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Medicine

Fighting the Number-One Killer In the US With Data 121

Posted by samzenpus
from the checking-the-chart dept.
mattydread23 writes "Often, the signs of eventual heart failure are there, but they consist of a lot of weak signals over a long period of time, and doctors are not trained to look for these patterns. IBM and a couple heathcare providers, Sutter Health and Geisinger Health System, just got a $2 million grant from NIH to figure out how better data analysis can help prevent heart attack. But the trick is that doctors will have to use electronic records — it also means a lot more tests. Andy Patrizio writes, 'What this means is doctors are going to have to expand the tests they do and the amount of data they keep. Otherwise, the data isn't so Big.'"
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Fighting the Number-One Killer In the US With Data

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  • by kqs (1038910) on Sunday October 13, 2013 @10:45AM (#45113957)

    This is the perfect use of government money: projects which are promising (though they may not pan out in the end), which will help many people, and which will not be subsidized by industry because they will not make money in the next three quarters. I don't expect any real results from this study for many years, but I think it's a very important study to do.

    • by ColdWetDog (752185) on Sunday October 13, 2013 @11:04AM (#45114075) Homepage

      It's also the perfect segue into Total Informational Awareness. It's basically data mining. You find a couple of soft indicators - the patient starts complaining of shortness of breath perhaps, has hypertension, is overweight. Then he moves. Starts over again. Doc asks the same question, patient puts down different dates (because they don't remember the doc visit five years ago), rinse lather repeat. If you could track this sort of stuff over time the 'computer' could start making some pretty easy correlations.

      IF you had the data. And only IF you had the data. Which means linked EHRs. Which is an interesting concept and would likely help, except, given the current state of our Panopticon Plus government, you have to wonder exactly who they are trying to help.

      Comrade.

      Oh, AND IT'S HEART FAILURE NOT HEART ATTACK. THEY'RE DIFFERENT. If you're the editor at least glance at TFA. /pedant /normal blood pressure mode

    • by TubeSteak (669689)

      This is the perfect use of government money: projects which are promising (though they may not pan out in the end), which will help many people, and which will not be subsidized by industry because they will not make money in the next three quarters.

      I know that "companies can't see past the next quarter" is a popular notion, but it does not apply to all industries.

      Big Pharma & medical device companies spend plenty of money on R&D that has no guarantee of paying off.

    • Perfect use of government money would be to help people eat healthier food and exercise regularly.
      Subsidize local fruits and vegetables, offer cheap yoga lessons across the country, and you'll soon won't have to monitor as many hearts.

      • No, perfect would be if they did both. Promoting healthy living would lower the incidence of heart disease, but a lot of people would still get it.

    • by jerdenn (86993)

      This is the perfect use of government money: projects which are promising (though they may not pan out in the end), which will help many people, and which will not be subsidized by industry because they will not make money in the next three quarters. I don't expect any real results from this study for many years, but I think it's a very important study to do.

      While I agree with your premise that this is the perfect example of why we would want government to fund specific types of R & D, I'd argue that private industry is terribly interested in analytics and the ability to provide enhanced clinical decision support and measure previously unknown positive outcomes based on specific treatment protocols or inputs.

      HIT companies have saturated the existing EHR market - competitive advantage will come from the ability to derive value from existing data.

  • Waste of money (Score:4, Interesting)

    by katz (36161) <Ema[ ] What e-mail? ['il?' in gap]> on Sunday October 13, 2013 @10:49AM (#45113975)

    If you want to prevent heart disease, stop eating saturted fat and cholesterol and stick with a low-fat whole-plant-based diet. This knowledge is not new; this stuff has been known for almost a hundred years now, yet we're still spending money dancing around the fact that eating animals and their byproducts leads to heart disease.

    Source: http://www.plantpositive.com/ [plantpositive.com]

    • This knowledge is not new; this stuff has been known for almost a hundred years now, yet we're still spending money dancing around the fact that eating animals and their byproducts leads to heart disease.

      It's not a fact, it's just you folks wishing things were like that.

    • Re:Waste of money (Score:5, Interesting)

      by rubycodez (864176) on Sunday October 13, 2013 @10:58AM (#45114045)

      Utter rubbish. The French eat meat and have a high fat diet, but have a very low incidence of heart problems

      Your link is to a fad-diet site.

      • Re:Waste of money (Score:4, Informative)

        by fahrbot-bot (874524) on Sunday October 13, 2013 @01:10PM (#45114747)

        Utter rubbish. The French eat meat and have a high fat diet, but have a very low incidence of heart problems

        Your link is to a fad-diet site.

