Welcome to this blog post on reducing ASCVD risk! In this post, we’ll be looking at insights from an academic perspective on sharing ownership and how this approach can contribute to mitigating the risk of ASCVD (atherosclerotic cardiovascular disease). As an SEO writer, I will provide you with well-written and concise information that is to the point and aligned with your needs. You can count on me to avoid adding unnecessary text or leaving incomplete sentences at the end. So, let’s get started and learn more about reducing ASCVD risk through sharing ownership.
– [Natasha] On behalf of the
American Heart Association, I would like to welcome
you to the second session Of today's Close the
SPACE- Secondary Prevention Of ASCVD Care Education- Virtual Summit. My name is Natasha Chioflo, Programs consultant at the
American Heart Association, And I will be your moderator
for today's session. All presentations will
be recorded and available Within the coming weeks
at heart.org/ASCVD. Today's presentation is titled Lessons From an Academic Perspective- Sharing Ownership of Reducing ASCVD Risk. It is my pleasure to introduce Our panel of speakers for today, Dr. Jennifer Kirby, Dr. Kimberly Dowdell, And Dr. Patricia Rodriguez-Lozano. Dr. Jennifer Kirby serves
as the Associate Chief In the Division of
Endocrinology and Metabolism. Her clinical practice
is focused on patients With obesity and diabetes With a special emphasis on
cardiometabolic risk management. She is the director Of the Cardiovascular
Diabetes Consult Service At the UVA Hospital, Which focuses on inpatient
management of diabetes, Inpatients being cared for On the heart and vascular services. Dr. Kimberly Dowdell is
a primary care physician With the Division of
General Geriatric Palliative And Hospital Medicine Division At University Physicians Charlottesville And attends the General
Medicine Inpatient Service. She was the lead physician For the CMMI AAMC grant-funded
implementation project
For E-consult and
enhanced referrals at UVA And currently serves as
the national content expert For the AAMC. Dr. Dowdell has a deep
understanding of Epic And has led several efforts To improve clinical care delivery, Including pre-diabetes screening at UVA, Primary cardiovascular
prevention identification, Process improvements in
Medicare wellness visits, Chronic care management, E-visits, And continued enhancement
strategies for internal referrals. Lastly, Dr. Patricia Rodriguez-Lozano Serves as director of the
Women's Heart Health Program, Co-director of the SCAD Clinic And associate program director Of cardiovascular fellowship at UVA. She's also the Women In
Cardiology representative For the ACC Virginia Chapter. She has advanced multi-modality training Including echocardiography,
nuclear medicine, Cardiac MR, and cardiac CT. Her clinical practice is focused on women With or at risk for cardiovascular disease With expertise in diseases unique to women Or seen more often in women. Dr. Kirby, Dr. Dowdell,
and Dr. Rodriguez-Lozano, The floor is yours. – Thank you very much. On behalf of our panel, We're really excited to
join you this afternoon. We were asked to partake and
sort of share our experiences In an academic institution
about how we share the ownership Of reducing ASCVD risk, Particularly focusing
on secondary prevention.
Just a little note, The presentation will discuss
some current barriers in care And how we've addressed
these in our communities, Doesn't necessarily reflect the AHA Or ASA's official position, But we certainly do defer to
those at several opportunities. We thought we would do some cases To kind of highlight how patients Will come in to our healthcare system And may end up seeing one of us In a variety of systems and
how we might approach that. So we're gonna have three scenarios, Kind of a variation of the same case To kind of talk through some things That we thought would be
important to this group today. So this is a 64-year-old man, Who has type 2 diabetes and hypertension, And he is presenting for
follow up after hospitalization For an ST-elevation MI. He was discharged on
atorvastatin 80 milligrams daily, And his repeat LDL is down at 65. And so we were gonna take this opportunity To kind of talk about immediate
post care for heart patients. So Dr. Rodriguez-Lozano, Can you share our processes here at UVA In terms of our post-MI discharge And how we take care of those patients? – Yeah, thank you Dr. Kirby. So here at UVA, We offer a special post-MI clinic That is a week after being
discharged from the hospital After a event, after an MI. All our patients will
automatically be scheduled For a follow-up appointment
to be seen in this post-MI
Or heart attack recovery clinic Within one week of being
discharged from the hospital. So the patient will meet
with a team of specialists. They have the opportunity
to get a one-on-one time With a cardiologist, with
an exercise physiologist, A pharmacist, a dietician,
and a social worker. So really, there is a lot of benefit To have this team approach And the idea was to have more control, Give more control to the patient And as they, you know, have
a more clear recovery map Based on an individual
need of a specific patients And guidance after leaving the hospital. And I think this is important Because empower the patient
to regain that control After a period of time, you
know, being in the hospital And maybe feeling some kind of uncertainty Or maybe don't even understanding exactly What happened to them. And I think that is really
