Apple Watch may soon be able to warn of a potential stroke

I bet your insurance plan will not pay for it, but they will pay for your stroke intervention and rehab costs. 

Apple Watch may soon be able to warn of a potential stroke

A device that’s embedded in a new wristband for the Apple Watch marries two existing features—the heart rate monitor and activity sensors—and takes them to a new level using artificial intelligence.

The KardiaBand from AliveCor uses a neural network to predict and analyze the wearer’s heart rate based on his or her history and a trove of cardiovascular data from both sick and healthy people. The device measures the heart rate every five seconds and tells users when it’s out of their expected range. It doesn’t apply a generic range—instead, it determines what’s abnormal for the user.

The Apple Watch already uses machine learning to identify when the heart rate spikes abnormally, but this personalized approach goes a step further. When the device realizes the person wearing it is out of range, it will prompt him or her to record the heart's electrical rhythm, using electrocardiogram (EKG) technology built into the wristband. The process involves placing a thumb over the sensor for 30 seconds while the results appear on the face of the watch. A recording is then available to send to a doctor.

Portable EKG readers that work with smartphones have been around for years, allowing consumers to check their heart’s electrical activity at will using a separate device. The crucial issue was knowing exactly when to do it. For people in danger of cardiovascular-related complications such as stroke, devices like this may soon play a critical role in helping wearers avoid a health emergency.

“This is continuously monitoring your heart rate to let you know if something is potentially off track,” said Eric Topol, director of the Scripps Translational Science Institute and a professor of molecular medicine who isn’t involved with the technology. “That’s the big difference.”

“This is the first time I've seen artificial intelligence on a smart watch,” said Topol, who is also a cardiologist. “It’s definitely a step in the right direction.”

The reading could help detect dangerous electrical abnormalities such as atrial fibrillation. The condition, marked by an erratic rhythm that can lead to deadly blood clots and strokes, develops in about one-quarter of people over age 40.

The technology, however, doesn’t come cheap. The KardiaBand, the first medical device accessory approved by the Food and Drug Administration for use with the Apple Watch, sells for $199. Users also have to subscribe to AliveCor’s premium service at a cost of $99 a year.

New software program allows early detection of arterial calcification

I can't imagine your insurance allowing expensive CT scans to test for this unless your doctor has another factor pointing to this high risk possibility. My Dads doctor upon seeing 80% blockage in one of his carotid arteries should have had him warn me to get tested.  Definition here: Arteriosclerosis is the stiffening or hardening of the artery walls. Atherosclerosis is the narrowing of the artery because of plaque build-up. Atherosclerosis is a specific type of arteriosclerosis.
https://www.news-medical.net/news/20171106/New-software-program-allows-early-detection-of-arterial-calcification.aspx

• Download PDF Copy

November 6, 2017

Little exercise, fatty food and too many cigarettes - factors like these aid the onset of arterial calcification, also known as arteriosclerosis. If blood can no longer be pumped through arteries properly, this can lead to a heart attack or stroke. Doctors are typically only able to diagnose the disease once it reaches an advanced stage. Computer scientists at the University of Kaiserslautern are developing a software program that will allow doctors to detect calcification earlier. To do so, they use image data from computer tomography (CT). They will present the technology at the medical technology exhibition, Medica, from 13 to 16 November in Dusseldorf, at the research stand (Hall 7a, Stand B06) of Rhineland-Palatinate.
According to the German Vascular League, around four million people in Germany suffer from arteriosclerosis. It is even responsible for half of all fatalities in industrialized countries. "Often, the disease is only discovered at an advanced stage," says Christina Gillmann, doctoral student at the chair for 'Computer Graphics and Human Computer Interaction' of Professor Dr Hans Hagen. "For example, doctors are only able to detect deposits in blood vessels on CT images once thicker layers are already present on the vessel walls." At that point, an operation is typically the only option available for treating patients. However, it is possible to detect the disease early enough in those who eat healthily and exercise regularly.
The computer scientists in Gillmann's team are currently developing a computer program that seeks to help doctors give an early diagnosis. To do so, they use existing CT images. This x-ray technology provides physicians layered patient images that are usually shown in greyscale. "The resolution of the images is not very high," the researcher continues. "The data has to be prepared differently in order to detect arteriosclerosis at an early stage." Although there are already techniques that can allow such values to be obtained from CT data, they are simply far too complicated and unsuitable for routine medical practice.