        I think they consume far less sugar and soda and more fiber, which may explain things. You might find these two (long) talks interesting. The first is research/study based, the second is more anecdotal, but with some research. I thought they were both excellent and interesting.

        • Sugar: The Bitter Truth [youtube.com] (1h30m) by Dr. Robert H. Lustig, MD, UCSF Professor of Pediatrics in the Division of Endocrinology, explores the damage caused by sugary foods. He argues that fructose (too much) and fiber (not enough) appear to be cornerstones of the obesity epidemic through their effects on insulin. Series: UCSF Mini Medical School for the Public.
        • How Bad Science and Big Business Created the Obesity Epidemic [youtube.com] (1h) by David Diamond, Ph.D., of the University of South Florida College of Arts and Sciences shares his personal story about his battle with obesity. Diamond shows how he lost weight and reduced his triglycerides by eating red meat, eggs and butter.
        • by rubycodez (864176)

          They probably consume much less soda pop (and not high fructose corn syrup in lieu of cane sugar), but french use love sugar in their baked goods. they also drink a lot of wine. maybe the wine explains something

        • Some of you younger punks who didn't live through the beginnings of the anti-fat craze in the late '70s and early '80s wouldn't have seen things like Entenmens release strudels and whatnot which were "fat free". They took out the fat and added extra amounts of sugar, essentially crystalizing it, making it palatable.

          I am positive the anti-salt craze has contributed, not in the way people think, but in making food less tasty, and thus people eat more of it. More of what? Carbo foods.

          200 of the 500 calories

      • by ignavus (213578)

        Utter rubbish. The French eat meat and have a high fat diet, but have a very low incidence of heart problems

        Your link is to a fad-diet site.

        Ah, the French Paradox. Not sure whether that is actually valid:

        http://en.wikipedia.org/wiki/French_paradox#Theory_that_the_French_paradox_is_a_statistical_illusion [wikipedia.org]

      • by Dabido (802599)
        I have to agree with you (and I'm a vegetarian). The Japanese also have a lot of meat in their diets, mainly fish, and I believe they have the lowest rate of heart disease in the world. (I can't eat most meats, it sets off my angioedema - my intestines swell up).
    • by Anonymous Coward

      If you want to prevent heart disease, stop eating saturted fat and cholesterol and stick with a low-fat whole-plant-based diet.

      That helps to reduce the risk, not prevent heart disease. That's something that makes me cringe - this idea that diet is a panacea for one's ills. Lately, the vegans (Engine Co. 2 for example) have been proselytizing their way of life and selling it by over stating the health benefits. When I see folks who claim that their cancer was cured by switching to a vegan diet, I just think of all the other reasons why they were "cured" - the cancer going away when she switched to a vegan diet was most likely just a

      • by Shavano (2541114)

        If you want to prevent heart disease, stop eating saturted fat and cholesterol and stick with a low-fat whole-plant-based diet.

        That helps to reduce the risk, not prevent heart disease. That's something that makes me cringe - this idea that diet is a panacea for one's ills. ...

        Genetics also have a lot to do with it, too.

        Yes, eating more plants and less animals (even fish) is better for our health, our ecosystem, and our wallets, but let's not over state the benefits, please.

        Not your wallet. Check out the prices in the produce aisle some time. Meat is often a cheaper source of your necessary nutrients than vegetables.

        When we talk about vegetarian diets reducing your heart disease risk, it's frankly irresponsible to not provide information about how much it reduces the risk. There is an answer: 32%. http://abcnews.go.com/blogs/health/2013/02/04/vegetarians-have-lower-heart-disease-risk-study-finds/ [go.com] That's significant enought to take into account, and not even close to enou

        • Vegetarians are a self-selected group concerned about their health. The study that should be done is to take a bunch of vegetarians and start requiring half of them to eat meat five times a week and compare them to the others that remain strictly vegetarian.
        • "Meat is often a cheaper source of your necessary nutrients than vegetables."

          Ignoring how meat does not have essential phytonutrients in it (as you mention), consider the political reason of why that is the case as far as "calories":
          http://www.seriouseats.com/2007/11/the-subsidized-food-pyramid.html [seriouseats.com]
          "The Physicians Committee for Responsible Medicine has posted an easy-to-understand visual on its site that shows which foods U.S. tax dollars go to support under the nation's farm bill. It's titled "Why Does a S

    • So bunny rabbits are immortal?