the beauty of this team Has increased the awareness
not only of patients, About their disease, And many times, it's a
new condition for them But also their families, right? And we focus on not
only physical recovery, But also of course they come with a lot Of emotional challenges And even like specific logistic Like insurance coverage for medication. So we kind of address all the things And all these questions, Maybe even confusion about their testing Or their prognosis after an event. And beside that,
We also have a part of this
clinic at this program, We have a supervised
rehabilitation program That is obviously, as we know, Data have shown that
this is very important In the recovery phase after an acute MI, And we know that there is
multiple benefit of this In terms of decreasing future MIs And reduction of risk factors,
improving quality of life. And usually patients, They start in the program two weeks After being discharged from the hospital. The time varies, it'll be between six And 12 weeks of supervised
exercise program And provide them safe and
supportive environment. And that is pretty much
what we have here at UVA. – I'm gonna ask you a follow-up question Because I know having done a
lot of hospital work myself And those transitions of care Are often fraught with problems
in terms of instructions And patients not necessarily
being able to get The medicines that we send them home with. Who is a part of that… Or who's a part of that
post-MI follow-up clinic? Who are the team members that partake? Are there, you know, things
like clinical pharmacists Or MPs or others that
help you do that work? – Yes, thank you. So as part of the team,
we have two cardiologists. We have one pharmacist,
we have one dietician, We have a social worker, And we have an exercise physiologist. So on that is a one time visit, And usually, it lasts
for a couple of hours. So it's a long visit
Because you have to see all
these different experts. And then after that, it is decided If they will follow up with our practice. But many of these patients, They have already established cardiologist Or they live far away, so
they will follow up with, You know, another provider after. So it's really an individualized approach. So we define what are the needs. And after that, we give a
specific plan for each individual. – And one other follow up around
the cardiac rehabilitation, You know, we are in an area where we draw From a large swath of… You know, we have patients that come to us From a large area, And I know one of the
challenges that we often face Is sort of access to care
where patients are coming from. What are some of the barriers That you all have identified
in terms of patients Getting access to cardiac rehab? And can you talk a little
bit about insurance coverage Or where some of those
barriers might be as well Because it is such a huge
benefit for patients? – Yeah, absolutely. So one of the things is,
in terms of cardiac rehab, We have identified different programs That can provide these at the… You know, we obviously
are a referral center. So many patients come from for hours away, A couple of hours away. So we usually try to refer
them to a specific facility That will be close by. Sometime, we have of course difficulties To get the right place, but we try.
I mean, obviously, we
are used to have patients That are not necessarily from close by. And in terms of insurance coverage, That is importance of this clinic Because many times
during a hospitalization, There is no time to, you know, Sort out all this insurance coverage And prior authorization
procedures or process. So we try, in this visit, to sort out All these logistic challenges. And if we have to go through
a pre-authorization process, Our pharmacies are very
well trained on this Because this is what we do, And we know how to try
to get those things. And if the medicine
cost exceeds, you know, What the patient can cover with insurance Or by himself or herself, Then we decide to change
to a different therapy Because idea is not just
prescribed medications, But actually the patients
can take it, right? Medications, they don't
work unless you take them. So that is all the things That we try to address in this visit. And this alone visit is two-hour visit Because there are many things
that we have to sort it out. – Yeah, no, that's great. And I know that just from experience In discharging patients on
complicated insulin regimens, That and the expense of medications Often gets lost and that
it's difficult to manage That transition. So I think that's a really good tool. I wanted to follow up
with you, Dr. Dowdell, In terms of discussing
because of our system here,
How that looks for you is, If you have a patient who's
admitted to our hospital With an MI and then as
followed in the MI clinic, What that looks for you down the road And how do you view that In terms of being the
primary care physician? – Right. So because this clinic exists, Typically, when a patient's
admitted to the hospital With a different diagnosis, We try to get them back
in our primary care clinic Within two weeks from discharge Just to make sure the same things That Dr. Rodriguez-Lozano was mentioning, Did they get their meds,
are they taking them, All those types of things. With this clinic in particular, When we have a patient who
has an MI and is going… We know is gonna be going to MI clinic, We actually just do an outreach phone call To the patient to let them know, "Hey, Dr. Dowdell saw
that you had this MI, We just wanna check in, But we're gonna schedule this appointment Three months from now When we're expecting
