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2009 Lown Forum 4

2009 Lown Forum 4

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Lown Cardiovascular Research Foundation's quarterly newsletter featuring Dr. Blatt's article about Stable Coronary Artery disease, an update on ProCor's role at the CVD training summit, second opinions at the Lown Center, promoting women's heart health, and an article by Dr. Lown, "Principles for a comprehensive health care system.
Lown Cardiovascular Research Foundation's quarterly newsletter featuring Dr. Blatt's article about Stable Coronary Artery disease, an update on ProCor's role at the CVD training summit, second opinions at the Lown Center, promoting women's heart health, and an article by Dr. Lown, "Principles for a comprehensive health care system.

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Published by: Lown Cardiovascular Research Foundation on Oct 11, 2011
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Charles M. Blatt, MD
“The good physician treats thedisease; the great physiciantreats the patient with thedisease.” Sir William Osler 
Because the Lown Cardiovascular Group treats patients aspeople, not diseases, we have had extraordinary successin the management of patients with coronary arterydisease (CAD). Our approach is based on a wealth ofclinical experience beginning in the 1950s with Dr. SamuelLevine, Dr. Lown’s mentor in cardiology. Throughout their renowned careers, both Dr. Levine and Dr. Lownemphasized the importance of a meticulous medicalhistory and physical examination in all patients.Today, this approach enables our group to lead thecardiology community in recognizing that the vastmajority of patients with CAD--and particularly elderlypatients--can be managed successfully without the need
Stable coronary artery disease: a benign condition
Lown Forum
      T      H      E
President’s message: Annual appealNew care-at-home project
Patient question: H1N1ProCor: Global CVD training summit
Guide to managing coronary arterydisease
      I      N      S      I      D      E
Second opinions
LCRF board member promotes women’s health
Lown Center 
Principles for a comprehensive health system
for invasive diagnostic or therapeutic interventions.Indeed, a careful history and a simple exercise test, inmost patients, can determine the right clinical approach.
Successful management of CAD is key
Stable, well-managed CAD is a
condition. Patientscan enjoy long and healthy lives, enhanced by physicalactivity and full involvement in activities at home and atwork. Lown Center cardiologists communicate thisoptimism--which is based on solid medical research anddecades of experience--to both the patient and family, andespecially to the worried spouse. We also include spouseswhenever possible in our patients’ CAD management.We utilize invasive procedures only when they are clearlywarranted and when the benefit of intervening far outweighs the potential harm.
Read the Lown Center patient guide to managing coronaryartery disease on page 4.
In March 1994, I was on track for quadruple bypass: twoof my main arteries were 100% blocked, and a third wasblocked 50%. My primary care physician and others Iconsulted all recommended surgery.
But my wife was persistent in looking for an alternativeand she learned about the Lown Center.My first meeting with Dr. Blatt is very vivid in my mind.I’d talked to so many people, I assumed I would be toldthe same thing--that with my kind of blockage, bypasswas the only option. I was scheduled to crossmatchblood for the surgery that day and was in a hurry to getthrough the appointment.Despite my impatience, Dr. Blatt spent a lot of timelistening to me. That surprised me--I was used to quickvisits. He said that my CAD could be controlled withmedication, exercise, and diet. I left his office walking onair--I felt terrific!I always enjoyed swimming but had gotten off-track withit. Now I’ve been swimming 4-5 times a week for 15years. Dr. Blatt prescribed medication and emphasizedthat I need to maintain a healthy weight and stay awayfrom certain foods. I was cooperative and it worked fineuntil September 2006, when I experienced my first chestpain ever and Dr. Blatt recommended a catheterization.He was with me during the procedure and suggestedthat they put stents in. I’ve had no symptoms since.I think it’s important to have confidence in, and listen to,your cardiologist. It’s also important to listen to your wife--I’m grateful that mine never gave up and I want togive her the credit she deserves.
Stephen Price, PhD
President’s message
Vikas Saini, MD
Putting people first—the core principle ofthe Lown Center---makes us more than amedical practice. Rather, we are acommunity of physicians, nurses, patients,and families working together to buildhealthier lives. We see every man or woman who comesthrough our door as a human being--someone’s parent or child, husband or wife, brother or sister, neighbor or friend, living a busy life in a complex world.Our efforts touch people locally and around the world--from Brookline to Botswana and beyond.Through the Lown Foundation’s research activities, wecontinue to deepen our understanding of cardiovascular disease and the most effective, cost-effective ways oftreating it. One of our current projects compares theeffectiveness of our care to other models, seeking toquantify what we have seen for decades—that our patients do substantially better than those who receivecare that is driven by available technologies.An exciting new home care project soon will beginexploring the use of laptop computers and the internet sopatients at home and clinical staff in the office can see andtalk directly to each other.
(Read more at right.)
Nowhere is the message about cost-effective preventionof heart disease more urgently needed than in theworld’s poorest countries. Through ProCor, our globaloutreach program, we share the latest groundbreakingresearch with health professionals in more than 200countries.Now in its third year, the Louise Lown Heart Hero Awardbrings international visiblity to grassroots health efforts inlow-resource settings. This year’s winning program, inUganda, promotes heart health from childhood throughold age with innovative strategies that can inspirecommunities around the world and here at home.We need your help to keep the Lown community strongand vibrant. I hope you will consider a charitable gift tothe Lown Foundation so we can continue our research,training, and global outreach.Your tax-deductible contribution is a gift to everyone inour community, from friends we’ve known for years tofriends we’ll never meet in distant countries.Your support makes a big difference. On behalf ofeveryone at the Lown Center, I thank you.
