Life Extension Magazine®

Issue: Sep 2012

A Deadly Waiting Game

An article in the New England Journal of Medicine describes the tragic experience of one doctor’s mother after admission to a hospital emergency room. Compelling motivation is provided for Life Extension® members to avoid being victimized like this.

By William Faloon.

William Faloon
William Faloon

Last year, I described the inefficiencies and incompetence I encountered during a 31-hour hospital stay.

My hospitalization was done as a precaution and nothing serious developed. My outrage was based on the egregious hospital waste I observed, along with what may have happened if I had a critical medical condition.

A few months later, an article was published in the New England Journal of Medicine that made my 31-hour ordeal look like a walk in the park.1 We asked permission to reprint this article, but were refused. We conjecture that the New England Journal of Medicine did not want us to use this article to further discredit this nation's broken sick-care system.

To enlighten Life Extension® members about this particular hospital-inflicted atrocity, I will report here on the article the New England Journal of Medicine denied us permission to reprint.

The Patient Did Everything Right

The Patient Did Everything Right

This tragic New England Journal of Medicine article describes a 69-year-old woman who suffered an acute attack of rapid atrial fibrillation.

This is not about someone without insurance who was delayed medical attention. This 69-year-old woman was not scientifically ignorant as her son was a medical doctor, and she was able to use an at-home device to quickly discern that a serious problem was developing. She immediately was taken to one of the most highly regarded academic medical centers on the west coast of the United States. Unlike so many people who fail to recognize serious symptoms, this woman did everything right!

This woman had mild heart disease, but was otherwise considered in excellent health according to her physician son. Early one day she noticed an irregular heartbeat and felt a bit short of breath. She used her at-home blood pressure cuff to ascertain her blood pressure was stable, but that her pulse was racing high at 130 (normal pulse rate is between 60-80). Most at-home blood pressure monitoring devices also measure pulse rate.

She was driven to the emergency room by her husband and seen within about an hour by a doctor, which is relatively quick by today's sluggish hospital standards. She was diagnosed with rapid atrial fibrillation that Thursday evening and admitted to the hospital.

The strategy was to perform a trans-esophageal echocardiogram the next day to see if there was a blood clot (thrombus) in the upper (atrial) chamber of her heart.9 Atrial blood clots are a frequent consequence of this kind of rapid atrial fibrillation.3 In the absence of a thrombus, the doctors planned to perform electric cardioversion, a procedure in which an electric current is used to reset the heart's rhythm back to its regular pattern. The low-voltage electric current enters the body through metal paddles or patches applied to the chest wall.

The patient was given intravenous heparin to prevent thrombus formation to get her through the night, which is standard therapy in these cases. So far, everything was done according to hospital protocol.

Atrial Fibrillation—An Increasingly Common Problem

As the population ages, an increasing percentage develops an irregular rhythm in the upper chambers of the heart called atrial fibrillation. It is the most common type of heart arrhythmia and approximately 5% of persons over 65 years of age are expected to be diagnosed with it.2

The primary danger of persistent atrial fibrillation is that it can create an abnormal blood clot to form in the left atrial chamber that breaks away and travels up the carotid artery causing a stroke.3

Atrial fibrillation patients are typically prescribed anti-arrhythmic and anti-coagulant drugs that reduce stroke risk, but are far from 100% effective and can induce serious side effects.4-7

Although some episodes of atrial fibrillation are short-lived and spontaneously resolve within 7 days while requiring no treatment, persistent atrial fibrillation that lasts longer than several days often requires either pharmacologic or electrical cardioversion to terminate the abnormal rhythm.8

With cardioversion treatment of persistent atrial fibrillation, an external electric shock returns the heartbeat to normal. If this is not effective, a catheter is inserted into the heart to eliminate (ablate) tissue segments along the electrical conduction tract of the heart that are producing abnormal electric impulses.8

In cases involving symptoms such as shortness of breath and high pulse rate in people over age 65, immediate medical attention is needed to prevent atrial blood clotting, and correct the rapid/irregular heartbeat.