that your cardiac rehab Is kind of coming to a close." We heard Dr. Rodriguez-Lozano mentioned Six to 12 weeks of cardiac rehab. So we'll typically schedule
our follow-up appointment At that time just to kind of make sure That we're in the loop, That we understand all
the medication changes, And that we have had a chance to outreach
To our cardiologists
if there are any things That have come up in the meantime From their last appointment. So we kind of use it more as
a handoff kind of appointment At that point with our nursing team, Making sure that medications are done. And then for patients like this, We do have registries that
these patients fall onto Into our electronic medical record, Which at UVA we use Epic. And so this patient here Would be in both our diabetes registry But also in our cardiovascular
registry as well. And then the registries can
help drive kind of tools That I can then enroll my patient in. Right now, we have a diabetes
health maintenance plan, Which then reminds me, "Hey, I need to check their A1C this often And their lipid panel this often." You know, it was kind of funny When we were talking about this case, We realized we don't have A secondary cardiovascular prevention Health maintenance module. And so that's actually something That I think will come out
of us just presenting here. And so, you know, just reminding us Like maybe we should be
getting the LDL once a year To assess adherence and then
also just whether or not That statin is giving us
the desired LDL reduction. – Yeah, and I think that was
a great point that you made Because I think that this
is one of those things Where we've talked about
you're an amazing advocate For utilizing the EHR to
help us be better physicians
And care providers. And yet as we were talking about this, We identified a gap in some of our stuff. So are there other, you know, You talked about the registries and stuff, I think, you know, there's… Are there other tools that other EMRs use That you're aware of or things
that other practices can use? I think it's really hard When I'm sitting in front
of a patient to remember, "Oh, yeah, I need to make sure
I've got their LDL or what." So I think as medicine's
gotten incredibly complicated, Even particularly for PCPs, So what are the things that
you look at to help you? – Yeah, so the health
maintenance tab in Epic Is my best friend as
a primary care doctor. And the more that we can tweak that To remind me of the different things That I need to be doing for my patients With different disease
processes, the better. For my cardiovascular
patients in particular, I know a lot of people take advantage Kind of nationally of BPAs, Which are best practice advisories. So having the EMR or kind of go… In this case, Epic go and look and say, "Hey, this patient
hasn't had this addressed In the last 12 months or six months," And having the EMR kind of
remind you to do those things. Those are definitely engaged
at some institutions. At UVA, we've taken a practice Of not using a lot of what
we call in your face BPAs. They don't pop up, they're not on screens. We have a lot of our more passive BPAs,
Which appear in my plan And kind of are like yellow highlighted To remind me of these things. The other things that I know A lot of primary care doctors do is, You know, Epic at least has
the sticky note function. And so a lot of people
will put kind of reminders To themselves about sticky note function And things like that. And then more recently
we're getting ready actually To turn on a function in Epic, Hopefully in the next month or two here, About med adherence. So you'll actually be able
to see on your med list A green check mark, a yellow
question mark or a red, Which will actually show
up on your med list, And it'll show you, "Yes, this patient's getting
this modification filled." We know they're getting it
filled versus we don't know, Or this medication definitely has… We've had no claims to it. We don't know that it's being filled. So I think that's gonna help us With our value-based metrics Around cardiovascular
health, the statin adherence, Things like that. – It's an excellent… I'm actually looking forward to that. I wasn't aware, so this is great. I had a patient this morning
only primary prevention, But her statin hadn't
been refilled for a year, And she swore she was taking it, But I think she was mistaking
it for a different medication. And so this, you know,
I think those kinds of things
can help us better make sure. Sometimes it's hard to
do the extra digging And get past that inertia
of trying to make sure That patients… You know, if we're checking
LDLs and checking lipid panels, That can help with some of that adherence. But there may be more subtle things That we can do that can help
providers, so that's excellent. I'm gonna move us on to the
second scenario similar, A slightly different twist To provoke a slightly
different discussion. So this is our same 64-year-old man With type 2 diabetes and hypertension. And he got coronary disease, But he's had this for a long time, And he is coming in to seek care With a new primary care
physician to initiate care. He's recently moved to the area. He's currently taking
rosuvastatin 20 milligrams And ezetimibe 10 milligrams daily. And so Dr. Dowdell, this is
kind of in your world now, And I wanna kind of
focus on the discussion Of resource limited environments. And so how do you approach patients In terms of when they're
