How The Patient Can Prevent Recurrent Heart Attack and Stroke [Interview]

dr_lori_mosca_heart_attack_preventionGuest: Dr. Lori Mosca
Presenter: Neal Howard
Guest Bio: Lori Mosca, M.D., M.P.H., Ph.D., is a leading authority on the prevention of cardiovascular disease and stroke. She currently serves as Professor of Medicine Emerita and Director of the American Heart Association Go Red for Women Strategically Focused Research Network Center at Columbia University Medical Center. Dr. Mosca received her medical degree from SUNY Upstate Medical University in Syracuse, and her Masters in Public Health and Ph.D. in Epidemiology from Columbia University. She completed a residency in Internal Medicine at Upstate Medical University and a fellowship in Preventive Cardiology at Columbia University. Dr. Mosca has been listed among America’s and New York’s Top Doctors numerous times and in 2015 was named the American Heart Association (AHA) Physician of the Year.

Segment overview: Dr. Lori Mosca, a noted cardiologist, researcher and preventive cardiology leader talks about how patients can better manage their condition, and measures they can take to prevent recurrent heart attack or stroke.

Transcription
Health Professional Radio – Prevent Recurrent Heart Attack and Stroke

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Neal Howard: Hello and welcome to Health Professional Radio, I’m your host Neal Howard. Thank you for joining us today. Our guest in studio today is 2015 American Heart Association Physician of the Year Dr. Lori Mosca in studio with us as a returning guest to talk about how patients can better manage their condition to prevent that second heart attack and some others trying to prevent that first one. Welcome to the program Dr. Mosca.

Dr. Lori Mosca: Thanks for having me back Neal.

N: Thanks for coming back Lori. We talked in another segments about some of the strategies for preventive cardiologic issues, we also talked about some of these side effects of daily aspirin therapy in other segments. Today we’d like to talk about some of the responsibilities that patients have in managing their own condition, becoming a candidate for heart attack takes years and years of a certain lifestyle, of certain diet, maybe exercise or sometimes too much exercise – who knows. When it comes to the responsibility of the patient, let’s talk about how we can help you help us.

M: Well that’s important because I do think it is a team based approach to optimizing one’s health. Certainly there’s a lot that we can do as health care providers, therapies that we can offer patients but it is also is important that patients are empowered to really take charge of their own health. And I always start off that conversation with patients, just making sure that we do a sort of a general scan of their bodies, talk to them about getting regular check-ups, committing to the time that it takes to focus on their own health so that I sometimes I call the fifty thousand mile checkup when somebody’s turning fifty or the sixty thousand mile checkup when they’re turning sixty and to really have them almost give themselves a birthday present to just go through a list of what are my risk factors for different conditions, what am I doing actively to try to live a long life and a healthy life because I think people want energy and they want to feel well just as much as they want to live long. So I talk to the patient about what are their goals and what are they doing to try to maximize the results that they’re looking for.

N: Is a risk factor a risk factor period or are there factors that the patient might want to hold unto yet you know full well that if they hold on to that one is just as bad as holding on to them all?

M: Well what you just said is right. I mean a risk factor is a risk factor, it doesn’t mean that you have definitely have a disease or definitely gonna have a recurrent of that. I always think back to Yogi Berra, prediction is difficult especially about the future. So you can take preventive actions to try to really alter future probabilities and so I think putting that back in a patient’s court that this is not necessarily a done deal, it’s not definitive, that you have power to really change your future, how you’re gonna feel, how long you’re gonna live and engage them more and it helps to inform the patient. In years past we doctors were put on pedestals and patients were afraid to ask us questions and that’s changing and that’s a good thing. I encourage my patients, I encourage everybody go to your doctor with a list of questions, make sure you know about yourself, what is your blood pressure, what is your cholesterol level, what is your waist size, what’s the likelihood that you’re going to develop a recurrent heart attack and have that conversation.

N: You mentioned that paradigm is changing where you guys are on a pedestal and we see all the things on the wall in your office and like hey you know, we bow down. That’s changing but it’s more because of what the physicians, it’s your approach to the patient I believe more so than the patient going out there and becoming all of a sudden this empowered patient. How do you as a health care professional tell other health care professionals how to empower someone who’s maybe a little bit reluctant to empowerment?

M: Well and that’s a great point you just brought up too. We should really keep in mind that there are still many, many individuals that feel marginalized by the health care system and these are often unfortunately the patients who are at highest risk of developing heart disease, those who are have the lowest levels of education, they may be depressed, they’re on multiple medications, they’re elderly, they’re frail – these are the individuals that I worry about but these are the ones that need the most empowerment and what I suggest in that situation is to engage caregivers. I’ve always taken very much a family centered approach to the prevention of chronic diseases and because it’s just hard that even when you’re just trying to live a healthy lifestyle, if you live in your own culture and the culture in your house and the culture at work is working against you – these toxic environments can make it very difficult to be empowered to make healthy choices. So I often bring in key stakeholders in your life to help engage them in the process of prevention, I mean we’ve actually developed contracts, prevention partners we call them in my clinic in years past because it is difficult to do on your own especially these individuals that are marginalized, the features that I just talked about.

N: What in your opinion can health care professionals say the specialist learn from the first line of defense the nurses that see your patients first often times that guy that 65 maybe 70 has such a rapport with the person that’s goanna take his blood pressure and then it seems to change once they’re in the office. What can you learn from the nurses?

M: You’re absolutely on the money with that one in fact I went so far as I had a dietician worked with me in my preventive cardiology clinic for 20 years. The patient first saw a nurse or a dietician or both and they would then come to talk to me after they triage the patient and gave me a heads-up on where the patient’s at because you know what, the patients will often disclose to nurses or dieticians, to individuals other than the physician many things that they won’t disclose to us and I think sometimes it’s because they feel more comfortable, they have more time but also I think there’s this hidden thing to not really disappoint the doctor, I’ve really felt that, I felt that my patients don’t always want to come clean with me coz they don’t want to disappoint me. So I try to make it easier for them by that first line of defense as you put it Neal, having them have some of that conversation, come talk to me before I go and to see the patient and my recommendation as you know when you go in there and this environment we have now in electronic medical records makes it very difficult. Look the patient in the eye, take a deep breath and ask them “How are you doing? No really, how are you doing?” And bring up some factors, “My dietician told me that your daughter’s getting married and you’re trying to lose some weight. How can I help you achieve that goal?” So I think you just look for little windows of opportunity and what’s going on in the patient’s life to try to help re-engage them in activities that are very difficult such as prevention and medication adherence.

N: When you’re speaking to folks and putting out some of these new information, when you’re talking to someone one on one and you see that they’re a little resistant to some of the new… thing as it were.

M: Well I’ve been involved in developing national guidelines for prevention for 2 decades and I can say that I’ve really heard it all, I’ve seen it all, I understand the resistance and I’ve learned that we’re not always right and doctors often have concerns that are very genuine and valid. And I think it’s important to remain very open-minded and to ask them what is their experience, why do they maybe not want to try something new, what are their concerns and I find the best solution to fears and we all have fears even as doctors is data, “Show me the data.” Because we do have anecdotal experiences but collectively when we look at the data I think that’s the most powerful knowledge that we can really share with each other.

N: Great. You’ve been listening to Health Professional Radio, I’m your host Neal Howard in studio with Dr. Lori Mosca. Noted cardiologist, researcher and preventative cardiology leader in studio this afternoon talking with us about how we as patients can take a little bit of control of our condition and help our physicians help us more effectively. Transcripts and audio of this program are available at healthprofessionalradio.com.au and also at hpr.fm and you can subscribe to this podcast on iTunes.

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