Patient-centered care

The Institute of Medicine has made patient-centered care a cornerstone in a strategy to improve healthcare in the U.S. This week offers proof that cardiovascular thought leaders are listening, plus one word of warning.

When the Society for Cardiovascular Angiography and Interventions convened a panel of experts to examine the definitions of MI after PCI or CABG, the group of experts saw two factors as critical in their assessment: patient-centered and evidence-based care. Although a universal definition exists, it does not reflect what matters to patients, they determined.

The biomarker cardiac troponin and the threshold under the universal definition detected damage to the heart, but because it was sensitive it signaled a level of damage that might not impact the patient’s life. The experts recommended a new definition using CK-MB, which also is released when heart muscle cells are damaged. CK-MB is a less sensitive instrument, so its presence may indicate clinically significant damage.

On another front, the FREEDOM trial’s researchers presented results from a substudy that looked at outcomes from the patient’s perspective. The bottom line is that both PCI and CABG provided an improved quality of life for patients with diabetes and multivessel coronary artery disease in the study. That should be reassuring to patients and their physicians, but the results pertain only to a patient population similar to FREEDOM’s.

A viewpoint in JAMA put a bit of a damper on the patient-centered campaign. The authors proposed that approaching shared decision making as a way to reduce overtreatment and costs may not be supported by the evidence. Shared decision making gives the physician an opportunity to educate the patient and engage him or her in treatment decisions, but arguing it also helps contain rising healthcare costs may overstate the case.

All of these are good trends. Greater awareness of what matters to patients and better communication between physicians and patients promote better care. And questioning the value of the drivers of change also protects patients and physicians from possibly following what may prove to be a wrong path.

Candace Stuart

Cardiovascular Business, editor