HILLSBOROUGH COUNTY SHERIFF’S DEPARTMENT

Slides:



Advertisements
Similar presentations
Patient Oriented Therapy Non STE ACS
Advertisements

Concierge Medicine American Academy of Private Physicians.
The Efficacy of Non-invasive Diagnostic for CAD in PMK Hospital Maj. Hutsaya Prasitdumrong, M.D. Cardiovascular Division, Department of Internal Medicine,
Comparison of the New Mayo Clinic Risk Scores and Clinical SYNTAX Score in Predicting Adverse Cardiovascular Outcomes following Percutaneous Coronary Intervention.
Clinical Trials. Date & location – January-November 1998, stress SPECT patients randomly received tetrofosmin or sestamibi (n~1550) Inclusion criteria.
British Cardiac Intervention Society Risk Assessment In Acute Coronary Syndromes Dr David Newby BHF Senior Lecturer in Cardiology Associate Director of.
Coronary Artery Calcification & Computed Tomography Scoring.
Long-term predictive value of assessment of coronary atherosclerosis by contrast- enhanced coronary computed tomography angiography: meta- analysis and.
Only You Can Prevent CVD Matthew Johnson, MD. What can we do to prevent CVD?
Tenth International Symposium HEART FAILURE & Co. CARDIOLOGY SCIENCE UPDATE FEMALE DOCTORS SPEAKING ON FEMALE DISEASES Milano aprile 2010 FEDERICA.
Screening for Coronary Artery Calcium with Computed Tomography: Angiography and Intervention in Patients with Scores Over 400 Screening for Coronary Artery.
Coronary Artery Disease Angina Pectoris Unstable Angina Variant Angina Joseph D. Lynch, MD.
Myocardial Ischemia Redefined: Optimal Care in CAD.
STROKE STATS Third leading cause of death deaths a year strokes a year stroke survivors Leading cause of adult disability Source:
Mortality Incidence of Patients With Non-Obstructive Coronary Artery Disease Diagnosed by Computed Tomography Angiography Naser Ahmadi, MD, Vahid Nabavi,
New guidelines for CABG
HILLSBOROUGH COUNTY SHERIFF’S DEPARTMENT Saving Our Law Officers From Sudden Death and Heart Attacks.
From Vulnerable Plaque to Vulnerable Patient From Vulnerable Plaque to Vulnerable Patient; Our Mission Is Eradication of Heart Attack Morteza Naghavi,
Predictive Value of Coronary Calcium Scoring Matthew Budoff, MD, FACC, FAHA Associate Professor of Medicine UCLA School of Medicine Director, Cardiac CT.
Ravi Doobay and Dr. Eric Harrison We care about the health of our firefighters Tampa Fire Rescue: Saving our Firefighters from Heart Disease.
The Century Health Trial A Comprehensive Integrated Strategy For Managing CAD K. Lance Gould, M.D. Martin Bucksbaum Distinguished University Chair, Professor.
Date of download: 5/28/2016 Copyright © The American College of Cardiology. All rights reserved. From: 2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS Guideline for.
CARDIAC CT IN SCREENING FOR CAD Hossein Nademi MD CARDIOLOGIST JAVADOL-A-EME HEART HOSPITAL OCT
Date of download: 5/30/2016 Copyright © The American College of Cardiology. All rights reserved. From: Coronary Computed Tomography Angiography as a Screening.
TAHAR EL KANDOUSSI, SARA ECHERKI, NAWAL DOGHMI, MOHAMED CHERTI. SEcurite de l’Echocardiographie de stress : plutôt l’effort. Cardiology B Department, Ibn.
Date of download: 6/3/2016 Copyright © The American College of Cardiology. All rights reserved. From: Detection of Coronary Artery Stenoses by Low-Dose,
Coronary Artery Disease Po Hu IMG 310 Sectional Anatomy for Medical Imaging Summer Pathology Presentation Project.
Date of download: 6/21/2016 Copyright © The American College of Cardiology. All rights reserved. From: Prognostic Value of Cardiac Computed Tomography.
Date of download: 6/21/2016 Copyright © The American College of Cardiology. All rights reserved. From: Cardiovascular Imaging Research at the Crossroads.
Date of download: 6/23/2016 Copyright © The American College of Cardiology. All rights reserved. From: ACCF/SCAI/AATS/AHA/ASE/ASNC/HFSA/HRS/SCCM/SCCT/SCMR/STS.
Date of download: 6/24/2016 Copyright © The American College of Cardiology. All rights reserved. From: The Year in Cardiovascular Surgery J Am Coll Cardiol.
