State Releases Data for Heart Bypass Surgery Death Rates

State Releases Data for Heart Bypass Surgery Death Rates

National Institutes of Health

The heart muscle is supplied blood through the coronary arteries.
The left coronary artery supplies blood to the left ventricle.
The right coronary artery supplies blood to the right ventricle.

Today the state released its annual data on death rates in California hospitals for coronary artery bypass graft surgeries, a common procedure used to treat heart disease.

The data is interesting because it's one of the first and few surgical death rates that hospitals are required to report so it gives consumers some insight into where they are more or less likely to die if they have to undergo the procedure. The results are based on surgeries performed in 2007.

The report for the first time also includes hospital ratings based on their risk-adjusted post operative stroke rates for the years 2006-2007. It singles out Alta Bates Summit Medical Center's Oakland campus for better than average performance on this measure.

Public outcome reporting by hospitals seems to have an impact. Since the state Office of Statewide Health Planning and Development started releasing the data in 2003, death rates for coronary bypass surgery have dropped 19 percent.

Heart bypass surgery is one of the top 10 surgeries in California in terms of cost, and preliminary 2008 data shows patients have a chance of dying of about 2.2 percent.

While no hospital performed better than the state average on the surgical mortality rates, four hospitals performed worse: Enloe Medical Center in Chico; Los Angeles County Harbor - UCLA Medical Center; St. Joseph's Medical Center in Stockton and Valley Presbyterian Hospital in Van Nuys. To check out the full report, go here.

Posted By: Victoria Colliver (Email) October 19 2010 at 11:18 AM

Read more: http://www.sfgate.com/cgi-bin/blogs/chronrx/detail?entry_id=74937&tsp=1#ixzz12v8bjKcG

CA Reports Stroke Rates in Bypass Surgery Data

http://www.healthleadersmedia.com/content/QUA-257919/CA-Reports-Stroke-Rates-in-Bypass-Surgey-Data

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CA Reports Stroke Rates in Bypass Surgery Data
Cheryl Clark, for HealthLeaders Media , October 20, 2010

California has recently become the first state to report hospital data on rate of stroke in patients after coronary artery bypass graft (CABG) surgery, and the results show a wide variation among 121 hospitals.


The new measure comes in the state's regular hospital data report for 2007 on CABG mortality, which has been issued eight times since 2001 when the first report covered hospital performance for 1998-99.

Joe Parker, director of healthcare outcomes for the California Office of Statewide Health Planning and Development, which issued the report, says that stroke was included this time in the CABG data because better hospital practices can reduce the number of patients who develop the complication, a known risk factor in these procedures.

"We want to be selecting something over which there is a possibility of control and improvement by a hospital," he says. "Stroke was selected because it is an important negative outcome of CABG surgery, and one that has a huge impact on families of those who care for stroke victims, as well as on the patients."

Of the 121 hospitals in the state that perform bypass graft surgery, one hospital had the lowest rate of stroke complications, Alta Bates Summit Medical Center, Summit Campus, a 337-bed hospital in Oakland.

Parker says that he visited with Russell Stanten, MD, cardiothoracic surgeon at Alta Bates, to learn what the hospital does to prevent stroke in these patients. He says Stanten replied that the hospital screens each patient for carotid disease, "and if they find it they deal with it prior to the CABG surgery." Additionally, Alta Bates surgeons also make sure the patients have transesophageal echocardiograms performed intraoperatively.

Additionally, Junaid Khan, MD director of cardiovascular services at Alta Bates, says a crucial reason for the hospital's success is in making sure that every anesthesiologist on a CABG case is board certified in echocardiography. The hospital, which does about 800 open heart procedures a year—many of them CABG—also limits the number of anesthesiologists and others who are allowed to work on these patients only "to those who do a lot of them."

"You may have people who are doing 10 cardiac surgeries a year. Ours are doing 100 cardiac cases a year," Khan says. "We also work with the perfusionists to make sure they maintain adequate pressure,"


The state's report says that risk adjusted post-operative stroke rates for five hospitals were worse than average:

1.Los Angeles County Harbor-UCLA Medical Center (4.17%)
2.Tri-City Medical Center in Oceanside (3.97)
3.Sharp Memorial Hospital in San Diego (3.15%)
4.Memorial Medical Center of Modesto (2.63%)
5.Sutter Memorial Hospital in Sacramento (2.43%)
In a letter to the state agency, Robert Adamson, MD, medical director of the cardiac transplant program at Sharp, says that in 2006, "we noted an unusual cluster of six strokes. Each case was individually reviewed and no trends or common causes could be identified," but "strongly influenced our results for the two-year period."

He says that in 2007, the incidence of stroke in this population was half that in 2006 and zero in 2008. "In view of this, we feel that the rating, while accurate in number, does not reflect our current performance in this area."

For Harbor-UCLA, Bassam Omari, MD, chief of the division of cardiothoracic Surgery, wrote the agency explaining that the hospital has discovered discrepancies in risk factors reported for its CABG patients, which "adversely affected our expected mortality and morbidity."

Other reasons for Harbor-UCLA's high rates, he wrote, dealt with the high number of Jehovah's Witnesses "whose beliefs preclude our ability to provide life-saving blood transfusions" and said the hospital failed to adequately count those patients who had a prior stroke, which put them at greater risk.

