a week, was at a healthy weight, and didn’t know of any preexisting medical conditions.

But following a series of tests, Reed learned he had a patent foramen ovale (PFO), a hole in his heart, through which a blood clot had traveled to his brain and caused the stroke. Two months later, he had surgery to close the hole. Reed made a full recovery and is back to life as usual.

Each morning on his doctor’s advice, Reed takes a low-dose aspirin to prevent clots and a second stroke.

“I run an average of 15 to 20 miles a week, and I am training for a half marathon,” says Reed.

“I eat as healthy as I can by eating more fruits, vegetables, and heart-healthy foods such as nuts and seeds.”

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PHOTO: MITCHELL ELKIND

n March 10, 2018, Tom Reed was getting ready for bed following a fun family vacation in Las Vegas.

“Suddenly I couldn’t talk,” recalls Reed, 37, of Boulder, CO. “I couldn’t lift my arm. My face was a little droopy on the right side, and I could only say ‘uh.’”

His wife, Jenni, a nurse practitioner, immediately suspected Reed was having a stroke. Within 30 minutes, she got him to the emergency room where doctors administered tPA, the clot-busting drug.

While Reed says he doesn’t fear having another stroke, about 1 in every 4 stroke survivors will have another one. The best way to avoid a secondary stroke is to work with your healthcare team on a plan to reduce your risks.

Aspirin, for example, is not appropriate for everyone, so it’s important to talk to your healthcare provider before starting an aspirin regimen.

Preventing stroke While not all strokes are preventable, according to the American Stroke Association, up to 80 percent may be. By not smoking, making healthy food choices, being physically active, maintaining a healthy weight, and controlling cholesterol, blood pressure, and blood sugar, you can mitigate your chances of having a stroke.

Even people with health conditions such as high blood pressure, diabetes, or atrial fibrillation (AFib) may reduce their risk of stroke by talking to their healthcare provider about how they can make healthy choices each day.

Nothing causes more strokes than high blood pressure. Of the 116.4 million people in the United States who have high blood pressure, fewer than half have it under control. Lowering your blood pressure by 20 points could cut your risk of dying from a stroke by half.

AFib, an irregular heartbeat, increases a person’s risk of stroke by five times. Fluttering in the heart may cause blood to pool and form clots, which can make their way to the brain.

Managing AFib and taking blood thinners on the advice of your

healthcare provider may reduce your risk of stroke.

Diabetes is treatable, but even when glucose levels are under control, it greatly increases risk of stroke. It’s important to manage diabetes with your healthcare team.

A key to stroke treatment is recognizing the signs of stroke, as Reed’s wife did. Today, he talks about stroke warning signs, noting that F.A.S.T. is an easy way to remember the most common signs of stroke that come on suddenly:

F

ace drooping: Does one side of the face droop or feel numb? Ask the person to smile.

A

rm weakness: Is one arm weak or numb? Ask the person to raise both arms. Does one arm drift downward?

S

peech di�ficulty: Is their speech slurred? Are they unable to speak, or are they hard to understand? Ask the person to repeat a simple sentence, like “The sky is blue.” Is the sentence repeated correctly?

T

ime to call 9-1-1: If the person shows any of these symptoms, even if the symptoms go away, call 9-1-1 and get them to the hospital immediately. n

Mitchell Elkind, M.D., M.S., Advisory Committee Chair, American Stroke Association; President-Elect, American Heart Association Lynn Bronikowski, Content Marketing Manager, American Stroke Association MEDIAPLANET

CONSIDER REFERRING PAT I E N T S TO C A R D I O LO G I S T S FOR PFO CLOSURE

CRYPTOGENIC STROKE

C O M M O N C H A L L E N G E S P H Y S I C I A N S H AV E I N T R E AT I N G C R Y P TO G E N I C S T R O KE* APPROXIMATELY

PFO FOUND IN

UP TO

1/3

~45%

25%

OF ISCHEMIC STROKES ARE CRYPTOGENIC 1

OF CASES

RECURRENCE WITH PFO

T H R E E L A R G E C L I N I C A L S T U D I E S CO N F I R M T H E S U P E R I O R I T Y O F P F O C LO S U R E TO M E D I C A L M A N AG E M E N T I N R E D U C I N G R I S K O F S T R O K E R E C U R R E N C E .

RESPECT

2

REDUCE3 ‡

‡

CLOSE4 ‡

Amplatzer™ PFO Occluder

GORE HELEX and GORE CARDIOFORM Septal Occluders

Amplatzer PFO Occluder, Multiple Approved PFO Occluder Devices

980 5,810

664 2,232

473

(mean 5.9 years)

(median 3.2 years)

NR (mean 5.4 years)

ANTICOAGUL ANT ALLOWED IN CONTROL GROUP?

