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Million Hearts Campaign: Clinical Perspective. Robert Marshall, M.D. Cardiocare , LLC George Washington and Georgetown University Hospitals. Goals. Increase access and improve quality of care

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million hearts campaign clinical perspective
Million Hearts Campaign: Clinical Perspective

Robert Marshall, M.D.

Cardiocare, LLC

George Washington and Georgetown University Hospitals

goals
Goals
  • Increase access and improve quality of care
  • Define effective “Care”: Data gathering, identify risk, treatment/intervention, monitor, motivate, provide incentive to improve
  • Preemptive strike: despite current tools, limited ability to identify impending MI/sudden death victims
  • Frontline Anecdotes:
    • High rate of young patients with acute cardiac events
    • Obesity and smoking are prevalent: lifestyle patterns differ geographically and socioeconomically leading to increased CV risk
    • Weight extremes
    • Young women smoking
    • Stress and modern society: economic, employment pressures, working mothers, multitasking, inadequate sleep
clinical context current tools
Clinical Context: current tools
  • Symptoms: acute or functional, age and gender differences in symptom character
  • Risk factors: medical condition, lifestyle/habits, biochemical markers, family history
  • Physiologic testing: role with or without symptoms? Health concerns and cost effectiveness.
  • Anatomy: imaging options
health statistics data in perspective
Health Statistics Data in Perspective
  • Clinician objectives
    • Pursue meaningful risk factors in order to maximize screening opportunities
    • Translate data into action: tailor medical therapy and affect behavioral change
    • Provide means to achieve goals (eg: weight loss directly reduces triglycerides and glucose levels; BP decrease from 150 to 130mmHg cuts CV risk in half)
health statistics data in perspective1
Health Statistics Data in Perspective
  • Patient perspective
    • How does this data affect me?
    • What do I need to do?
    • What should I eat/drink and not eat/drink?
    • Takeaway from doctor visit: tangibles (points to remember, resources, directives, goals)
    • Attitude: proactively engaged, taking control vs. disillusioned and feeling judged
patient xy
Patient XY
  • 44 yo Asian man presenting to the hospital with acute MI: stent, recovery, discharge on meds
  • First office visit: 5’9” 192lbs (BMI 28.4)
    • BP 145/84, HR 62
    • Waist 36”, Hip 30”
    • Habits: weight lifting, fruit juice, diet soda, pasta
    • LDL 138, HDL 32, TG 210, Glu 130
    • Plan: Med: ASA, statin therapy; Activity: aerobic and light resistance interval training; Diet: portion reduction, eliminate sugar containing beverages, reduce carbs: white bread, white pasta, dairy, ice cream
patient xy1
Patient XY
  • 6 months later:
      • Wt 190 to 176lbs BMI:
      • Waist 36” to 33”
      • BP 118/70
      • LDL 144 to 78
      • TG 210 to 88
      • HDL 32 to 36
      • Glucose 130 to 88
      • Feels great, looks great! Risk for recurrent MI low.
patient xx
Patient XX
  • 48 yo African American woman presenting with fatigue, shortness of breath
    • 5’4” 225lb (BMI 38.6)
    • BP 162/90 HR 88
    • Waist 38” Hip 34”
    • LDL 150, HDL 65 TG 288, glu 140, Hgb A1C 6.3
    • Habits: sedentary office job, diet soda, chips, healthy juice
    • Plan: Med: ARB/HCTZ, Activity: walking program, light dumbbells, Diet: 2 4oz servings fresh fruit, no juice, 1 oz unsalted nuts twice daily, no chips, decrease bread, pastry and pasta intake
what s missing
What’s Missing?
  • Patient friendly publications/internet resources: most can’t remember specifics of doctor visit
  • “Go to” resources for info/nutrient content of individual foods and commercial diet plans: (calories, % CHO/Pro/Fat, Fat composition: sat/.unsat./chol, vitamin content)
  • Cooking methods: effect on nutrient values
  • Office tools: %body fat, metabolic rate,visit preparation given time limits: review pre-loaded data before visit (patient portal)
  • Specific Exercise plans
  • Age/Gender specific info- calorie expenditure