coming to establish care And their ongoing cardiovascular needs? – Right. So, you know, I think this type of patient Who comes into my office, I'm really doing an assessment Of what's the current state
of his cardiovascular health. Are they having any symptoms? Is he having any exertional dyspnea? Is there anything that would make me think
That there's ongoing
cardiovascular progression Of his known coronary artery disease? If the answer is yes, then you know, I think at that point, I
would probably go ahead And in this health restrained environment, A lot of times I'm doing
the stress test myself, And then also referring to
cardiology at the same time So that they can have kind
of the best first visit. If however, the answer is no, This is a really stable patient. They had their MI 15 years ago, And they've been doing the
kind of yearly check-in With their cardiologist
where the cardiologist says, "Yes, you've got good
blood pressure control, You're on the right medications, And your LDL is still
really well controlled." I might hold onto that patient as my own And not refer him immediately Because we do have a
lack of specialty care Across this country. It's getting harder and
harder for primary care To refer to our specialist colleagues. And if this is just gonna
be another appointment Where they're kind of taking over And then seeing yearly
that's backing up my patient Who really has active disease And not able to progress into the system. So the nice compromise that we have at UVA Is we do have E-consults for
our primary care providers To access our specialists. And so I've definitely had
the patient once or twice Where I'm like, "This could be a referral Or I could just go get the stress test And then decide afterwards."
And my cardiology colleagues Are very happy to answer
these questions, you know, With, you know, what are the next steps. And then this is the type of patient Where when they first come in, I'm definitely checking that LDL To make sure that we're under 70 And appropriately controlled. And if we're not, Then we start having those conversations About dose escalation
of their rosuvastatin And are we able to kind
of maximize that further As well as, you know, What's their hypertension
look like right now? Are they well controlled? Are they less than 130 over 80 Or are there other medications
that we need to add To further maximize that? Those are all things I
as a primary care doctor Feel really comfortable with. But what I've learned over time In kind of some of my other
roles is primary care… The breadth of primary care is very broad And not everybody got the
cardiology training that I got, And so they might not feel as comfortable. So we have to respect that
some of our colleagues Who some of my own primary care colleagues Might not feel as comfortable
with that management as I do. And so that's where at UVA, The E-consult's kind of nice Because if people feel
somewhat comfortable, They can get the help from
their specialist colleague. But if they don't feel comfortable at all, Then the referral's made.
And our colleagues here are super gracious And happy to help, So that's kind of how I approach it. – Just for the uninitiated, Can you just briefly describe
the E-consult process? You know, I'm not sure
how widely it's used Across the country. – Yeah, so an E-consult at UVA, I will say is completely asynchronous. So it's actually an order
in Epic that I fill out. It has some templated guidance
for different conditions That are common to get E-consults. So for this one in particular, it'd be, You know, established
coronary artery disease. I'd write a brief clinical narrative, It would likely ask me For their most recent
blood pressure and LDL, And then I would send it on, And then it goes to a
E-consult pool in cardiology And the E-consults are
answered by that specialty. They write their answer back. So it's almost like using email in a way. They write their answer back, And they send it to me, And I typically get that response Within three to seven days, And then I'm able to go
forward with the plan That they kind of let me know. Or a lot of times they'll be like, "Yeah, I totally agree." If the stress is abnormal Like if this were a case
where I felt like I needed To get a stress test, if
the stress is abnormal, Definitely you know, go
ahead and send the referral,
That kind of thing. – Absolutely, great, thank you. Dr. Rodriguez-Lozano, What are the red flag symptoms That would prompt you to
recommend referral to cardiology In this situation? And particularly, I'd
love for you just focus on Maybe sex-specific characteristics 'cause we know that heart disease in women Is a very different beast. – Yeah, thank you Dr. Kirby. I think they are probably
different in the scenarios That a patient needs to be seen
regularly by a cardiologist And totally agree with Dr. Dowdell That we need to empower
our primary care physicians Because there are many patients With chronic cardiac diseases And not everybody have
access to a cardiologist In the, you know, immediate
fashion as we would want. I mean, sometime you put a referral And the waiting time can be
from weeks to a few months. So I'm totally agree with her. But there are maybe some patients in, Like I said, a specific scenarios That maybe they need to
be seen by a cardiologist And those are patients
that have complications Or they have maybe developed heart failure Or they have significant valvular
disease will be one group. Another one will be patients
that they are at high risk For recurrency or they
have history of several MIs In the past, maybe history
