Candid Physician Electronic Medical Records and Blood Work

Candid Physician Electronic Medical Records and Blood Work

HEALTH TRENDS

Candid Physician: Medical Records and Testing

Would it surprise you if your doctor shares
some of your healthcare system frustrations?

Stop me if you have thought or heard any of these common healthcare complaints.

There are too many medical record systems. It’s too difficult to make sense of information in an after-visit summary. Why does every health care provider request the same blood work? It feels like my doctor spends more time looking at my charts than talking to me. The way patients are billed is confusing.

Those are five of the most common complaints about the healthcare system. Here is the shocking part: your doctor most likely feels the same way you do when it comes to improving your care quality and the inefficiencies in the healthcare system.

On a recent episode of HeartTalk presented by Capital Cardiology Associates, I had a candid conversation with Dr. Connor Healey, a board-certified cardiologist on the challenges healthcare providers face. I was surprised to learn that a physician shares many of the frustrations of his patients. He was also open to sharing his thoughts and feedback on how we can improve the system. Our talk opened with the after-visit summary (AVS), a paper or electronic document, given to patients after an appointment. As one study found, “the AVS is nearly universal in the United State. However, patients infrequently reference or even retain their AVS, suggesting currently designed documents do not meeting patients’ needs.” The main goal of the AVS was to create a basic report of your doctor’s visit, enabling patients to make better lifestyle choices, while also providing transparency in the care orders. Instead of a standard report that could be freely shared between the patient and their providers, “most of these summaries are inadequate and speak to the inefficient system we have,” stated Dr. Healey. “There is too much medical jargon or information that patients don’t understand, like billing or coding.

There are too many medical record systems

It should be noted that one driving factor behind why every healthcare provider in the United States is pushing to provide an AVS is to meet a standard in the Health Information Technology for Economic and Clinical Health (HITECH) Act. This unlocks financial incentives from the Centers for Medicare and Medicaid Services (CMS). The AVS information is also useful for providers and healthcare teams when they are collecting data before a visit or procedure. The AVS is part of the electronic health records (EHR) system outlined in HITECH. “Most patients would know an EHR as a ‘patient portal,'” Dr. Healey pointed out. This component was initially one of the most challenging goals to reach due to the lack of a national medical records system. “More than 50% of affluent countries have a national health records system, according to the World Health Organization (WHO). The United States is not one of them.”

The reason why you must fill out a separate medical records information form at every health provider is due to the fact that there is not an industry-standard EHR. “Number one, there are way too many different EHRs out there. Your primary doctor may use one; we use a different one at Captial Cardiology Associates (CCA), your rheumatologist may use another. None of them are the same as what is used where you receive your hospital care,” added Dr. Healey. According to the National Electronic Health Records Survey of 2017, nearly 9 in 10 (86%) of office-based physicians had adopted an EHR. “None of these systems talk to each other, that is my biggest complaint.”

Blood work and testing

Whether you visit your doctor for your annual physical once a year or have a roster of health care specialist appointments during the year, chances are you have your blood tested. Blood work and testing are two examples of services that could be difficult to understand on an AVS. “What do the results mean,” is a common question asked by patients. The other is, “why do I have to get my blood checked by every doctor?” As we have learned, since most healthcare providers do not have access to the same patient records, this is an inefficiency in the system. Or as Dr. Healey stated, “blood work is probably the number one example of lack of communication between healthcare providers. Ask any patient the number of times they get blood drawn in a year, it’s ridiculous.” In most cases, the tests that are order are the same test. As part of your routine physical, your primary care provider typically checks your kidney functions, electrolytes, vitamin D levels, cholesterol, and other areas depending on your medical history. “When you come to the cardiology office, that’s a lot of what I’m looking at too. I may look at a troponin, which is a blood test for heart damage. I may look at BNP, a blood test that indicates how much MI stretch there is and acts as a surrogate for, ‘hey, do you have too much fluid circulating in your body?’ While most of it is redundant, there are specialty tests that do get ordered, which is why you will need more than one blood test a year. Having said that, there is so much waste on the redundancy of the standard blood tests that the country would save, literally, tens of millions of dollars if we had a better capability of sharing results.”

