- Unhealthy habits, such as smoking, poor diet, and being overweight should be treated as aggressively as high blood pressure, high cholesterol and other cardiovascular disease risk factors.
- Insurance reimbursement policies need to be improved so that registered dieticians, psychologists and others can become part of the primary practice team.
DALLAS — Healthcare providers should treat unhealthy behaviors as aggressively as they treat high blood pressure, cholesterol and other heart disease risk factors, according to an American Heart Association science advisory published in Circulation.
“We’re talking about a paradigm shift from only treating biomarkers — physical indicators of a person’s risk for heart disease — to helping people change unhealthy behaviors, such as smoking, unhealthy body weight, poor diet quality and lack of physical activity,” said Bonnie Spring, Ph.D., lead author of the statement and a professor of preventive medicine and psychiatry and behavioral sciences at Northwestern University in Chicago.
“We already treat physical risk factors that can be measured through a blood sample or a blood pressure reading in a doctor’s office, yet people put their health at risk through their behaviors. We can’t measure the results of these behaviors in their bodies yet.”
Among the statement’s recommendations, healthcare providers should create “inter-professional practices” to connect patients with behavior change specialists such as dietitians or psychologists and implement the five A’s when caring for patients:
- Assess a patient’s risk behaviors for heart disease.
- Advise change, such as weight loss or exercise.
- Agree on an action plan.
- Assist with treatment.
- Arrange for follow-up care.
For inter-professional practices to work, reimbursement policies must be revised, Spring said.
Under an effective healthcare system, professionals can work with patients and draw on community and technology resources to provide intensive behavior interventions.
“This isn’t a problem that can be solved alone by the patient or the doctor who is strapped for time,” Spring said. “We need to break out of our silos and get ahead of the curve in prevention.”
She said to achieve the American Heart Association’s 2020 impact goals –to improve the cardiovascular health of all Americans by 20 percent while reducing deaths from cardiovascular diseases and stroke by 20 percent — we must make preventing cardiovascular diseases a priority.
Judith K. Ockene, Ph.D., co-chaired the writing group with Spring. Other co-authors are Samuel S. Gidding, M.D.; Dariush Mozaffarian, M.D., Dr.PH.; Shirley Moore, R.N., Ph.D.; Milagros C. Rosal, Ph.D.; Michael D. Brown, Ph.D.; Dorothea Vafiadis, M.S.; Debbie L. Cohen, M.D.; Lora E. Burke, Ph.D., M.P.H.; and Donald Lloyd-Jones, M.D., Sc.M. Author disclosures and sources of funding are on the manuscript.
. The American Heart Association/American Stroke Association receives funding mostly from individuals. Foundations and corporations donate as well, and fund specific programs and events. Strict policies are enforced to prevent these relationships from influencing the association’s science content. Financial information for the American Heart Association, including a list of contributions from pharmaceutical companies and device manufacturers, is available at www.heart.org/corporatefunding