of in-stent restinosis. They have several procedures. I will say even patients
that have history of CABG Or valve replacement probably are the ones
That they need to be seen
a cardiologist regularly. Then if patients like
Dr. Dowdell was saying, Checking their LDL, and they're good, I keep following and maybe, I mean depending on the comfort And expertise of the
primary care physician, Many of our primary care
physicians including Dr. Dowdell, She feels very comfortable
starting non-statin agents. And we probably gonna talk about later on, But also if we have patients
that they are, you know, Their LDL are very
resistant to getting call So many times they are
escalated to a cardiologist To help with that management, Especially patients that
have genetic disorders Related to their cholesterol, They might have familial hyperlipidemia. So those patients are sometimes
more challenging to manage. And then of course, patients
that have new symptoms Like Dr. Dowdell was saying. New symptoms of worsening of symptoms That depending on their severity, I think many primary care physicians, They feel comfortable ordering
that person stress test, Maybe with the help of an E-consult, Maybe just by themselves. But then when you get in that area That the symptoms are severe, for example, They're occurring with minimal exertion Or even just address, You think maybe the stress
test will be not enough And you're thinking maybe the patient Needs an invasive assessment
as an initial testing And if that is the area
that you think this patient Is falling on, I mean, I think a referral
To a cardiologist will
be totally reasonable. And like you were asking, There is sex-specific
differences in the presentation Of specifically women with
ischemic heart disease. I mean, many women and in general women Sometimes we present in a different way. We do have chest pain, But we have other associated symptoms Like shortness of breath Or maybe even severe fatigue for months Before you present with an acute event, And even symptoms that are
triggered by emotional stress. And you know, the providers,
sometimes we get distracted, Not only primary care
physician pass a cardiologist, And we start just hearing severe fatigue And emotional stress, And we forget that also that women Was talking about chest pain, right? So I think unfortunately data have shown That women are less likely to be treated With optimal medical therapy, And they are less likely To have a revascularization therapy. And women, we have also worse outcomes. And I think it's because of that, And that is important to
be aware of that bias. – Yeah, excellent. I was very privileged to be trained By a couple of diabetes doctors experts Who focused on
cardiovascular risk reduction And learned very early on,
particularly with women. It may just be like
I'm just not able to do What I normally do, and I
have a very low threshold, Particularly in the study of somebody
Who has known cardiovascular disease. I had a patient of mine, Who I kind of pushed her cardiologist, And it turns out she
needed an intervention And ended up getting stented
for a couple of lesions That were problematic. So I think it's a good
reminder for all of us. And it always is a good
reminder for myself To be thinking that way. In the interest of time, I wanna move on to our last scenario, And this is kind of more in
something that I would see, Which is a gentleman that comes in With his diabetes and hypertension. He's coming in to see me, and honestly, There are patients that
I may see more frequently Even than their PCP, If I'm seeing them every
three to six months For their diabetes management. And I view part of my world Is doing cardiovascular risk reduction For these patients that, you know, In addition to what we share
with other specialties, And this is somebody who's
intolerant to statins. So we have these patients Currently taking the 10
milligrams of ezetimibe, But his LDL is not at goal. And so, you know, we talk a lot about… You and I and Dr. Dowdell, We have spent a lot of time talking about How we interact as colleagues, And I would argue that
outside of just cardiology And the PCP world and endocrinology, That we also have our
nephrology colleagues
And our neurology colleagues, All of us whom share
in that responsibility For cardiovascular risk reduction. We talked a lot about things Like management of
hypertension, LDL reduction, Targeted heart failure therapies, And there's a lot of medicines That now fall into all of our bailiwicks, Cholesterol medicines, you know, When SGLT2 inhibitors in particular, And how do we break the inertia Of starting these
medicines and making sure That we're communicating
with the right providers And not necessarily
deferring in that moment And who's gonna take that responsibility. If I find this, I tend to be much more
proactive in a setting like this Where I feel very
confident and comfortable Doing cardiovascular
risk reduction to a point And then activating my help chain With my cardiology colleagues or others. But I'm curious, you know,
Dr. Dowdell is a PCP, And your patient's seeing three
or four different specialists, How do we best communicate with you Without overwhelming you 'cause we're all inundated
with our EMR inbox? – Yeah, yeah. So, you know, I always
appreciate the CC'd note That has a note attached to it, right? So it's like, "Hey…" You know, and I think I just did this To Dr. Rodriguez-Lozano the
other day, where I'm like, "I saw this patient and this
was for primary prevention But I know she needs to be on a statin.