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For their program, the computer scientists filter out the additional information from the CT scans. This makes it possible, for example, to depict the branches of the arteries accurately. The researchers at Kaiserslautern are cooperating closely with physicians from Dayton in the United States, led by Professor Dr Thomas Wischgoll, and from Colombia under Professor Dr José Tiberio Hernández Peñaloza. The procedure is not only interesting for doctors, but also industrial companies. They could use the technology, for example, to screen their products more precisely and thereby identify any areas of damage.
However, it will take a few more years of development work before the system may one day be used in hospitals. At Medica, the researchers are presenting their technology at the research stand of Rhineland-Palatinate.
The Working Group for Computer Graphics and Human Computer Interaction has already been conducting research for a long time on preparing data from imaging processes for medicine, such that it can be used simply and reliably in routine clinical practice. They have thereby succeeded, for instance, in using their procedure to separate tumors more distinctly from healthy tissue in images. The computer scientists are working closely with various partners in their projects, including the University of Leipzig Medical Center and the Premier Health Clinic in the US state of Ohio.

Source:

http://www.uni-kl.de/en/news/news/news/detail/News/medica-2017-neue-software-ermoeglicht-fruehe-diagnose-bei-arterienverkalkung/

ESC: At Long Last, Inflammatory Hypothesis Confirmed in CVD by CANTOS Residual major CV event risk reduced by 15%

Since this is an orphan drug you better start saving your pennies, your insurance likely won't pay for it. They would rather pay for your heart attack or stroke. 
https://www.medpagetoday.com/MeetingCoverage/ESC/67529?xid=nl_mpt_DHE_2017-08-28&

• by Peggy Peck, Editor-in-Chief, MedPage Today August 27, 2017
• This article is a collaboration between MedPage Today® and:
  

Action Points

• Note that this large randomized trial demonstrated that the anti-IL-1 therapy canakinumab reduces the rate of myocardial infarction among those with prior MI and an elevated CRP.
• Be aware that deaths from infection were significantly more common in the canakinumab arm.

