{"id":22697,"date":"2019-02-21T08:00:03","date_gmt":"2019-02-21T15:00:03","guid":{"rendered":"https:\/\/www.uchealth.org\/today\/?p=22697"},"modified":"2024-07-17T13:35:18","modified_gmt":"2024-07-17T19:35:18","slug":"heart-failure-project-pinpoints-an-underused-resource-patients","status":"publish","type":"post","link":"https:\/\/www.uchealth.org\/today\/heart-failure-project-pinpoints-an-underused-resource-patients\/","title":{"rendered":"Heart failure project pinpoints an underused resource: patients"},"content":{"rendered":"
<\/div>
\"An
Heart failure is one of the most common chronic conditions in the world, but the right medications can make people feel better and live longer. Photo: Getty Images.<\/figcaption><\/figure>\n

A portrait of heart failure in the United States would be etched in tones gray and gloomy. Some 5.7 million people have hearts that can\u2019t pump sufficient volumes of blood to the rest of the body. The disease costs nearly $31 billion a year<\/a> \u2013 a figure that doesn\u2019t include the many ways it diminishes the quality of life for its sufferers.<\/p>\n

But there are bright spots in the otherwise dismal portrait, says Dr. Larry Allen<\/a>, a cardiologist at UCHealth University of Colorado Hospital<\/a> on the UCHealth Anschutz Medical Campus and medical director of Advanced Heart Failure<\/a> at the University of Colorado School of Medicine.<\/p>\n

\u201cHeart failure is one of the most common chronic conditions in the world,\u201d Allen acknowledged. \u201cThe good news is that we have a number of medications that make a big difference for patients with the disease.\u201d They include meds to rid the body of excess water, strengthen the heart muscle, relax blood vessels and raise potassium levels \u2013 all of which improve cardiac function, making people feel better and live longer.<\/p>\n

Missing the meds<\/strong><\/h2>\n

But Allen quickly adds a dose of bad news. \u201cWhen we look across the U.S. at who is getting the medications, we find that, depending on which type of medication, anywhere from 20 percent to 80 percent of patients aren\u2019t getting their medications,\u201d he said.<\/p>\n

\"Headshot
Heart failure specialist Dr. Larry Allen leads a UCHealth trial that aims to maximize the effectiveness of medications by engaging patients in their own care. Photo by UCHealth.<\/figcaption><\/figure>\n

Even among patients who are prescribed these medications, many don\u2019t necessarily receive optimum care, Allen added.<\/p>\n

\u201cWe have great therapies, but there are a lot of them, and each one is complicated because you have to gradually intensify the dose \u2013 and that\u2019s just not happening as often as we would like,\u201d he said. For example, only about half of all patients on beta blockers for their heart failure receive 50 percent of the maximum recommended dose, Allen noted.<\/p>\n

Terms of engagement<\/strong><\/h2>\n

Allen does not see cost as the major culprit. He points instead to providers who may be reluctant to make changes to patients\u2019 medications without an emergency and to patients who feel \u201cdisempowerment,\u201d or a lack of involvement in their own care.<\/p>\n

Allen is out to change that with a study spanning all UCHealth hospitals. It uses the Epic electronic health record (EHR) as one tool to encourage heart failure patients and their providers to communicate openly and work together to achieve the best care possible. The strategy aims to move as many patients as possible to the optimum dosage for their prescribed medications.<\/p>\n

\"Headshot
Gracie Finnigan-Fox serves as project manager for the trial. She says easy-to-use technology with understandable messages can help heart failure patients take control of their medications and improve their health. Photo courtesy of Gracie Finnigan-Fox<\/figcaption><\/figure>\n

The study targets patients with left ventricular ejection fractions \u2013 a key measure of the heart\u2019s pumping power \u2013 of 40 percent or less. Half of those enrolled \u2013 the overall target is 300 \u2013 receive standard care. The study group receives materials through My Health Connection, the Epic patient portal, prior to their next appointment with their cardiologist. The materials include a three-minute \u201cpatient activation\u201d video<\/a> that emphasizes the importance of patients taking their heart failure medications and speaking honestly with their physicians about their disease.<\/p>\n

