Truth About Heart Health Tests and Treatments
Sometimes, creating a heart health care plan for yourself or a family member can be tricky – especially when it comes to tests and treatments. There are some situations in which various heart health tests and treatments are critical, others in which they are reasonable, and yet others in which they could be unnecessary and even harmful.
The tests needed to diagnose heart disease depend on what condition your healthcare provider thinks you might have, and heart disease treatments vary by condition. That is why it is important to get a better understanding of heart disease, and to become more informed of cardiac care options to make better decisions based on your individual needs.
Dr. J Shah, M.D., board-certified Cardiologist and Epidemiologist in Boulder, Colorado and the author of Heart Health: A Guide to the Tests and Treatments You Really Need joined me to share more about heart health tests and treatments. During our discussion he dispelled some of the myths that have guided and misguided patients for years; and offered advice on how to make better decisions for heart health care and treatment for yourself and your loved ones.
Makeba: You shared some very eye-opening patient scenarios throughout your book, that most anyone can relate to, whether it’s via themselves or a loved one. Tell us a little more about those, and a glimpse of other highlights readers can expect.
Dr Shah: With the years I have seen patients in my clinic and worked on how to explain complex ideas of healthcare to the patients, over time I’ve finessed those ideas and I wanted to spread that much further. And that was the circumstance under which I decided to write this book. All of it is based on composite patient stories and gives the reader an idea about how and what happens in the healthcare system.
If one has to take a summary of what the book is about, it is really breaking down some of the myths, but also helping you navigate the healthcare system. What are the circumstances under which the tests are helpful? What are the circumstances in which they have not helped? And what are the circumstances in which these may be harmful even?
[The book is] based on five myths that I’m trying to eradicate among the readers and the patients, which is: more testing is better. More testing is better if you are having symptoms, if you are at risk of having the disease, but randomly doing tests just because the insurance pays for it, is not good for you, your health and your body.
Number two, is that most heart-related issues lead to heart attack and need to be looked on immediately or emergently. This is true if you go to the emergency room with chest pain, or EKG shows heart attack. However outside of this, which is 95% of the rest of the scenarios, most issues can be dealt with in a more composed manner. There is enough time to weigh the options, and even to get a second opinion.
The third [myth] is that surgeries and procedures are always better and imminently needed rather than medicine. That is not always true based on scientific evidence that we have accumulated over the past 30 years. We understand that medications actually work just as well, if not better.
Number four, stents save lives. I want to tell everyone that stents do save lives if you’re having a heart attack, however outside of that circumstance stents do not prolong life. They only help relieving your symptoms, and they do so almost as much as medicine do. And the fifth myth is that everything that the doctor does is for my benefit. In the medical system that we live in, doctors who provide service collect fees for the service, meaning thereby if they provide more service, they collect more fees. So that is every incentive to do more testing, and more procedures. And some of them may or may not benefit the patient. So that is the message I wanted to bring through this book.
From a patient perspective, when will the patient know when is the best time for them to ask for heart health testing, and what specific tests should they be asking for when they’re speaking with their healthcare provider?
Dr Shah: If the patient is experiencing certain symptoms, in that case it would be advisable to go to the doctor and ask about what is causing that symptom. And at that point in time the doctor will say, it could be related to your blood count, or it could be related to your lung issues, or it could be related to sleep deprivation, or it could be related to your heart. So, we are going to do testing for those 4 things. That is a very reasonable approach. On the other hand, if you go to the doctor for an annual checkup and everything is fine and you’re getting the blood count done and looking for kidney function and the doctor says, “By the way, you’re now at an age where we should do stress test”. If you’re not having any symptoms, there is no benefit to doing a stress test under those circumstances. Even if you have had a heart attack in the past and are currently doing well, there is no need to do a test when you do not have symptoms for it.
The American College of Cardiology, the American Heart Association, all of those professional organizations are asking doctors to refrain from doing that kind of testing, because we know from scientific evidence that when patients undergo testing without having symptoms, they do not gain any benefit from such testing. So that’s when, if a doctor says, ‘we’re going to do this test’, the patient should be a more informed and educated consumer and say, what gain will it give me? And what do we do if the test is positive, what do we do if the test is negative? Is the test and whatever treatment that follows, is that going to prolong my life? If not, why should we do this because I have no symptoms right now.
So that’s how I would approach the healthcare system, by asking questions and then understanding the information. And if you are not very clear or you’re thinking, well, this doesn’t sound right, there is always time to get a second opinion.
In my book, I mentioned a scenario where a patient was prescribed or recommended bypass surgery and he was saved from bypass surgery by just getting second opinion with another doctor who looked at it in a very unbiased manner and said, ‘no, your heart arteries are clear, you don’t need to go through another bypass surgery.’ We also know historically that we have had cases in this country where physicians and surgeons are performing bypass surgery when not needed, and the federal agents had to intervene, take away the license from these physicians, and levy fines on the hospitals which are doing it. That can still happen, and you have to be careful.
For treating heart health conditions, what is the difference between medicines versus those invasive procedures, like the surgeries for treating heart health? And what people should know when they’re presented with those options for treatment?
Dr Shah: In terms of surgery, let’s look at a common scenario, which is patients undergoing a stenting procedure. This is where the doctor puts catheter inside the heart, injects dye and looks at blockages in the heart artery, and then puts in the stent to open it up so that the blood flow is better. Now, logically speaking, it just sounds wonderful that it’s better to have more blood flow than less, which is absolutely true. However, study after study has shown that these stents are no better than medications in terms of prolonging life, nor preventing the next heart attack.
Medications do equally good job and they do not come at this humongous cost, and it does not have the same level of complications. And remember even after you get the stent, you still need to be on medication. So, it is not a replacement for medication, and it is no better than using medication itself.