BARCELONA -- Long-awaited evidence that targeting an inflammatory pathway can reduce heart attacks and stroke independent of lipids is now in hand -- canakinumab (Ilaris) reduced events by 15% compared with placebo.
But there is a two-fold catch: Because canakinumab is an immunotherapy, the drug carries a high price tag and use was associated with an increased risk of fatal infections.
Canakinumab is a human monoclonal antibody that targets the interleukin-1beta innate immunity pathway and it is currently approved as an orphan drug for treatment of two rare pediatric conditions -- systemic juvenile idiopathic arthritis and cryopyrin-associated periodic syndromes for which it is administered monthly and carries an annual price tag of $200,000.
Thus, the reception was mixed: Anthony DeMaria, MD, of the University of California San Diego School of Medicine, called the results "really big because it is a totally new mechanism." But while Stanford cardiologist Robert Harrington, MD, agreed that CANTOS provides evidence to validate the inflammation hypothesis, he suggested it is too soon to strike up the band.
In the Canakinumab Anti-inflammatory Thrombosis Outcomes Study (CANTOS), 150 mg of canakinumab every 3 months reduced high-sensitivity C-reactive protein (hs-CRP) levels by an average of 37% compared with placebo and achieved a 15% reduction in cardiovascular events -- mostly MIs -- compared with placebo, Paul Ridker, MD, reported here at the European Society of Cardiology 2017 congress.
The CANTOS findings were simultaneously published online by the New England Journal of Medicine.
After a median follow-up of 3.7 years, the event rate was 4.5 per 100 person-years in the placebo group versus 3.86 events per 100 person-years in the canakinumab 150 mg group. Two other arms -- canakinumab 50 mg and 300 mg -- also achieved reductions in events (4.11 and 3.90 per 100 person-years, respectively) but only the 150-mg dose achieved a statistically significant reduction. There was no reduction in mortality.
The trial recruited patients who had a history of MI and a hs-CRP level of 2.0 mg/L or higher.
Reflecting on the finding, Ridker told MedPage Today that he had spent roughly 25 years investigating "one fundamental question: Why do half of all heart attacks and strokes occur in people with no known risks?"
Click here for video comments from study authors of the ESC late-breaking trials, and discussions by leading cardiologists from around the world.
His timeline for proving the inflammation hypothesis began more than 20 years ago, "when we published the first paper that said if you checked an inflammatory marker, what we now call CRP, you could identify people at high risk for heart attacks ... 19 years ago we published a paper showing that statins reduced inflammation, and about 8 0r 9 years ago we published a paper that showed if you had high CRP and low LDL, you had better be on a statin.
And through that whole process the fundamental question we asked remained: Can we lower event rates by reducing inflammation?"
The answer, based on CANTOS, is yes, Ridker concluded.
Moreover, he noted that, although there was no cardiovascular mortality benefit, there was 30% reduction in need for bypass surgery, angioplasty, and heart failure -- all of which means a significant improvement in quality of life. And treatment was also associated with a reduction in gout, rheumatoid arthritis, and osteoarthritis, he said.
Interestingly, the treatment had no effect on lipids, which suggests that the benefit was all attributable to the anti-inflammatory activity. But Ridker added that the inflammatory hypothesis in no way competes with the lipid hypothesis. "I think statins are the miracle drugs of the century, and all of these patients [in CANTOS] were on aggressive statin therapy."
Cancer Benefit
And canakinumab treatment had yet another benefit: There was an apparent decrease in risk of cancer, a finding that was elucidated in a Lancet paper also published today. In the cancer analysis, also authored by Ridker, total cancer mortality was lower only in the 300-mg group, but "[i]ncident lung cancer (n=129) was significantly less frequent in the 150 mg (HR 0.61 [95% CI 0.39–0.97]; P=0.034) and 300 mg groups (HR 0.33 [95% CI 0.18–0.59] P<0.0001."
And now the bad: Canakinumab was associated with a higher incidence of fatal infection than placebo -- the rate was 0.18 in the 3,344 patient placebo group versus 0.32 among the 6,717 patients who received any dose of the drug, which worked out to 23 deaths vs 78 deaths (P=0.02).
There was no significant difference in all-cause mortality (HR for all canakinumab doses vs placebo, 0.94; 95% CI 0.83-1.06; P=0.31).
"Despite the scientific and clinical excitement associated with having a new mechanism of action to attack in the treatment of coronary artery disease," Harrington wrote, "a better understanding of the risks and benefits of this form of therapy is needed. Given that there was no observed effect on cardiovascular mortality in this trial, more information about the details of the myocardial infarctions (infarct size, Q-wave vs. non–Q-wave, and spontaneous or procedure-related) is needed to better assess the clinical benefit of canakinumab. We also need additional information about the fatal infections encountered in CANTOS. Furthermore, any discussion of the use of canakinumab in patients with a previous myocardial infarction must consider cost. Given monthly for approved indications, canakinumab is priced at approximately $200,000 per year in the United States. Such pricing may be suitable for rare diseases, but not for a common indication such as coronary artery disease, even if given every 3 months."
Price vs Benefit
Harrington is not the first to point out this difficulty with CANTOS -- on June 28 heart failure specialist Milton Packer, MD, wrote this in his MedPage Today blog: "My prediction: [canakinumab] may cost $64,000 for a 15-20% reduction in the risk of a major cardiovascular event, without decreasing cardiovascular death by itself.
"Is it worth it? If there was push back from payers for [evolocumab] Repatha, I can just imagine what will happen if Ilaris receives a cardiovascular indication."
Repatha is a PCSK9 inhibitor that aggressively lowers lipids and is approved for patients who fail statin therapy, including patients with heterozygous or homozygous familial hypercholesterolemia. But while the lipid reductions with the PCSK9 therapy are impressive, and the FOURIER trial found a 15% reduction in events with treatment, neither evolocumab nor alirocumab (Praluent), a PCSK9 inhibitor from Sanofi/Regeneron have achieved wide uptake as payers balk at the high price tags for the drugs.
Speaking at an ESC press briefing, Ridker said, "This is what personalized predictive medicine is all about." Once a patient has experienced an MI, there is always residual risk of recurrence. Thus, he suggested that residual risk can be divided into residual lipid-driven risk and residual inflammatory-driven risk.
Co-investigator, Peter Libby, MD, of Massachusetts General Hospital, put it this way: 30 days after an MI, when a patient is on statin therapy and stable, physicians could check LDL and then initiate more aggessive statin therapy if it is not well-controlled. Similarly, physicians should check hs-CRP, and if it is elevated -- 2.0 mg/L or higher -- initiating anti-inflammatory therapy targeting interleukin-1 beta would be an option.
That said, Libby noted that he was not recommending off-label use of canakinumab. "We need to wait for guideline committees to assess the evidence."
Ridker told MedPage Today he believed canakinumab might prove to be most useful if it were given to an identified high-responder group. He noted that after a single injection responders have a significant reduction in highly sensitive-CRP and it is those patients who would benefit from continuing on treatment. At that point, "I believe the benefit would outweigh the toxicity risk," he said.
"Maybe that first dose could be free," Ridker added.
And while canakinumab is the first anti-inflammatory agent to demontrate benefit, there may be others, Ridker said. For example, "we have a [National Heart, Lung, and Blood Institute] trial of methotrexate that is on-going. If that proves to be effective, it would be only pennies per treatment." At the press conference, Ridker said the methotrexate trial has "randomized about 4,000 patients, and we will need to get to 7,000 so it will be a few years before we have results."
Novartis, which developed canakinumab, may be sympathetic to that approach. Novartis Global Head Drug Development and Chief Medical Officer Vas Narasimhan, MD, and Jay Bradner, MD, president of the company's Institutes for BioMedical Research, told reporters that the company planned to go ahead with a filing with the FDA as early as October.
"We plan to move ahead with a cardiovascular filing" based on the CANTOS results, Narasimhan said. And while the filing will be based on the total results, "we plan to bring the findings in the hs-CRP responders to our meeting with the FDA." The company also plans to proceed with a phase III trial in non-small cell lung cancer in the first quarter of 2018.
Narasimhan said that, in CANTOS, patients whose hs-CRP declined to 1.8 mg/L or less had a much more robust response. In that subgroup, the number needed to treat to prevent a primary endpoint event was 50 at 2 years and 30 at 3.7 years.