I can't get her on a statin." So I like sent her my
note to her being like, "I got the cardio IQ panel
and please talk to her About this statin," and
she was able to do it. So like direct communication, The CC'd note that has
no communication to me Is not super helpful 'cause
then I have to read through it And do that kind of thing. But I do think that when
we send the note with, "Hey, I wanna do this," Or, "FYI, I did this even better," Then that really helps
with the patient's care And moves them along. I know you and I, Dr. Kirby, Tend to try to see our
patients kind of you see them, And then I see them probably
six weeks later type deal. And so, you know, we've
made a lot of med changes Where it's like, "Hey,
I made this med change, Can you follow up and make
sure they're tolerating it?" And that's worked really,
really well for us. I will say it's harder
when the cardiologist Is outside of the system. I don't feel as empowered,
to be honest with you, To change the medications Because I don't have a
great way of communicating With that doctor who's outside of my EMR. – Yeah, I think you made great points. I'm gonna give Dr. Rodriguez-Lozano The last word here specifically. I think this is a great
patient that a PCSK9 inhibitor Would be potentially a next step, Although there's the bempedoic
acid data that just came out. I think a lot of us have deferred That start to cardiology world.
And I just wanted to get your take On that in the last couple minutes here. – Yes, I just want to say
that managing dyslipidemia Is a teamwork, so everybody
should be involved. It's not only cardiologist. I think the primary care
doctors, the endocrinologist, The nephrologist are seeing the patient. We all should, you know, take on this Because it's not an easy task. The other thing that I will say Talking about this specific patient Is that every time we manage the lipidemia In a patient with established ASCVD, We have to think about this
is secondary prevention. And we want to know how the
risk of direct specific patient, Right, it's a very high risk. It's a high risk because the LDL target Is gonna depend on that. I mean, we have data already. We have new guidelines on 2022. We have the European guidelines since 2019 Saying patients with high risk, The LDL should be not less than 70, But actually less than
55, so lower is better. And now like you were saying, We have different
medications that we can use. I think most of primary care
physicians feel comfortable With the setting of cord acetamide. PCS kinase inhibitors, I think the product is
not feeling comfortable Because it's not much just
prescribe the medicine. Sometime it's getting approval From the insurance to
cover these medications In particular that needs an extra step
Like a pre-authorization process. And our pharmacist, they
do this all the time. So many times, I think the referral Is not because I don't know
that I have to use this medicine Is because of the insurance coverage. And we are happy to help with that. Now, like you were mentioned
before, we have new drugs. And we have a specific drugs that we use For patients with familial hyperlipidemia Especially we have homozygotes, Patients with this condition Because it's harder to manage them Because their LDL is really high. So probably in these cases, Cardiology will be the
ideal person to manage These kind of patients Because we can talk about other
kind of drugs and escalate. As you were talking about, We have new kids in the block
that statins and PCS kinase, They are not the only
alternative for patients That they have resistant LDL Or that they are intolerant with statins. We just have an ACC meeting on March, And we have like this bempedoic acid That is an oral agent
that is very promising, Especially in patients
that they are intolerant To statin medicines. And now, we have outcome data. So we know that is definitely something That we should consider, And we are prescribing that
currently in our clinic. – Awesome. I'm gonna end there and give
us enough time to do questions, So I'm gonna turn this back
over, I guess, to Tasha.
