A new Scientific Statement from the American Heart Association, published in Circulation, emphasizes the significant benefits of adopting a patient-centred approach to adult cardiovascular care. This approach, as detailed by Michael J. Goldfarb, M.D., M.Sc., the chair of the statement writing committee and an associate professor of cardiology at Jewish General Hospital and McGill University, revolves around treating patients as individuals, respecting their beliefs, preferences, and values. It advocates for a harmonious blend of the healthcare professional’s expertise with the patient’s health priorities, fostering an environment where informed decisions are made through the empowerment of patients. This entails not just providing information but cultivating an active partnership among patients, their families, and the healthcare team. However, it is made clear that this does not grant patients carte blanche to make any healthcare decisions indiscriminately.
Goldfarb highlights the current gap in guidance and practical tools for healthcare professionals managing adults with heart disease in terms of integrating person-centred care into everyday clinical practice. The statement outlines essential elements of patient-centred care, such as shared decision-making, effective medication management, and the prioritization of patient-oriented outcomes. Shared decision-making is underscored as a process grounded in trust, mutual respect, and open communication, encouraging patients to express their values and preferences openly.
Despite the known benefits of medication in preventing and treating heart disease, adherence remains a challenge, with more than half of patients not consistently taking their medication as prescribed. The statement suggests that patient-centred discussions could enhance medication adherence and reduce costs and side effects. Importantly, any decision regarding starting, adjusting, or cessation of cardiovascular medications must consider the patient’s preferences and goals.
The comprehensive care model also includes the evaluation of patient-reported outcomes like physical functioning, symptom burden, and quality of life, offering a more holistic view of a patient’s condition and treatment impact. Goldfarb stresses the importance of aligning healthcare outcomes with what matters most to the patient, acknowledging that traditional metrics such as hospital stay length might not capture a patient’s primary concerns regarding their quality of life post-treatment.
The statement addresses the need to overcome barriers to patient-centered care, especially for populations disproportionately burdened by cardiovascular disease. It calls for culturally and linguistically competent care teams to assess and address social determinants of health alongside considerations for special groups such as older adults, women, individuals with behavioural and mental health disorders, adults with congenital heart disease, and those with physical disabilities.
However, the path to implementing patient-centred care is fraught with challenges from patient, clinician, and health system barriers, including distrust, limited health literacy, time pressures on clinicians, and fragmented health systems. Despite these obstacles, Goldfarb remains optimistic about the feasibility and existing instances of patient-centred care within current delivery systems. He advocates for the further development and inclusion of patient-centred outcomes measures to optimize care for patients, their families, and caregivers, highlighting the pivotal role of patient-centred care in improving medical outcomes and patient experiences in cardiovascular health.
More information: Michael J. Goldfarb et al, Patient-Centered Adult Cardiovascular Care: A Scientific Statement From the American Heart Association, Circulation. DOI: 10.1161/CIR.0000000000001233
Journal information: Circulation Provided by American Heart Association