Speech language therapy delivered through the Internet leads to similar improvements as in-person treatment

Well, there goes your insurance paying for your speech therapist.
https://medicalxpress.com/news/2017-07-speech-language-therapy-internet-similar.html
Telerehabilitation helps healthcare professionals reach more patients in need, but some worry it doesn't offer the same quality of care as in-person treatment. This isn't the case, according to recent research by Baycrest.

The study, published in the journal Aphasiology, found that patients who accessed speech language therapy over the Internet saw large improvements to their communication abilities that were similar to those of patients doing in-person therapy.
This finding encourages greater adoption of telerehabilitation to treat patients living in remote communities who are recovering from post-stroke communication disorders as a way to improve the use of limited healthcare resources.
"People with communication disorders, such as aphasia, are often provided with therapy only for the first few months after they have been diagnosed, despite evidence that therapy can benefit them for years," says Dr. Jed Meltzer, lead author and neurorehabilitation scientist at Baycrest's Rotman Research Institute. "Location can limit a patient's access to a speech-language pathologist, especially for individuals living in rural areas. Our study shows that telerehabilitation can remove this geographic barrier since participants saw similar recovery results."
Despite these comparable improvements, an unexpected finding was that patients who did telerehabilitation therapy weren't as confident in their communication abilities compared to those who did in-person treatment.
"Low confidence can lead to continued isolation and it is important that patients be encouraged to find other ways to socially engage with others beyond their therapy," says Dr. Meltzer.
Based on the study's findings, Dr. Meltzer suggests that speech-language pathologists continue to play a critical role in the creation and supervision of treatment for patients and computer-based or tablet-based applications can help handle day-to-day treatment exercises.
The study analyzed the recovery of 44 patients who had a communication disorder caused by a stroke at least six months prior to recruitment. All patients received an in-person assessment and participated in a language skills test in the first week of therapy. They were then assigned either telerehabilitation or in-person treatment for 10 weeks. Once treatment was completed, each patient completed a language skills test and a questionnaire. Their partners also provided feedback about the patient's recovery.
As the only Ontario hospital offering one of the few clinically validated, gold standard telerehabilitation programs for Parkinson's patients, the Lee Silverman Voice Treatment (LSVT®) eLOUD Clinic, offering telerehabilitation services at Baycrest allows clinicians to help more patients. "Older adults may face mobility issues and have a difficult time travelling to a specific location for treatment," says Maria Piccini, a Baycrest speech-language pathologist who runs the LSVT® Clinic. "Telerehabilitation makes it easier for these individuals to access the therapy they need and improves their chances of completing the treatment."
These findings support Dr. Meltzer's next steps which involve combining telerehabilitation technology with other therapies, such as medication or brain stimulation, to explore ways to provide more efficient treatment to patients.

Explore further: New intervention brings hope to patients with primary progressive aphasia

More information: Jed A. Meltzer et al, Computer-based treatment of poststroke language disorders: a non-inferiority study of telerehabilitation compared to in-person service delivery, Aphasiology (2017). DOI: 10.1080/02687038.2017.1355440

Does Task-Specific Training Improve Upper Limb Performance in Daily Life Poststroke?

So your insurance company could take the conclusions from this and state that there is no point to therapy since it doesn't translate to actual use. Leaving you on your own once again.

 Does Task-Specific Training Improve Upper Limb Performance in Daily Life Poststroke?

