Emphasis on changing lifestyle factors key to managing coronary patients

Fewer people are dying of cardiovascular disease, and the reason why is probably not due to emergent or elective revascularization procedures, such as angioplasty or bypass surgery. Instead, improvements in risk factor modification and advances in medical management are benefitting patients. -

Citing a “sobering positive statistic” found in a landmark study published in the New England Journal of Medicine that showed a 40% decrease in cardiovascular mortality between 1980 and 2000, Barry Franklin, PhD, director of preventive cardiology and cardiac rehabilitation at William Beaumont Hospital in Royal Oak, Michigan, said that only about 7% of the recent decline in mortality is due to coronary angioplasty or bypass surgery.

“Most of the reason behind the reduced mortality is due to improvements in risk factor modification, and advances in the medical management of cardiovascular disease, including the use of aspirin, statins, beta blockers, ACE inhibitors as well as exercise-based cardiac rehabilitation,” Franklin recently told Medical Economics

In his presentation entitled “Changes in Patients, Changes in CR in 2016: Complexities and Opportunities” delivered during the American Heart Association (AHA) annual meeting, Franklin spoke on the challenges of treating coronary patients and where the field of preventive cardiology and cardiac rehabilitation is headed in meeting the needs of these patients.

Underlying the challenge of treating coronary patients is the often many comorbidities with which they present, including diabetes and lower functional limitations, said Franklin, adding that many of these patients often have undergone repeated revascularization procedures. Although these procedures may reduce symptoms and, in some cases, even be lifesaving, Franklin emphasized that such interventions don’t address the underlying causes of heart disease.

Treatment of these patients, he said, is moving toward a greater emphasis on high risk subsets, such as patients with congestive heart failure or very low fitness.

Next: The importance of regular physical activity

“We now recognize that the foundational or proximal risk factors for cardiovascular disease include poor dietary habits, physical inactivity and cigarette smoking,” he said, adding that many cardiac patients may not substantively change their lifestyle, highlighting the need for providers to increasingly focus on behavior modification strategies for the patients they counsel.

“We need [to] refer and enroll more patients in quality secondary prevention programs to address these underlying lifestyle issues,” he said, noting that angioplasty, revascularization and bypass surgery, although potentially lifesaving, don’t correct the underlying cause of the disease.  

He stressed the importance of regular physical activity as a “powerful cardioprotective intervention” and integral component of cardiac rehabilitation. “We need to get patients more physically active,” he said. “Unfortunately, we are increasingly dealing with a society that has literally engineered physical activity out of our lives; for example, work that requires hours each day sitting in front of a computer.”

In addition to cardioprotective lifestyle changes, he also emphasized that cardiac rehabilitation programs should increasingly focus on ensuring that patients are taking the optimal doses of their medications and adhering to them. In addition, he said that less emphasis will be placed on peak or symptom-limited exercise testing prior to starting cardiac rehab.

To get patients to maximize attendance to exercised-based cardiac rehabilitation programs, Franklin mentioned that insurers are beginning to incentivize healthcare systems to refer greater numbers of patients to cardiac rehab and patients by considering reduced copays based on attendance. “For example, if a patient is enrolled in cardiac rehab and attends 95% of sessions, their copay may be as low as $5 or $10 per session versus $20 per session at lower attendance,” he said.

Finally, Franklin stressed the importance of developing better mechanisms to follow patients over time to ensure they are maintaining the cardiovascular risk reduction interventions that have been recommended.