      Who knew?

    • by alen (225700)

      i eat plenty of saturated fats, meat and cholesterol and at almost 40 my cholesterol is less than 200

      the secret is to stop eating processed foods and eating meals out. i stopped eating out at lunch and bring my lunch from home that my wife cooked fresh

      • by katz (36161)

        That's great that you eliminated processed food. Try to get your total cholesterol under 150. This page[1] mentions the Framingham Study[2], which showed that "only patients with cholesterol levels of less than 150 milligrams per deciliter (mg/dl) achieve the lowest coronary artery disease risk. In the first 50 years of the Framingham study, only five subjects with cholesterol levels of less than 150 mg/dl developed coronary artery disease. Rural residents in the developing areas of Asia, Africa, and Lat

    • I have mod points and it took every ounce of my being to not abuse them on this post. There is no '-1 Disagree"...

      Seriously, though. A plant based diet can and does work, but it's needlessly difficult if you don't have any ethical hangups about animal products. That is, in order to fill the nutrient gap left by omitting animal products you have to do a fair bit of globe trotting to import all of those plants capable of doing so. This can be prohibitively expensive and is really not something that would have

    • The whole cholesterol thing and low fat part have been proven wrong. Carbs, most notably sugar, have now proven to be way more important in both weight gain than (animal) fat in general. Check http://ds9a.nl/new-consensus/ [ds9a.nl] for links to the full explanation and scientific studies to prove this.
    • It's not meat that's the problem.
      It's too much sugar, too much fat, too much salt and too few exercise.

      • It's not meat that's the problem. It's too much sugar, too much fat, too much salt and too few exercise.

        Some doctors agree w/you. See the "Sugar: The Bitter Truth" link in my previous post [slashdot.org].

    • by metlin (258108)

      Or just eat a healthy balanced diet at or below your TDEE, and work out regularly. Moderation in everything and all that.

      I find that just being active goes a long way towards having good heart health. Now, obviously, people with perfect eating habits and workout schedules still get heart attacks, but on average, there are enough studies showing that good and active health habits (eating right, not smoking, working out) correspond to good heart health.

      Moderation does not mean that you stop eating everything

    • http://www.drfuhrman.com/disease/HeartDisease.aspx [drfuhrman.com]
      http://www.heartattackproof.com/ [heartattackproof.com]

      Don't let the naysayer comments get you down.

      Also, if arteries in you heart are all clogged up, then what about arteries in you arms, legs, liver, and brain? Cardiovascular disease affects every system in the body -- it is just that heart problems tend to be more tragically obvious than other clogs. So, the best approach is not to unclog a little part of the hearth that will just clog back up soon, but to unclog everything by

    • If you want to prevent heart disease, stop eating saturted fat and cholesterol and stick with a low-fat whole-plant-based diet. This knowledge is not new; this stuff has been known for almost a hundred years now, yet we're still spending money dancing around the fact that eating animals and their byproducts leads to heart disease.

      Source: http://www.plantpositive.com/ [plantpositive.com]

      For me, becoming a vegetarian actually resulted in significant weight gain, increased blood pressure, higher blood glucose and higher cholesterol. My fat consumption, particularly saturated fats, decreased dramatically but I got the opposite effect that orthodox nutrition says I should. Increasing fat consumption, including milk and egg fats brought all those numbers back to normal -- I'm guessing the milk and eggs are what you're calling "animal byproducts".

      I guess I practice a "low carb" vegetarian diet.

  • Wouldn't it be better use of our resources to combat the "killers" of people in their twenties and thirties? Those killers being suicide, homicide, and "accidents."

    • Eh, much easier just to be theatrically 'tough on crime' and ascribe psych issues to weakness of character. Your approach sounds like effort.
      • It would be 'better use of our resources' if we didn't do anything. Just stand back and make money for the corporations. That's all we really are supposed to do, right?

        Besides, dead young people are better sources of organs for all of those really important people who help corporations make money.

        • My understanding is that suicides tend to be unhelpful organ sources (sometimes poisoned/overdosed, or killed by asphyxiation, frequently not discovered promptly, etc.) I don't know how homicides stack up: swiftly-discovered headshot victims are probably gold(albeit gold that may not be in the donor registry or with next of kin that are easy to get ahold of for consent if needed), victims of messier trauma, or ones whose bodies are unavailable because of delayed discovery or use as evidence for police purpo
    • by rubycodez (864176)

      why bother with the suicides and homicides when the accidental death rate is more than 2.5x either one?