For bypass graft mortality without stroke, no hospital performed significantly better than the state average. But Enloe Medical Center in Sacramento, Los Angeles Co. Harbor—UCLA Medical Center, St. Joseph's Medical Center in Stockton and Valley Presbyterian Hospital in Van Nuys, performed significantly worse.

The California agency keeps the largest public outcomes database in the country and is an important source of comparative information for performance.


Other significant findings from the report include the following:

•Of the 30,379 patients who underwent isolated CABG surgery, 405 experienced a stroke in which symptoms lasted for 72 hours or longer, a rate of 1.33%, which is close to the national rate of 1.4% reported by the Society of Thoracic Surgeons.
• The operative mortality rate for CABG surgery in the state in 2007 was 2.35%, slightly higher than 2.2% for 2006, but much lower than in the prior three years 3.1%, 3.3% and 2.9%.
•There were 347 operative deaths among the 14,756 CABG surgeries during 2007.
This latest report also scored hospitals on their use of the internal mammary artery (IMA) during CABG procedures, a practice associated with better surgical outcomes but may take longer. Five hospitals had low rates of IMA usage, including Citrus Valley Medical Center in Covina, Dameron Hospital in Stockton, Lakewood Regional Medical Center in Lakewood, Suttter Medical Center in Santa Rosa and Tri-City Medical Center in Oceanside.

Parker says that use of the IMA in bypass graft surgery is longer lasting and is associated with lower mortality, but takes about 15 minutes longer to perform than traditional use of the radial artery or saphenous vein, and that may be why some surgeons fail to use it. In 2007, the state had a 93.7% IMA usage, a 4% increase since 2003.

With its next report the state hopes to add in comparative data on how many CABG patients go into renal failure and require post-operative dialysis, another complication. Renal failure occurs in between 1% and 2% of CABG cases, on average, he says.

Debby Rogers, vice president for Quality and Emergency Services for the California Hospital Association, says her organization is "pleased that they're issuing reports with more recent data." She noted that the reports indicate a distinct "through the years that care is improving" related to CABG mortality.


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Cheryl Clark is a senior editor and California correspondent for HealthLeaders Media Online. She can be reached at cclark@healthleadersmedia.com.

American Heart Association honors new research grant recipients and leaders in cardiovascular innovation in the Bay Area

FOR IMMEDIATE RELEASE

CONTACTS: Linda Tsai, communications director,
(408) 367-9784; linda.tsai@heart.org


(SAN FRANCISCO) – More than 100 people, including prominent leaders and pioneers in the health and medical community, joined together this week evening to honor the American Heart Association’s newest local recipients of cardiovascular research funding at the Four Seasons San Francisco.

The evening reception, made possible with support from Gilead Sciences Inc., is the first ever gathering dedicated to the Association’s Northern California research grant recipients. It is also honored research recipients from the past decade.

Deepak Srivastava, M.D., President of the American Heart Association’s San Francisco Board of Directors, had this message for the awardees, “Young scientists in the room: Never give up. It does not matter if you are a post-doctoral scholar, a medical student or an undergraduate. There are opportunities for you to pursue your dream.” Dr. Srivastava first received American Heart Association funding early in his career; today he serves as Director of the Gladstone Institute of Cardiovascular Disease at the University of California, San Francisco.

Junaid Khan, M.D., President of the Association’s East Bay Board, also knows the value of an early research grant. “I received funding from the AHA as a medical student and it helped define the direction of my medical career.” Today, Dr. Khan is Managing Partner at East Bay Cardiac Surgery, with hospital affiliations at both Alta Bates Summit Medical Center in Oakland and Doctors Medical Center in San Pablo.

This year’s awardees are recipients of nearly $4 million in grants funded by the American Heart Association’s Western States Affiliate. Including funding from the American Heart Association’s National Center, $28 million in AHA research funds was awarded in the past year to Northern California institutions.

The 34 recipients of 2010 AHA Western States funding are:
Children’s Hospital Oakland Research Institute: Mistuni Ghosh, M.S.
Gladstone Institute of Cardiovascular Disease: Nathalie Gaborit, Ph.D.
Palo Alto Institute for Research and Education, Inc: Patricia Nguyen, M.D.
Stanford University and Stanford University School of Medicine: Marion Buckwalter, Ph.D., M.D.; Cindy Chung, Ph.D.; Shijun Hu, Ph.D.; Kiran Khush, M.D.; Josh Knowles, Ph.D., M.D.; Nick Leeper, M.D.; Merritt Maduke, Ph.D.; Foteini Mourkioti, Ph.D.; Mikyoung Park, M.S.; Valeria Vásquez, Ph.D.; Iqin Xiiong, M.D.; Masayuki Yazawa, Ph.D.; Yaozhong Zou, Ph.D.
University California, San Francisco: Gregory Marcus M.D.; Khanh Nguyen, M.D.; Jose Perez, Ph.D.; Sharon Poisson, M.D.; Sven Reischauer, Ph.D.; Carrie Shiau, B.A.; Jeoung-Sook Shin, Ph.D.; James Smyth, Ph.D.; Samantha Stehbens, Ph.D.; Hua Su, M.D.; Monika Suchanek, Ph.D.; Shantel Weinsheimer, Ph.D.; Yafeng Zhang, Ph.D.
UCSF and San Francisco Veterans Affairs Medical Center: Elaine Tseng, M.D.
University of California, Davis: Colleen Clancy, Ph.D.; Javier López, M.D.; Jon Sack, Ph.D.; Fan Yang, B.S.

