Statement Highlights:
Embargoed until 4 a.m. CT / 5 a.m. ET Thursday, April 11, 2024
DALLAS, April 11, 2024 — Adult cardiovascular care centered on the patient can improve individuals’ experiences and their medical outcomes, according to a new American Heart Association Scientific Statement published today in Circulation .
“Patient-centered care means seeing the patient as a person and being respectful of their beliefs, preferences and values. Patient-centered care combines the health care professional’s expertise with consideration of the patient’s health priorities. It involves empowering patients to make informed decisions by providing information and developing an active partnership among the patient, family and the health care team. Patient-centered care does not mean that patients can choose what they want, when they want ,” said Michael J. Goldfarb, M.D., M.Sc., chair of the scientific statement writing committee and associate professor of cardiology at the Jewish General Hospital and McGill University in Montreal, Quebec, Canada.
“There is a need for health care professionals managing adults with heart disease to receive guidance and practical tools on how to incorporate a person-centered care approach into routine clinical practice,” said Goldfarb.
The new scientific statement describes several elements that are essential to patient-centered care, including shared decision-making, medication management and patient-oriented outcomes.
Shared decision-making is a collaborative partnership among patients, family and health care professionals based on trust, mutual respect and open and honest communication. Health professionals need to consider their patient’s level of health literacy and provide clear, jargon-free and relevant information about risk factors, current health conditions and the realities, risks and benefits of possible screening and treatment options. Patients must have the opportunity to ask questions, express their values, preferences and goals, and work together with the medical team to agree on a plan for managing their heart disease.
Although the benefits of using medication to prevent and treat heart disease are well known, for a myriad of reasons, more than half of patients with cardiovascular disease do not always take their medications as prescribed. Conditions such as high blood pressure and high cholesterol raise the risk of heart attack and stroke, but undertreatment of these silent conditions is common.
Patient-centered discussions of current and proposed medications may also help to improve adherence to needed medications and minimize drug costs and side effects. In some cases, a combination pill may reduce the number of tablets that must be taken each day, or a less expensive but equally effective medication may be substituted for a more expensive option. An open, honest discussion about medication may also lead to the decision to eliminate a longstanding medication that may no longer be needed.
“Prior to starting, adjusting or stopping cardiovascular medications, there is a need to establish and take into account patient preferences and goals,” said Goldfarb.
While physical examinations and lab tests provide important data about how a patient with heart disease is doing, patient-centered care incorporates people’s own reports of their physical functioning, symptom burden, emotional well-being, social functioning and quality of life. Collecting this information gives health care professionals a more complete picture of how a patient is doing so they may detect subtle changes in the progression of heart disease and assess the impact (negative or positive) of current or proposed treatments.
“While some care outcomes are important for health care professionals and health systems, these may not always reflect what is important to the patient. For example, while the length of a hospital stay is often recorded as a marker of care quality, the patient may prioritize their physical functioning and quality of life after a heart attack,” said Goldfarb.
Ensuring patient-centered care for all
The statement gives special consideration to overcoming barriers to patient-centered care and in applying patient-centered care to the people who carry an outsized burden of cardiovascular disease. For example:
Barriers to patient-centered care
There are many barriers to incorporating patient-centered care, including those arising from patients, clinicians and health systems.
“Patient-centered care is possible—and already occurs to a certain extent—in today’s care delivery systems. Further development and inclusion of patient-centered outcomes measures will be important for optimizing care for patients, their families and caregivers,” said Goldfarb.
This scientific statement was prepared by the volunteer writing group on behalf of the American Heart Association’s Council of Clinical Cardiology; the Council on Cardiovascular and Stroke Nursing; the Council on Hypertension; the Council on Lifestyle and Cardiometabolic Health; the Council on Peripheral Vascular Disease; and the Council on Quality of Care and Outcomes Research. American Heart Association scientific statements promote greater awareness about cardiovascular diseases and stroke issues and help facilitate informed health care decisions. Scientific statements outline what is currently known about a topic and what areas need additional research. While scientific statements inform the development of guidelines, they do not make treatment recommendations. American Heart Association guidelines provide the Association’s official clinical practice recommendations.
Co-authors and members of the statement writing group are Vice Chair Martha Gulati, M.D., M.S., FAHA; Martha Abshire Saylor, Ph.D., R.N.; Biykem Bozkurt, M.D., Ph.D.; Jillianne Code, Ph.D.; Katherine Di Palo, Pharm.D., M.B.A., M.S., FAHA; Angela Durante, Ph.D, R.N.; Kristin Flanary, M.A.; Ruth Masterson Creber, Ph.D., M.Sc., R.N.; Modele O. Ogunniyi, M.D., M.P.H., FAHA; Fatima Rodriguez, M.D., M.P.H., FAHA. Authors’ disclosures are listed in the manuscript.
The Association receives funding primarily from individuals. Foundations and corporations (including pharmaceutical, device manufacturers and other companies) also make donations and fund specific Association programs and events. The Association has strict policies to prevent these relationships from influencing the science content. Revenues from pharmaceutical and biotech companies, device manufacturers and health insurance providers, and the Association’s overall financial information are available here .
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About the American Heart Association
The American Heart Association is a relentless force for a world of longer, healthier lives. We are dedicated to ensuring equitable health in all communities. Through collaboration with numerous organizations, and powered by millions of volunteers, we fund innovative research, advocate for the public’s health and share lifesaving resources. The Dallas-based organization has been a leading source of health information for a century. During 2024 - our Centennial year - we celebrate our rich 100-year history and accomplishments. As we forge ahead into our second century of bold discovery and impact our vision is to advance health and hope for everyone, everywhere. Connect with us on heart.org , Facebook , X or by calling 1-800-AHA-USA1.
Circulation
Patient-Centered Adult Cardiovascular Care: A Scientific Statement From the American Heart Association