Taking heart disease to heart in your practice

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 - Lori Mosca, MD, MPH, PhD

Cardiovascular disease accounts for nearly one in every three deaths and is the number one cause of death in both men and women in the United States. Research suggests that 80 percent of cardiovascular disease may be preventable (New Engl J Med 2000; 343:16-22,  World Health Organization, Cardiovascular Disease Facts and Figures, accessed June 13).

Lifestyle changes, such as getting regular physical activity and eating well, can substantially reduce an individual’s cardiovascular disease risk, and also may improve quality of life (American Heart Association, FACTS Cardiovascular Disease: Women’s No. 1 Health Threat, Circulation 2013; 19;127[11]:1254-1263). As physicians, we know helping our patients achieve a heart healthy lifestyle is easier said than done.

At a time when patients seem to need physician guidance the most, it’s getting increasingly difficult to talk to patients about exercise and nutrition due to time constraints. Having managed a busy practice in preventative cardiology for more than 20 years, I also know that opening the dialog with patients about making changes in their lifestyles can be tough.

Helping patients improve their lifestyles cannot only save their lives, but may also improve their sense of well-being.  Research I have conducted with the American Heart Association shows patients are more motivated to make a healthy lifestyle change if it improves how they feel, rather than if it were just to extend life (Circulation 2013; 19;127[11]:1254-1263).

Below are techniques that I have used in my practice to educate and motivate my patients to live a heart-healthy lifestyle.

When educating patients about living a heart-healthy lifestyle, authenticity is critical, and is conveyed when we practice what we preach.

Remember the saying: Do as I say, not as I do? Like kids, your patients won’t buy into this either. In order to really inspire patients to make life-saving changes— like quitting smoking, losing weight and eating right—we, as physicians, need to embrace healthy lifestyles, too. And, if you give the impression to your patients that you don’t follow your own advice, they could potentially see you as less credible. For example, a recent study in the International Journal of Obesity found that patients were less inclined to follow a physician’s medical advice if he or she was overweight or obese, compared to normal-weight physicians who elicited significantly more favorable reactions (Int J Obes online March 19).

Show empathy.

When talking to your patients about difficult subjects, such as losing weight or quitting smoking, show compassion and empathy. I recommend physicians include themselves in the conversation if they are comfortable with it. Open up to your patients about similar challenges you face (such as time constraints) and problem solve together about approaches for heart healthy living. This can help validate patient barriers and also emphasizes that you value the importance of overcoming challenges.

Arm them with a strategy.

In order to have a real impact on patients and tip the scales, so to speak, share practical skills and strategies they can use when they leave your office. For instance, I like to share my tactics for eating right, which involve meal planning.

I share with my patients that on Sundays at my house, we prepare most of our meals for the rest of the week. For my lunch, I prepare ingredients for my favorite tuna sandwich. I mix up a can of tuna with a small amount of light mayonnaise or olive oil and a dash of vinegar, and put it in a plastic container. Then I can quickly add a variety of healthy breads to easily make a heart-healthy meal on the go. I use this example because it’s a meal I can prepare ahead of time, which saves valuable time and is also heart-healthy.

I also take this opportunity to share more about the different foods I recommend my patients eat more of that are not only low in calories, but also heart-healthy. For instance eating a variety of fish rich in omega-3s at least twice a week can reduce the risk of cardiovascular disease by 30 percent (JAMA 2006;296[15]:1885-1899). It’s important to give patients enduring support so referral to websites that provide practical advice is very helpful.

Don’t wait until patients are in the exam room to ask questions about their lifestyles.

According to a new scientific statement published in Circulation, using standardized patient surveys to assess patients’ cardiovascular health that ask questions