A better system

As we have transitioned from hand-written notes to electronic records, there are still improvements necessary to upgrade the American healthcare system. A valid point on a Twitter thread stated that EHR’s should be more intuitive. As one doctor tweeted, “As a millennial doc, I still wonder how my older colleagues managed to learn and use. Then read a recent study that EHR is one of the top reasons for physician burnout… and it all makes sense.”

“The goal is to improve the system so that physicians can deliver the highest quality of care at the lowest cost. This starts with a standardized AVS and better connected EMR,” Dr. Healey suggested. Healey visualizes a digital document designed as a standard medical record file, delivering a simple visit summary to the patient, and pertinent information. “Ideally, the solution would be that every patient has a single chart that is unique to them but would accessible by all providers.”

Patient Summary example from Modern Healthcare

A standard patient records system would also improve patient visits. A study released in February of approximately 100 million patient encounters with about 155,000 physicians from 417 health systems, showed that providers spend an average of 16 minutes and 14 seconds per encounter using EHRs. That’s almost a patient visit to review charts, documents, and order tests. Dr. Healey detailed, preparing for a typical patient appointment. “I will get a note that is eight pages long for a single encounter. I have to parse through all of this garbage to find vital signs, physical exam, what was discussed, and the concern or reason why I am seeing this patient. And that’s just one visit! I’m also getting messages from their oncologist, their lung doctor, and in some ways, this is more time consuming that when we used paper charts where we had more control of things.”

Written by Michael Arce, Host of HeartTalk presented by Capital Cardiology Associates

The Role of Public Health

The Role of Public Health

PATIENT EDUCATION

The Role of Public Health
During a Pandemic

“Public health is interesting
because it is a union between
individual health needs and
community health needs”

In regular times, public health is a large part of our nation’s healthcare system. Public health includes your doctor, who strives to promote wellness in your life, by preventing you from getting sick or developing health issues. Researchers that conduct scientific studies, your child’s school nurse, health inspectors, and advocates that educate the community on the risks of tobacco use or diabetes are all examples of public health. What is public health is a question we posed to Dr. Brion Winston, an interventional cardiologist at Capital Cardiology Associates. He began his medical career as an intern with the New York Department of Health (NYDOH) after graduating from Columbia University with a Masters in Public Health. “Public health is interesting because it is a union between individual health needs and community health needs,” Dr. Winston replied. At the time, he was part of the NYDOH’s Bureau of Tuberculosis Control. He described his role as a contact tracer, “basically determining the contacts that patient with a communicable disease has had as a way of eliminating further exposure.”

In normal times, public health workers cover a wide scope of concerns from childhood vaccinations, to speaking out for smoke-free areas and seatbelt warnings. They are either directly engaged in the community or speaking out for laws to protect the people. But, when disease outbreaks occur, public health’s role becomes even larger as we turn to these officials as a trusted source for health information. These people continue to work in the background to keep us healthy and safe while also combatting an unknown infectious disease.

Who are public health officials and how do they become a trusted source?

It’s a safe bet that most Americans could not identify Dr. Anthony Fauci, Director of the National Institute of Allergy and Infectious Diseases (NIAID), before the COVID-19 pandemic. For two months this year, he became a staple during news briefings as the main scientific voice on the White House Coronavirus Task Force. “In the case of Dr. Fauci, he has a long and storied career in infectious disease and immunology, including his work with the National Institutes of Health. He also had a track record with the HIV/AIDS pandemic,” Dr. Winston shared. Dr. Facui has held his current role (Director of NIAID) since 1984, serving several administrations and congressional leaders. He was awarded the Presidential Medal of Freedom in 2008 by President George W. Bush. “He was a natural choice to head up the COVID response efforts. His tenure through several administrations, making his appointment less political over the years, allows him to be a voice of research and advocate for public health.” And while he never asked for it, there is an online petition pushing to Make Anthony Fauci People Magazine’s Sexiest Man Alive.

