June 26, 1998

Patients’ lifestyles at heart of new Cardiology program

Patients' lifestyles at heart of new Cardiology program

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Nurse Gail Thompson worked with patient Timothy Tappan to help manage his heart condition. (Photo by Donna Jones Bailey)

When a heart attack strikes, modern cardiology is there with the urgent fix.

But if the silent process that led to the heart attack is not addressed, the patient's heart disease continues beyond the immediate repair. And for many patients, stepping in early and making lasting lifestyle changes could eliminate the need for the urgent fix altogether.

Many of us know from personal experience that making those changes isn't easy. That's what the new Heart Disease Prevention Program at Vanderbilt University Medical Center is all about.

"Modern cardiology is characterized by swift response to acute emergencies with dramatic and costly procedures," said the new program's medical director, Dr. David J. Maron, assistant professor of Medicine and director of Preventive Cardiology.

"All too frequently, the underlying lifestyle issues that lead to heart disease and to these acute events are neglected. When we can address those issues in a systematic and integrated way, we can reduce patients¹ risk of having a heart attack or other acute event, improve their health and lower health care costs. All this inevitably leads to improved quality of life."

Heart disease is a significant problem in the United States, accounting for more than 700,000 deaths and $165 billion in direct and indirect costs each year.

The Vanderbilt Heart Disease Prevention Program (VHDPP) is designed to address the problem before the costly interventions are necessary. Specifically, the program is intended to reverse the progression of heart or other vascular disease, to reduce the risk of a new heart attack, and to restore and maintain optimal physical condition

The VHDPP is modeled after a successful research project program at Stanford University that slowed progression of heart disease and reduced recurrence of heart attacks and other "clinical events" by 40 percent over four years. Maron was a core member of the research team that developed the Stanford model.

Patients are carefully evaluated for the factors that specifically put them at risk for heart disease, such as smoking, high cholesterol or having diabetes. Customized plans are developed to address these various factors through programs at the Kim Dayani Center for Human Performance or through referral ‹ in conjunction with the patient¹s primary care physician ‹ to other Vanderbilt Patient Care Centers.

Much of the face-to-face counseling and other interventions are provided by a nurse case manager and dietitian in clinic visits, through the mail and over the phone. That design makes the VHDPP more cost effective without sacrificing quality of care, Maron said.

The continual contact is the reason for the program's success, believes Gail Thompson, B.S.N., the nurse case manager for the program.

"We hold patients accountable," Thompson said. "When they have to come in to talk to Dr. Maron or me, it's like having to bring in their homework."

Medication is used when appropriate to lower a patient's blood pressure or blood lipid levels. However, it is the comprehensive management of all the behavioral issues that contribute to the individual's risk that sets the VHDPP apart from other programs in the region, Thompson said.

The VHDPP meets a demand for preventive services that is beginning to be heard from employers and insurers who recognize that preventing illness is less costly than treating it, said Dr. F. Andrew Gaffney, professor of Medicine and interim director of Cardiology.

"The data are absolutely clear ‹ smoking cessation, lipid management, exercise and those other factors that make for a healthy lifestyle would prevent almost all of the heart disease in the United States," Gaffney said. "Payors, employers and society are beginning to demand a shift in focus to prevention. We¹re fortunate to have David Maron to lead this effort because he¹s nationally recognized in this field and has dedicated his whole career to trying to do something about this major problem."

Because it is based at the Dayani Center, the VHDPP can take advantage of the wide array of resources and services offered at Dayani to address heart disease-related lifestyle concerns, such as exercise, weight loss, smoking cessation and stress management.

The relationship also fits with the original mission envisioned by the Dayani family when they made the gift to the medical center that established the center in 1987 in honor of Dr. Kim Dayani. Dayani, a 1965 graduate of Vanderbilt University School of Medicine, died unexpectedly of a heart attack in 1981. Among the purposes of the gift was to create a center for heart disease prevention.

"The Dayani Center is proud to be the home of the VHDPP," said center director Jay Groves, Ed.D. "Our core purpose is to empower the individuals we serve with the knowledge and skills to achieve their optimal health.

"We anticipate that this program will be very appealing to graduates of our Cardiac Rehabilitation Program, our referring physicians and many of our corporate clients."

For more information, call the Dayani Center at 322-4751.