If you are going into the hospital with a heart attack, you are having crushing chest pain, shortness of breath, you go to the emergency room, they get an EKG and you are having a heart attack. Under those circumstances, stents will be beneficial. Anything outside of that, it is not beneficial. So, when you are faced with this situation, you should be very clear about what is it going to accomplish. If a doctor says it’s good for you, that’s not good enough. You need to know very specifically what the life-saving potential of that treatment is for that surgery. That is number one.
Number two is, which symptoms are we addressing with this specific surgery? And number three, you have to look at your own individual circumstance. For example, if you are 86-years old and you have kidney problems, and lung problems, and then the heart surgeries being recommended, I think you and your family should ask as to what value is this surgery going to add, [especially] when the patient is already suffering from the lung disease, or the kidney disease, or dementia, or what the case may be. It is very easy to fall into the trap of let’s do this and it will be good. Not everything we do in medicine is lifesaving, there are very specific scenarios where it will prolong life, and under other circumstances it will not. So, you have to ask, especially in reference to your own individual situation, especially at an advanced age.
For those people who are left to seek out their own cardiologists, what should people look for when seeking out the cardiologist for the first time to assess them with their heart health?
Dr Shah: One of the things I would look for in a cardiologist is somebody who sits down in the clinic, somebody who’s not looking like he’s in a rush to go over to the next patient or the next surgery. So, number 1, you want a cardiologist who will sit down with you and try to understand your situation from yourself. Rather than reading the chart and making choices. We are all individuals. If charts were able to give answers, computers will already tell us what treatment we need, we don’t need human beings in that case. You need a cardiologist who is willing to sit down with you, understand your individual situation, and then tailor-make the test and treatment for you. Number 3, you want a cardiologist who will not only understand your situation, but also explain to you what test they’re recommending, how is it going to be done? But more importantly, what benefit you will get from it, and somebody who is willing to tell you about what risks and complications one can expect from this test. So that you can make a wise choice.
If all this information is very technical and you do not understand, I believe you have every right to ask again, and if you don’t understand it may be time to get a second opinion so that you understand before you jump into this. I see patients day after day who go to the cardiologist. They don’t understand the technical language, and they agree with everything that is done without even understanding it. I will tell you: I never go to a car mechanic, give him my credit card and say do everything that is needed. We all participate in the process, we understand what is needed, and decide if we want to get that work done or not done on our car. We should treat our body with the same, and higher level of respect than we do with our car.
So I would choose a cardiologist who’s willing to sit down and talk to you, understand your individual situation. Explain what tests and treatments are needed in a language that you understand, and if you make a different choice, say for example he’s recommending a surgery and you say, ‘can I try medication first?’ I would speak to a cardiologist who is willing to walk me through that. Also, if the cardiologist says you’re going to do medication, then [they] don’t need to see you for another year, I don’t think that doctor is wanting to work with you. I would look for another cardiologist at that point in time.
We all know that heart health care and the rate of survival after a heart emergency has evolved greatly over the past decades. You’ve talked a lot about stents and other treatments and medicines. Tell us what other advancements do you currently see in the area of heart health treatment, and also some that you even hope to see in heart health care and treatment over the next 5 to 10 years.
Dr Shah: We have a lot of high tech, but also a lot of low-tech strategies to help. What research has shown over the past 20 years, is after a heart attack, the sooner you can get a stent put in, the better it is. Further down the road, if your heart is weak, then that progress, that medication treatment has made even up until this year is tremendous. Every year we are seeing newer medication, which are helping as much, if not better, than some of these surgeries. And third, more and more scientific evidence is coming to the fore how much patients can help their own cause at home, and though it may seem boring or too much time consuming, it is quite helpful. Sticking to a good healthy diet, quitting smoking, regular exercise. We all talk about this and it seems oh so boring, however that is there. the battle is won.
It is not in the surgical suite, but it is at home and in the gym that we are winning the battle against heart disease. It is by quitting smoking. It is by going to a healthy lifestyle, a heart healthy diet, and also for the next level up, keeping an eye on our blood pressure, taking our blood pressure medicine on a regular basis and keeping an eye on our blood sugar, and keeping our diabetes under control. All of that has tremendous benefit on heart condition, and think of heart condition as a culmination of lack of exercise, poor diabetic control, poor high blood pressure control, poor tobacco use and so on, and by cutting back on that we are really helping make our heart healthier.
Any final thoughts you would like to leave with us?
Dr Shah: I want to leave everyone with the thought that – think of your healthcare as hospital care and home care, and please know that home care is ninety percent of the battle. Quitting smoking, regular exercise, low salt diet, healthy dietary habits, controlling your blood pressure and controlling your diabetes is ninety percent of the battle. The rest – stents, bypass surgeries, pacemakers and so on – are 10% of the solution. You can do ninety percent of the work at home yourself. And that is the key to having a healthier heart.
Heart Health: A Guide to the Tests and Treatments You Really Need (Rowman & Littlefield; Aug 26, 2019) by Dr. J Shah, MD, is available at bookstores everywhere.
Dr. J Shah, M.D. is a board-certified Cardiologist and Heart Rhythm Specialist. For more than 20 years, he has worked at hospitals in Ohio, Kentucky, Minnesota, Iowa, Indianan and Ethiopia. Dr. Shah trained at Harvard Medical School, the University of Louisville and the State University of New York at Syracuse. He holds his Medical Degree from Seth G.S. Medical College in Mumbai India, an M.P.H. and Ph.D. in Epidemiology and Biostatistics from the University of Texas at Houston. He is passionate about patient experience of healthcare and hopes to bring human elements back to medicine. When he is not seeing patients, he is writing, traveling or hiking. He lives in Boulder, CO.