Tuesday was also a celebration for the Bay Area’s productive cardiovascular research community and the American Heart Association’s commitment to support it.

In addition to Dr. Khan and Dr. Srivastava, other notable speakers Tuesday night included: José Cisneros, Treasurer for the City and County of San Francisco, and Luiz Belardinelli, M.D., Senior Vice President of Cardiovascular Therapeutics, Gilead Sciences Inc.

Dr. Belardinelli, an American Heart Association grant recipient early in his own career, mentioned the importance of giving back to the community.

Dr. Khan gave special recognition to the following attendees for their dedication to and support of the American Heart Association, including:
Rod Starke, Former Chief Science Officer for the American Heart Association
Fredric B. Kraemer, MD, Western States Affiliate Board Member
Hal Barron, Executive Vice President and Chief Medical Officer at Genentech
Shaun Coughlin, Director, Cardiovascular Research Institute at UCSF
R. Sanders "Sandy" Williams, President of The J. David Gladstone Institutes
Mark Hlatky, Professor of Health Research and Policy and of Medicine at Stanford University
Hans Reiser, Senior Vice President, Medical Affairs, at Gilead Science
Patricia Sprincin, Chair of the American Heart Association’s Heart and Stroke Society
John Woods, Executive Vice President and CFO of Union Bank and Chair of the Bay Area Heart Walk
Amanda Wallis-Blue, Chair of the Patron Committee for the Celebrate with Heart Gala.

These individuals are “true leaders in the world of research and leaders within the American Heart Association,” Dr. Khan said.

The American Heart Association is the second largest single funder of cardiovascular research after the National Institutes of Health. The Association has invested more than $3.2 billion nationally in cardiovascular research since 1949.

Tuesday’s event was the first of what will become an annual celebratory gathering to highlight the lifesaving work quietly being carried out every day by so many members of the Bay Area community.

About the American Heart Association
Founded in 1924, we’re the nation’s oldest and largest voluntary health organization dedicated to building healthier lives, free of heart disease and stroke. To help prevent, treat and defeat these diseases — America’s No. 1 and No. 3 killers — we fund cutting-edge research, conduct lifesaving public and professional educational programs, and advocate to protect public health. To learn more or join us in helping all Americans, call 1-800-AHA-USA1 or visit www.heart.org.

Aortic Valve Replacement (MIS)

Mouth-to-Mouth May Not Save More Lives During CPR, Two Studies Conclude

Mouth-to-Mouth May Not Save More Lives During CPR, Two Studies Conclude
By Arielle Fridson - Jul 28, 2010 2:06 PM PDT Wed Jul 28 21:06:34 UTC 2010

CPR is performed on a dummy. Source: American Heart Association

Hollywood heroics aside, mouth-to- mouth resuscitation does nothing to improve the outcome of CPR, two studies showed. It doesn’t provide any benefit over the chest-pumping procedure, U.S. and Swedish scientists said.

In the research, there was no significant difference in survival for patients who received just chest-compression CPR from bystanders after heart stoppages compared with those who got both that treatment and mouth-to-mouth breathing, according to two papers published today in the New England Journal of Medicine.

While cardiopulmonary resuscitation can double or even triple a patient’s rate of survival, two-thirds of people in cardiac arrest outside a hospital don’t receive CPR, according to the American Heart Association. Bystanders might refrain from acting because they can’t identify cardiac arrest, are afraid of hurting the person, or are averse to mouth-to mouth contact, said Thomas D. Rea, an associate professor of medicine at the University of Washington in Seattle.

“Eliminating mouth-to-mouth from CPR may make a layperson less reticent to act and if they act, they can save a life,” said Rea, the lead author of the U.S. study. “Chest compression alone is simpler and intuitively easier.”

The U.S. researchers considered 1,941 people in cardiac arrest who needed bystanders to perform CPR until an ambulance arrived. The scientists reported finding no significant difference between the 981 patients who received chest compression alone and the 960 who received both that procedure and mouth-to-mouth breathing.

Survival Rates

The first group survived to hospital discharge at a rate of 12.5 percent and the second had an 11 percent survival rate, the scientists wrote. The trials were carried out in two counties in Washington state and in London in 2009. The Laerdal Foundation for Acute Medicine, based in Stavanger, Norway, funded the research.

For the other study, Swedish researchers collected data on 1,276 patients from 2005 to 2009. Of the 620 patients who received chest pumping only, the rate of 30-day survival was 8.7 percent. Of the 656 patients who received both chest pumping and mouth-to-mouth breathing, 7 percent survived the 30-day period. The study was funded by the Swedish Heart-Lung Foundation, based in Stockholm.

Emergency medical services each year treat about 300,000 people in the U.S., according to the Dallas-based heart association. These patients have a less than 8 percent chance of survival. Sudden cardiac arrest is the loss of heart function, breathing and consciousness, according to the Mayo Clinic, based in Rochester, Minnesota. It can be caused by diverse conditions, including heart attack, drowning, choking, and electrocution, or it can happen without any known cause, according to the heart association.