Yes

No

No

REL ATIVE RISK REDUC TION

(Recurrent ischemic stroke of unknown mechanism)

DEVICES USED PATIENTS FOLLOW-UP PATIENT-YE ARS

62%

77%

97%

(Recurrent ischemic stroke)

(Recurrent ischemic stroke)

NR = not reported PFO = patent foramen ovale *Based on a survey conducted by Abbott in December 2017 of physicians treating cryptogenic stroke.

L E A R N M O R E AT C R Y P T O G E N I C S T R O K E .C O M IMPORTANT SAFETY INFORMATION INDICATIONS AND USAGE: The AMPLATZER™ PFO Occluder is indicated for percutaneous transcatheter closure of a patent foramen ovale (PFO) to reduce the risk of recurrent ischemic stroke in patients, predominantly between the ages of 18 and 60 years, who have had a cryptogenic stroke due to a presumed paradoxical embolism, as determined by a neurologist and cardiologist following an evaluation to exclude known causes of ischemic stroke.

CONTRAINDICATIONS: Patients with intra-cardiac mass, vegetation, tumor or thrombus at the intended site of implant, or documented evidence of venous thrombus in the vessels through which access to the PFO is gained. Patients whose vasculature, through which access to the PFO is gained, is inadequate to accommodate the appropriate sheath size. Patients with anatomy in which the AMPLATZER™ PFO device size required would interfere with other intracardiac or intravascular structures, such as valves or pulmonary veins. Patients with other source of right-to-left shunts, including an atrial septal defect and/or fenestrated septum. Patients with active endocarditis or other untreated infections.

ADVERSE EVENTS: Potential adverse events that may occur during or after a procedure using this device may include, but are not limited to: Air embolus; Allergic drug reaction; Allergic dye reaction; Allergic metal reaction: Nitinol (nickel, titanium), platinum/iridium, stainless steel (chromium, iron, manganese, molybdenum, nickel); Anesthesia reactions; Apnea; Arrhythmia; Bacterial endocarditis; Bleeding; Brachial plexus injury; Cardiac perforation; Cardiac tamponade; Cardiac thrombus; Chest pain; Device embolization; Device erosion; Deep vein thrombosis; Death; Endocarditis; Esophagus injury; Fever; Headache/migraine; Hypertension/hypotension; Myocardial infarction; Pacemaker placement secondary to PFO device closure; Palpitations; Pericardial effusion; Pericardial tamponade; Pericarditis; Peripheral embolism; Pleural effusion; Pulmonary embolism; Reintervention for residual shunt/device removal;

Sepsis; Stroke; Transient ischemic attack; Thrombus; Valvular regurgitation; Vascular access site injury; Vessel perforation. 1. Truelsen T, Piechowski-Jozwiak B, Bonita R, Mathers C, Bogousslavsky J, Boysen G. Stroke incidence and prevalence in Europe: a review of available data. Eur J Neurol. 2006;13:581-598.

2. Saver JL, Carroll JD, Thaler DE, et al. Long-term outcomes of patent foramen ovale closure or medical therapy after stroke. N Engl J Med. 2017; 377:1022-32. 3. Søndergaard L, Kasner SE, Rhodes JF, et al. Patent foramen ovale closure or antiplatelet therapy for cryptogenic stroke. N Engl J Med. 2017;377:1033-42.

4. Mas J-L, Derumeaux G, Guillon B, et al. Patent foramen ovale closure or anticoagulation vs. antiplatelets after stroke. N Engl J Med. 2017;377:1011-21 and supplementary appendix. CAUTION: This product is intended for use by or under the direction of a physician. Prior to use, reference the Instructions for Use, inside the product carton (when available) or at eifu.abbottvascular.com or at medical.abbott/manuals for more detailed information on Indications, Contraindications, Warnings, Precautions and Adverse Events.

Abbott 3200 Lakeside Dr., Santa Clara, CA 95054 USA, Tel: 1 800 227 9902 www.cardiovascular.abbott ™ Indicates a trademark of the Abbott group of companies. ‡ Indicates a third party trademark, which is property of its respective owner. © 2019 Abbott. All Rights Reserved.

32324-SJM-SH-0419-0073 | Item approved for U.S. use only.

PHOTO: TAKE CHOLESTEROL TO HEART CAMPAIGN

Howie Mandel’s Advice for Heart-Healthy Living

Comedian and game show host, Howie Mandel, talks about how he and his doctor work together to manage his health conditions.

What was your initial reaction to your atrial fibrillation (AFib) diagnosis?

I was diagnosed with AFib about six years ago, and it took me by surprise because, at the time, I felt pretty good. By that point I’d been living with high cholesterol for decades and had already learned by experience that any condition that impacts my heart health is one I need to talk to my doctor about on a regular basis, instead of just trying to manage on my own. I didn’t really know much about 6 • FUTUREOFPERSONALHEALTH.COM

AFib and was surprised by how common it is.