Unfortunately, in life, with every blessing comes a curse. “I don’t think you are the one person who gets to make a decision,” Sen. Rand Paul sharply stated at Dr. Fauci during a Senate hearing. The senator was not the only one to challenge Dr. Fauci or other public health officials during the pandemic. Many county health departments across the country found themselves struggling to mount an adequate response to COVID-19 with limited budgets and resources. They were criticized for slow or conflicting policy rollouts. Even with daily press briefings and an endless stream of information being shared in the media, frustrations began to mount as the conversation shifted on social media platforms from public health to personal freedoms and economic fallout. These are two areas that public health workers and officials do not typically address. When you think about it, the same people who remind us to wear our seatbelts are also the ones to layout social distancing guidelines — but they have their limits. While most public health officials are political appointments, they are not “political” figures.

Dr. Winston relayed the attitude he embraces as a physician and public health advocate. “We are used to explaining to patients the areas of their health, providing them with informed consent, but not telling them things they want to hear. This has served me well over the years in my practice, to be honest with patients. There are experts in public health, based on years of experience and keeping abreast of the latest research and developments of physicians in other countries, to build the expertise of managing pandemics. In healthcare, we are constantly examining how we can continue to treat people safely in our hospitals and facilities.”

The role of the individual in public health

While Dr. Fauci is out in front of the cameras sharing evidence-based guidance with the country, the rest of the public health community is working overtime to protect us. “Not just from healthcare workers, but also the essential workforce who have kept our supply chains open. We also saw quite a bit of patience from those who had to sit things out for a while. I think that our response in that sense has been very favorable and that we have reason to be proud,” concluded Dr. Winston. As we strive to be good neighbors and citizens in our daily lives, we must also consider our contribution to community health. There is a valid reason why we are urged to simple things like visiting our doctor at least once a year, get a flu shot, wear a seat belt, or consider eating a heart-healthy diet. We contribute to the health of the population. A healthy lifestyle is the strongest determinant of health. While we thank our public health workers, we also need to listen to them.

Written by Michael Arce, Marketing Coordinator, Capital Cardiology Associates

How A Drug Is Made

How A Drug Is Made

PATIENT EDUCATION

A Drug’s Journey to
Your Medicine Cabinet

The steps involved to test a new drug for use

The pharmaceutical industry is working quickly to test a wide variety of potential cures for COVID-19. While drug makers have suggested a cure will be available by the end of the year, researchers are setting a timeline of 12 to 18 months to develop a vaccine. We asked, Mohammed Uddin, Albany College of Pharmacy and Health Sciences intern to explore the clinical trials and research development involved in drug development.

Microscope

The journey of an experimental drug from the laboratory into your medicine cabinet takes on average about 15 years. The researcher’s main goal is to find better ways to prevent, detect, and treat diseases. The first 6 to 7 years of drug development consists of researchers discovering a number of molecules that have the potential to become a drug for medical treatment. Once a molecule is identified by a researcher, it first goes through the preclinical testing period to ensure it is safe and effective in the laboratory and in animals.

Prior to testing the molecule in humans, researchers must find out whether the drug molecule has the potential to cause serious harm. If the results of preclinical testing determine the molecule to be safe and effective, researchers will then file an ‘investigational new drug application’ (IND). The IND must be approved by the Food Drug Administration (FDA) and by an institutional review board (IRB). The purpose of the IRB is to protect the safety and well-being of people who will be testing the new drug and to ensure ethical values are met. If the FDA approves the IND, this means the researcher may begin phases of clinical trials. Clinical trials are research studies that involve humans to test the new drug for safety and efficacy, and is typically done in a series of 3 steps:

Phase 1 Trials

This phase takes several months and includes about 20 to 100 healthy volunteers. The goal is to find a safe dose for the new drug, determine how the treatment should be given, and learn how the drug affects the body. If safety is determined, then the drug testing moves to the next phase.

Phase 2 Trials

This phase may take several months and up to 2 years and includes several hundred people with the disease or condition for which the drug is being developed. The goal is to further assess safety, but now also see if the drug actually works. If efficacy is determined, then the drug moves to the next phase.

Phase 3 Trials

This phase may take up to 4 years and may include several thousand people from patient populations for which the medicine is eventually intended to be used. The goal is to further assess if the drug works, but also to look at the long-term side effects of the drug.