Date of download: 6/25/2016 Copyright © The American College of Cardiology. All rights reserved. From: ACCF/SCCT/ACR/AHA/ASE/ASNC/NASCI/SCAI/SCMR 2010.
Screening for CAD Nuclear Medicine prospective S.R.Zakavi,MD,IBNM Nuclear Medicine Research Center Mashhad University of Medical Sciences.
Date of download: 7/2/2016 Copyright © The American College of Cardiology. All rights reserved. From: Prognostic Value of Multidetector Coronary Computed.
Date of download: 7/6/2016 Copyright © The American College of Cardiology. All rights reserved. From: Prognostic Value of Multislice Computed Tomography.
Indication Contraindication Preparation
Ischaemic heart disease. Coronary artery disease(CAD) is the leading cause of death worldwide. The rates of mortality and disability due to CAD are increasing.
Date of download: 9/18/2016 Copyright © The American College of Cardiology. All rights reserved. From: ACCF/ASNC/ACR/AHA/ASE/SCCT/SCMR/SNM 2009 Appropriate.
Date of download: 11/12/2016 Copyright © The American College of Cardiology. All rights reserved. From: Asymptomatic Individuals With a Positive Family.
Choosing Wisely: Cardiology Jeffrey Ziffra D.O. Mercy Medical Center – North Iowa 10/14/2016.
Atherosclerotic Cardiovascular Heart Disease in Women
Women and Cardiovascular Disease
Total Occlusion Study of Canada (TOSCA-2) Trial
18th Annual Primary Care and Cardiovascular Symposium
It’s Both the Vulnerable Patient and the Vulnerable Plaque
Journal of Nuclear Cardiology | Official Journal of the American Society of Nuclear Cardiology Validation of a Clinical Pathway to Assess Asymptomatic.
Clinical need for determination of vulnerable plaques
Journal of Nuclear Cardiology | Official Journal of the American Society of Nuclear Cardiology Differences by HIV Serostatus in Coronary Artery Disease.
Journal of Nuclear Cardiology | Official Journal of the American Society of Nuclear Cardiology Prediction of 14-year cardiovascular outcomes by dobutamine.
Phenotype vs. Genotype: Defining Severe Familial Hypercholesterolemia
Risk of post-operative stroke in patients with known extra-cranial carotid artery disease undergoing Non-Cardiac Surgery Heart and Vascular.
Population subsets, risk predictors, and distribution of sudden cardiac deaths (SCDs) according to clinical circumstances. A. The population subset with.
Prevalence and Impact of Anxiety Disorders in
Imaging the event-prone coronary artery plaque
Connecting the Dots: One Man’s Story
ACCF/SCAI/AATS/AHA/ASE/ASNC/HFSA/HRS/SCCM/SCCT/SCMR/STS 2012 appropriate use criteria for diagnostic catheterization  Manesh R. Patel, MD, FACC, Steven.
Section 5: Intervention and drug therapy
Clopidogrel Reduces ADP-Induced Expression of Platelet-derived CD40L
Figure 2 Imaging of atherosclerotic plaque burden
Canadian Cardiovascular Society Guidelines for the Diagnosis and Management of Stable Ischemic Heart Disease  G.B. John Mancini, MD, Gilbert Gosselin,
MACE rate among CAD severity groups (total 0
Undetectable High Sensitivity Cardiac Troponin T Level in the Emergency Department and Risk of Myocardial Infarction Nadia Bandstein, MD; Rickard Ljung,
Undetectable High Sensitivity Cardiac Troponin T Level in the Emergency Department and Risk of Myocardial Infarction Nadia Bandstein, MD; Rickard Ljung,
CT coronary angiography and coronary calcium scoring
Patient Examples of CMR Stress Test in Women Patient #1 is a 70-year-old, post-menopausal woman with typical angina and 3 coronary artery disease (CAD)
Figure 3 Imaging of adverse plaque characteristics
Train-the-Trainer Cases
Cardiovascular calcification in patients with chronic renal failure: Are we on target with this risk factor?  Peter A. Mccullough, Sandeep Soman  Kidney.
Train-the-Trainer Cases
Train-the-Trainer Cases
Presentation transcript:

HILLSBOROUGH COUNTY SHERIFF’S DEPARTMENT Saving Our Law Officers From Sudden Death and Heart Attacks

Heart Attack and Sudden Death Law Officers are 70X more likely to die of coronary artery disease while in active engagement of emergency on duty compared to the general population!!!