CPR Guidelines

The group, in guidelines published jointly with the Antwerp, Belgium-based International Liaison Committee on Resuscitation, has recommended hands-only CPR since April 2008, said Junaid Khan, president of the association’s East Bay Division and a cardiothoracic surgeon at Alta Bates Summit Medical Center in Oakland.

“These two studies are the first randomized control trial in this area, which constitutes the highest level of evidence that physicians trust,” Khan said in a telephone interview. “This will enable the strongest level of recommendation.”

Association officials now are “probably going to modify their statements in a more forceful way based on this study and other similar ones,” most likely by the end of this year, said Myron L. Weisfeldt, director of the Department of Medicine at John Hopkins Hospital in Baltimore.

Weisfeldt wrote an editorial on CPR, urging more research, that was published in the medical journal along with the studies.

Rescue Training

While the studies may cause instructors to place less emphasis on mouth-to-mouth techniques, it would be a mistake to eliminate them from CPR courses, Weisfeldt wrote in the editorial. The technique is effective against respiratory failure, the most common cause of cardiac arrest in children, he wrote. Each year, about 5,800 children under 18 suffer cardiac arrest in the U.S., according to the heart association.

MIS Surgery w/ Edwards IMRand MC3 Rings Videos

Aortic Stenosis Still Goes Under-treated Despite Lower Risk Surgical Procedures

Aortic Stenosis Still Goes Under-treated Despite Lower Risk Surgical Procedures — Junaid Khan, M.D.

In the United States, up to four percent of the population over the age of 65 is affected by aortic stenosis. Yet, for every one patient treated for this condition, it is estimated that there is one patient who goes untreated. The consequences of not treating aortic stenosis are dire. The average survival of patients with the condition who are experiencing symptoms and do not receive treatment is only two years, and the five-year survival rate is less than 20 percent. Unfortunately many of these patients are not referred for surgical consultation because severity of the disease is underestimated or the operative risk is overestimated by nonsurgeons (Surgeons use the STS national database to calculate predicted risk of mortality). To better understand the prevalence of unoperated severe aortic stenosis within the Oakland community, two local cardiology groups participated with the Alta Bates Summit Research and Education Institute analyzing 101 patients with clinically severe aortic stenosis. The results were surprising: 73% of the patient cohort was not referred for surgical intervention, despite half of them reporting symptoms related to AS. Eleven of these patients died within 11 months following their last echocardiogram.

Outcomes
Aortic valve replacement surgery has advanced over the past decade. Cutting-edge procedural techniques and innovations have led to an average mortality below 5% nationwide and at the Summit Campus, even patients in their eighties with comorbidities have a lower than expected surgical risk and typically gain an additional 6 to 8 years of quality life. Age is not a contraindication for surgery and more of these patients should be considered for surgical intervention. In addition, minimally invasive techniques like port access can result in faster recovery for patients. As surgical techniques continue to improve and risk declines, efforts must continue to reduce the number of untreated patients with severe valve disease.

Routine EKG testing of young athletes' hearts could save lives, Stanford study says

Routine EKG testing of young athletes' hearts could save lives, Stanford study says

By Sandy Kleffman

Contra Costa Times

Posted: 03/01/2010 04:30:31 PM PST

Updated: 03/01/2010 05:32:57 PM PST

Using electrocardiograms to test the hearts of young athletes before they participate in sports could be a cost-effective way to reduce sudden deaths, a Stanford University study concludes.

Questions about what type of pre-screening to require have drawn heightened interest since two seemingly healthy East Bay high school students suddenly collapsed during basketball games earlier this year.

One student died. The other was hospitalized and later released with a diagnosis of an electrical abnormality in his heart.

The California Interscholastic Federation, which oversees high school sports, requires all students to have a physical exam, including providing a family health history, before participating. That is the extent of screening for most students.

EKGs can detect signs of hypertrophic cardiomyopathy, a genetic defect that causes thickening of the heart muscle and can lead to dangerous heart rhythms that can stop the organ. Nationally, it is estimated that one in 500 people have this condition, a common cause of sudden deaths in young athletes.

But many experts consider routine EKG screening too expensive, especially since sudden deaths remain rare, involving fewer than 100 young athletes each year in the United States. A panel of the American Heart Association estimated mandatory EKG screening for all middle school and high school athletes would cost $2 billion annually.

The Stanford study, published today in the Annals of Internal Medicine, challenges such opinions and encourages people to re-examine the issues.

Combining routine EKG screening with a family health history and physical exam "would save the most lives at a cost that is generally acceptable for the U.S. health care system," said Dr. Matthew Wheeler, a fellow in cardiovascular medicine at Stanford and a lead author of the study.

EKG screening would cost about $88 per athlete, including follow-up tests, the study estimates. The test takes about 10 minutes, with five minutes more for a physician to examine the results.

For every 1,000 athletes screened, it would save the equivalent of two years of life, the study concludes. The expense for saving one year of life would be $42,900. Anything under $50,000 is generally considered cost-effective in health care, the study notes.

In Italy, where routine EKG screening of young athletes has been mandatory since 1982, sudden deaths during competitions have plunged nearly 90 percent since testing began, Wheeler said.

Yet many experts continue to have reservations about routine EKG screening.