If all 3 phases are successfully completed and the trials have shown the drug is safe and effective, then the researcher may file an application known as the “new drug application” or NDA. The purpose of this application is for the FDA to approve the researcher to begin marketing the drug for commercial sale. Reviewing of the NDA by the FDA can take up to 2 years. If the NDA is approved, the drug may be marketed with FDA regulated labeling.

After approval, a phase known as ‘post-marketing monitoring’ begins. Although clinical trials have shown the drug is safe and effective, it is impossible to complete long-term safety information by the time the drug is approved. After the public begins to use the medication, the researcher is responsible to submit safety updates such as side effects and other reports of issues or concerns to the FDA. The FDA will review these reports and may decide to add cautionary statements for use or if side effects are too serious, may withdraw the drug from the market.

New drugs are protected by patents when they are approved for marketing, which means no generic drugs can be manufactured until the patent expires. Although this process may be seemingly long, it is the only way to get the safest drugs to make it to your local pharmacy!

Written by Mohammed Uddin, Pharmacy Intern

References:
Drug Development Process [Internet]. [cited 2020Jun13]. Available from: https://ccts.osu.edu/content/drug-development-process
Learn About Drug and Device Approvals [Internet]. 2018 [cited 2020Jun13]. Available from: https://www.fda.gov/patients/learn-about-drug-and-device-approvals
The Drug Development and Approval Process [Internet]. [cited 2020Jun13]. Available from: https://www.fdareview.org/issues/the-drug-development-and-approval-process/

COVID-19: Do I Need to Stop or Change My Meds?

COVID-19: Do I Need to Stop or Change My Meds?

HEART HEALTH

Ask a Pharmacist

Do I Need to Stop or Change My Meds?

COVID-19 is a very new virus, and there is a lot that we still do not know about it. There have been some recent claims or speculation about how certain drugs may interact with the COVID-19 infection, but nothing yet has been proven. Some of the medications discussed throughout media sources recently include angiotensin-converting enzyme (ACE) inhibitors, angiotensin receptor blockers (ARBs), and non-steroidal anti-inflammatory drugs (NSAIDs), all of which are very common among CCA patients.

There is a protein, ACE2, in our bodies that the COVID-19 virus binds to and thereby enters targeted cells. An early concern was that patients on medications like ACE inhibitors, ARBs, or NSAIDs that also work on ACE2, may be at an increased risk of getting COVID-19 or having worse outcomes. However, this has not been proven, and in fact, there are recent suggestions that the opposite occurs with ACE inhibitors and ARBs, and that being on one of these medications may be beneficial in the setting of COVID-19.

Below, we aim to help you understand your risks and the best plan of action in these uncertain times. As always, it is highly recommended that you speak to your healthcare provider before changing any of your medications.

ACE inhibitors and ARBs

What are ACE inhibitors and angiotensin receptor blockers (ARBs)?
ACE inhibitors and ARBs are medications commonly used to treat high blood pressure or heart failure and include lisinopril, enalapril, losartan, irbesartan, and valsartan.

Should I continue to take my ACE inhibitor or ARB?

To date, there is no data to support this hypothetical concern. The American College of Cardiology (ACC) and American Heart Association (AHA) both recommend continuing to take ACE inhibitors or ARBs as directed by your healthcare provider. Recently there has been one small study published that provided encouraging data for continuing the use of ACE inhibitors and ARBs. While this evidence is preliminary, it is promising that the benefit of these medications in cardiovascular health may outweigh the risk in COVID-19. Overall, the use of guideline-directed medical therapy is key in controlling blood pressure, and stopping them could lead to a heart attack or stroke.

In conclusion, the FDA, WHO, and CDC are currently unaware of any scientific literature connecting the use of NSAIDs, ACE inhibitors, or ARBs and worsening or causing COVID-19 infections. The information being reported is mainly from purely observational studies, and not based on scientific data. New studies are planned, and we will continue to keep you updated as any new information emerges.

Non-Steroidal Anti-Inflammatory Drugs (NSAIDS)

What are NSAIDs?
NSAIDs include medications you may know more commonly as ibuprofen (Motrin, Advil), naproxen (Aleve), celecoxib (Celebrex), and aspirin. They are commonly used to reduce fevers and relieve mild pain.

