June 22, 2008
Task Force Targets Suffolk’s High Heart-Disease Death Rate
By Ridgely Ochs, Newsday, Melville, N.Y.
Jun. 22--Tricia Restucci of East Setauket had a stroke when she was 34. She had a heart attack when she was 38. Now 43, the mother of three is one of the lucky ones. Heart disease is the number one killer nationwide, and both Suffolk and Nassau have higher death rates from it than either state or national averages.
Concerned about Suffolk's heart disease death rate, which ranks 13th worst among the state's 62 counties and worse than Nassau, Suffolk Health Commissioner Dr. Humayun Chaudhry has set up a task force. Eleven doctors and nurses from around the county began meeting in February to come up with ways to educate practitioners and patients to ensure they are up-to-date on risk factors, symptoms and treatments.
Journalist Tim Russert, who died earlier this month, will be one of 870,000 Americans to succumb this year to heart disease or stroke. Suffolk's heart disease death rate for 2005, the latest data available, is 257.5 per 100,000. The state average was only 240.7 and the national average 210.3. That means an extra 693 people in Suffolk died from heart disease in 2005 compared with the rest of the country.
Nassau's heart disease mortality rate is slightly better: 250 per 100,000, which makes the county 15th worst. That is an extra 526 Nassau residents who die from heart disease compared with the rest of the country.
Last year, Nassau started its Healthy Nassau campaign to reduce risk factors that can lead to heart disease, such as smoking, obesity, diabetes, hypertension and high cholesterol.
Dr. Maria Torroella Carney, Nassau's health commissioner, said while the county is doing better than the state in some areas, such as diabetes, "we acknowledge we can do better."
Chaudhry concurred. "We can't be satisfied with the status quo," he said.
The task force decided to focus first on just heart disease, which causes more deaths, and not on stroke, Chaudhry said. But Suffolk's stroke rate is also high: 36.5 per 100,000 compared with a state average of 30.4. By contrast, Nassau's rate is much lower: 25.4.
Chaudhry suggested Suffolk's relatively high numbers "probably relate" to Suffolk's geography and size, and the fact it has only one hospital that offers all medical services, Stony Brook University Medical Center, compared with four in Nassau. Other reasons, the commissioner said, could include residents' "insufficient understanding" of the signs and symptoms of the disease and "less than 100 percent adherence" by doctors of heart disease prevention guidelines.
"We can't change geography or create a new university hospitals," Chaudhry said. But, he said, "we will do everything we can to address the latter two areas."
Suffolk is three times the size of Nassau with a slightly larger population, but many of its demographics are similar. Both are affluent and well educated, which "usually correlate with favorable health behaviors," said Dr. Alan Guerci, chief executive of St. Francis Hospital in Roslyn.
He said the counties' high numbers baffle him. "I've never understood it," he said. "And we know we have good cardiac surgery. It doesn't add up."
But geography and access to care may play a role in Suffolk. Although five Suffolk hospitals provide emergency angioplasties, only Stony Brook offers a full range of cardiac services. While more than 90 percent of Nassau residents who need heart surgery get it at a Nassau hospital, only 47 percent of Suffolk residents receive surgery at a Suffolk hospital, according to New York's Statewide Planning and Research Cooperative System data from 2007. Moreover, state Health Department data show that in 2005 Nassau hospitals did five times more angioplasties than Suffolk hospitals.
There are also fewer doctors who specialize in cardiovascular disease in Suffolk: 133 vs. 263 in Nassau, according to the Medical Society of the State of New York.
This "out-migration" of patients to Nassau concerns state Sen. Kenneth LaValle (R-Port Jefferson). "We are not doing right by the people in the county because we should be attracting the best and brightest medical individuals," he said.
The best doctors are generally those who perform high volumes of a procedure, he said.
But Chaudhry and the task force believe it may not only have impact, it can also become a model for the rest of the state. Beginning in the late summer, task force members plan to visit Suffolk's 11 hospitals and the county's 11 health clinics with a presentation on heart disease. They are working on a pamphlet for doctors and they hope to host two community health fairs.
For Restucci, their efforts can't come a moment too soon.
"It can happen to anyone," she said. "I'll be scared for the rest of my life because it's a very, very scary thing."
SOME OF THE LUCKY ONES
AGE 91: Three arteries needed stents
Charles Thomas, 91, Wading River
Diagnosis: Diabetes, high blood pressure, irregular heartbeat, blocked arteries
A diabetic for 40 years with high blood pressure, Thomas, a former LILCO employee, had a pacemaker implanted in 2005 to regulate his heartbeat. He also began to have trouble breathing. It was determined he needed a heart valve replaced. A catheterization at Stony Brook University Medical Center found that his valve was fine but three of his arteries needed stents.
