AAMC Magazine

Fall 2007

Suddenly “At Risk”

Visit the Dare to C.A.R.E.Web site by clicking here

Screening Program Reveals Surprise Blockage

Screening was a lifesaver for Jan Hill, shown with her husband Rolf.

“I didn’t even want to go that night!” said Jan Hill, recalling her reluctance to attend the seminar that just might have saved her life. “I wanted to stay home and watch the American Idol finale.” Instead, Mrs. Hill and her husband, Rolf, of Odenton, Maryland, attended a Dare to C.A.R.E. cardiovascular seminar at Anne Arundel Medical Center. “I’m only 60 years old and fairly healthy. I felt it wasn’t something I needed to attend,” said Mrs. Hill of her disinterest in the event.

A few weeks earlier, primary care physician Andrew S. Dobin, M.D., who practices in Bowie, had recommended the cardiovascular seminar to Rolf Hill during a routine office visit. “Dare to C.A.R.E. studies are a great non-invasive way to look at someone’s vascular system and overall cardiac risk,” said Dr. Dobin. “Even if someone doesn’t have critical blockage, it helps guide us to push treatment for risk factors such as lowering cholesterol.”

John D. Martin, M.D., vascular surgeon and medical director of the AAMC Vascular Center, and one of the driving forces behind Dare to C.A.R.E., regularly speaks at the seminars and describes the program’s fight against cardiovascular disease as two-pronged: an informational seminar and screening. “We invite guests to attend a free seminar at which we discuss the causes and risks of cardiovascular disease, as well as current treatment options. After we’ve provided that information, we welcome guests to have a free ultrasound screening of the arteries in the neck, legs, and abdomen.”

The carotid artery travels up the neck toward the head and supplies the brain with oxygenated blood. Stenosis or narrowing of the carotid artery slows blood flow, which can lead to clotting, a major cause of strokes.

Many people in their 50s and older suffer from carotid arterial blockage but are asymptomatic and lack the medical indications that insurance companies want before covering the cost of diagnostic imaging tests. “The result can be a gap in the circle of treatment,” said Dr. Martin. “The lack of symptoms or defined risk often prevent insurance companies from authorizing the very tests needed to assess that risk.”

Enter Dare to C.A.R.E., a screening program that fills the gap in the treatment circle by offering free Doppler ultrasound scans of the neck’s arteries. Carotid arterial stenosis (also called carotid artery disease) is diagnosed by ultrasound, the results of which allow physicians to see an artery’s shape and size, as well as narrowing caused by plaque build-up.

Mrs. Hill’s ultrasound revealed her left carotid artery was nearly 100 percent blocked. “Nurses immediately started scurrying around,” notes Mrs. Hill, who had her ultrasound performed at the Anne Arundel Diagnostics office in Bowie. “Dr. Martin came in a few moments later and we discussed my situation.”

Dare to C.A.R.E. provides free faceto- face consultations with a physician for patients whose ultrasounds reveal serious blockages. AAMC has supported Dare to C.A.R.E. by purchasing telecommunications equipment that allows physicians to provide consultations even when they are not physically on location. “Patients screened outside of Annapolis receive the same consultation as patients screened in my office,” says Dr. Martin. “That face-toface is vital for peace of mind and for patients to understand their potential care options.”

A computed tomography angiogram (CTA) exam confirmed the blockage in Mrs. Hill’s carotid artery. Dr. Martin advised her of the treatment options: carotid stenting to surgically widen the carotid artery; or carotid endarterectomy to surgically remove plaque buildup in the carotid artery. Mrs. Hill opted for the endarterectomy and, on May 29, a two-inch piece of arterial plaque was removed from her left carotid artery. Almost immediately, blood flowed freely again.

Mrs. Hill and Dr. Martin are thrilled with the outcome to the odyssey that began with Mrs. Hill being caught by surprise that she was “one of those in the room who was at-risk” for coronary artery disease.

“The entire Dare to C.A.R.E. experience has been fantastic,” she said. “I had so many people help navigate me through the processes of getting screened and tested. People from the program called me to check on me and ask how I was doing. They are just wonderful.”

Your AAMC Medical Staff at Work

John Martin, M.D., Jon Hupp, M.D., Louise Hanson, C.R.N.P., and a team of researchers, evaluated the economic and community impact of the Dare to C.A.R.E. program, the results of which were published in the August issue of the prestigious Journal of Vascular Surgery.

Of the 12,000 people tested between mid-2000 and 2006, they found:

Almost half showed some degree of vascular disease.
Those with risk factors and advanced age were more likely to have more significant disease.
Diabetes alone doubled the prevalence of disease in all age groups.
Risk factors included: past smokers, 51.3 percent; current smokers, 7.3 percent; diabetes, 10.6 percent; hypertension, 46.7 percent; high cholesterol, 49.4 percent; and prior myocardial infraction, 11.9 percent.

More than 340 individuals requiring intervention were identified in the first five years of the program.

For more information on screenings, visit www.daretocare.us.

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