The election potential of an ejection fraction.

We are always interested when there is a Presidential candidate who breaks the norm.  I was very young when President John F. Kennedy was elected, but I remember that there was a lot of attention paid to the fact that he was the first Roman Catholic elected as President.  I was in my teens in 1984 when Geraldine Ferraro became the first woman to run on a major party national ticket for vice president, increasing the speculation regarding when and who the first woman President might be.  I was much older when another Democrat, Barack Obama, became the first African American President. 

But in late February, I was listening to the local news on NBC when another first of a different sort came to my attention.  The news anchor announced that candidate Mike Bloomberg released his ejection fraction.  She even explained what that term meant, probably anticipating the blank stares on most of her viewers faces.  The ejection fraction, as readers of this blog know, is a measure of how well your heart pumps blood.  I quickly did an internet search and indeed found a number of stories sharing a synopsis of Bloomberg’s heart health. 
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Referring to a letter about Bloomberg’s recent “cardiac stress testing with a stress echocardiogram", a February 27, 2020 USA Today article said: The results showed, according to Sisson, that Bloomberg's "left ventricular ejection fraction was 60-65%" and was deemed "normal", as well as his left ventricular cavity size.  Ejection fraction is a key measurement of heart health, as it gauges how much blood the heart pumps. A low measure suggests a major heart attack with significant tissue damage.  The article also said that the letter noted that Bloomberg, 78, "underwent coronary stent placement surgery for a blocked coronary artery in 2000" but that there is no evidence of lasting damage to his heart. 

The stories also noted that the Bloomberg campaign was putting pressure on candidate Bernie Sanders to release his ejection fraction.  This was because Sanders had suffered from a heart attack earlier in the campaign.  The USA article also noted that the issue came up in a debate, and afterwards the mudslinging appeared to ramp up between the Bloomberg and Sanders campaign.  A Sanders press agent said questions about his medical records and his health were equivalent to a "smear" campaign and claimed Bloomberg has had "heart attacks in the past."  Then according to the article, Bloomberg campaign senior adviser Tim O'Brien compared the claim to those from President Donald Trump, slamming it as a "Trumpy lie."  While it wasn’t as childish as the 2016 Republican debate discussion on hand size, well it certainly wasn’t the most mature line of discussion.   

Normally, I would just roll my eyes about the sad trend for one candidate to attack the other about his or her deficiencies rather than to state what the candidate stands for and how that can actually benefit the country and the taxpayer.  But I found it intriguing that someone was injecting the election process with knowledge about health issues.  I wrote a post earlier about how former candidate Marianne Williamson made a plea for starting the conversation on how health greatly impacts these United States: 

•  "We have a sickness-care system in the United States. We just wait until somebody gets sick and then we talk about who's going to pay for the treatment and how they're gonna be treated. We need to talk about why so many Americans have unnecessary chronic illnesses, so many more compared to other countries."

Williamson’s website had a section devoted to health care issues.  There were a few ideas that appealed to me – some because I have suggested them myself.  For example: 

• Provide patients with more robust ongoing support from nutritionists, health coaches, therapists and mental health, exercise specialists, and other peripheral lifestyle treatment providers.   

I cannot say that I put the Bloomberg campaign comments about heart health into the Wililamson category.  By that I mean a category focusing on more enlightened health care.  His heart message was not at all altruistic.  The comments about heart health were lodged with the implication that the other candidate might drop dead or be deficient as President.

But I will give kudos for one thing.  The positive influence I got from the Bloomberg comments was that it put a term out there than I would venture to say the majority of the American population has never heard before:  Ejecton fraction.  If you live in the world of heart disease, heart attack survival or heart failure, you know that this is a very important number and one that perked up your ears. 

The others in the audience might have been thinking they had time travelled to a sixth grade math class.  Trust me, the only common denominator in this conversation was a brief sound bite to get the attention of the electorate.  People heard the word heart, and recalled that Senator Sanders had a heart attack last year.  So, I believe that the intent of the sound bite was to say:  my heart is healthier than his.  But does the fact that the ejection fraction is or is not normal make that true?

According to the American Heart Association, a normal ejection fraction can range from 50 to 70%.  Why isn’t it 100%?  The Barnes Jewish Hospital website is associated with Washington University in St. Louis.  Their website says:

• "Fraction" refers to the fact that, even in a healthy heart, some blood always remains within this chamber after each heartbeat.  An EF is a percentage of blood that is pumped out of the heart during each beat.  Ejection fraction is a key indicator of heart health.”

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The American Heart Association also tells us that:  “A ejection fraction measurement under 40 percent may be evidence of heart failure or cardiomyopathy.  An EF from 41 to 49 percent may be considered “borderline.” It does not always indicate that a person is developing heart failure. Instead, it may indicate damage, perhaps from a previous heart attack.”  This again seems to be the reason for the Bloomberg revelation about ejection fraction – to challenge Sanders, the heart attack patient, into revealing whether or not there is heart damage that can impact his health going forward.  But does normal always mean that your heart is okay?

The American Heart Association website says “you can have a normal ejection fraction measurement and still have heart failure (called HFpEF or heart failure with preserved ejection fraction).  If the heart muscle has become so thick and stiff that the ventricle holds a smaller than usual volume of blood, it might still seem to pump out a normal percentage of the blood that enters it. In reality, though, the total amount of blood pumped isn’t enough to meet your body’s needs.”  Additionally, too high an ejection fraction can be a sign of something called hypertrophic cardiomyopathy. 

So like everything else these days, you sometimes need to look beyond the statements you see on your iPhone.  (Note to self:  despite what my smartphone says, Tito Vodka and aloe vera is not an acceptable hand sanitizer!).  I do suspect that Bloomberg’s numbers really are a sign of good heart health, otherwise his staff wouldn’t have been talking about ejection fractions at all. 

But still, in this season of lots of allegations and challenges being thrown out in the press, it is good to remember that numbers do not always tell the whole story.  Especially when it comes to heart health where there are so many variables and conditions each person may have!  The bottom line for me is that it is a good thing to make the general population more aware of heart health. 

It is especially helpful for the public to realize the disability endured by a heart failure patient, or a heart attack survivor with a compromised ejection fraction.  When you think about it, the people with an ejection fraction of 40 or less have hearts pumping at a rate of at least 10 or much more percent lower than those with a healthy ejection fraction.  Just think of it as the energizer bunny with a very low battery, and then you might get an idea about the energy deficit that a heart patient has to manage.
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So, the election potential of an ejection fraction is questionable, but the education potential of an ejection fraction is priceless.