His breathing did not improve after the stents were inserted, however. A CT scan found that fluid had filled his left lung cavity and twice he had the fluid pumped out. He has since had other problems, including nose bleeds.
He is on medication for his diabetes, high blood pressure, to keep his arteries clear and to prevent the nose bleeds. Although he no longer drives, he lives on his own and still rides his 26-year-old thoroughbred, Krugerrand.
Thomas: "Right now I feel wonderful. I don't say I'm perfect by any means. It's not easiest thing to get on the horse."
AGE 31: Ignored heart attack signs
Belinda Jenkins, 31, Roosevelt
Diagnosis: Heart attack at age 26
An insulin dependent diabetic all her life, Jenkins was getting dressed one morning in 2002 when she had the classic symptoms of a heart attack: chest pain, shortness of breath and vomiting. She called 911 for an ambulance. Three days later she underwent quintuple bypass surgery; she said all of her arteries had 90 percent or more blockages.
Since then she said she has had several angioplasties and gets a stress test every six months. She still works full-time in marketing and public relations and is active in the American Heart Association.
Jenkins: "I learned to listen to my body. I had symptoms for 2 1/2 weeks before my heart attack and I kept ignoring them."
AGE 43: Fell ill making lunch with son
Tricia Restucci, 43, East Setauket
Diagnosis: Stroke at age 34; heart attack at age 38
When she was 34, Restucci was preparing lunch when she suddenly lost vision in her left eye and felt tingling in her left hand. She tried to tell her toddler son something but the wrong words came out. She called her mother and 911 to tell them she was having a stroke. She learned she had a hole in her heart, which she had repaired in a minimally invasive procedure at St. Francis Hospital in Roslyn.
After a heavy meal on a cruise four years later with her husband, she felt very weak and felt a pain "like a pulled muscle" across her chest. She took Tylenol and Tums but neither helped. Her stomach started to turn and she got the runs. Taken to the infirmary, she was ultimately diagnosed with a heart attack and taken to a hospital in Florida. An emergency catheterization revealed no blockages; her cholesterol and blood pressure were normal and she was not overweight. Finally, a doctor discovered she had sticky platelets, which can cause blood clots. An advocate for the American Heart Association fighting childhood obesity, she is now on aspirin and an medication to keep platelets from sticking together.
Restucci: "Its not breast cancer that kills more women. It's heart disease."
AGE 4: Hole in his heart repaired as infant
Jack Schlichting, 4, Islip Terrace
Diagnosis: Born with a hole in his heart
Born four weeks early, Jack at two months was not gaining weight and was having breathing problems. One night when he was 5 months old and having a hard time breathing, his mother Tina Schlichting, a pediatric nurse, took him to the emergency room. A CT scan showed he had an enlarged heart; it was later determined he had a large hole in his heart. Three months later he had open heart surgery to close up the hole.
Now 4 1/2 with a normal life expectancy, he is the Long Island American Heart Association's ambassador for 2008, plays soccer and does karate.
Tina: "I want him to know what he went through. He loves being the ambassador."
THE LI FACTORS
POSSIBLE FACTORS IN HIGHER DEATH RATES FROM HEART DISEASE IN SUFFOLK
Authorities do not know why Suffolk's heart disease rate is somewhat higher than Nassau's and worse than the state and national average. Here are some possible contributing factors:
Suffolk's geography, combined with the fact it has only one tertiary hospital, Stony Brook University Medical Center, which provides a full range of services and subspecialties -- compared with four in Nassau. Suffolk is three times the size of Nassau, with a slightly larger population.
Insufficient understanding among the general population of the signs and symptoms of the disease.
Less than 100 percent adherence by doctors of heart disease prevention guidelines. Fewer doctors specialize in cardiovascular disease in Suffolk.
Sources: Suffolk County Health Commissioner Dr. Humayun Chaudhry, Medical Society of the State of New York
HEART DISEASE DEATH RATES 2005
Suffolk 257.5 per 100,000 people. Of New York's 62 counties, Suffolk ranked 49th
Nassau 250 per 100,000. Of New York's 62 counties, Nassau ranked 47th.
State average 240.7 per 100,000
National average 210.3 per 100,000
Source: News York State Department of Health and U.S. Centers for Disease Control and Prevention
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