EKGs do not pick up all heart problems, notes Dr. Junaid Khan, director of cardiac services at Alta Bates Summit Medical Center in Oakland. He worries that after getting a clean bill of health, students may no longer be concerned if they start to feel faint, have shortness of breath or develop chest pain.

"They could ignore symptoms," said Khan, president of the East Bay division of the American Heart Association. "That's a real issue."

Khan added that there would be an emotional toll on students who have false positives. They might become unduly worried and might be denied participation in sports until additional tests rule out heart problems.

The best way to save lives, Khan argues, would be to have more defibrillators at schools and to ensure that adults know how to use the equipment and to do CPR.

Pat Middendorf, athletic director at Clayton Valley High School in Concord, which will soon receive defibrillators, said the $88 expense for an EKG could be a "huge burden" for many families and prevent some students from participating.

"I don't see the state or federal government picking up the cost of it," she said. "Would it be covered by insurance? Now that's a different story."

In an editorial accompanying the study in the Annals of Internal Medicine, Dr. Barry Maron of the Minneapolis Heart Institute Foundation calls mandatory EKG screening impractical at this time. He questioned whether there would be enough doctors to perform the tests, whether students would argue that their liberties had been infringed upon if they are denied the ability to play sports, and whether nonathletes could argue that they should also receive screening.

Wheeler counters that a massive, nationwide program is not necessary and that local school districts could consider requiring EKGs for their students.

Contact Sandy Kleffman at 925-943-8249.

Warriors’ Ronny Turiaf donates defibrillators to prevent deaths among high school athletes

Warriors’ Ronny Turiaf donates defibrillators to prevent deaths among high school athletes

By: Elise Craig February 23, 2010 – 3:38 pm

Ronny Turiaf poses with school children at the kickoff of his charity foundation.

After an enlarged aortic root nearly kept him from his dream of playing NBA basketball, Warriors’ center Ronny Turiaf learned how dangerous heart problems could be. Now, in the wake of three recent cardiac emergencies on East Bay high school basketball courts, Turiaf is donating automatic electronic defibrillators (AEDs) and CPR training to four local high schools. “As someone who has been affected directly by a heart health issue, it is important for me to assist others in their efforts to prepare for a heart trauma incident,” Turiaf said.

Since October, two Bay Area student athletes have died while playing basketball, and one survived a near-lethal cardiac arrest. Joshua Ellison, the 17 year-old co-captain of El Sobrante Calvary Christian Academy, collapsed on the court and died on January 29. De La Salle freshman Darius Jones, 14, died during a preseason basketball camp at Diablo Valley College on October 11. A third student, El Cerrito High School sophomore David Gurganious, went into cardiac arrest on February 2 while sitting on the bench, but was saved by CPR administered by his basketball coach, who is a Richmond police officer, and parents in the stands.

The three schools, along with Oakland’s Life Academy High School, will each receive defibrillators, as well as AED and CPR training for ten staff members and CPR training for 30 students. The donation, which was announced Tuesday on the basketball court of Oakland’s Leonard J. Meltzer Boys and Girls Club, comes from the Ronny Turiaf Heart to Heart Foundation, which Turiaf established in 2009 to help provide medical care for children without health insurance. Through the foundation, Turiaf hopes to provide EKGs, heart surgeries and defibrillators to kids in need.

About 100 students attended Tuesday’s event, along with representatives from the schools, the American Heart Association and Cardiac Science, the company that manufactures the defibrillators and provides training. Some members of the audience also wore black armbands with “Josh #1” in white writing in honor of Ellison.

“I don’t get nervous very often,” Turiaf said. “I play in front of 20,000 people.” But he said that talking about things that matter to him, in front of a crowd that was mostly composed of high school students, as well as some parents, coaches and younger kids in Warriors apparel, was a little more nerve-wracking.

Kent Mercer, head athletic trainer De La Salle, a private Catholic school in Concord, is glad to have the defibrillator, particularly after the death of Jones, whose “dream was to play basketball at La Salle,” he said.

“It’s a great thing that they’re doing to have something in place to save somebody—not only students at the school, but anyone who comes to the school,” Mercer said. “Hopefully, it continues to spread.”

El Cerrito High School Assistant principal Marcos Garcia said he will be relieved to have a defibrillator on campus, even though coaches at El Cerrito have already been trained in CPR. “The health and safety of our students is our utmost concern,” he said. “We’re very grateful.”
As for Gurganious, the sophomore who survived cardiac arrest thanks to quick action by coach Michael Booker, he was released from the hospital last week, and is expected to make a full recovery. “We want to bring him back slowly,” Garcia said.

“It’s a whole transition between collapsing on the basketball court and going back to a full academic load,” said Kenny Kahn, head football coach at El Cerrito High and Gurganious’s creative writing teacher. “I’m looking forward to his poems and creative writing—he’s quite the poet.”

Dr. Junaid Khan, a heart surgeon at Alta Bates Summit Medical Center in Oakland and president of the East Bay division of the American Heart Association, addressed the students directly, telling them not to be too scared about sudden cardiac arrest: it’s highly unusual in teens, he said, and very rare to see three cases at the same time in the same area. Chances are better that a young person would die in a car accident, or of cancer, Khan said. “It’s like lightening striking the same place twice,” he said. “It’s that rare. In a 26 year period, there were only 30 events around the country.”

