How can physicians partner with their patients to ensure a healthy heart environment? The AMA hosted a vibrant tweet chat on World Heart Day Tuesday to explore answers to this question. Primary care physician Michael Rakotz, MD, sat down with leading cardiologist Clyde Yancy, MD, as his guest.
Dr. Yancy is past president of the American Heart Association (AHA) and current chief of the Division of Medicine-Cardiology and Magerstadt Professor at Northwestern University’s Feinberg School of Medicine. And Dr. Rakotz is director of chronic disease prevention with the AMA’s Improving Health Outcomes initiative.
The two doctors discussed the state of the nation’s heart health and the ways primary care physicians can use the many tools in their everyday practice. The conversation was tweeted to a national audience who used hashtag #AHealthierNation to participate.
Here are the top 9 questions from Tuesday’s tweet chat, along with the resources that can help you in your practice:
1. Should the ASCVD risk estimator replace other risk calculators for estimating 10-year risk in patients 40-79 years old?
Takeaway: Use the ASCVD risk estimator to calculate 10-year and lifetime risk for developing arteriosclerotic cardiovascular disease.
2. The 2013 cholesterol guideline by the American College of Cardiology (ACC) and the AHA was a major shift in how we determine who needs therapy. What is the critical message?
Takeaway: The clinician-patient risk discussion (CPRD) is a key for communicating risks, benefits and concerns about using statins between doctors and patients. Use this conceptual framework for CPRD from the Journal of the American College of Cardiology.
3. Some physicians have questioned the benefits of statins, creating doubt for some patients and clinicians. Do you have any advice for clinicians?
Takeaway: When approaching the conversation with patients in regards to blood cholesterol, use the 2013 ACC/AHA Guideline on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults.
4. PCSK9 inhibitors are here. Do you see a use for them in primary care, or will they be prescribed mostly by cardiologists?
Takeaway: PCSK9 inhibitors appear to fit with the 2013 ACC/AHA guideline for lowering cholesterol, but cost may be a concern.
Read about the cost of these new cholesterol medications.
5. Guidelines for lifestyle may inform physicians about evidence, but changing patient behavior is hard. How should a primary care physician approach patients about behavior change?
Takeaway: For clinicians, the 2013 AHA/ACC Guideline on Lifestyle Management to Reduce Cardiovascular Risk is an excellent tool.
For working with patients, Dr. Rakotz recommends No Sweat by Dr. Michelle Segar.
@PamelaSmithAPRN chimed in to provide a link to the AMA’s M.A.P. framework on its STEPS Forward website. Use this module to obtain accurate numbers and improve blood pressure control.
6. Why is Life’s Simple7 so effective?
Takeaway: Use Life’s Simple7 as an effective assessment tool for engaging with patients. When used in primary care, it can motivate patients to kickstart change.
7. Mobile apps that remind patients through texts to help with behavioral change have evidence and possibilities for the future. Do you see this as their primary role?
Takeaway: Using text messages to keep patients aware of the lifestyle changes they are trying to make is showing promise for some patient-physician partnerships. A JAMA study found a definite increase in physical activity over six months of use. Try these new tools for motivating your patients to make healthy changes.
8. Because 75 percent of our sodium intake comes from pre-packaged foods and restaurants, do you think we need restriction laws in place
Takeaway: Check out this infographic from the AHA that details sodium intake in America and use it in conversation with patients to raise awareness of our high sodium diet.
9. Based on the preliminary reported results from SPRINT, what changes do you foresee in the 2016 ACC/AHA blood pressure guideline
Takeaway: SPRINT is designed to answer the question, “Will lower blood pressure reduce the risk of heart and kidney diseases, stroke or age-related declines in memory and thinking?”
Visit the SPRINT homepage or read this overview of the approach used by SPRINT to achieve the systolic blood pressure (SBP) goal of under 120mm Hg.
If you missed the tweet chat, visit the storify for this #AhealthierNation chat to see all of Dr. Rakotz’ questions, Dr. Yancy’s answers and tweets from participants in a chronological recap of the event.
