Saturday, November 18, 2017
Health

Heart patient gets startling letter from competing cardiology practice

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ST. PETERSBURG

Valeeta Gibson thought it was "kind of strange" when her husband, Carl, received a letter from the Tampa Bay Heart Institute at Northside Hospital, asking whether he knew his "ejection fraction'' measurement.

For one thing, Mr. Gibson, 69, is a cardiology patient, but not at Northside. So why was he on the hospital's mailing list?

Equally mystifying: What, the couple wondered, is ejection fraction?

They were particularly unnerved by these words: "If you don't know your measurement, you should — it could save your life."

"I kind of felt like, 'is it something that my husband needs to be concerned about?' " said Mrs. Gibson, who promptly brought the Dec. 27 letter to her husband's cardiologist, Dr. David Mokotoff.

Mokotoff, who heads the four-office Bay Area Heart Center, said that by his count, hundreds of his practice's patients received the Northside letter.

He didn't much care for it as a marketing tool. And he really didn't care for its alarming tone, which he said caused "a lot of fear and concern."

He and his colleagues complained to Heart Institute and Northside CEO Stephen Daugherty, who then suspended what he called a "community education campaign." He couldn't be reached for comment and a spokeswoman didn't say how many of the letters went out, or how they were targeted.

But what about the letter's main question: If you have heart disease, should you know your ejection fraction measurement?

Not necessarily, experts say. This isn't a number such as weight, cholesterol or blood pressure that patients can monitor on their own between doctor visits.

Ejection fraction refers to the percentage of blood that leaves the heart each time it contracts. It's measured using sophisticated (and costly) tests such as an echocardiogram, cardiac catheterization or magnetic resonance imaging.

"In certain patients, it's important," said Dr. Christopher Kramer, professor of medicine and radiology at the University of Virginia and chair of the imaging council of the American College of Cardiology.

For patients with symptoms of congestive heart failure, ejection fraction could help determine whether they'll need a defibrillator or pacemaker implant, Kramer said.

But as for everyone with heart disease knowing their measurement, "I think that's probably not necessary," he said.

Mokotoff also took issue with the letter's statement that if your ejection fraction measurement is less than 50 percent, "your heart muscles could be weak and in danger of sudden cardiac arrest."

"That's absolutely not true," he said.

Kramer agreed, calling the statement "a drastic oversimplification of a very complicated area."

There's general agreement that normal ejection fraction is between 50 to 75 percent, and that anything less than 35 percent is dangerous. But Mokotoff said there's little data to suggest people with measurements of between 36 and 49 percent are at higher risk of cardiac arrest.

Aimee Bennett, a spokeswoman for Northside Hospital, wrote in an email that the letter was part of a series of education pieces on heart disease leading up to National Heart Month in February.

"For years, we have encouraged our patients to be involved in their health care by knowing their numbers — weight, blood pressure, blood sugar levels and cholesterol, to name a few," she wrote. "For those with heart disease, ejection fraction is another number to monitor and discuss with their physician." But, she added "we have temporarily put the communication on hold as we evaluate whether additional explanation may be warranted."

Richard Martin can be reached at [email protected]

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