Want common ground managing CHF? Close gaps between patients at risk
Caregivers need to cross barriers of poverty, race, complexity of therapy
CHF patients have a lot in common. Add up their symptoms and ejection fractions, and they usually fall into one of four recognized classes of the disease.
They have to weigh themselves every day. And they all seem to frustrate and challenge their caregivers with common reasons for noncompliance.
Lately, however, these similarities seem to be taking a back seat to the differences between patients.
Earlier this spring, for example, researchers suggested there were differences in referrals for cardiac catheterization according to the race and sex of the patient. News spread quickly and in the re-analysis, the editors of The New England Journal of Medicine admitted the bias was overstated — although black women still showed a dramatic difference in rates of referral compared to their black and white male counterparts.
"That still brings us right back to square one," says George A. Mensah, MD, chief of cardiology and head of cardiovascular care at the Veterans Affairs Medical Center in Augusta, GA, who was a commentator on the report in the May issue of CHF Disease Management.
And at this first stage where doctors are still trying to figure out the differences in how to treat African-American patients, another study is gearing up to follow a population of black Mississippi residents. It seems that while the Framingham (MA) study put practitioners on common ground with recognizing risks and treating heart disease, the lessons learned from the white participants in New England don’t always apply to everyone.
"It’s high time we had a look at cardiovascular disease in African-Americans," says Herman Taylor, MD, director of the Jackson (MS) Heart Study and cardiologist at the University of Mis-sissippi Medical Center, also in Jackson. "The Jackson Heart Study does that." Investigators will find what is truly common to all sufferers only after working out the nuances between the people who develop heart disease.
An added wrinkle to the Jackson study is to train future public health specialists to take up the cause, as members of their own minority group and members of the human family.
Likewise, it may first appear that angiography is commonplace and just about everyone who gets a referral will go on to get one in a timely manner. But Texas researchers warn that may only hold true when patients have established methods of payment available to them. If they must rely on securing funds through social services, some poor patients may encounter delays on the way to the cath lab. Under some circumstances, they may even go on to have a worse prognosis.
It will be up to the caregiver
Even the recent success with spironolactone in increasing patient survivability and reducing hospitalization is dependent on an individual’s ability to add one more drug into the daily routine. And the early success seen with blocking tumor necrosis factor indicates drug therapy probably will continue to become even more complex.
But one common thread continues to run through CHF care: No matter what differences each patient may bring to each case, the caregiver is going to have to be the one who keeps everything straight and motivates the patient to continue with treatment. The following articles provide more details.
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