But, when it does happen, CPR and defibrillators increase survival rates significantly. Only five percent of people survive sudden cardiac arrest without CPR or defibrillation. With CPR, the odds go up to 30 percent. If a defibrillator is present, they go up to 50 percent. “Automatic defibrillators really are the key to saving lives,” Khan said. “These things are so easy to use. Just put them on and they do the rest of the work. But the devices alone, not including the training to use them, can cost between $1,500 and $2,500.

Brett Reisner, a representative from Cardiac Science who lost his own brother to sudden cardiac death, applauded Turiaf for his donation, and advocated for a new State Assembly bill that would require schools to have defibrillators available at sports contests and practices. The bill is co-sponsored by State Assembly Members Mary Hayashi (D-Hayward) and Jerry Hill (D-Castro Valley). “Fourteen states in the US have laws requiring AEDs in schools,” he said. “California is not one of them. We need to support bill 1647.”

Turiaf started his charity, the Ronny Turiaf Heart to Heart Foundation, in 2009, but he had been thinking about starting a charity for a long time. “I played basketball my whole life to make a living for my family,” said Turiaf. “In 2005, I finally signed a contract. I thought everything was perfect.”

Two days after he signed with the Los Angeles Lakers in 2005, Turiaf, now 27, was diagnosed with an enlarged aortic root during a physical exam. His doctor, Stanford surgeon Craig Miller, told him had two options: quit basketball, or have surgery. Turiaf told the crowd of students that Miller told him to have the surgery, and that he had “confidence in my ability to get you back on track.”

Turiaf believed him. “If the guy that’s going to open me up like a lobster tells me I’m going to be able to play basketball again, I have confidence in myself to do the rest,” he said.

The open-heart surgery lasted six hours, and Turiaf was back on the court in less than six months. “After I went through my surgery,” he said, “I told myself that if one day I was financially stable enough, I would do whatever I could to give back to the community.”

How to live your heart-healthiest life

Click here to check out Dr. Khan in this article by the American Heart Association...

Limiting dangers for young athletes

Thanks to Junaid Khan, MD, cardiac surgeon with Alta Bates Summit for his help in educating the community regarding sudden cardiac events in young athletes. The attached article appeared in yesterday’s Contra Costa Times.

http://www.contracostatimes.com/high-school-sports/ci_14359447


Limiting dangers for young athletes
By Sandy Kleffman, Chace Bryson and Ben EnosContra Costa Times
Posted: 02/08/2010 02:02:45 PM PST
Updated: 02/09/2010 07:06:44 AM PST

In a four-day span, two seemingly healthy East Bay high school basketball players suddenly collapsed during games this year. One died and the other was hospitalized.

The incidents, on Jan. 29 and Feb. 2, have shaken the school sports community and prompted soul-searching about avoiding such tragedies.

Experts point to many ways that students, coaches and administrators can lessen the risks such as better physical exams, more attention to players' problems and concerns, better emergency equipment and training.

But sometimes, despite everyone's best attempts, problems remain hidden and the first symptom is a collapse, said Dr. Casey Batten, associate team physician for UC Berkeley.

It has not yet been determined what caused the death of Joshua Ellison, a 17-year-old senior at Calvary Christian Academy in El Sobrante, or the collapse of 15-year-old David Gurganious, a varsity basketball player at El Cerrito High School.

But most sudden deaths of young athletes involve heart problems, according to a 2009 study in the Journal of the American Heart Association.

Researchers looked at 1,866 athletes in 38 sports who died suddenly or survived cardiac arrest from 1980 to 2006. The athletes ranged in age from 8 to 39.
Of the deaths:
· 56 percent were due to cardiovascular disease. About a third of these deaths involved an enlarged heart.
· 22 percent were caused by a chest injury that structurally damaged the heart.
· 4 percent were due to a chest blow that interrupted heart rhythm.
· 2 percent were caused by heat stroke.

Such deaths remain rare. Young people have a much greater risk of dying from cancer, leukemia, cystic fibrosis, automobile fatalities, meningitis and homicides.

"It's like getting struck by lightning," said Dr. Junaid Khan, director of cardiac services at Alta Bates Summit Medical Center in Oakland.

Yet prevalence statistics matter little to communities rattled by tragedies, and the most recent incidents were not the first in the East Bay.

Last year, 15-year-old Darius Jones from Concord's De La Salle High School collapsed and died of apparent heart failure at a nonschool league basketball game.

And Cal freshman Tierra Rogers's basketball career ended after having a defibrillator implanted to address a rare heart problem. Doctors discovered her condition, known as arrhythmogenic right ventricular dysplasia, after a workout in which she had trouble breathing and then collapsed.

So what can be done to protect young athletes?

A thorough pre-screening can be an important step, experts say.

The California Interscholastic Federation, which oversees high school sports, requires all students to have a physical exam before participating in a practice or game. The exam must include a family health history.

Among the questions doctors should ask, Batten said, is whether any of the student's relatives died of heart problems before age 50.

Students should also reveal whether during exertion they have nearly passed out, felt discomfort or pain in the chest, or had their heart race or skip beats.

Although young athletes must file a form with the school indicating they have had a physical exam, how much scrutiny such forms receive varies.