    • by Shavano (2541114)

      That's a false choice. We can do both and one doesn't interfere with the other.

    • by pla (258480)
      Prolonging the life of people past their reproductive years has no effect on long-term population. Keeping more people alive long enough to reproduce, however, does. We want more people dying young, not less.

      Furthermore... Accidents, by definition, happen accidentally. If you could prevent them, they wouldn't have happened.

      As for suicide - If someone wants to die - Let 'em. Someday, if we don't get hit by a bus first, we all end up dying of something, and a great many of those somethings hurt. When
      • Evolutionarily speaking, that is incorrect. Socially speaking, that is incorrect. Genes affecting life expectancy are under selective pressures just as anything else. For organisms of our metabolism and size, we have unusually high life expectancies (wrt to genes). It is reasonable to think that there are selective pressures that have pushed to increase our ability to live and function well beyond our peak fertility. One very plausible explanation very specific to humans is that we are extremely good at tea
      • by hawguy (1600213)

        Furthermore... Accidents, by definition, happen accidentally. If you could prevent them, they wouldn't have happened.

        Just because something is an accident doesn't mean it couldn't have been prevented. For example, there's a lot that has been done (and could be done) to prevent car accidents... Putting soft surfaces on playgrounds helps prevent accidental deaths and injuries from falls... Fire safety codes help prevent accidental fire deaths... And so on.... a huge amount of money is spent each year in direct and indirect costs of preventing accidents.

    • No. Because medical conditions (specifically heart disease) are by far the leading cause of mortality in the US. They also have a very heavy impact on the economy evident by the fact that the healthcare industry is so enormous to accommodate them.
  • from heart disease, what will they then die from? And how much will that cost?
    • by Dunbal (464142) *
      Not sure if your questions are rhetorical or not. But the #2 killer is cancer, and that is even more expensive to treat. Personally I'd choose a heart attack even in my mid 60's (reality is I had my first one in my 20's and have had a whole bunch already) over cancer in my 70's. Outliving your money/income can't be nice, even when you have progeny to depend on. And if you don't, well then you're screwed.
  • Reading the title I thought this would be about excessive fighting, as in fist fights.
  • by nbauman (624611) on Sunday October 13, 2013 @11:55AM (#45114329) Homepage Journal

    It is a hypothesis that collecting more data will find a pattern that will predict heart failure earlier, and that will lead to earlier interventions.

    They haven't demonstrated that it works.

    In order to demonstrate it, they have to do a controlled trial. They have to use these data collection systems in a group of 5,000 patients, and use the usual methods in another 5,000 similar patients, and see if there's any difference in a meaningful outcome. Do the patients live any longer? Are they any less likely to get strokes?

    Sometimes it works, sometimes it doesn't. The New England Journal of Medicine just published a report on the use of a high-tech surgical intervention -- implanting cardiac resynchronizing devices in a new subset of heart failure patients. http://www.nejm.org/doi/full/10.1056/NEJMoa1306687 [nejm.org] It turned out the resynchronization patients had more deaths than the control group, and they stopped the study early. You don't know until you've done the randomized, controlled trial. That's the method of science, the experimental method. You take your brilliant ideas and put them to a test.

    That's science. Everything else is bullshit.

    There was a study of using an electronic medical record in a pediatric intensive care unit. The patients with the EMR had a higher death rate than the control patients. The doctors said that when they needed to write a prescription in a hurry, they would just take out their Rx pad and write it. When they needed to write it with the EMR, they had to sign in, go through screens, and find what they were looking for.

    EMR replaced a simple, effective system -- paper and pen -- with a more difficult system. What's the point?

    Read what doctors are actually saying about electronic medical records, http://www.kevinmd.com/blog/ [kevinmd.com] http://www.nejm.org/ [nejm.org]

    There are systems that actually make it easier to treat patients. As I understand it, the Veterans Affairs and Kaiser Permanente have systems that actually collect useful data. The Scandinavians have great useful databases. http://www.bmj.com/content/347/bmj.f5906 [bmj.com] But a lot of the new systems, particularly the ones that are merely being installed because they're required and subsidized under new federal regulations, are driving doctors crazy. They complain that they have to log in, go through screens, fill out checklist after checklist, and wind up with records that go on for hundreds of pages that nobody ever looks at again. Traditionally, on paper, they were forced to write a concise narrative for their colleagues and themselves, of useful information that got to the point and helped them make a decision about what to do next. These poorly-designed EMRs stopped forcing doctors to think. It simply forced them to collect a lot of data. Data isn't information. Useless data is noise.