Is it safe to continue taking NSAIDs?

There are currently no studies that suggest taking NSAIDs increase your risk of getting COVID-19 or worsening outcomes with COVID-19 infection. The European Society of Cardiology (ESC) and the Food and Drug Administration (FDA) are both unaware of any scientific data to support the worsening of COVID-19 infection associated with NSAID use. The concern to avoid the use of these medications is theoretical, and at this time, patients can continue to use them safely and as directed. The National Institute for Health (NIH) suggests using the lowest dose of NSAIDs, for the shortest period of time, to provide relief of pain and fever, and this is especially important for those with cardiac conditions and kidney issues.

Is there an alternative medication I can take for fever or pain?

If you are looking for a medication to help with pain and fever reduction that is not an NSAID, Tylenol (acetaminophen) is an option! The CDC currently states that acetaminophen (Tylenol) is an appropriate choice to help reduce pain and fever related to COVID-19 infection. Over-the-counter (OTC) products are safe and effective when you follow the directions on the label and use them as directed by your healthcare provider. The maximum daily recommended dose of acetaminophen (Tylenol) is 3,000 mg per day.

Is it safe to take my ‘baby’ Aspirin?

Yes! A low or “baby” dose, 81 mg, aspirin is commonly taken for heart health. The findings of “aspirin worsening COVID-19” are unfounded. It is very important to continue aspirin therapy as it has significant benefits, especially after a heart attack, a coronary stent, or stroke. Aspirin works by a different mechanism of action than other NSAIDs, and thus the cardio-protective effect and the reduction in risk of cardiovascular events outweigh any theoretical risk of aggravation of COVID-19 symptoms.

Please call Capital Cardiology Associates or the Clinical Pharmacy Team at Capital Cardiology Associates for more information, questions, or concerns.

Stay well and wash your hands!

Written by Emily Kronau Pharm Intern, Dylan Carmody Pharm Intern, Emily Plumadore PharmD, Kate Cabral PharmD, BCCP

References:
1. Center for Drug Evaluation and Research. FDA advises patients on use of NSAIDs for COVID-19 [Internet]. U.S. Food and Drug Administration. FDA; [cited 2020Apr3]. Available from: https://www.fda.gov/drugs/drug-safety-and-availability/fda-advises-patients-use-non-steroidal-anti-inflammatory-drugs-nsaids-covid-19
2. Coronavirus [Internet]. World Health Organization. World Health Organization; [cited 2020Apr3]. Available from: https://www.who.int/emergencies/diseases/novel-coronavirus-2019
3. Coronavirus Disease 2019 (COVID-19) [Internet]. Centers for Disease Control and Prevention. Centers for Disease Control and Prevention; 2020 [cited 2020Apr3]. Available from: https://www.cdc.gov/coronavirus/2019-ncov/index.html
4. Uncertainty Surrounds Use of OTC Anti-Inflammatory Drugs in Patients With COVID-19 [Internet]. Pharmacy Times. [cited 2020Apr9]. Available from: https://www.pharmacytimes.com/news/uncertainty-surrounds-use-of-otc-anti-inflammatory-drugs-in-patients-with-covid-19
5. New Study Provides First Clinical Insight into ACE-inhibitors and ARBs in patients with COVID-19 [Internet]. Pharmacy Times. [cited 2020Apr13]. Available from: https://www.pharmacytimes.com/news/new-study-provides-first-clinical-insight-into-ace-inhibitors-and-arbs-in-patients-with-covid-19
6. HFSA/ACC/AHA Statement Addresses Concerns Re: Using RAAS Antagonists in COVID-19 [Internet]. American College of Cardiology. 2020 [cited 2020Apr13]. Available from: https://www.acc.org/latest-in-cardiology/articles/2020/03/17/08/59/hfsa-acc-aha-statement-addresses-concerns-re-using-raas-antagonists-in-covid-19

What we have learned about the coronavirus

What we have learned about the coronavirus

HEART HEALTH

What we have learned about the coronavirus

“We are learning about
this virus every day and
working together to
benefit all of us.”

