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DOCTORS SAY CHECKING PULSE CAN HELP LOWER RISK OF STROKE

The highest death rates from heart disease and stroke in the state occur in the Buffalo area. In fact, the region consistently reports some of the highest rates in the nation.

Perhaps that news shouldn't surprise us in the home of the fat-fried-in-fat chicken wing.

Experts don't place all the blame on the bad food we chow down, though. There is too much cigarette smoking, physical inactivity and high blood pressure in this area's overweight and aging population.

We don't reduce the health risks we control.

"We could prevent hundreds of deaths here every year if people took ownership of their health," said Dr. Frederick E. Munschauer, a neurologist and internist at Buffalo General Health System.

Indeed, he and other physicians want to do something about this by literally taking the community's pulse.

They say that teaching people, especially those over 65, to take their own pulse could sharply reduce chances of a stroke caused by an irregular heartbeat. And they are preparing for the day soon when posters on how to take a pulse will be as common as those for the Heimlich maneuver and breast self-examinations.

In addition to this project, part of a proposed Vascular Disease Prevention Center at Buffalo General, the physicians want to increase use of a powerful blood thinner that research shows is drastically underused in the treatment of an irregular heartbeat.

Diseases of the blood vessels are the largest cause of death in the nation, killing nearly 900,000 Americans a year.

New York State has the highest death rates for heart diseases in the nation, and Erie, Chautauqua and Niagara counties have the highest rates in the state.

A few years ago, "The Truth About Where You Live," an atlas that compares government health records by county, ranked Erie County fifth in the nation for annual excess deaths from heart disease. That means there are more deaths here from heart disease than would be expected based on the average death rate in the United States.

Why is this so?

There's no leading reason. Experts point to the usual suspects, such as cigarette smoking, lack of exercise and being overweight.

"What we have here is a high risk factor level," said Joan Dorn, assistant professor of social and preventive medicine at the University at Buffalo. "It's not as though we are a red flag, and the rest of the nation is OK. These are the leading causes of death in the country, and there are other areas with high rates."

The truth is that Americans are getting bigger and more sedentary everywhere, not just in Western New York.

The surgeon general this year reported that more than 60 percent of adults do not achieve the recommended amount of physical activity; 25 percent don't exercise at all. And one-third of the U.S. population is overweight, up from 25 percent in 1960, according to the federal Centers for Disease Control and Prevention.

Doctors elsewhere have tried community-wide projects to lower death rates from heart disease and stroke. But to Munschauer's knowledge, no one has tried teaching thousands of people to check for an irregular heartbeat by taking their own pulse.

Two million Americans suffer from atrial fibrillation, a heart rhythm disturbance that increases the risk of a blood clot breaking free and lodging in the brain. The irregularity causes more than 15 percent of all strokes and 40 percent of strokes in people older than 75.

The heart consists of four chambers, two atria and two ventricles, which normally work together to pump blood throughout the body. In atrial fibrillation, the atria beat out of rhythm with the rest of the heart. Many sufferers feel a rapid thumping or fluttering inside their chests.

Munschauer described atrial fibrillation as a condition to discuss with a doctor, not an emergency.

The Trustees Council of Buffalo General, a volunteer fund-raising group, plans to support the $65,000 project, which will include the distribution of posters later this year and visits by educators to community centers, retirement communities and other sites. Rural Metro Ambulance already has pledged $30,000.

"The ambulance company sees this as a chance to reduce false alarm calls they respond to," said David Gesue, president of the hospital's Foundation.

A more ambitious proposal for the Vascular Disease Prevention Center would attempt to increase use of warfarin and other medications to prevent blood clots from forming, including aspirin.

Studies show warfarin is especially beneficial, but its use has yet to filter down to physicians.

A recent national study showed that the drug, which is marketed as Coumadin, could cut the risk of stroke caused by atrial fibrillation by 67 percent but was prescribed in only 32 percent of the patients who could tolerate it.

The estimated 11,000 Western New Yorkers with atrial fibrillation don't fare much better. Work by Munschauer and his colleagues shows that only 40 percent of the patients able to take Coumadin get it.

"If this proportion could be increased by just 10 percent, we could prevent about 800 strokes a year in Erie County alone," he said.

Munschauer suggested that doctors may be reluctant to prescribe warfarin because patients must be closely monitored. Too little of the drug and it has no effect; too much and it can cause internal bleeding.

In addition, many patients ignore some of stroke's symptoms, such as weakness in an arm or hand.

Warfarin is expensive, as much as $1,000 a month, but far less expensive than treating a person after a stroke. The National Stroke Association estimates the cost of the first 90 days of post-stroke treatment at $15,000.

Officials involved in establishing the center envision a centralized system for tracking patients on Coumadin and sharing the information with the patients' doctors. They are hoping that health maintenance organizations will help fund it.

"The way we do things now with atrial fibrillation is a little haphazard," said Dr. Susan P. Graham, a Buffalo General cardiologist. "And we have evidence with other illnesses that centralizing management of some patients is good."

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