Patients also receive a one-page checklist of heart failure medications with brand and generic names to help them identify what they take and the dose, as well as information about each category of drug. A bottom-of-page message emphasizes the importance of taking control of their own care and asking questions of their providers. Patients bring the completed checklist to their clinic visit as an icebreaker of sorts for a two-way conversation aimed at identifying at least one positive change in their care by visit\u2019s end.<\/p>\n

If it sounds like a straightforward approach, that\u2019s by design, said Gracie Finnigan-Fox, project manager for the study and a senior professional research assistant with the Colorado Program for Patient Centered Decisions<\/a> (Allen is a member of the program\u2019s faculty). Finnigan-Fox handles patient enrollment, follow-up, record-keeping and materials delivered to patients through My Health Connection to help keep them involved in their care.<\/p>\n

\u201cThe beauty of the study lies in its simplicity,\u201d Finnigan-Fox said. \u201cThe three-minute video and the checklist give patients a place to start with their providers. Providers have been very pleased that patients have been engaging them more.\u201d<\/p>\n

Flip the script<\/strong><\/h2>\n

That\u2019s an important shift from a long-established dynamic that often puts providers at the center of the prescribing universe.<\/p>\n

\u201cTraditionally, decisions about medications have been relegated only to physicians,\u201d Allen said. \u201cFor patients, there have not often been discussions about \u2018Why am I on this medication or not on this medication?\u2019 I think patients want to have some control over their heart failure management, but they feel that FDA-regulated medications aren\u2019t really something they have control over.\u201d<\/p>\n

As for providers, Allen believes that for too long, they\u2019ve lacked an incentive to invest time in engaging with patients to optimize their medication dosages. This \u201cclinical inertia,\u201d as he calls it, has spawned a reluctance to \u201crock the boat,\u201d especially if patients profess that they\u2019re doing ok. He believes that the study tools could put patients in control of their clinic visits, but focus the discussion on the medications proven to be effective in improving their condition.<\/p>\n

Tailored education<\/strong><\/h2>\n

For Alexander Bruce Campbell, 73, the study is important, but only a first step in involving heart failure patients in their care. A private practice lawyer for 30 years in Denver, Campbell went on to complete a 14-year term as a federal bankruptcy judge before retiring in 2015. He said he had no history of heart issues until last summer when he began noticing unusual shortness of breath.<\/p>\n

\"Headshot
Alexander Bruce Campbell received an unanticipated diagnosis of heart failure last summer. He sees the need for heart failure patients to receive tailored education about their disease. Photo courtesy of Alexander Bruce Campbell.<\/figcaption><\/figure>\n

The bouts went on long enough that he\u2019d planned to visit his primary care physician, but a summons for jury duty and selection to serve put that on hold. In the midst of deliberations after a weeklong trial, his symptoms worsened sufficiently that he visited an urgent care clinic. There, an EKG revealed atrial fibrillation, which sent him ultimately to UCH for a weeklong stint in the Cardiac Intensive Care Unit.<\/p>\n

Campbell left UCH with a diagnosis of heart failure \u2013 an echocardiogram showed his left ventricular ejection fraction stood in the mid-20s, he said \u2013 and an ongoing risk of blood clots that require blood thinners.<\/p>\n

After enrolling in Allen\u2019s study, Campbell met with UCH cardiologist Dr. David Kao<\/a> for an 80-minute visit he approvingly described as \u201cunrushed, with lots of explanation.\u201d Kao, he added, was \u201cincredibly candid\u201d in stressing to Alexander that while cardiac rehabilitation and attention to diet are important parts of his care, it\u2019s the heart failure medications, including beta blockers, that will play the biggest role in managing his condition.<\/p>\n

\u201cHe was not resistant to a holistic approach, and he encouraged me to listen to the dietitians and exercise specialists, but he was very clear that they won\u2019t alone fix my heart,\u201d Campbell said.<\/p>\n