No Room At The Inn…

Despite the life-threatening condition this 69-year-old woman suffered, the hospital had no inpatient bed available. This 69-year-old woman, diagnosed with rapid atrial fibrillation, was kept on a stretcher in the emergency department hallway overnight. The stretcher was uncomfortably narrow. Combined with the all-night noise and bright lights in the emergency department hallway, it was hard for her to get much sleep. She was not wheeled to a real bed until shortly before noon the next day (Friday), which was 24-hours after her symptoms initiated the day before (Thursday).

I have used this analogy for decades, but I am going to repeat it to put this woman's needless agony into context. Just imagine you try to check into a hotel. You wait for an hour (or more) for a desk clerk to see you. You are checked in (admitted) after completing a LOT of paperwork. After you are checked in, you are told there are no rooms available so the hotel staff forces you on to a stretcher that stays in the hotel lobby where the commotion and lights keep you from sleeping all night.

Unlike even low-cost hotels that would never treat their guests like this, once you are "admitted" to a hospital, you give up your liberty. You become submissive to the doctors and hospital staff. If you try to leave, they threaten to tell your insurance company and say that you will personally be stuck with the entire bill. This is a blatant lie, but hospitals don't like their prisoners (they call patients) to escape without permission.

The difference between a hospital and hotel is that those who check into hotels are usually healthy. Yet even healthy individuals would find it miserable to be victimized by standard hospital practices (like being denied restful sleep, edible food, and timely service). The issue here is that when one is hospitalized, it is often the absolute worst period in their life, with vital organs sometimes shutting down. Ironically, at this precarious phase when a human being may be barely clinging to life, they encounter hospital services so substandard that death is often hastened.

What you're going to read next is beyond appalling.

Unconscionable Delay

Unconscionable Delay

Early Friday afternoon, the 69-year-old woman's cardiologist told her that since her admission had been delayed the day before, the hospital staff would not complete her procedures before their Friday "workday" ended. Recall this woman had arrived at the hospital early the day before (Thursday).

Due to the hospital's delay, this woman was to remain in the hospital throughout the weekend. As a precaution against atrial thrombosis, they continued intravenous heparin and initiated oral warfarin. The objective was to blindly rely on these anticoagulant drugs until Monday, when the trans-esophageal echocardiogram and electric cardioversion would be done at the convenience of the hospital staff.

Tragic Outcome!

The next day in the hospital, this woman suffered a massive embolic stroke caused by a blood clot that formed in her atrium due to the untreated rapid atrial fibrillation. The clot blocked her right carotid artery and extended into the branches that feed the brain. The woman was rushed to an operating room where a neurosurgeon attempted to extract the blood clot (embolus) that was suffocating her brain.

During this emergency procedure, her internal carotid artery was torn. Since her system was loaded with anticoagulant drugs, there was rapid intracranial bleeding that resulted in loss of critical brain function. For the next two days, this woman laid unconscious, intubated, and brain dead in the hospital's intensive care unit. She continued to receive mechanical ventilation until preparations for her funeral could be finalized. Life support was withdrawn 112 hours after she walked into the hospital with a condition that could have been successfully treated had the hospital staff not played this deadly waiting game.

Reaction Of The Mother's Physician Son

A Deadly Waiting Game

One irony of this tragedy is that this woman's son is an academic surgeon and founder of a training program dedicated to improving the availability and quality of emergency surgical care. Since he practiced in a different city, he was unable to persuade the staff of his mother's hospital to expedite her care. As her son noted, "Many Americans cling to the notion that the shortcomings that afflict our health care system affect only the poor. They are mistaken."1

The hospital cardiologist who postponed this woman's care never returned to face her family. One of the only doctors who acknowledged this needless loss was an intensive care unit intern, who offered his condolences in the hallway the following day.

An Exposé Of A Broken System

This woman's physician son was determined to not let this tragedy be covered up.

