Storm Warning: Preparing for a Deluge of Cardiovascular Patients

Tsunami. The word kept coming up as we researched this issue. Physicians and nurses, trained in a variety of cardiovascular specialties and serving different patient populations, worry that a tsunami of patients is not far away.

Stroke Nurse Practitioner Amy Nieberlein, who is working on a transition-to-home initiative, worries not just about the “stroke tsunami” that will accompany aging baby boomers but also about “dangerous levels of stress and anxiety” their families and other caregivers will face. She offers perspective in this issue’s Executive Insights.

Specialists we talked to for “Coming of Age: Congenital Heart Disease Programs Hustle to Meet Needs of Adult Patients” warned that the healthcare system must get ready for the swelling population of adults with complex, lifelong conditions that will make them high utilizers of healthcare resources.

The electrophysiologists featured in our cover story, including Dr. Matthew Reynolds who moderated the roundtable, detail an afib epidemic that is already overwhelming some of the nation’s waiting rooms. They’d be under water were it not for physician assistants, nurse practitioners and nurses who make it possible for them to continue seeing more patients while tackling a growing list of administrative and quality-metrics requirements. It is a familiar cry: EPs already feel stretched, more than a decade before, according to forecasts, their afib patient roster may double.

Yes, ominous predictions, but experts point to a silver lining: There is time to get ahead of the dark skies. If done right, we can be in a better spot when the storms hit. The calls for better prevention make sense, of course, but perhaps an additional, less talked-about strategy for shoring up the levies is to embrace efficiency. Helping the healthcare workforce prepare for more patients who need complex care of chronic cardiovascular conditions also may mean tailoring health systems so clinicians have more time for face-to-face patient time. But that’s not what’s happening. In March, Casalino and colleagues reported that physicians and their staff have been spending 15.1 hours/physician/week on external quality measures, at a cost of more than $15.4 billion/year. Reducing the quality measures workload on physicians could free them up to see as many as nine additional patients each per week (Health Affairs 2016;35[3]:401-406).

No one I know is suggesting physicians should abandon quality or metrics. Cardiology, perhaps more than any other specialty, was founded on evidence and measurement. But preparing for a patient tsunami may require computers that do a better job of talking to each other and data collection that takes a bit less attention from caregivers who need to be more focused on patients than on figures. If there is one thing I’ve learned from working with cardiologists and their teams, it’s that they are formidable problem-solvers. This brings me to a theme we’ll explore in a future issue: The potential of dyad leadership. A cardiologist recently told me, “Doctors don’t need MBAs, and health execs don’t need MDs.” What they need, he said, is to work together to solve problems. Ideally before the tsunami hits.