It has been a month since the coronavirus spread throughout New York, closing schools, sending non-essential workers home, canceling public events, clearing our social calendars, and stalling the economy. When the first reports of patients infected with coronavirus disease 2019, COVID-19, in China surfaced in early January of 2020, most Americans were focused on the beginning of the new year. In only a few months, we have transformed into a society on PAUSE as medical officials and elected leaders responded to a virus that can only be viewed under an electron microscope, virtually unknown to science until its effect was reported on the nightly news.

Scott Purga, MD, FACC

What has the Capital Region medical community learned about the coronavirus and how might that knowledge help end this pandemic? That is the question we posed to Dr. Scott Purga, a board-certified cardiologist at Capital Cardiology Associates, who is part of the area’s COVID-task force. “What’s new for all of us is that we are learning about this virus every day. Our team is quite thorough and working together to provide the best care. You may see things on the news about how hospitals were overwhelmed, that is not the case in Albany. We had extra time to get our systems in place.” Dr. Purga joined me on a recent episode of HeartTalk, presented by Capital Cardiology Associates to discuss the treatment, recovery, and possible cure options during this pandemic.

What we have learned

It has been established that COVID-19 is highly contagious and quickly spread across the globe after first being reported in Wuhan, China, on December 31, 2019. The World Health Organization began publishing risk assessments and advice to the public health crisis that was developing in Wuhan medical institutions. On January 13, the first confirmed case of COVID-19 in Thailand was reported, signaling that the virus had traveled outside of China. Fast forward to February 29 when the first death from the virus was reported in America. Dr. Purga explained the challenge with COVID-19 is in identifying those who have the virus. “We have seen COVID-19 in patients with the main presenting symptom of fever, chills, the usual flu-like symptoms, but then a substantial portion also have lung involvement.” The virus had reached America during the peak of the seasonal flu. Common respiratory viruses (like the common cold and influenza) affect young children, those with health conditions, and adults 65+ at greater rates, causing a spike in hospitalization. Unlike the cold and flu, coronavirus “can progress to pneumonia, which can become severe, requiring intensive care unit (ICU)admission. A large subset also have cardiac complications, either from the virus itself or from breathing issues associated with the virus. Anywhere from 10-20% are going to have a heart issue coming from the coronavirus infection, particularly those that are more severe cases,” noted Dr. Purga.

Another unique twist to coronavirus is that an infection can be generally mild. “A substantial portion, manly younger and healthier people with fewer comorbidities, they have a relatively mild illness with flu-like symptoms with shortness of breath for a few days but can recover quickly,” commented Dr. Purga. Mild symptoms create an opportunity for the virus to spread to others through a cough, sneeze, or any close contact. This is why there is a concern about hand washing, wearing masks, and adhering to social distancing. And like the cold and flu, coronavirus is transmitted from germs that can live for hours on unsanitized surfaces.

Dr. Lance Sullenberger, COVID-19 task force

“Once inside, the virus attacks the body’s immune cells and is able to ‘get inside’ to replicate using our own cells to make more copies of the virus. The concern here is that this virus spreads to affect the lungs, which is the major reason that this virus is deadly. This virus is able to get through certain receptors on the cell surfaces. You may have heard about the ACE receptor. (Cell receptors play a key role in passing chemicals into cells and in triggering signals between cells.) There are some theories that COVID is using these receptors to gain entry into cells. A lot of that is being studied every day by researchers,” said Dr. Purga. Even worse, coronavirus may trigger the body’s immune system into overdrive, causing inflammation in the lungs, causing Acute Respiratory Distress Syndrome (ARDS), which requires the use of a ventilator to assist with breathing. “The downside is two-fold, we are learning about residual damage to the heart and lungs from the virus as well as the fact that these people can spread the virus to others without realizing it. We think a good percentage of people are asymptomatic, meaning that they have the virus infection but have no symptoms of it. They can be walking around with friends, spreading the virus without realizing it. That is the double-edged sword when you have milder cases.”