Campbell said that he accepts Kao\u2019s clinical judgment that the medications are effective. \u201cI get the picture of how important the physicians feel the meds are in the treatment,\u201d he said. Still, he feels the study tools are only a first step in engaging patients.<\/p>\n

\u201cPhilosophically, I couldn\u2019t agree more that the study reflects the concern about the importance of communicating and engaging patients so they will appreciate the importance of the medications,\u201d Campbell said. He made clear, however, that he\u2019d like to see even more comprehensive education about heart failure that avoids a \u201cone-size-fits-all\u201d approach and takes into account \u201cdifferent learning styles and abilities.\u201d<\/p>\n

First steps<\/strong><\/h2>\n

Allen acknowledges that the study narrowly focuses on optimizing patients\u2019 heart failure medications and improving their adherence to their medication regimens. It\u2019s one step toward a broader discussion of issues that affect care.<\/p>\n

\u201cWe\u2019re saying, \u2018Let\u2019s start with the low-hanging fruit,\u2019\u201d he said. \u201cThe challenge with this study is to redirect the conversation to things that we have evidence for.\u201d<\/p>\n

Longer term, Allen sees the study as one piece of an ongoing move to population health, which stresses using standardized, evidence-based care to manage patients with heart failure and other chronic conditions. A key part of the groundwork for the study was work with UCHealth\u2019s Information Technology team that integrated the software used to store echocardiogram images, the best way to pinpoint the left ventricular ejection fraction, with the Epic EHR. In addition, the ejection fraction appears in the EHR as a number, meaning that Allen and his colleagues can identify all the heart failure patients in the UCHealth system who fall below the 40 percent threshold.<\/p>\n

\u201cThat number triggers me, as a provider, to say, \u2018Are my patients getting the right meds for this serious problem?\u2019\u201d Allen said. \u201cWithout that number identified, that is very difficult. If you can\u2019t find the patients, it\u2019s hard to automatically employ health resources to improve these conditions.\u201d<\/p>\n

The availability of reliable data, on the other hand, opens the door to examining prescribing patterns across different care settings and different patients and evaluating the effectiveness of his own study and others, Allen said.<\/p>\n

His work ultimately is an effort to use technology as a prod to old-fashioned give-and-take, Allen concluded.<\/p>\n

\u201cInstead of a patient coming in and saying, \u2018I\u2019m doing great,\u2019 now patients can come in and say, \u2018What can I do to make this better?\u2019\u201d he said. \u201cIt\u2019s now an easier thing for a clinician to say, \u2018Great. Let\u2019s have a discussion.\u2019\u201d<\/p>\n

 <\/p>\n","protected":false},"excerpt":{"rendered":"

A portrait of heart failure in the United States would be etched in tones gray and gloomy. Some 5.7 million people have hearts that can\u2019t pump sufficient volumes of blood to the rest of the body. The disease costs nearly $31 billion a year \u2013 a figure that doesn\u2019t include the many ways it diminishes […]<\/p>\n","protected":false},"author":2143,"featured_media":22704,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"_relevanssi_hide_post":"","_relevanssi_hide_content":"","_relevanssi_pin_for_all":"","_relevanssi_pin_keywords":"","_relevanssi_unpin_keywords":"","_relevanssi_related_keywords":"","_relevanssi_related_include_ids":"","_relevanssi_related_exclude_ids":"","_relevanssi_related_no_append":"","_relevanssi_related_not_related":"","_relevanssi_related_posts":"","_relevanssi_noindex_reason":"","footnotes":""},"categories":[5],"tags":[3512,1013,3300,9167,890],"class_list":["post-22697","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-innovative-care","tag-heart-and-vascular-care-cardiovascular","tag-heart-failure","tag-heart-surgery-treatments","tag-specialized-services","tag-uchealth"],"acf":[],"yoast_head":"\nHeart failure project pinpoints an underused resource: patients - 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