"Sometimes those forms just get put in a file and that's the end of it," said Frank Allocco, De La Salle basketball coach. His school's training staff is " taking those forms and looking at them and taking action on them," he said. At Oakley's Freedom High School, athletes must get an annual physical from either their personal physician or a chiropractor. Because some insurance companies pay for a physical only once every two years, many athletes choose the cheaper option of seeing a chiropractor the second year, said athletic director Steve Amaro.

Students with risk factors such as a family history of heart disease or warning signs should have an electrocardiogram, or EKG, recommends Khan, president of the East Bay division of the American Heart Association.

But experts are divided over requiring EKGs of all young athletes. Khan worries that false positives could needlessly disqualify students or subject them to additional costly tests. EKGs can also miss problems, giving a false sense of security.

Khan noted that in Italy, where EKGs are mandatory for young athletes, the frequency of sudden deaths is slightly higher than in the United States.

The cost could also be prohibitive. Mandatory EKG screening of all middle school and high school athletes in the United States could run as high as $2 billion annually, according to a 2007 statement by the American Heart Association Council on Nutrition, Physical Activity and Metabolism.

As a result, such massive EKG screening is probably impractical, the council said.
But others insist that screening requires additional study, particularly since an EKG can pick up signs of an enlarged heart, the cause of many of the sudden deaths.

This condition, known as hypertrophic cardiomyopathy, typically results from an inherited genetic defect. The walls of the ventricles thicken and become stiff. The problem may be present at birth, or it can develop later. That means that screening a student at 14 would not reveal a condition that develops at age 18, Batten said.

For these reasons, experts say it is crucial that students and coaches watch for warning signs, including fainting, chest pain, shortness of breath, irregular heartbeats, severe headaches, dizziness and blurry vision. Students should tell their coaches if they feel ill rather than "toughing it out," Khan said.

Parents and coaches need to be observant and proactive when an athlete may be struggling, said Lindsay Wisely, girls basketball coach at Antioch's Deer Valley high.

"One thing to be aware of is that sports are not just a seasonal thing anymore," Wisely said. "We're training kids 365 days a year. "... with athletes trying to play and train at an elite level, perhaps we should be screening them a little more than a standard physical."

Amaro agreed that coaches must be attuned to students who appear to be having difficulties.
Communication is key, he said. "If they're not feeling better, you need to dig a little deeper and find out why."

Such suggestions struck a chord with Travis Carrie, who sat out two years of athletic competition at De La Salle High after he fainted during football conditioning and doctors discovered a heart condition.

Carrie's coronary artery developed on the wrong side of his heart. It was operable; he returned to the field and earned a scholarship to Ohio University.

"The doctors knew I had a problem," he said. "But until I fainted, we didn't know how serious it was and exactly what it was."...

"I think coaches should listen more," he said. "During a couple of my incidents while running. I'd tell my coach that my chest is really hurting and I think I need to stop. Coaches need to really pay attention to their players and listen to them. That's a big factor."

Some say much more can be done to protect young athletes.

"I think we have a long way to go," North Coast Section Commissioner Gil Lemmon said. "I'm not saying that our contests are unsafe, but if we're talking about having top-notch safety within our programs, then I think every school needs a full-time trainer on campus and maybe some reform needs to go into our physicals."

For the past four years, the NCS has partnered with Children's Hospital to have a certified medic at its championship events. Lemmon said that 90 percent of the section's fall championships were covered and 100 percent of its football games.

But along with the focus on safety, Batten encourages people not to lose sight of the many health benefits of exercise and team sports.

"There's a much more well-defined risk of inactivity than there is with activity," he said.

REDUCING RISKS
Pre-screening
Students must have a physical exam before playing sports. The exam should include a family history, including relatives' heart-related deaths before age 50, or who had Marfan syndrome. Students should be asked whether during exertion they have ever nearly passed out, felt discomfort or pressure in the chest, or had their heart race or skip beats. Those with risk factors should have an electrocardiogram, or EKG. Experts are divided about whether EKGs should be required of all young athletes.

Warning signs
Fainting, chest pain, shortness of breath, irregular heartbeats, severe headaches, dizziness and blurry vision.

What students can do
Don't "tough it out": Tell a coach if you feel ill during a workout or game.
Make sure you drink enough water.
Avoid energy drinks, which cause dehydration.

What schools can do
Have an automatic external defibrillator on-site.
Ensure water and First Aid supplies are available at all practices and games.
Make sure all coaches know how to use the school phone system to call 911.

Source: Bay Area News Group research

Rare heart conditions a danger to teen athletes--San Francisco Chronicle

Thanks to Junaid Khan, MD, cardiac surgeon at Alta Bates Summit, for his assistance in the following article from today’s San Francisco Chronicle on teenage athletes – and the possibility of undiagnosed cardiac conditions.

Rare heart conditions a danger to teen athletes
Victoria Colliver, Chronicle Staff Writer
Friday, February 5, 2010

The collapse of two teenaged basketball players in less than a week - one of whom died - highlights the fact that even young, seemingly healthy athletes may have hidden defects that can strike with little warning.

Heart specialists acknowledge that it's extremely rare for a young athlete to collapse or die after physical exertion, but say that an undiagnosed cardiac condition is the most likely cause.
"Unfortunately, the first presentation of these diseases can be sudden death, and that's what makes it so vexing of a problem," said Dr. Byron Lee, professor of medicine in UCSF's cardiology division. "Often, there are no warning signs."