COVID-19 Task Force members at Albany Med

Working together

There is no specific antiviral treatment recommended for COVID-19, and no vaccine is currently available. While we have been separated during this pandemic with social distancing and the New York State on PAUSE guidelines, a group of Albany-area medical professionals has formed to combat this virus, together. Special COVID-19 task forces have been assembled at area hospitals, comprised of emergency room nurses and physicians, nursing care, respiratory therapists, ICU physicians, and cardiologists. “We do this in a controlled fashion, keeping everyone safe, isolating COVID patients for treatment,” detailed Dr. Purga. “The cardiologists consult the attending internal physicians on the care and treatment progress. Our diverse backgrounds are the strength of the team; we can bring new ideas to each other and share what we know from our unique specialties and training. Our team at Albany Med can collaborate with the team at St. Peter’s to benefit all of us. It is a good atmosphere and quite unique!”

There are two main goals in ending the COVID pandemic: treating symptoms and finding a cure. Currently, there is considerable discussion on the effectiveness of drugs used to treat other illnesses on COVID patients. Dr. Purga addressed the two most popular drugs being used to treat symptoms. “Under controlled circumstances, it is useful to give these drugs under physician supervision. Zithromax, or as it is called ‘Z-pack,’ is typically used for community pneumonia, pneumonia caught outside of the hospital, and some other bacterial infections. It also can reduce inflammation in the lungs. That is why we think it may be helpful in combatting the lung problems associated with coronavirus. Hydroxychloroquine is traditionally an anti-malarial drug that is used to fight that parasitic infection. It also has some anti-inflammatory properties and has been used in autoimmune conditions like lupus. The thought here is that by reducing the body’s response, this may reduce the frequency of severe complications, needing a ventilator and other respiratory problems. They are being used together with the hope that they are helping. It’s premature to say that they are making a definitive impact yet.” It has also been reported that remdesivir, a drug developed to treat disease caused by the Ebola virus, could possibly stop the virus from being able to copy and spread to other parts of the body. The drug was successful in animals and laboratory dishes, but scientists insist on more studies to confirm its effectiveness in people. “There is a lot to come, with the use of other off label anti-inflammatory medication options that are being used in the hospital, on the treatment of COVID symptoms,” added Dr. Purga.

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The race for a cure

As of April 8th, there were 115 COVID-19 vaccines under development around the world. The most advanced candidates have recently moved into clinical development, some looking to being human testing this year. Time is the one commodity scientists will need to develop a cure. Even Dr. Anthony Fauci, the longtime director of the National Institute of Allergy and Infectious Diseases (NIAID), has questioned a drug being developed within a year. While scientists have cracked COVID-19’s code in record time (determining the genetic sequence of the virus), there are still critical steps in developing a vaccine. Researchers will use clinical trials to test for dangers, and adverse side effects in small to large populations before a cure can be released. “Typically, randomized trials, say for a new heart drug that comes to the market, that usually takes several phases of trials over years to develop approval from the FDA. In the case of the COVID virus, the CDC and FDA have are expediting approval of trials and allowing us to enroll patients quickly due to the rapid need for this data,” said Dr. Purga.

Healthcare during the new normal

One concern that has developed while we wait for things to return to normal is that doctors throughout the United States have reported treating fewer patients than normal for heart attack and stroke symptoms since the start of the COVID-19 pandemic. This week, the Journal of American Medical Association reported results from a large study involving patients hospitalized with COVID-19 in the New York City area, that people with obesity, diabetes, and high blood pressure are at greater risk for complications from the coronavirus. I asked Dr. Purga about the issue of patients not reporting their conditions out of fear of the virus. “My message is if you have a true concern, a new symptom: chest pain, shortness of breath, dizziness — any of our red flag cardiac symptoms — do not stay home. Heart disease isn’t on hold just because there is a viral outbreak. People have heart attacks, stroke, arrhythmia even while staying at home during this pandemic. The hospitals have isolated patients being treated for COVID conditions. Setting foot in the hospital does not mean you are going to catch coronavirus. I would encourage people who are presenting heart or cardiac symptoms to call their primary doctor, call our office, or if it is an emergency, go to the hospital.”

(l to r): Karen Canniff, NP with Dr. Scott Purga – holding a portable ultrasound unit

Written by Michael Arce, Host of HeartTalk presented by Capital Cardiology Associates