OUR RESEARCH IN HILLSBOROUGH COUNTY USING LOW RADIATION CARDIAC CT

McDill CCTA Retrospective Study Objective: CCTA as a screening method for CAD in military Methods: A retrospective chart review of 40 active duty military that underwent CCTA without known CAD or angina Average age: 43 +/- 7 38 (95%) were male Results: 9/40 (23%) patients had plaque 6 (16%) had single vessel disease 3 (8%) had multiple vessel disease 5 (13%) had vulnerable plaques 1 had stenosis of 67% Conclusion: CAD is very common in high stress active duty military. Plaques occurred in 23% with 13% having vulnerable characteristics. One resulted in prediction of heart attack within 4 days of warning. This warning resulted in saving his life. Lives saved: 2.5% for a cost of $10,560 per life saved. In medical field, $50,000 per life saved in is considered a reasonable expense. Others were put on treatment to avoid progression of disease.

48 year-old life saved– CCTA Results Green: Lumen Blue: Fibrous Red: Lipid

PROTE-CT Study 15 asymptomatic patients underwent CCTA Results: 2 showed vulnerable plaque on CCTA and elevated inflmmatory proteins Pt one had MI 12 days after CCTA!!! Pt two had MI 185 days after CCTA!!! BOTH LIVES WERE SAVED Cost per life saved: $3,292.50 (In medical field, $50,000 per life saved in is considered a reasonable expense)

67 year-old life saved –CCTA Results Green: Lumen Blue: Fibrous Red: Lipid

PROTE-CT Study

Coronary Computed Tomography Angiography - CCTA Low radiation exposure Excellent diagnostic accuracy regardless of patient status Coronary Calcium Detection 99.9% Negative Predictive Value Plaque characterization Low Cost 10 minute Procedure

Preparation for CCTA No caffeine or decaf for 12 hours before the test May have to take Toprol-XL (Metoprolol) 2 days before test and day of test No food or drink 3 hours prior to test

COST CURRENT PRICE POINT $ 264

Radiation Exposure Prospective CCTA Retrospective CCTA

Treatment Based on Results No Plaque means no worry! Minimal Calcification is low risk Mixed Plaque will get aggressive treatment Severe Stenosis will get aggressive treatment Vulnerable Plaque is of highest priority https://cias.rit.edu/media/uploads/faculty-s-projects/287/1271_showcase_project_detail_item.jpeg

Our Proposal to Save Lives CCTA for the following:  MALE LAW OFFICERS > 40 and  FEMALE LAW OFFICERS > 50 http://www.iaff.org/HR/ReproductiveHealth.htm

References 1) Singh M, Kroman A, Tariq H, Amin Shetal, Morales A, Cahill K, Harrison EE. Special Operations Soldier with Cardiac Family History. JSOM. 2014. 2) Hartlage G, Patel A, Amin S, Morales A, Harrison EE. No One Left Behind. SOMA. 2014. 3) Singh M, Tariq H, Amin S, Morales A, Harrison EE. Are Vulnerable Plaques in Vulnerable Patients Predictive of ST Elevation Myocardial Infarction? AHA. 2014. 4) Tariq A, Amin S, Singh M, Morales A, Cahill K, Harrison EE. Predicting Heart Attack in a Patient Post-Radiation Therapy Using Plaque CCTA Analysis and Serum Biomarker Test. OncoReview. 2014. 5) Hadamitzky et al. Optimized Prognositic Score for Coronary Computed Tomographic Angiography: Results From the CONFIRM Registry: J Am Coll Cardiol 2013;62(5):468-76 6) Pontone G, Andreini D. A Long-Term Prognostic Value of CT angiography and Exercise ECG in Patients with Suspected CAD. J Am Coll Cardiol Imaging 2013: 6(6): 641-50 7)Lloyd-Jones D, Adams R, Carnethon M, et al. Heart disease and stroke statistics – 2009 update: a report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Circulation. 2009; 119:480–486. 8) Cross DS et al. Coronary risk assessment among intermediate risk patients using a clinical and biomarker based algorithm developed in validated in two population cohorts. CMRO 2012;28(11):1819-30 9) Fishbein, Michael C, Robert J. Siegel. How Big Are Coronary Atherosclerotic Plaques That Rupture? Circulation.1996; 94: 2662-2666