The Good, the Bad, and the Ugly of Heart Disease 

Author: Erik D. Axene, MD, FACEP, MA

The GOOD: The human heart is an amazing organ! This muscular pump moves about 2,000 gallons of blood daily with its chambers, valves, and electrical circuitry. And to move all that blood, the heart pumps about 100,000 times daily without taking a break. That works out to about 2.5 billion heartbeats and 60 million gallons of blood throughout a lifetime!1. In our communities, we are experts at identifying the warning signs, treating emergent heart conditions, and getting patients to the right place for life-saving care.

The BAD: Unfortunately, based on statistics, this amazing organ is also our weak point. Heart disease is the leading cause of death in the United States.2 As of 2019, males accounted for approximately 70% of all heart attacks and usually have a heart attack 7-10 years earlier than females. However, when female patients have a heart attack, they have a higher mortality risk.

ACE Corner:

Your ACE in the hole: 11% of STEMI patients have a normal initial EKG.

Let’s look at a case study. A 91-year-old female calls 911 due to chest pain. In the elderly population, symptoms can be subtle, and in women, atypical signs are more common. The bottom line is that we should always be concerned when patients complain of chest pain regardless of demographic. Keep an eye out for sweating, vomiting, and/or complaints of radiating pain to the arms or jaw. These are red flags and could indicate a STEMI. But even then, 11% of STEMI patients have a normal initial EKG, so be on your guard.

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The UGLY: We are not so good at taking care of our own. Did you know that the average age of a first cardiac event is 65, and in the first responder community, studies have shown the average age of a first cardiac event is as young as 46? The risk of death by sudden cardiac arrest increases 18 times when first responders reach the age of 45 (this risk is even higher with high blood pressure and tobacco factored in).3

ACE Corner:

Did you know that the average age for a first cardiac event is 65? And in the first responder community, studies have shown the average age of a first cardiac event is as young as 46.

As a medical director, I get a lot of calls, texts, and emails related to health improvement. Most of the time, the questions I get are usually related to diet and exercise. And these should be components of any personal wellness plan to improve health. But I would argue that sleep, mental health, and loneliness should be addressed first. And the data is proving it! Anxiety, depression, chronic stress, and PTSD have been linked to an increased risk of heart disease and often lead to behavior choices that further increase the risk of adverse cardiac events.4

But there is hope! We can do many things to decrease our risk of heart disease. Being aware of your stress level and mental well-being is a good place to start. This is a tough job; we must look out for ourselves and our colleagues. For me, it meant decreasing the number of shifts I worked per month. For others, it might mean seeing a counselor or talking to your physician about stress management techniques and other treatment options. Improving your level of fitness and nutrition can also help you decrease your cardiac risk. The good news here is that there are things we can do to take control of our health. Start small and build healthy life habits into your routine.

We recorded a podcast about the good, the bad, and the ugly of heart disease! This episode addresses the unique health-related challenges of first responders. Check it out here:


[1] Temple Heart & Vascular Institute. (2021, February 10). 10 interesting heart facts you may not know. Temple Health.,up%20to%20over%202%2C000%20gallons.

[2] National Center for Heart Statistics. (2023, January 18). FASTSTATS – leading causes of death. Centers for Disease Control and Prevention.

[3] Baker, D. (2022) Lexipol. Understanding Cardiovascular Risks to First Responders

[4] Centers for Disease Control and Prevention. Heart Disease and Mental Health Disorders.,indirectly%2C%20through%20risky%20health%20behaviors.

[5] Riley RF, Newby LK, Don CW, Roe MT, Holmes DN, Gandhi SK, Kutcher MA, Herrington DM. Diagnostic time course, treatment, and in-hospital outcomes for patients with ST-segment elevation myocardial infarction presenting with non-diagnostic initial electrocardiogram: a report from the American Heart Association Mission: Lifeline program. Am Heart J. 2013 Jan;165(1):50-6. doi: 10.1016/j.ahj.2012.10.027. Epub 2012 Nov 21. PMID: 23237133; PMCID: PMC3523309.

About Axene Health Partners, LLC (AHP)

AHP is an independent actuarial and clinical healthcare consulting firm, established in 2003 and wholly owned and operated by its Partners.  AHP provides healthcare consulting services to a wide spectrum of healthcare companies including health plans, health insurance companies, healthcare providers, brokers, employee benefit plan sponsors, healthcare innovators, and various governments and regulatory agencies.  AHP has offices throughout the United States with its corporate headquarters located in Texas. For more information, please see

About Axene Continuing Education, LLC (ACE)

ACE is a wholly owned subsidiary of AHP based in Texas committed to providing high-quality, practical educational experiences that support the learner in their commitment to provide the best possible healthcare to their patients.  Initially, these efforts have been focused on firefighters, EMS, and EMT professionals. For more information, please see