Trillium Health recognized nationally for its work in one area

Trillium Health has been recognized by the American Heart Association and American Medical Association for its commitment to improving blood pressure control rates, earning the silver level recognition as part of the Target: BP initiative.   

Trillium Health has been recognized by the American Heart Association and American Medical Association for its commitment to improving blood pressure control rates, earning the silver level recognition as part of the Target: BP initiativeThe award recognizes practices that have demonstrated a commitment to improving blood pressure control through measurement accuracy. 

“Controlling blood pressure is key for cardiovascular health – especially today, when heart disease and stroke are among the leading causes of death in Rochester and the Finger Lakes,” said Sarah Bolduc, MD, vice president of Clinical Services and Chief Medical Officer at Trillium Health. “By helping more people to control their blood pressure and reduce their risk for heart disease and stroke, Trillium Health is helping more people live longer, healthier lives.” 

According to the 2020 Monroe County Health Profile by Common Ground Health, the four leading causes of death in the region were cancer, heart disease, unintentional injury and stroke. In addition, 36 percent of Monroe County residents had physician-diagnosed hypertension. 

Target: BP is a national collaboration between the American Heart Association and American Medical Association aimed at reducing the number of adults in the U.S. who suffer from heart attacks and strokes each year by urging physician practices, health systems and patients to prioritize blood pressure control.  

The initiative aims to help health care organizations to improve blood pressure control rates by using evidence-based protocols. 

[email protected] / (585) 653-4021 

New device brings military tech to heart health

Clinical nurse educator Erica Perez fits Dr. Scott Feitell with a ReDS heart fluid monitor vest from Sensible Medical.
Clinical nurse educator Erica Perez fits Dr. Scott Feitell with a ReDS heart fluid monitor vest from Sensible Medical.

With a white, plastic vest wrapped tightly around his shoulder and across his chest, a wire slithering into an LCD monitor to his left side, Dr. Scott Feitell sits patiently as a small loading bar on the screen ticks forward. At precisely 90 seconds, the bar finishes its crawl, displaying a simple “30” on the screen.

“That means 30 percent fluid,” Feitell, director of Heart Failure at the Sands-Constellation Heart Institute. “Anything below 35 percent we consider normal, and anything above would indicate we need to examine the patient.”

This vest comes from Sensible Medical, and could be used to drastically reduce the number of patients in a revolving door relationship with a hospital by catching potential heart failure early on. Now two years out from FDA approval, the vest is working its way through patient trials. Rochester General Hospital is the first hospital in upstate New York, and one of the first community hospitals, to get their hands on it.

“The problem with heart failure is the heart fills up with fluid,” Feitell said. “And, to be honest, a lot of times physical examinations miss that. It’s one of the biggest causes of readmission, and patients don’t tend to live as long if they keep returning.”

The vest utilizes a radar sensing technology known as remote dialectic sensing (ReDS) to detect fluid levels in the heart. The purpose of ReDS, however, was not originally intended for the medical field, as Feitell explains.

“When this technology was originally designed, it was for the Israeli military,” Feitell said. “As the situation can be over there, when something horrible happens, you could use this technology for trying to find bodies buried in rubble. This is essentially the same concept.”

In its early hours, the ReDS technology showed promise in reducing readmission rates for heart patients. According to a study done by Sensible Medical looking at readmission rates among hospitals running trials of the vest, including four Israeli hospitals and the Davis Heart & Lung Research Institute in Columbus, Ohio, readmission rates plummeted under the use of ReDS. Specifically, readmission dropped 87 percent in the three months following the introduction of ReDS and rose 78 percent in the three months following its removal.

“We are at about 25 percent readmission at Rochester General,” Feitell said. “If we could get that down to 20, it would be an amazing win for us, and if we can get that 87 percent reduction we saw in the study, that would be incredible.”

While showing promise in successfully reducing the number of readmissions, the ReDS technology can give assurance that medical professionals don’t overlook anything before a patient walks out the door.

“What makes this so great is that it’s a quick, non-invasive preventative measure,” said clinical nurse educator Erica Perez. “We can use this with every patient on their way out.”

While the vest is still in its trial phase, Feitell hopes to see it as a standard in medical centers and, in the long-run, in patient’s homes.

“It can be so that a patient takes a reading at home, and if there’s anything abnormal, calls with the number and we send out a nurse,” Feitell said.

