This TRC Hot Topic webcast features an expert panel discussion and clinical guidance for treatment of venous thromboembolism. Listen as Clyde W. Yancy, MD, MSc, MACC, FAHA, MACP, FHFSA and other panelists discuss and answer common clinical questions, including:

  • What are some strategies for engaging patients to renew focus?
  • What are some problem-solving approaches?
  • How can med regimens be simplified?

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Here’s an excerpt of the
Medication Adherence for Patients with Heart Failure webcast:

Lori Dickerson:
You’ll need your whole team’s help to improve med adherence for patients with heart failure with reduced ejection fraction, especially as the care of chronic diseases is widely impacted  due to the COVID-19 pandemic. We’re thrilled to have Dr. Clyde Yancy with us here today to discuss this important topic.

We start out the article by saying that many heart failure patients are discharged on 10 or more meds per day but only half of the patients are actually adherent to those meds. Clyde, can you start us off by talking about how clinicians can use that hospitalization as an impetus, or to renew focus on med adherence?

Clyde YancyYou know, Lori, that’s a great question, but there’s no way that we can sit and listen to the foregoing conversation without making evident that this is everyone’s concern. This is everyone’s directive. This is everyone’s objective. We really do need to achieve an extraordinary level of immunization if we are to have sufficient protection going forward. Most are estimating it needs to be about 70% of the American population.

That means it can’t just be the family practitioners. It can’t just be the Pharm D’s. It can’t just be the nurses. It can’t just be the infectious disease specialists. Everyone that’s personally engaged with patients and their families, I think has a – and I’ll say this carefully – a duty to carry this message forward, that taking the vaccine and having a sufficient representation in our community that’s been vaccinated is the absolute necessary step for us to get back to something that affords us a little bit more freedom. And it aligns actually quite nicely with our conversation about heart failure, because that is one of the conditions that makes you more vulnerable to the novel coronavirus infection.

So, do count us in, as cardiologists, in these conversations about protecting our community. Public health is important to all of us. 

Lori Dickerson: That’s a great segue, Clyde. I appreciate you making that segue and talking about the importance of caring for the whole patient, in terms of managing their heart failure and other conditions.

One of our next paragraphs talks about partnering with patients and shared decision-making in terms of med adherence and caring for their heart failure condition, and having that shared decision-making discussion reflect the patient’s goals, resources, and risks.

Can you comment on how you do incorporate goals, resources, risks, comorbidity, socioeconomic factors when working with your heart failure patients, in terms of making these decisions?

Clyde Yancy: We have to understand that before you talk about goals and decision-making and provide resources, you’re bypassing a critical step. And that critical step is education, and it’s gaining that patient’s trust. I have been struck, as a senior practitioner, how many times I sit down and say, “Tell me something about yourself. Help me understand you as a person before we talk about you as a patient.” Lori, it works consistently, because it’s a sincere question, first.

But to give patients those few moments to articulate the world through their lens and help them see that you want to work with them through their lens gets the conversation started. And then the education piece starts.

“Why are these medicines necessary?”

“No, they’re not a bunch of pills. These are medicines for which we have evidence that your outcome, your sense of wellbeing, your comfort, your ability to enjoy life and engage with your family will be better.”

It’s pretty clear to me that talking about statistics and percent improvement and longevity really is not relevant. Talking about engaging with family and doing the things one enjoys – that is relevant. And taking enough time to listen and learn what it is that makes that person feel valuable, and demonstrating how our therapies can restore that sense of worth – I think that’s where it all starts.

Lori Dickerson: That’s a great segue, Clyde. I appreciate that. We certainly talk about engaging your patients as our first segment of this article. We talk about the core treatments: triple therapy with an ACEI/ARB or Entresto plus an evidence-based beta-blocker, and aldosterone antagonist. We have a nice graphic here to talk about that standard triple therapy.

One of the things that I thought was really interesting that we came across was – it is a statistic, but – to talk about that the risk of hospitalization or death goes up for these patients who take fewer than 80% of doses over a year. That seems like a really high number to me. It’s a powerful statistic, especially for patients who were taking up to 10 meds a day.

I agree with not wanting to throw numbers to your patients, but in terms of helping them understand daily adherence, do you think that sharing this sort of information is helpful, or is it really just about us us understanding where that threshold is? 

Clyde Yancy: You know, I think this kind of information empowers the practitioner to understand just how important the adherence message is. But what’s striking to me, Lori, is that I look at the graphic that we have in front of us, and I’ve juxtaposed that with the landmark data from the CHAMP-HF registry that says that in contemporary practice, where practitioners, physicians, cardiologists know that they’re participating in a quality improvement initiative, only 25% of patients are taking one of each drug from the triple-drug category that you just demonstrated on the graphic. And then, only 1% are taking one of each of those drug classes at the recommended doses. That is the ultimate pause moment. The juxtaposition that with the requirement that you need to be 80% adherent in order to have best possible outcomes? That’s not just a gap, Lori. That’s a gulf.

There is really a necessity for us to completely recalibrate. And by the way, what happens when this standard triple-therapy treatment becomes quadruple therapy because of the emerging and incredibly persuasive data of the sodium glucose cotransporter 2 inhibitors? We’ve talked about that before in this very platform.

That language continues. The evidence evolves. We really do have this incredible problem where we have a wealth – and I do want to emphasize this – a wealth of evidence that we can use to change the natural risks of heart failure, and we have a paucity of interventions that will improve adherence. That’s our challenge.