First Word: March Madness

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 - C.P. Kaiser

In the cardiology realm, the phrase “March Madness” can signify the run-up to the American College of Cardiology meeting, in addition to the college basketball playoffs.  Similarly, the gulf between sports and cardiology can be maddening close.

For example, it’s been noted that cardiac death rates in Los Angeles County increased after the 1980 Super Bowl loss (31-19, Pittsburgh Steelers over the Los Angeles Rams), but decreased after the 1984 Super Bowl win (38-9, Los Angeles Raiders over the Washington Redskins).

Kloner et al from the Heart Institute at Good Samaritan  Hospital in Los Angeles recently dug deeper into the mortality phenomenon of those two Super Bowls to determine what role age, sex and race may have played (Clin Cardiol 2011;online Jan 31).

They found that the loss affected older fans more than younger fans, men and women equally and whites/Hispanics more than non-whites/non-Hispanics. Conversely, the 1984 win was associated with a slight reduction in mortality, especially for women.

Researchers noted the unique equality of mortality between men and women after the loss, unlike mortality trends associated with European soccer matches, which tend to be predominantly male. They cannot explain with certainty the underlying mechanisms associated with these phenomena, but suggest older fans could have vulnerable plaque that’s more prone to rupture.

However, in Los Angeles County today, those who experience an acute MI, whether associated with a sporting event or not, will receive faster, more efficient care because of the STEMI system of care established between the area’s EMS personnel and hospitals. These coordinated networks have proven their worth in reducing mortality, but they can be challenging to get off the ground. Los Angeles and other U.S. locales, such as Minnesota and North Carolina, are model examples.

Another challenging area is proving the benefits of remotely monitoring heart failure patients. Home telemonitoring has a secure place in the U.S., and rightly so, as a means to reduce clinic visits and rehospitalizations. However, the evidence to support heart failure telemonitoring is spotty and conflicting. The next wave of innovations, however, are seeking to take the field into an era of success.

As remote patient monitoring perhaps provides some clinical relief for providers, it could be just the right time to think about attracting more referrals. That task is no longer as easy as meeting primary care docs in the hospital setting. Practices need to adopt smart and sophisticated methods to reach into the community of referrers. They have to make an impact—not just once or twice, but continually.

March Madness is upon us, and that could just as well refer to the madness of juggling the pressures associated with the practice of cardiology. So, you might want to slip in a bit of basketball for relaxation, but remember, it’s only a game.