His article published by the New England Journal of Medicine revealed that these kinds of needless deaths happen every day in US hospitals. He noted that the factors contributing to emergency room over-crowding and its consequences have been documented by the Institute of Medicine, the Government Accountability Office, the Robert Wood Johnson Foundation, and the Center for Studying Health System Change.10-12

Her son went on to state that "boarding" admitted patients in emergency exam rooms and corridors for extended periods has become commonplace and is being accepted as the norm. Her son noted that a crowded emergency department is a threat to individual patients and to public health. One reason this occurs is that financial profits trump patient safety. The General Accounting Office has stated that hospital administrators tolerate emergency room boarding rather than postpone or cancel profitable elective admissions.12

Her son elaborated further in stating that crowded emergency rooms are only part of the problem: "Inefficient hospital operations are another." While disease and injury occur around the clock, many hospitals operate the majority of critical services five days a week. Many specialists are opting out of on-call duties and not making themselves available after-hours.13 Her son revealed studies showing increases in in-hospital mortality from serious conditions that occur because of gaps in after-hours and weekend coverage at hospitals.14

An Exposé Of A Broken System

As far as solutions, her son stated that in other countries, hospitals first take care of emergency room patients and inpatients with serious problems, and only then allow elective procedures if beds are available. Her son stated that a solution to emergency room boarding (which is what his mother suffered through her first night) would be to provide financial reimbursement that reprioritizes health care resources for patients with urgent conditions. Her son also expressed concern that health care law changes may make tragedies like his mother's more common, as millions more Americans use overwhelmed emergency rooms for primary care.

The name of the editorial written by this woman's physician son is "The Waits That Matter." The following quote by this physician says a lot about the inadequacies of today's sick-care system: "Those of us who have dedicated our careers to health care must confront the fact that our inability (or, more likely, unwillingness) to reduce the waits and delays that bedevil emergency care is harming and even killing our patients." 1 We at Life Extension® commend the physician son of this unfortunate woman who spoke out against conventional medicine's deadly waiting game.

With hospital care costing thousands of dollars a day it is absurd that any patient would be mistreated this way. Medicare's hospital trust fund is facing insolvency as inefficient hospital policies drive up costs, while patient care deteriorates.

Medicare and Medicaid will pay for nearly any hospital procedure regardless of value, but then attempt to restrain costs through price controls. This and other forms of bureaucratic mismanagement result in horrific delays and needless patient suffering and death. Reminiscent of the old Soviet Union, senseless regulations are bankrupting this nation's medical system while quality devolves despite high costs.

Staying OUT of Hospital Emergency Rooms

Staying OUT of Hospital Emergency Rooms

There's a lot we can do to reduce our odds of being victimized in an emergency room hospital setting.

Other than accidents, two major reasons people are rushed to emergency rooms are heart disorders and stroke. Yet these conditions are the most preventable diseases in America.

The problem is the majority of Americans wait until symptoms manifest before seeking proper medical care. That means they face long delays in an emergency room setting and less-than-optimal treatment when their underlying condition acutely manifests.

The first step everyone must take is to ensure they maintain ideal 24-hour blood pressure control. Refer to the box below to learn where your blood pressure needs to be to optimally reduce disease risk.

Newer Anti-Coagulant Drugs Available

Selecting the proper anticoagulant therapy in cases of atrial fibrillation is a delicate matter dependent on a multitude of individual factors. Traditionally, drugs like warfarin or Coumadin® are used to manage clot risk. However, there are new oral anticoagulant treatments available as alternatives to warfarin, with safety and efficacy benefits versus warfarin.

For example, in a major hard endpoint study of Pradaxa® (dabigatran) versus warfarin (the RE-LY trial), Pradaxa® was superior for anti-coagulant efficacy at 150 mg two times a day with similar major bleeding risk as warfarin treatment (when patients maintained their INR 2.0 to 3.0),15

The INR (international normalization ratio) is a test that evaluates the clotting tendency of blood. A normal INR reading is 0.8-1.2, but in patients predisposed to abnormal vascular blood clotting (such as those with mechanical heart valves or atrial fibrillation), physicians seek to boost INR to 2.0-3.0, which reduces clotting propensity. Increasing INR to this higher level (2.0-3.0) also increases bleeding risk. When Pradaxa® was used at a lower dose of 110 mg two times daily, it showed similar efficacy to warfarin, but with reduced major bleeding risk.

