Close to six million Americans carry the diagnosis of heart failure.
Heart failure also is the leading cause of all hospitalizations in individuals over the age of 64. Additionally, once hospitalized for heart failure, the patient carries a 30 percent risk of being readmitted with heart failure in the next 30 days.
Can these admissions and readmissions be prevented or at least reduced? The answer is an astounding yes. The patient has a vital role in avoiding one of every five hospitalizations for heart failure. Furthermore, a dedicated patient may decrease the risk of annual readmission by almost 40 to 45 percent
The role of the cardiologist does not stop after diagnosing and treating the failing heart with medications, surgery and/or devices, such as pacemakers and defibrillators. Actually, diagnosing and prescribing medical and surgical options are only the first steps in a long-term relationship between the cardiologist and the patient with heart failure. The role of the cardiologist is fourfold in such a setting. The cardiologist wears several hats. She not only has to connect with the patient, engage as an active listener, convey and deliver the treatment plan, but most importantly, she assumes the role of the patient's coach, as well.
One would think that for such a common disease as heart failure, the treatment would be universal and cut and dry, as well. Unfortunately, that is not the case. There is no cookie cutter approach to heart failure. The treatment plan not only has to complement the patient's lifestyle, likes and dislikes, but also has to be consistent with his abilities and habits. Most importantly, the heart failure treatment plan has to conform to the beliefs of the patient. All the above-described patient characteristics have to be identified, recognized and acknowledged by the doctor.
The cardiologist must respect and accept these characteristics in her patients. For such a relationship to exist and be cultivated between the cardiologist and her patient, a clear, concise and predictable routine would be needed. The simplest way to connect with a patient and execute such a plan of care would be to ensure that the same cardiologist sees the patient on all the clinic visits.
To be an active listener, the cardiologist is lucky, as she already has the important ingredients of compassion and care. However, active listening also requires both time and patience. To have time, the vital component on her side, the cardiologist would need to schedule her Heart Failure Clinic with meticulous care.
The duration of these clinic visits may have to be clearly established from the onset. Adequate time has to be allotted for such visits. Thus a tailored approach for the treatment of heart failure is provided to the patient. This, of course, can only be accomplished when not only the patient listens, but also the doctor engages in active listening with time.
The cardiologist conveys the treatment plan for heart failure to the patient at the initial clinic visit. However, the subsequent clinic visits will help adjust and modify this treatment plan. The changes in this treatment plan for heart failure may reflect the changes in the patient’s current clinical condition and psychosocial needs. For example, traveling would render readjustments in both the dose and timing of the water pill.
Similarly, anticipated increase in salt consumption over the holidays, during the Super Bowl and other events may render readjustment in not only the water pill but also the blood pressure pill. An unexpected episode of arthritis, with its associated need for Ibuprofen and Naldixic Acid, may require a revisit of the treatment plan. A new emotional stress or anxiety may be uncovered on one of the clinic visits, which may require a readjustment in the plan of care.
Next comes the secret of successful heart failure treatment. The cardiologist has to reach out as a coach to the patient to ensure adherence of the heart failure treatment plan. On each visit, the cardiologist asks the patient for any new challenges experienced by the patient. The cardiologist also interrogates the patient regarding issues, which interfere with his medical compliance.
An in-depth understanding of the patient’s support group, or lack of one, also enables the cardiologist to identify and offer options pertaining to psychosocial needs, meal planning and choice of medications. Depression and mood changes are addressed on each and every clinic visit. The cardiologist engages with the patient to set new goals on each visit. At each clinic visit, a tailored approach to the patient’s needs, habits and abilities establishes the foundation for a successful heart failure treatment plan.