congestive heart failure

Isaac Asimov once remarked that a sufficiently advanced technology was indistinguishable from magic.

Were he alive today, Mr. Asimov might also remark that both advanced technology and magic got nothing on Pharos Innovations, whose website reports a world-record 79% reduction in admissions for congestive heart failure (CHF) patient monitoring.

Pharos achieved this Nobel Prize-worthy result in CHF monitoring without actually using CHF monitoring devices, but rather just the telephone and that favorite tool of the frail elderly, the Internet. Most magical was the time this admission reduction took: 31 days.

On the graph below, you can see that the baseline ended December 31, 2007, while the full impact started February 1, 2008.

That means Pharos was magically able to find all these members’ contact information, write to them to announce the program, schedule the phone calls to the members to convince them to join the program, collect their information, conduct those phone calls, explain the system to the members, get them set up on the system, collect the information, get members to visit their doctors, and adjust lifestyles and medications…all during January.

Thanks to that lightning speed, there was literally a 90% decline between the December admissions rate and the February admissions rate, as this chart demonstrates.  Overall, this chart is a dramatic rebuttal to the conventional wisdom, which would state that:

  1. it takes a long time to make even the most minor improvements in a population through telephonic and Internet disease management, if indeed improvements are possible at all; and

  2. a trendline that is “unchanged” does not decline 25% like Pharos “unchanged” matched cohort trendline above.

In college Al was assigned a roommate who was like the bad seed from the Richie Rich comics, a kid who, among other things, would have a snifter of cognac before bed.  Once Al told this guy he was decadent.  “Decadent, Al?” he countered.   “Let me tell you about decadent.  I spent last summer at a summer camp –everyone was there, Caroline Kennedy, everyone – where we played tennis on the Riviera and then went skiing in the Alps.”

Al agreed he had a point.  “Wow, Lance, you’re right.  That was decadent.”

“Al,” he replied, “I haven’t even gotten to the decadent part yet.”

Continue reading “Pharos Innovations Meets Isaac Asimov”

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A recent meta-analysis published in the American Journal of Clinical Nutrition suggests that coenzyme Q10 is of benefit in congestive heart failure. For those who like the idea that food and nutrients can be excellent medicine, this paper is interesting at the very least. But there is a case to be made that it is far more than that. There is a case to be made that it is, in a word, miraculous.

For resurrection, after all, is a miracle. And according to a paper published in the Annals of Internal Medicine in April of 2000, coenzyme Q10 for heart failure was a dead concept. The authors reported 13 years ago that “coenzyme Q10 has been studied in randomized, blinded, and controlled studies and … these studies have found no detectable benefit” and that “coenzyme Q10 should not be recommended for treatment of heart failure.”

The final nail had been driven into the CoQ10-for-heart-failure hypothesis 13 years ago — and yet now, it’s back. If that’s not a miracle — then what is going on?

First, a bit of relevant orientation. The condition in question here, congestive heart failure, occurs in particular in the aftermath of one or more heart attacks (myocardial infarctions) which cause portions of the heart muscle to die for want of oxygen. Those areas stop pumping, of course, and the whole heart does its job less well.

The pumping efficiency of the heart is routinely measured using ultrasound as the “left ventricular ejection fraction” (LVEF), which, as the name suggests, is the proportion of blood the left ventricle is able to pump out of itself when it contracts. Roughly 55 to 70 percent is considered normal. High values can occur when the heart is stiff and muscle-bound, and tend to mean the heart empties well, but fills poorly. Congestive heart failure is associated with low values.

Continue reading “Building a Better Health Care System: Why the Next Blockbuster Drug Probably Won’t Be a Drug at All”

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