Advantages of Pradaxa® (dabigatran) vs. warfarin:16

  1. Rapid onset of action;
  2. Consistent, predictable anticoagulant effect;
  3. Reduced potential for drug-food (i.e. foods that contain vitamin K) interactions;
  4. No requirement for anticoagulant blood testing;
  5. Results from a major trial (RE-LY study) showed better protection against stroke, with similar risk for bleeding.

Disadvantages of Pradaxa® (dabigatran) vs. warfarin:

  1. No antidote for severe bleeding (in contrast, overdose with warfarin can be reversed with administration of vitamin K1);
  2. Increased risk of stomach upset;
  3. Need for dose adjustment in patients with kidney disease;
  4. Preliminary, pooled safety data from several trials (published in 2012) suggests a possible increase in heart attack risk.25

Critical Importance of Annual Blood Tests

The probability of you winding up in an emergency room has a lot to do with what's circulating in your blood right now. By having your blood tested before symptomatic disease strikes, corrective actions can be taken before one requires hospital care.

Problems that impede Americans from having their blood properly tested are inconvenience, long waits at doctor's offices, physician ignorance about what tests to prescribe, and high costs.

Life Extension eradicated these issues by enabling members to order comprehensive blood tests directly, go to a drawing station in their area usually with no appointment required, and obtain the critical blood tests they need at a fraction of the price charged by commercial laboratories.

The price of the comprehensive Male or Female Blood Test Panel is much lower than commercial labs, thus enabling members to affordably ascertain their disease risk status and initiate preemptive measures before acute illness strikes.

The retail price for the many individual tests included in the Male or Female Blood Test Panels can be astoundingly high, but Life Extension members obtain them for only $269.

The next page describes the many tests that are included in Life Extension's comprehensive Male or Female Blood Test Panels. When you order them, we send your requisition out immediately, but you can usually walk in for your blood draw at a time that is convenient to you.

For longer life,

William Faloon

Doctors Ignore Dangerously High Blood Pressure

High blood pressure is a silent epidemic that was the primary or contributing killer of over 347,000 Americans in 2008.17 Since increased blood pressure is a major risk factor for heart disease, stroke, congestive heart failure, and kidney disease, it acts as an accomplice in millions of additional deaths each year.18

Mainstream medicine has fallen fatally short of relieving high blood pressure. Of those taking blood pressure medications, control rates are abysmally low.19,20 A major problem is that mainstream medicine accepts blood pressure levels that are too high. This means that the majority of those diagnosed with hypertension spend most of their day with blood pressure levels dangerously elevated.

The medical establishment defines high blood pressure (hypertension) as over 139/89 mmHg. However, in 2006, researchers found that blood pressure levels ranging from 120 to 129 mmHg systolic and 80 to 84 mmHg diastolic were associated with an 81% higher risk of cardiovascular disease compared to levels of less than 120/80 mmHg. Moreover, blood pressure levels of 130-139/85-89 mmHg were associated with a frightening 133% greater risk of cardiovascular disease compared to levels below 120/80.21 Worse yet, studies suggest that conventional physicians are unlikely to treat hypertension until levels exceed 160/90 mmHg, a level that dramatically increases the risk of disease and death.22

Controlling blood pressure means radically reducing disease risk. Studies have estimated that reducing blood pressure by 10/5 mmHg, to 115/75, can reduce the risk of stroke death by 40% and the risk of death due to heart disease or other vascular causes by 30%.23 In individuals 40 to 70 years old, each 20/10 mmHg increment over 115/75 doubles the risk of heart attack, heart failure, stroke, or kidney disease.23,24 Based on this and other data, Life Extension recognizes that for many individuals, a target blood pressure of 115/75 mmHg yields the best preventative benefits.24

To review Life Extension's updated Blood Pressure Management protocol, log on to www.lifeextension.comhttps://www.lifeextension.com/magazine/2018/3/hypertension2

References

1. Available at: http://www.nejm.org/doi/full/10.1056/nejmp1101882. Accessed May 15, 2012.

2. Sellers MB, Newby LK. Atrial fibrillation, anticoagulation, fall risk, and outcomes in elderly patients. Am Heart J. 2011 Feb;161(2):241-6.