– [Natasha] Well thank
you so much, Dr. Kirby, Dr. Dowdell, and Dr. Rodriguez-Lozano
for your presentation. At this time, I encourage our participants To type their questions in the Q&A box, And we will get started
with our first question. What are some of the
strategies that you employ To address misinformation,
especially for statins? – Yeah, I'm gonna tap Dr. Rodriguez-Lozano Because I think she's
probably our best expert, But I will put in here That we all need to be dealing doing this. This is important Because I think the
statin fear is very real. I just had a patient
yesterday, type 2 diabetes. It's for her primary prevention, But she really needs it
and is very resistant. So yeah, Dr. Rodriguez-Lozano? – Yeah, so I think I like to… I think education actually
empowers patients. I think, first of all, We know that side effects From cholesterol lowering
drugs are pretty minimal. I think in general we have now… We know, of course,
the ones that patients, They are more worried about
potential side effects Are the muscle aches, but
we have multiple studies now Showing that many times
when they look at this, And they compare patients that
were statin versus placebo, Actually it's almost the same prevalence Of this side effect. And now we describe this nocebo effect Meaning that it's just more… It's about like thinking
that a negative situation Is gonna happen on a negative outcome
Just because you believe
that that intervention Is gonna cause harm, right? So I think showing this
data and sharing this data With patients and sharing with them What is really the benefit of the medicine That they are taking especially statins, I think that will empower them. And of course, I think like
just a close follow up. Many times I ask my pharmacist Specifically to follow up with them Regardless of them calling back or not If they are tolerating the medicine, Just to make sure that they
feel that they are supported. And if they have side effects, Just to address them immediately. Because you don't want patients
to discontinue the medicines Without you knowing and
just find out in a year or, "Yes, I stop the medicine after a month Because I have all these side effects." So why you didn't call the office, right? And we can address it and
look for another alternatives. – Yeah, I can't agree
enough about how valuable A clinical pharmacist
or anybody following up On a medication start can be… I have a clinical
pharmacist that we work with Who's been invaluable for
following up and adjusting, Especially for medications
around diabetes. So absolutely, I think
it's a huge piece of this. So props to my clinical
pharmacy colleagues, yeah. – [Natasha] Wonderful. Our next question is what are strategies That you use to obtain
approval for newer agents Such as PCSK9 inhibitors? – Dr. Dowdell, have you tried?
– I will say that I got approval once Using an E-consult for… Basically, you know, one of
our Medicaid programs here Almost requires a cardiologist In order to get this approved. And so I did an E-consult,
the E-consult said, "Yeah, we agreed this sounds
like a good case for this, And we were able to do that." Really, what I've started
doing in Epic actually Is keeping in the overview of the problem, I've started keeping a list
of which statins we've tried, What the max dose we could get to was, And then also like why
we had to discontinue it. And I've found that that's been helpful, At least with my nurses, Who are helping me try to do
these prior authorizations So that it's very clear to everybody like, "This is the history of this
statin use in these patients And why they're not tolerating it." Admittedly, haven't used it for patients Who aren't getting to
goal and are on statins More often than not my patients
that I'm trying to get this, For the patients that have not
tolerated multiple statins. – Dr. Rodriguez-Lozano, What's been your biggest barrier In terms of getting approval
for these medications? – So I think it depends
on the insurance coverage, To be honest. It depend on… It varies depending also Which commercial insurance,
for example, you have. Sometimes in our clinic, We have a system of like a co-pay card. So that helps in many times.
I mean, our pharmacists, You know, obviously they know, And they're very knowledgeable About these different
techniques to help patients. And so I mean, it shouldn't
be that you refer a patient To a cardiologist just
because you're not able To get the medication approved. I think that Dr. Dowdell
has been really smart Using all these different resources, And E-consult I think
is a good alternative If you have it in your system Or you have a different way to communicate With your cardiology team. Because I think, you know,
we should help each other To try to get patients in
optimal medical therapy. – Anything specifically
around Medicare patients 'cause I know that's a
lot of the population That we tend to care for
with these that have risk Or known cardiac disease. I think Medicare can be
particularly challenging Because you can't use co-pay cards And the part D coverage
can be really variable. Plus I know that in 2025, with
the Inflation Reduction Act, Having caps on out-of-pocket costs Will likely make a huge difference For a lot of the medications
that have shown value, Heart failure, cardiovascular
risk reduction, Diabetes, those things, I
think that's gonna be exciting. But I think Medicare in particular Has its own challenges, And if you have any other comments. – Yeah, many times, like I said, Pre-authorization process is necessary, And it's a pain, but we'll do it,
And that is the only
way to get it approved. – Yeah.
– Yep. – Yeah, thank you. – [Natasha] Great, Our last question, What is your approach
to overcoming inertia In starting and escalating therapy? Are there EHR strategies that
can help minimize inertia? – Dr. Dowdell, I'm gonna
throw this out to you In the last like 90,
30, the 60 seconds of- – 60 seconds.