With the only requirement being 90 seconds sitting in a chair, Perez pointed to the painless nature of the vest as a truly great thing for patients, nurses and doctors alike.

“We always have to say ‘this will only hurt a little bit,'” Perez said. “For this, we can really say this isn’t going to hurt.”

(c) 2017 Rochester Business Journal. To obtain permission to reprint this article, call 585-363-7269 or email [email protected].

Doctors’ insight on keeping your heart in good shape

As new studies emerge and what was once scientific doctrine evolves, it can be a challenge to keep track of what practices make a healthy heart. Some findings on the ways diet, exercise and oral health affect the heart suggest that keeping an eye on these elements of a person’s daily routine may contribute to a reduction in the likelihood of developing heart disease and thereby living a longer, healthier life.

Fuel the furnace

In the realm of heart health, coffee is one item that tends to consistently crop up in the news. Whether modest coffee intake contributes to good health seems to be debated frequently, as the effects of caffeine can interfere with restful sleep.

Several studies suggest that coffee may decrease the chance of developing heart disease. One study published in the American Heart Association journal Circulation contends that people who drink one to four cups of coffee per day have a lower risk of dying from cardiac disease.

John “Chad” Teeters M.D., chief of cardiology at Highland Hospital, agrees that coffee may have a heart-healthy component.

“Unfortunately, there’s been good and bad and indifferent about coffee and caffeine, and there’s always been some thought that caffeine is a slight stimulant, so it makes the heart work a little bit harder and dilates the blood vessels,” says Teeters. “But coffee seems to have other properties to it that appear to be cardio-protective by decreasing inflammation in the heart and arteries. Inflammation is the precursor to blockage formation and tension in the walls of the vessels, so by relaxing that you’re improving your heart.”

But other doctors are not as certain that coffee benefits the heart.

“I would stress that the association between caffeine and a reduced risk of heart disease is small, modest at best,” says Nicholas Venci M.D., cardiologist at the University of Rochester Medical Center. “The links are associated, meaning it may not necessarily be a causal relationship between caffeine and a reduced risk of cardiac disease.”

One choice that remains prominent in the dietary landscape is the Mediterranean diet, which has long been labeled heart-healthy. The Mediterranean diet primarily consists of fresh fruits and vegetables, beans, nuts, whole grains, fish and lean poultry.

“For patients who are looking to go on a heart-healthy diet, the Mediterranean is definitely a smart choice,” says Venci. “I think one of the benefits of this diet is that it moderates cholesterol and high fat foods, and that has been shown to reduce the development of cardiovascular disease.”

Teeters agrees that the Mediterranean diet is among the heart-healthiest diets, but he recommends going a few steps further to an entirely plant-based diet.

“The Mediterranean diet got its juice because they compared it against the standard American diet, and there’s almost nothing that you can’t compare to the standard American diet and find out that it’s better,” says Teeters. “But, if you look at the data, the net benefit went from a 32 to 33 percent risk of cardiovascular disease in the standard American diet, down to a 26 to 28 percent risk on the Mediterranean diet.”

Teeters adds: “We don’t have a head-to-head comparison for plant-based versus Mediterranean, but if you look at plant-based versus standard American and Mediterranean versus standard American, the plant-based diet more significantly beats the standard American than the Mediterranean.”

Teeters also warns against obsessing over fat, protein and carbs. Complex carbohydrates tend to be fine since most people make their bodies work to release those carbs, says Teeters. Too many simple sugars, however, are where people run into trouble.

“People should be focusing on diversifying their diet, preferably with fruits and vegetables, so that they’re getting plenty of micro and macronutrients,” says Teeters.

Calorie intake is another dietary element that has piqued the interest of researchers examining heart health.

According to a study from the American Heart Association, the heart benefits when people consume more calories earlier in the day and spread calories across small, frequent meals throughout the day.

“There’s a Sardinian reference that you eat like a king at breakfast, a prince at lunch and a pauper at dinner,” says Teeters.

Teeters asserts that it is advantageous to the heart to eat five or six small meals a day in order to maintain a stable metabolic rate. Otherwise, people tend to engorge themselves when they only eat a couple of large meals a day.