What advice do you have for someone recently diagnosed with AFib who doesn’t know much about it?

In addition to medication, it’s important to avoid potential triggers for AFib. I learned that even moderate alcohol consumption can cause AFib symptoms, so since my diagnosis I’ve really limited my intake. Fatigue is also a trigger, so I make sure to get a good night’s sleep. Lastly, I

make it a priority to speak regularly and candidly with my doctor, even when I feel healthy, so that we can make sure my treatment plan is still working for me.

As a person with such a hectic schedule, how have you adjusted your lifestyle to prioritize your heart health?

Despite my crazy schedule, I’ve committed to a heart-healthy routine that keeps my numbers looking good. After initially trying some statins that I felt were causing side effects,

I worked with my doctor to find the right statin medication for me. I make sure to take it at the same time every day, no matter where in the world I am.

I also try to eat healthy about 80 percent of the time, and be as active as possible every day.

When I’m on the road touring I try to stay at hotels that have gyms, but that’s not always possible, so I’ll do exercises like sit-ups and lunges in my room.

At my office I don’t have a dedicated desk. I stand for meetings, walk around, play ping pong, or just pace. I pretty much never sit down, and it gives me more energy throughout the day.

What are some best practices for managing high cholesterol?

For me, the key to managing high cholesterol is to make it part of your normal, long-term routine.

Don’t think of statin medication and healthy lifestyle changes as optional — they’re both really important for keeping your levels in check. If you aren’t feeling good on the statin you’re currently taking, bring it up to your doctor. There are multiple options out there, and another medication may be a better fit for you. You can learn more about your choices at www.takecholesteroltoheart.com.

How does your family help you manage your heart health?

My family is supportive and they live a pretty healthy lifestyle, so they’re great role models. I’m a lucky guy. n

Regaining the Ability to Walk A�ter a Stroke

How Rehabilitation Nurses Are Enhancing Post-Stroke Care In recognition of National Stroke Awareness Month, we asked stroke expert Kathryn Funk, MSN-RN, about the role of nurses in rehabilitative care of the post-stroke patient.

What should stroke patients know when considering rehabilitative care?

Not every patient goes to an acute rehab facility for intensive care. Many patients receive home therapy or outpatient therapy. There are also different types of therapy that a stroke patient might receive. In addition to speech, physical, or occupational therapy, some patients might also have the options of cognitive or vestibular therapy. Additionally, some patients might qualify for cardiac or pulmonary rehab, based upon their preexisting risk factors.

What are a few of the most important things that stroke patients need from their nurses?

Patients look to nurses as their source of information.

Not only do nurses pro-

vide care and medication, we provide comfort and reassurance. We need to prepare patients for what to expect at the next level of care.

Board of Neuroscience Nurses offers certifications as a stroke certified registered nurse and certified neuroscience registered nurse.

What programs can neurology nurses get involved with to help advance their quality of patient care?

What do you recommend neurology nurses keep in mind when treating a stroke patient?

For neurology nurses, I highly recommend joining nursing organizations and seeking certifications specific to their role. The American Association of Neuroscience Nurses (AANN) has been a great resource for me throughout the years. AANN offers webinars and guidelines for care, as well as producing a monthly magazine with cutting-edge research and informational articles. I am also a member of the Stroke ListServ, where I am able to connect with nurses throughout the country. The American

Our patients had a whole lifetime before seeing us, and our goal is to ensure that they have a successful life after they leave us. What we say and do in those few short days or hours with our patients are important to successful recovery and rehabilitation. It is important for nurses to advocate that their patients are treated with speech, occupational, and physical therapy while hospitalized to ensure that they receive the opportunity to reach maximum recovery following a stroke. n

Dr. William C. Bridges of the Texas Rehabilitation Hospital of Fort Worth talks about how some patients can relearn to perform daily tasks after suffering from a stroke.

Why do some patients have di�ficulty walking a�ter a stroke?

Patients who have suffered a stroke often have impaired signaling from the brain to the muscles they use to walk. Depending on where in the brain the stroke occurred, this may impact one or both sides of the body.

How can rehabilitation help patients regain their mobility?

After a stroke, patients must relearn how to perform certain tasks. Rehabilitation in an inpatient setting presents a multidisciplinary approach with skilled clinicians to address the patient’s cognitive, physical, and emotional needs while recovering.

How do you incorporate advanced technology into your patients’ rehabilitation?

The team at Texas Rehabilitation Hospital of Fort Worth includes some of the most highly trained clinicians in our industry. As the demands of healthcare change, we are committed to investing in technology, like the EksoGT wearable robotic exoskeleton. New technologies give our team the tools to offer the absolute best patient experience and opportunity for recovery. In particular, advanced technology has allowed us to increase the number and quality of therapeutic repetitions we are able to achieve, which has positively impacted our patients.

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