People in poor heart health more likely to give their doctors low marks

People with poor heart health have worse perceptions of their patient-doctor relationship, according to a new study that also found overall cardiovascular health is worsening in the U.S.

The research, published Thursday in the Journal of the American Heart Association, sought to shed light on cardiovascular health and how it squares with people's impression of their health and their health care experience.

The study looked at data from 2006 to 2015 among 177,421 adults without known cardiovascular disease. First, researchers measured their cardiovascular health by weighing six risk factors: smoking status, physical activity, weight, high blood pressure, diabetes and blood lipid levels, including cholesterol.

They found 11.5% had poor cardiovascular health, a number that rose over the 10-year time frame regardless of age, gender, race or income.

"No matter how you slice it or dice it, we found cardiovascular health is sliding backwards, which tracks with national trends," said senior author, Dr. Erin Michos. "It's disappointing, but not surprising."

Recent data from the Centers for Disease Control and Prevention show obesity prevalence is at 42% for the adult U.S. population – "the highest it's ever been, and its associated complications of hypertension and diabetes are likewise on the rise," Michos said.

Researchers also zeroed in on survey questions about people's health experience and health-related quality of life.

After adjusting for various factors including income, health insurance and other health conditions, they found that poor cardiovascular health was associated with having a poor perception of general health, poor health-related quality of life and a higher number of disability days off work.

Michos said she was most surprised to find that people with poor heart health were 21% more likely than those with optimal heart health to say their doctors didn't listen to them, explain things in a way they could understand or show them respect.

"It's alarming that people in poor health are more likely to report bad experiences with clinicians. These are people with multiple risk factors who are on a bad trajectory towards potentially having a major heart attack or stroke. They need optimal treatment to turn things around," said Michos, associate professor of preventive cardiology at the Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease in Baltimore.

She said past studies have shown that improved patient experiences with the health care system translate into more favorable cardiovascular outcomes. To achieve that, she urged medical professionals to shift to "a more patient-centered" approach.

"Good communication skills aren't always taught in medical school," she said. "We need to learn how to deliver care as more of a partnership and a shared decision-making collaboration, as opposed to a paternalistic relationship."

The study was limited by self-reported data and the lack of information about what participants ate, so diet was not factored in, Michos said. Also, because of its design, the research only showed associations and didn't prove cause and effect, she said.

Dr. Gina Lundberg, who was not involved in the research, cautioned that patient satisfaction is "a very complicated issue."

"I've been surprised by patients' perception," said Lundberg, a preventive cardiologist and medical director of the Emory Women's Heart Center in Atlanta. "There have been times when I know I spent a lot of time and answered a lot of questions, and then they still say, 'The doctor didn't listen to me.' There are always going to be patients who felt like it wasn't enough."

She said one way to boost satisfaction and results is to encourage patients to adopt the concept of working with a team of health professionals.

"I think you get the best quality care when you have coordinated care between doctors and well-trained nurse practitioners, physician assistants, nutritionists and others who can really expand what the doctors do," Lundberg said.

The most crucial method to improving cardiovascular health, she said, is convincing people to lower their risk factors through Life's Simple 7, which the American Heart Association defines as managing blood pressure, controlling cholesterol, reducing blood sugar, getting active, eating better, losing weight and stopping smoking.

"People are always looking for the special pill or the latest surgery or technology, when the real answer is the one we've been hearing since health class in second grade: healthy lifestyle," Lundberg said.

"It's not sexy or exciting, but it's the key."

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