“I tell my patients that if you eat until you’re about 80 percent full, and you do that five times a day, then the furnace never turns off,” says Teeters. “So your metabolic rate stays high and you don’t get that hungry sensation because you’re constantly filling the tank a little bit.”

Some activity better than no activity

It’s no surprise that our society has grown increasingly sedentary over the years. Between sitting at a desk all day and then sitting in front of the television at home, a lot of people struggle to fit exercise into their schedules.

According to the American Heart Association, people should be exercising for at least 150 minutes per week. Teeters and Venci concur, suggesting 30 minutes of physical activity five days a week.

“I tell patients that you need to go at a pace where you can’t sing or hum a tune because you’re breathing so hard, but you can still speak in complete sentences while you’re moving,” says Teeters.

Venci recommends setting the bar at a reasonable height so that patients can achieve their goals and have the motivation to continue exercising.

“Not everyone can exercise for 30 minutes a day or 30 minutes a day for five days,” says Venci. “That’s a lot of exercise. So, starting small with some activity is better than no activity. With time and perseverance, you can build up to that ultimate exercise goal.”

For people who loathe exercising or have a hard time pushing themselves to get active, the American Heart Association suggests walking throughout the day as a simple yet effective component of living a heart-healthy lifestyle.

Periodontal problems

Over the years, there have been signs that point to an increased risk of heart disease in patients with gum disease or other oral health issues. Studies continue, and while there is no substantial causal evidence that dental disease causes heart disease, there is a strong association between the two.

“I think there’s compelling evidence that points to an association between moderate and severe periodontal disease—basically infection around the teeth, in the bone and gum tissue—and cardiovascular disease, including heart attack, stroke and fatality,” says Jack Caton DDS, periodontist at the University of Rochester Medical Center.

Studies observing the link between gum disease and heart disease typically differentiate between the severity of the oral disease rather than the type of disease.

“There are a lot of risk factors, but if you adjust epidemiological studies so that people with normal or near-normal health of the gum versus those with moderate or severe periodontal disease, it increases the risk of heart attack by 30 to 70 percent, which is a huge increase,” Caton says.

There are several ways that oral disease may lead to a cardiovascular episode. One pathway is through infection. If there is an infection in the mouth, it can lead to inflammation. When the inflammatory response travels through the bloodstream, the walls of the blood vessels thicken over time and may form atherosclerotic plaques. These plaques narrow the vessels even further, and when they break off they can block the coronary artery and lead to a heart attack, says Caton.

Another common way that oral health may affect the heart is through bacteria. When bacteria around the teeth enter the bloodstream, they can get tangled up and grow in the atherosclerotic plaques, again leading to blockages and eventually a possible heart attack, according to Caton.

“The take-home message is that you really increase the risk for heart disease and stroke if you don’t have preventive methods of keeping gums healthy,” says Caton.

[email protected] / (585) 363-7031

(c) 2017 Rochester Business Journal. To obtain permission to reprint this article, call 585-363-7269 or email [email protected].

Haircutters have a tip for you: Check your blood pressure

As blow dryers whoosh and electric clippers hum, hairstylists and barbers across Rochester are asking their clients if they have had their blood pressure checked lately.

Their intention is not to be nosy. They just want to save lives.

As one of various initiatives led by the High Blood Pressure Collaborative, the Get It Done program has trained more than 25 local beauticians and barbers to be community health educators.

“Not only do they offer blood pressure reading and monitoring, they’re trained to encourage their clients to see their doctors” if their readings are high, says Dina Faticone, director of community health and engagement at Common Ground Health, which partners with Rochester-based Trillium Health on Get It Done. “They’re trained to counsel them on lifestyle and behavior change and really are that trusted, go-to resource for many of their patrons.”

This year, salons and barbershops participating in Get It Done have begun hosting events to raise “awareness about high blood pressure and healthy lifestyles not only with their patrons and in their shops but outside of their four walls,” Faticone adds. “So that’s been a really, really great expansion of the program and a way for the stylists and the barbers to give back to the community.”

In light of research showing that low-income Americans have not benefited equally from efforts to minimize risk factors for cardiovascular disease, outreach related to heart health is poised to be a focus of health advocates in Rochester and elsewhere. Using data collected from the U.S. National Health and Nutrition Examination Survey, a study published last month in JAMA Cardiology reveals that while risk factors have decreased among the wealthy and the middle class, those living at or below the federal poverty level—$24,600 for a family of four—do not have improved heart health.