Kimberly J. Waddell, MS, Michael J Strube, PhD, Ryan R. Bailey, PhD, Joseph W. Klaesner, PhD, Rebecca L. Birkenmeier, OTD, Alexander W. Dromerick, MD, Catherine E. Lang, PhD

First Published March 1, 2017 research-article

Abstract

Background. A common assumption is that changes in upper limb (UL) capacity, or what an individual is capable of doing, translates to improved UL performance in daily life, or what an individual actually does. This assumption should be explicitly tested for individuals with UL paresis poststroke.  
Objective. To examine changes in UL performance after an intensive, individualized, progressive, task-specific UL intervention for individuals at least 6 months poststroke.  
Methods. Secondary analysis on 78 individuals with UL paresis who participated in a phase II, single-blind, randomized parallel dose-response trial. Participants were enrolled in a task-specific intervention for 8 weeks. Participants were randomized into 1 of 4 treatment groups with each group completing different amounts of UL movement practice. UL performance was assessed with bilateral, wrist-worn accelerometers once a week for 24 hours throughout the duration of the study. The 6 accelerometer variables were tested for change and the influence of potential modifiers using hierarchical linear modeling.  
Results. No changes in UL performance were found on any of the 6 accelerometer variables used to quantify UL performance. Neither changes in UL capacity nor the overall amount of movement practice influenced changes in UL performance. Stroke chronicity, baseline UL capacity, concordance, and ADL status significantly increased the baseline starting points but did not influence the rate of change (slopes) for participants.  
Conclusions. Improved motor capacity resulting from an intensive outpatient UL intervention does not appear to translate to increased UL performance outside the clinic.

Why Your Health Insurance Won’t Cover Medical Marijuana

This is why your Mom and grandma need to be screaming in your federal legislators faces for full legalization. Helpful drugs are being censored.

My 13 reasons for marijuana use post-stroke. I would have to self treat my stroke rehab needs because we have NO stroke leadership or strategy to figure out how to create THC or marijuana protocols. I can't self treat using any form of medical marijuana including legal THC because it would require getting a prescription and with no protocol doctors are not going to write prescriptions. Our fucking failures of stroke associations are doing nothing to actually help survivors by creating stroke protocols and solving all the fucking problems in stroke.

http://www.cheatsheet.com/money-career/why-your-health-insurance-wont-cover-medical-marijuana.html/?ref=YF&yptr=yahoo

ReWalk Exoskeleton Must be Covered by Insurer, Says Medical Review Organization

Our fucking failures of stroke associations should be following up with all the other exoskeletons out there and making sure they are covered. That is a joke since it will NEVER occur.
These 67 exoskeleton posts. These 354 walking posts.
Your doctor can correlate the intersection of these posts, I'm not being paid for this, they are.

ReWalk Exoskeleton Must be Covered by Insurer, Says Medical Review Organization

This week, ReWalk Robotics Ltd., a company that designs exoskeletons for use by paraplegics, announced that an independent medical review organization ruled that a U.S. health insurance provider is responsible for reimbursing a patient for a ReWalk Personal exoskeleton system.
The news comes after the health insurance provider initially denied the patient coverage.
While official details are scant from ReWalk, the company did mention that the beneficiary is a surgeon, who, after suffering a spinal cord injury, makes use of a wheelchair 11 hrs per day.
“The ruling by the independent medical organization marks an important moment for exoskeletons being accepted as protocol technology for those with spinal cord injury,” said ReWalk’s CEO Larry Jasinksi. “Health benefit providers have historically been hesitant to acknowledge the clinical benefits in their case assessments. This ruling, and subsequent coverage and reimbursement will help ReWalk in our efforts to facilitate greater patient access to the device.”
According to Motherboard, the ReWalk costs $69,500. The device was approved for marketing by the U.S. Food and Drug Administration (FDA) in June 2014. At the time, the Centers for Disease Control and Prevention estimated that around 200,000 people suffered from spinal cord injury in the U.S.
The ReWalk isn’t the only exoskeleton recently receiving media attention. The company SuitX recently unveiled their model for the Phoenix, which costs around $40,000. The research behind the device was funded by the Defense Advanced Research Projects Agency (DARPA).
However, ReWalk has stated that its model is the only exoskeleton currently approved for market by the FDA. Under the approval, it can be used in rehabilitation and personal settings.
According to ReWalk, the Personal model is capable of walking speeds up to 1.6 mph, helps improve bowel and bladder function, and decreases body fat and pain, among other things.
In December 2015, the U.S. Dept. of Veteran Affairs set a national policy, and agreed to pay for ReWalk exoskeletons for eligible veterans with spinal cord injuries.