Using communication technology toenhance patient-focused care
The Lown Cardiovascular Center’s application process for our exciting new research project, “Virtual Home Visitsfor Elderly Cardiology Patients: A Pilot Study,” isunderway. Approval by Partners Healthcare’s InstitutionalReview Board is required for all research involving humansubjects to protect patients and ensure that their rightsare being upheld.As soon as the application process is completed, theLown Center will recruit a small number of patients toparticipate.The project will utilize internet videoconferencing toenhance communication with patients about their medical care. Participants will be randomly assigned toone of two groups.Members of one group will receive a small laptopcomputer that will be used to videoconference with their doctor and other staff at the Lown Cardiovascular Center.During a videoconference, patients will be able to see andhear their doctor on the laptop, and the doctor will beable to see and hear the patient on his computer. These“e-Visits” will be scheduled every two weeks and will bein addition to patients’ regularly scheduled office visits.Patients will also be able to initiate a videoconferencevisit if and when they want.Members of the other group will continue with their regular care, which will not change in how it is delivered.We look forward to bringing you future updates aboutthis exciting new venture.
 A patient at home (left) can see and speak with Lown Center physicians and staff during e-Visits that are conducted over theinternet using a laptop computer. In the photo on the right,medical assistant Elena Popkova, Dr. Shmuel Ravid, and Padraig Carolan, research assistant, speak with a patient.
For mor e information, contact Padraig Carolan, researchassistant at 617-732-1318 x3349 or pcarolan@partners.org.
If you would prefer to receive the Lown Forum byemail, send your full name and preferred email addressto info@lownfoundation.org.
Question from a patient
Fred Mamuya, MD, MPH
Constantly in the news, swine flu (H1N1) can be confusing and frightening.
Question:What is swine flu?Answer:
The World Health Organization (WHO) hasdesignated the 2009 pandemic influenza (H1N1) as the“Swine flu.”
Question:If I am a cardiac patient, what should I do?Answer:
You should receive the regular annual influenzavaccine and the newly approved swine flu vaccine. If youare over 65 years of age, you should also make sure thatyou are up to date with your pneumonia vaccination.
Question:What symptoms should I be concerned about?Answer:
Shortness of breath with activity or at rest, highfever that persists more than 3 days, rapid or shallow
breathing, turning blue, bloody or colored phlegm, chestpain, low blood pressure, decreased activity,lightheadedness, decreased urination, lethargy,drowsiness, difficulty awakening, confusion, severeweakness, or paralysis are some common concerningsymptoms. However, if you do not feel well, please callyour physician before more serious symptoms develop.
Question:What is the recommended treatment forswine-flu (H1N1)?Answer:
Oseltamivir (Tamiflu) started within 48 hours ofonset of symptoms is the recommended treatment. IfTamiflu is unavailable, treatment with Relanza (zanamivir)should be considered. Treatment should be started asearly as possible, and laboratory confirmation of influenzavirus infection is not necessary prior to initiation oftreatment. Thus, please remember to call your primarycare physician with any concerning symptoms.
Updates on H1N1 are available at the US Department of Healthand Human Services website: www.flu.gov.
ProCor plays leading role in international CVD training summit
"Am health worker, I need your help, I need freeOxford handbook on medicine. I hope you helpme in this way. My address in Algeria...." Message from visitor to ProCor's website, Oct. 2009
Access to the global knowledge-base is fundamental torecruiting, educating, developing, and retaining peoplewho can play a role in cardiovascular disease prevention--from village health workers to cardiologists.ProCor recently helped organize a two-day internationalsummit focused on developing new strategies for training a global workforce to prevent CVD. Seventypeople from 20 countries attended the Global Summit onEducation and Training in Heart Disease and StrokePrevention at the US Centers for Disease Control andPrevention in Atlanta on October 14-16, 2009.Dr. Brian Bilchik, ProCor’s Director, is Co-chair of theRegional and Global Collaboration ImplementationGroup of the National Forum for Heart and StrokePrevention, which sponsored the summit. CatherineColeman, Editor in Chief, ProCor, and Dr. Vikas Saini,Foundation President, also participated.To guide the planning of the Summit, a survey of globalCVD training needs was emailed to ProCor’s 1300-member network and to members of the NationalForum. Based on survey results, plenary sessionsexplored diverse trainingformats, such as short courses,fellowships, and continuingeducation. Dr. Bilchik andCatherine Coleman deliveredpresentations on OnlineLearning that highlightedProCor and other programsthat use technology to supportCVD training and education.Small-group “brainstorming”sessions explored potentialways of meeting the training needs of clinicians, healthprofessionals, researchers, and policymakers. Dr. Sainimoderated a session on the training and education needsof clinicians.In the final plenary session, participants were asked tocollectively describe an “ideal” long-term strategy todevelop and sustain a national CVD prevention workforce,after which Dr. Billy Bosu, Director of NoncommunicableDiseases, Ministry of Health, Ghana, was asked to providea reality check. “Other things will be required as well---likepolitical will and funding for chronic disease prevention,”he observed. “We need to be aware of the challenges, butnot daunted.”
Read more about global heart health at www.procor.org.
Dr. Brian Bilchik presented asession on Online Learning atthe Global Summit onEducation and Training inHeart Disease and StrokePrevention.

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