Based on data from 17,199 adults ages 40 to 79, the study shows that the percentage of poor people with a 20 percent or greater risk for heart disease increased from 15 percent between 1999 and 2004 to 16.5 percent between 2011 and 2014. Among the well-heeled, however, the percentage at high risk for heart disease fell from 12 percent to 9.5 percent.

The study also shows that disadvantaged Americans are as likely to smoke as they did two decades ago, but the number of high-income earners in the study’s sample who still light up declined by 5 percent.

“The findings related to income disparity and cardiovascular risk were alarming but not surprising,” says Robert Fortuna M.D., associate medical director of UR Medicine Primary Care. “Although multiple interventions exist to improve (blood pressure) control in low-income and minority populations, there is limited evidence that these interventions actually reduce disparities. When it comes to interventions to improve cardiovascular risk factors, a rising tide does not always lift all boats equally.”

Still, “In our community, there have clearly been interventions that have made improvements in cardiovascular risk factors in select and underserved populations,” Fortuna says.

As is the case nationally, improvement in heart health has not reached all economic classes in the Rochester area.

According to the High Blood Pressure Registry, which is maintained by Common Ground Health and includes clinical data from 60 percent of the population believed to have hypertension in Rochester’s nine-county region, the average high blood pressure control rate for those in poor neighborhoods was 70 percent as of last December compared to 82 percent in affluent neighborhoods.

That gap has led the High Blood Pressure Collaborative to launch programming beyond Get It Done, including health ministries now operating at 12 African-American churches.

“And we’re tracking those participants and seeing that when people have naturally occurring social networks, when there’s a foundation of trust already built among the participants, we see some positive changes in behavior,” Faticone says. The overall high blood pressure control rate among African-Americans in the High Blood Pressure Registry is much lower than that of participants in the health ministries, she adds.

Sparking meaningful change within the complex web of health disparities often means meeting people where they “live, work, play and pray,” says Marc Natale, executive director of the American Heart Association of Rochester and Buffalo.

“Social determinants of health really do underscore a lot of what we do in the community,” he adds.

One way the American Heart Association’s Rochester office interacts with the community is through its 800-square-foot teaching garden at the Freedom School on North Goodman Street, where students tend to crops such as collard greens, peppers, sage and squash.

“Parents are dropping the kids off and picking them up every day, so we’ve overlaid a blood pressure program,” Natale says. “So on Tuesdays at pickup or dropoff, parents can get their blood pressure taken and can get access to resources in the community if they don’t have a primary care provider.”

AHA does not track how many people have had their blood pressure screened at the Freedom School, but approximately 150 students participate in the summer program there, and the service is available to neighbors of the school, Natale says.

AHA also established a 2,050-square-foot teaching garden at East High School last year that now has a pollinator section in order “to provide education and emphasis on the importance of the interdependent nature of our food system,” Natale says.

He adds: “I find that Rochester is such a unique community. I mean, we are much more collaborative in nature. We are ahead of much of the health care curve, and I think for that very reason we tend to see a little more results” from community programming and partnerships.

But challenges still lie ahead.

“When we talk about class divide—when we talk about socioeconomics and social determinants of health, in particular—it’s not just saying to people, ‘You gotta eat more fresh fruits and vegetables.’” Natale says. “It’s so multifaceted. There’s food deserts; there’s limited income, there’s limited transportation to (health services); there’s need for improvement in (access to) better-paying jobs.”

Nevertheless, Rochester is in good stead to make heart health gains a reality for all, Natale says.

“We know that (focus) has to be interwoven in the fabric of everything across the community in order to make that class divide narrow,” he says.

Sheila Livadas is a Rochester-area freelance writer.

(c) 2017 Rochester Business Journal. To obtain permission to reprint this article, call 585-363-7269 or email [email protected].

Study casts doubt on beta blockers during heart attack

Local physicians are reacting with intrigue and caution to a recent study challenging the long-held notion that everyone who suffers a heart attack should receive beta blockers.

The observational study from the University of Leeds in England was published this spring in the Journal of the American College of Cardiology. It looked retrospectively at patients who experienced a heart attack but did not suffer heart failure. That is, their heart muscle was not damaged enough for it to lose proper function.

