Getting Back to Basics for Complex Patients

Problems put off are problems exacerbated. In life and health, we need to study and address problems to find solutions. 

In this issue, we take a deep dive into the complex PCI patient. We know this population is challenged by comorbidities such as diabetes, chronic kidney disease and obesity that increase their risks as well as anatomical and physiological features such as multivessel disease, bifurcations, severely calcified lesions and chronic total occlusions. Age, left ventricular function, valvular disease and severity of disease further complicate the mix—and this tangle of conditions is getting worse.

I was in a cath lab recently with a complex PCI patient who was 42, morbidly obese, hypertensive and having his fifth catheterization. To the cath lab team, his profile was common and increasing in prevalence. Among adults, extreme obesity has been outpacing other risk factors. Severe and morbid obesity, defined as a body mass index (BMI) of 40 and 50 and above, posted increases of 100 percent and 120 percent, respectively, between 2000 and 2010.  

What is also common among this hospital’s patient population is an extreme lack of primary care. The staff shares the frustration that stretches across the country and down the road: patients need basic and ongoing primary care to learn how to be, get and stay healthy. 

Before the Affordable Care Act, 60 million Americans lacked access to primary care. In 2014, more than 30 million newly insured Americans joined the healthcare system. These newly insured came with untreated chronic diseases and share characteristics typically associated with poor health such as less education and higher unemployment. But having care, using it, understanding it and taking the advice to heart are not always mutual. 

“We get down to basics,” a nursing advisor told me in the cath lab, “starting with what they should and should not eat to lose weight and get healthier. We are always surprised, but shouldn’t be, when patients give us the blank stare that they have never heard this before.”

Diseases cannot be addressed solely through a visit with the doctor. Text messaging may be one solution to engage patients. A just-released study of heart patients shows reductions in BMI, cholesterol and blood pressure thanks to lifestyle-focused text messages. We need more solutions like this one.

Cardiology’s piece of the solution is encouraging and facilitating complex patients to access primary care and heed the recommendations. Stop putting off and put in place. As the nurse told me, “we try to help fix the problem, one patient at a time.”