3. Available at: http://www.mayoclinic.org/medical-edge-newspaper-2009/july-03a.html. Accessed May 8, 2012.

4. Tamargo J, Caballero R, Delpón E. Pharmacological approaches in the treatment of atrial fibrillation. Curr Med Chem. 2004 Jan;11(1):13-28.

5. Naccarelli GV, Wolbrette DL, Khan M, et al. Old and new antiarrhythmic drugs for converting and maintaining sinus rhythm in atrial fibrillation: comparative efficacy and results of trials. Am J Cardiol. 2003 Mar 20;91(6A):15D-26D.

6. Scott PJ. Anticoagulant drugs in the elderly: the risks usually outweigh the benefits. BMJ. 1988 Nov 12;297(6658):1261-63.

7. Available at: http://circ.ahajournals.org/content/104/17/2118.full. Accessed May 15, 2012.

8. Zak J. Ablation to treat atrial fibrillation: beyond rhythm control. Crit Care Nurse. 2010 Dec;30(6):68-79.

9. Thamilarasan M, Klein AL. Transesophageal echocardiography (TEE) in atrial fibrillation. Cardiol Clin. 2000 Nov;18(4):819-31.

10. Institute of Medicine Committee on the Future of Emergency Care in the United States Health System. Hospital-based emergency care: at the breaking point. Washington, DC: National Academies Press, 2006.

11. Hospital emergency departments: crowding continues to occur, and some patients wait longer than recommended time frames. Washington, DC: Government Accountability Office, 2009. (GAO-09-347.)

12. Hospital emergency departments: crowded conditions vary among hospitals and communities. Washington, DC: General Accounting Office, 2003. (GAO-03-460.)

13. Available at: http://www.facs.org/ahp/ emergcarecrisis.pdf. Accessed May 16, 2012.

14. Bernstein SL, Aronsky D, Duseja R, et al. Society for Academic Emergency Medicine, Emergency Department Crowding Task Force. The effect of emergency department crowding on clinically oriented outcomes. Acad Emerg Med. 2009 Jan;16(1):1-10.

15. Wallentin L, Yusuf S, Ezekowitz MD, et al.; RE-LY investigators. Efficacy and safety of dabigatran compared with warfarin at different levels of international normalised ratio control for stroke prevention in atrial fibrillation: an analysis of the RE-LY trial. Lancet. 2010 Sep 18;376(9745):975-83.

16. Available at: http://www.permanente.net/homepage/kaiser/pdf/66380.pdf. Accessed May 16, 2012.

17. Available at: http://www.cdc.gov/bloodpressure/facts.htm. Accessed May 16, 2012.

18. Available at: http://circ.ahajournals.org/content/123/4/e18.full.pdf+html. Accessed May 16, 2012.

19. Mosley WJ 2nd, Lloyd-Jones DM. Epidemiology of hypertension in the elderly. Clin Geriatr Med. 2009 May;25(2):179-89.

20. Lloyd-Jones DM, Evans JC, Levy D. Hypertension in adults across the age spectrum: current outcomes and control in the community. JAMA. 2005 Jul 27;294(4):466-72.

21. Kshirsagar AV, Carpenter M, Bang H, Wyatt SB, Colindres RE. Blood pressure usually considered normal is associated with an elevated risk of cardiovascular disease. Am J Med. 2006 Feb;119(2):133-41.

22. Hyman DJ, Pavlik VN. Poor hypertension control: let's stop blaming the patients. Cleve Clin J Med. 2002 Oct;69(10):793-9.

23. Lewington S, Clarke R, Qizilbash N, Peto R, Collins R; Prospective Studies Collaboration. Age-specific relevance of usual blood pressure to vascular mortality: a meta-analysis of individual data for one million adults in 61 prospective studies. Lancet. 2002 Dec 14;360(9349):1903-13.

24. Chobanian AV, Bakris GL, Black HR, et al. Seventh report of the joint national committee on prevention, detection, evaluation, and treatment of high blood pressure. hypertension. JAMA. 2003 Dec;42(6):1206-52.

25. Uchino K, Hernandez AV. Dabigatran association with higher risk of acute coronary events: meta-analysis of noninferiority randomized controlled trials. Arch Intern Med. 2012 Mar 12;172(5):397-402.

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