The death last Friday of 17-year-old Joshua Ellison, co-captain of El Sobrante's Calvary Christian Academy high school basketball team, was followed Tuesday night by the collapse of a 16-year-old varsity basketball player from El Cerrito High School. The boy, whose name has not been released, remains hospitalized and is in stable condition, according to his coach.

While the cause of the boys' collapses has not been determined, physicians say the most likely culprit is a heart problem, one of the most common being a condition called hypertrophic cardiomyopathy, which causes the heart muscle to thicken and makes it harder to pump blood.

Other common reasons for athletes to collapse include concussions and heat-related illnesses, but those seem less likely in these cases.

The statistics

A study published last year in the journal of the American Heart Association looked at 1,866 U.S. athletes, ages 8 to 39, who either died from or survived sudden cardiac arrest between 1980 and 2006. Of the athletes who died, 56 percent suffered cardiac arrest; about a third of them were attributed to cardiomyopathy.

Blunt trauma to the chest causing structural damage to the heart was the second-most common cause, accounting for 22 percent of deaths. About 4 percent were caused by a chest blow that interrupted the rhythm of the heart, and just 2 percent resulted from heat stroke.

But even cardiac arrest - the most common cause - is so rare that doctors were shocked by the collapse of the two teenage basketball players from the East Bay within four days.

"Leukemia, cancer, motor vehicle accidents - this is infinitesimally smaller compared to those," said Dr. Junaid Khan, a heart surgeon at Alta Bates Summit Medical Center in Oakland. "This is compared to getting struck by lightning."

High school athletes in California must have a physical examination before playing sports. Since 2004, the California Interscholastic Federation, which oversees high school sports, has required athletes to also submit a complete family medical history to their doctors.

Physicians say such information could help prevent tragedy. A heart attack or sudden death of a non-elderly relative could indicate that a more extensive evaluation is needed.

Controversial EKGs

But doctors don't agree whether all young athletes should undergo routine electrocardiogram, or EKG, screenings, which can show signs of cardiomyopathy or other heart conditions that may indicate the need for additional tests.

Khan, president of the East Bay division of the American Heart Association, said mass EKG screenings of student athletes would not only be costly and impractical, but potentially lead to both false positive and negative results. He recommended EKG screenings only for athletes with other risk factors.

Khan said studies show that the incidence of young athlete deaths in the United States is not statistically different than that in Italy, where all professional and amateur athletes are required to undergo EKG testing before they can participate in competitive sports.

But Lee, of UCSF, disagrees. "It's an opportunity to save lives," he said, acknowledging the hassles that false EKG results could cause. "If lives are saved, it seems like a reasonable price to pay."

Physicians also recommend that parents and children be aware of symptoms that could indicate a heart problem. Such symptoms include extreme shortness of breath, dizziness, heart palpations and, most significantly, fainting.

Warning signs, however, can be difficult for young athletes to recognize and easy to ignore.
In a high-profile case, Cal basketball player Tierra Rogers had to give up the sport last year after being diagnosed with another heart condition known to cause sudden death called arrhythmogenic right ventricular dysplasia. She fell ill during a workout in September, but said her only warning signs before that were two episodes of a racing heart and shortness of breath several years earlier.

Dr. Zian Tseng of UCSF, who was part of the medical team who implanted a defibrillator in Rogers to manage her condition, said she was fortunate to have had some warning signs.
"If some of these symptoms were present in these two young victims, there might have been the time for intervention," he said.

One advantage the El Cerrito athlete had was the quick action of the coach and two parents, who administered CPR to the youth.

Physicians say another potentially lifesaving tool would be the increased availability of automated external defibrillators, which use electricity to help the heart re-establish its rhythm.
A proposed state law co-authored by Assemblywoman Mary Hayashi, D-Castro Valley, and Assemblyman Jerry Hill, D-San Mateo, would require that an external defibrillator be available at all high school games and practices.

Sudden cardiac death in young athletes

A study published last year in the journal of the American Heart Association looked at 1,866 young U.S. athletes between 1980 and 2006. Of the deaths:

-- 56 percent were due to cardiovascular disease. A condition called hypertrophic cardiomyopathy, which causes an enlarged heart, is the most common form of the disease.

-- 22 percent were caused by blunt trauma to the chest, which damaged the heart.

-- 4 percent were due to a chest blow that interrupted the heart rhythm.

-- 2 percent were related to heat stroke.

Source: Circulation: Journal of the American Heart Association

Lowering the risk

Here are some of the ways physicians say teenage athletes can reduce the chances for cardiac arrest:

Get a physical with a complete family history
Sudden cardiac arrest in a non-elderly relative is a key part of a family's medical history that may signal a young athlete's need for additional medical screenings such as an EKG.

Be aware of the warning symptoms
Extreme shortness of breath, light headedness, heart palpitations and, in particular, fainting with exertion are signs that warrant immediate attention.

Talk about heeding the signs
Parents should talk with their children about these health symptoms because kids are prone to ignoring the signs, in part because they feel young and invincible. But they also may lack the life experience to know when something is wrong.

Source: Chronicle research.
E-mail Victoria Colliver at vcolliver@sfchornicle.com.
http://sfgate.com/cgi-bin/article.cgi?f=/c/a/2010/02/05/BABG1BS14N.DTL
This article appeared on page C - 1 of the San Francisco Chronicle


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