Wednesday, June 29, 2016

Atrial Fibrillation. Will you Ever Have it?

Atrial Fibrillation is one of the most common arrhythmias of the heart. It is often referred as “irregular heart beat” or “quivering of the heart”1. It is important because it is related to strokes, heart failure and cognitive decline. Its treatment, in addition to trying to control the arrhythmia, usually involves anticoagulation in order to decrease the risk of stroke.

Even if people are healthy and have few or no cardiovascular risk factors, there is a age-related risk of developing atrial fibrillation. This risk has been measured and it increases progressively with age. In one study, people between 55-59 years old have a 0.7% risk, 60-64 years old 1.7%, 65-69 years old 4.0%, 70-74 years old 6.0%, 75-79 years old, 9.0%, 80-84 years old 13.5% and older than 85 years old 17.8%2. The risk seems to be slightly higher in men than in women.

The risk of developing atrial fibrillation increases with the presence of conditions such as hypertension, diabetes mellitus, hyperthyroidism, heart failure, obesity, obstructive sleep apnea, excessive sports practice, chronic inflammatory states, and alcohol abuse3. In addition there are genetic markers that might explain why certain people develop atrial fibrillation at a younger age and why white people are more affected than people from African of Hispanic descent. There are mutations in certain genes that increase the risk and there are genetic variants called single nucleotide polymorphisms (SNP) that are associated with early onset atrial fibrillation.

Like with every condition, there are modifiable risk factors and non-modifiable risk factors (like the genetic ones). If anyone has any of the non-modifiable risk factors, it is better to be on the safer side and make sure that more risk is not added to the already present ones. Also, be in close communication with your personal physician for proper prevention and treatment if needed.


1. Obtained June 20, 2016

2. Jan Heeringa, Deirdre A.M. van der Kuip, Albert Hofman, Jan A. Kors, Gerard van Herpen, Bruno H.Ch. Stricker, Theo Stijnen, Gregory Y.H. Lip3, and Jacqueline C.M. Witteman. European Heart Journal. 2006;27: 949-953

Marco A. Ramos MD

Thursday, June 16, 2016

The Importance of Clinical Documentation Improvement

Clinical Documentation Improvement (CDI) is the recognized process of improving healthcare records to ensure improved patient outcomes, data quality and accurate reimbursement1. The effects of having a good CDI program are multiple and they include excellent record keeping for future chart review, (especially beneficial in medical research and legal discovery processes), great communication amongst healthcare providers and better resource consumption and length of stay.

An essential part of the CDI process is the role of the Clinical Documentation Specialist (CDS). The CDS is usually a registered nurse (RN) who has specialized in documentation compliance and integrity. The CDS is trained to identify records that may be lacking the specific language needed to support the documentation standards as defined by insurance companies, research protocols and the legal system. The CDS will query the healthcare providers associated to the chart to look for clarification, avoiding at all times leading the healthcare provider towards a specific diagnosis.

The query is the way the CDS communicates with the healthcare provider. It is framed as a question with background information and a request for an action which is usually an agreement or a disagreement with the question. Queries are important because the help clarify terminology so that the medical record accurately reflects reality. The timeliness of a response to a query is very importance because the closer the gap in time between the generation of the query and the response, the more better the response will reflect reality.

The CDI program is usually enhanced by a physician advisor or medical director, who is in charge of advising the CDS, generating education processes and increasing compliance with the query answering process.

Marco A. Ramos MD
Second Medical Opinions PLC
Physician Advisor in Clinical Documentation


1. Retrieved June 2, 2016