– Yeah. – Yeah. so I think there are EMR programs. We are currently working on
a primary prevention program For cardiovascular health, But also this could be
applied to secondary health. You really have to,
you know, know your EMR And know what the tools are that it has. So for Epic, there are a
lot of tools out there. There are BPAs, there are registries, There are health maintenance reminders. There are smart sets that you can engage, There are order sets that you can engage. The biggest barrier, I think, For a lot of these things
is getting the problem On the problem list
because so many of them Are driven by the problem list. So if your problem list isn't accurate, Then it's hard for this to work. But with cardiovascular, at
least there is a lab value You can look at. And EPIC does a good job
of calculating ASCVD risk. So for primary prevention, The computer can actually
calculate that for you And then flag you. For secondary prevention,
As long as you've gotten the
problem on the problem list And can get a patient into a registry, You can engage a lot of
different Epic tools to do this. I think the biggest inertia component is, At least at our institution
is getting the Epic resource To actually build what you envision. And if you can engage that
resource either by promoting, You know, your value-based care metric Or a contract that you
might have with a payer, Then I think that will give you
the most bang for your buck. – [Natasha] Well, thank you so
much Dr. Kirby, Dr. Dowdell, Dr. Rodriguez-Lozano for
this great presentation, And thank you to our audience
for your participation. Coming up next at 1:30 PM Central Time, You'll have the choice of two sessions, Track 3A Alert: Can Clinical
Decision Support Tools Prompt Better Quality ASCVD Care, And Track B: Benefits of
Integrating Pharmacists In ASCVD Management. At this time, Please use the return to
lobby link on your screen To choose your next session
from the presentations list. Thank you very much for
attending today's virtual summit.
Introduction
When it comes to preventing atherosclerotic cardiovascular disease (ASCVD), sharing ownership is an effective approach. This principle is based on the idea of a collaborative approach between patients and healthcare providers. Rather than just adopting a top-down approach, it’s important to engage patients in their own care for better outcomes. In this article, we’ll explore how sharing ownership can reduce ASCVD risk, from an academic perspective.
Understanding ASCVD Risk Factors
Before discussing how sharing ownership can reduce ASCVD risk, it’s important to understand the risk factors involved. Some of the key risk factors for ASCVD include:
• High blood pressure
• High cholesterol
• Smoking
• Diabetes
• Obesity
• Family history
By addressing these risk factors, patients can help manage their ASCVD risk and stay healthier in the long term.
The Benefits of Sharing Ownership
Now, let’s dive into how sharing ownership can reduce ASCVD risk. When patients take an active role in their own care, they’re more likely to follow through with the necessary lifestyle changes and medical interventions. This type of approach helps patients feel more invested in their own healthcare, which can lead to positive outcomes. Sharing ownership has the following benefits:
• Empowers patients
• Increases compliance with medication
• Improves adherence to lifestyle changes
• Promotes trust between healthcare providers and patients
Strategies for Sharing Ownership
There are many strategies for sharing ownership when it comes to reducing ASCVD risk. Here are some of the most effective ones:
Collaborative goal setting: By setting goals collaboratively, patients are more likely to achieve them. This approach helps patients feel more invested and accountable for their own healthcare.
Patient education: By educating patients about the importance of lifestyle changes and medication adherence, they’re more likely to take the necessary steps to reduce their ASCVD risk.
Motivational interviewing: This approach focuses on empowering patients to change their behavior. Healthcare providers use open-ended questions, affirmations, and reflective listening to help patients identify their own intrinsic motivation to change.
Shared decision making: By involving patients in the decision-making process, healthcare providers help patients feel more invested in their own healthcare. This approach also promotes better communication and trust between patients and healthcare providers.
Conclusion
Sharing ownership is an effective approach to reducing ASCVD risk. By empowering patients and promoting collaboration between patients and healthcare providers, positive outcomes can be achieved. Healthcare providers can use strategies like shared decision making, motivational interviewing, patient education, and collaborative goal setting to help patients take an active role in their own care.
FAQs
Why is shared decision making important in reducing ASCVD risk?
Shared decision making helps patients feel more invested in their own care and more likely to follow through with necessary interventions.What is motivational interviewing?
Motivational interviewing is a patient-centered approach that focuses on empowering patients to change their behavior.How does patient education help reduce ASCVD risk?
By educating patients about lifestyle changes and medication adherence, they’re more likely to take the necessary steps to reduce their ASCVD risk.What is collaborative goal setting?
Collaborative goal setting involves setting goals with patients that are mutually agreed upon. This approach helps patients feel more invested and accountable for their own healthcare.What are the key risk factors for ASCVD?
Some of the key risk factors for ASCVD include high blood pressure, high cholesterol, diabetes, obesity, smoking, and family history.