The findings suggest that those who had a heart attack—but did not suffer heart failure—did not live longer after being given beta blockers. The claim caught the attention of local cardiologists, because 95 percent of patients who fall into this category are prescribed the medication as part of their treatment plan based on guidelines from the American College of Cardiology and American Heart Association.

“The study looked retrospectively at people who got beta blockers during a heart attack,” says John Bisognano M.D., a cardiologist at the University of Rochester Medical Center. “It found that, for the most part, they didn’t help, except for a small group of people who had an injury to their heart muscle, which reduced the ability of the heart muscle to squeeze.”

Beta blockers were developed in the 1980s and are often used to treat high blood pressure and migraines. However, data at that time led physicians to believe that if this medication was given to people having a heart attack, there might be an improvement in the outcome for the patient.

“This was in an era where there wasn’t much you could do about a heart attack except watch it happen,” says Bisognano, who serves as president of the American Society of Hypertension. “I was taught in medical school to give reasonable doses of this medication to people who were having heart attacks.”

However, Bisognano says, “Those medications probably were useful in their day, but the way we approach heart attacks now is so different. We go in there with clot-dissolving medications and we put in stents and restore blood flow to the heart.

“Since the way we treat our patients in recent years has changed, these medications are no longer beneficial,” he continues. “Beta blockers are still considered the standard of care to give people these medications. We see now these medications are probably not necessary at the starting gate.”

Local physicians note that beta blockers are still used to treat many conditions.

“Beta blockers are widely used today,” Bisognano says. “I use them all the time for people with high blood pressure. People use them for chest pains. They are a widely used medicine for a host of reasons. It’s actually a great class of medications. We probably just don’t have to rush them into patients at the time of a heart attack.”

Not everyone is as comfortable drawing conclusions from the study, though. Tim Malins M.D. was intrigued by the study, but it won’t change how he approaches patient care.

“It’s interesting— the data is a little bit questionable, and I’d be very cautious when reading it,” says Malins, director of the Finger Lakes Branch of Rochester Regional Health’s Sands-Constellation Heart Institute and chief of medicine at Geneva General Hospital. “But it brings up a question: Do we need to study this further?

“I loved the thought of the study, but it wasn’t a randomized, controlled study, so you have to be very cautious when taking studies like this and moving them into practice,” he adds. “The purpose of an observational study is to say, ‘Hey, is there a cause and effect?’ And observational studies often lead to randomized, controlled studies, which are the gold standard. That’s the beauty of observational studies. They bring up questions.”

Scott Feitell D.O., director of heart failure for the Sands-Constellation Heart Institute, describes the study as intriguing, but he isn’t sold on the findings, either.

“Much of the data we have about beta blockers really is old data, but the data at the time was quite robust,” he says. “The improvement in survival was real, with a 20 percent to 25 percent reduction in mortality.

“I don’t know that we can draw a strong conclusion from this study,” Feitell adds. “It’s really important that we don’t extrapolate data from population-based studies. If you’re not going to have a truly randomized, double-blinded, controlled trial, I’m not sure how much we can rely on it. With statistics, you can play a lot of games with numbers. I’m not saying that’s what happened here, but you have to be careful how you interpret those results. From a clinical perspective, it makes us want to know more. This is definitely a thought-provoking study, but it’s not going to change my management style just yet.”

Feitell is calling for a comprehensive randomized, controlled trial to prove whether beta blockers are beneficial to those who have suffered a heart attack, but have not sustained damage to the heart muscle.

“I think there’s going to be a big push to answer this question,” he says. “Based on this one study, I would not stop giving beta blockers to my patients.”

For those who have had a heart attack and suffered heart damage, the use of beta blockers isn’t being challenged.

“What we do know for certain, without question, is that people who have had a heart attack and have reduced pumping action of the heart, there is no question that these people benefit from beta blockers,” Malins says. “They live longer.”

Cardiologists should do what they believe is best for each individual patient, says Malins, a governor for the New York chapter of the American College of Cardiology. The group advises governmental and professional organizations regarding cardiovascular disease.

“If physicians followed every single guideline for every single patient, then computers could do our job,” he says. “These guidelines aren’t the Ten Commandments set in stone. They are constantly changing based on the data.”

Travis Anderson is a Rochester-area freelance writer.

(c) 2017 Rochester Business Journal. To obtain permission to reprint this article, call 585-363-7269 or email [email protected].