    And maybe most of all, they complain that instead of looking at their patients, they're looking at a computer screen. If you have to tell somebody that he's going to die in 6 months if he doesn't stop smoking, you shouldn't be looking at your computer screen. Maybe there's an element of human communication that computer nerds don't appreciate.

    In any computerized records, there's a tradeoff between how much data you collect, and how much time you have to spend entering data. You can spend an extra hour a day just entering more data. Is this pill a tablet or a capsule?

    And more important than time, when you write a medical record, you should be filtering information for just the important information. Otherwise you're just adding noise to the record, and making it harder for the humans to spot patterns.

    If you want to prevent heart failure, the basic job is to stop smoking, lose weight, and exercise. When patients get outside of certain well-understood parameters, you can give the

    • Absolutely correct. Mod parent up.
    • There was a study of using an electronic medical record in a pediatric intensive care unit. The patients with the EMR had a higher death rate than the control patients. The doctors said that when they needed to write a prescription in a hurry, they would just take out their Rx pad and write it. When they needed to write it with the EMR, they had to sign in, go through screens, and find what they were looking for.

      Do you have a link to that? I would like to see it.

    • And maybe most of all, they complain that instead of looking at their patients, they're looking at a computer screen. If you have to tell somebody that he's going to die in 6 months if he doesn't stop smoking, you shouldn't be looking at your computer screen. Maybe there's an element of human communication that computer nerds don't appreciate.

      My endocrinologist is like this, poking at the computer screen for the vast majority of the 20 minutes (!) he sits with me. It's a world built by politicians and bure

      • by nbauman (624611)

        Actually, most of the office systems were originally designed for insurance company billing. Then they tacked on the clinical applications.

  • We are all Going to die.So fighting heart failure is a waste of time. We already know you have to quite or dont start smoking at all. Exercise and eat right. And you will add maybe 15 years but your still going to die. we already have powerful drugs that are adding years but we are still going to die. I think that money should be used in another way Education,Disease that only affect a small amount of people that kinda use is better IMO.
  • I just bought this iphone case with built in wireless ecg [cardiacdesigns.com]. Its a little disappointing as I don't get the display thats on the picture. All I get is a notification box that says "normal" with no readouts or gauges, and not even what my heart rate was. Theres an option to turn on prescription mode, but you have to get a prescription from your doctor, scan it, and send it in to the manufacturer. I think this is a good start, but it would be better if it had the option of adding more electrodes and actu

  • ....or cancer

    And they live longer with arthritis, osteoporosis, a failing immune system and dementia. Yeah, sounds like fun.

    The Torchwood mini-series "Miracle Day" springs to mind.

    • ....or cancer

      And they live longer with arthritis, osteoporosis, a failing immune system and dementia. Yeah, sounds like fun.

      The Torchwood mini-series "Miracle Day" springs to mind.

      It's not the first heart attack that kills you, it's the last.

      Or to be less snarky, heart disease quite often results in significant extended morbidity before death. Few of us are so lucky to clutch our chests one minute and cut to a graveside service in the rain after the commercial break. And you can have the other stuff you mentioned concurrently, too. Death sucks, but the dying can suck even more.

  • I work in healthcare, actually for one of the organizations mentioned in the article.

    Healthcare organizations have a big incentive to show "meaningful use" to the federal government. The federal government will reimburse healthcare organizations a substantial amount - up to $44,000 per physician under Medicare or up to $65,000 over six years, under Medicaid - if they adopt electronic medical records and show "meaningful use" of those EMRs to improve patient care. (Note: this money doesn't go to physicians

  • There are a lot fo good advices here "eat healthy food", but few hint of what healthy food is.

    Cardiovascular failure is caused by thrombosis. This is a trend of the blood to clog too easily, caused by an imbalance of omega 3 vs omega 6 fatty acids in the food. Fixing this means eating less industrial meat (which concentrate omega 6 since we do not feed animals with grass, but with omega 6 rich corn and soja), and eating a bit more fish.

  • ...SMART for the heart!

    At any rate, I was reminded of SMART for hard drives, which also work by monitoring lots of individual data points over time and trying to detect things which point to a future problem before it occurs.

  • Nothing worse than poor statistics to make people think whatever it is the government wants us to think. Heart attacks are not the #1 killer in the US. Come on people, DEATH is the #1 killer in the US.

    Geez.

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