Patients Lack Motivation to Make Heart-Healthy Choices
Table. Top Concerns and Barriers for the Majority of Patients in Taking Steps to Reduce Heart Risks
| Barrier | PCPs, % (n = 234) |
Cardiologists, % (n = 208) |
|---|---|---|
| Lack of motivation | 82.5 | 87.5 |
| Cost of eating healthy, joining a gym | 59.0 | 53.4 |
| Lack of insurance | 22.6 | 19.7 |
| Cost of going to the doctor | 18.8 | 13.9 |
| Time (ie, don't have time for the drive/wait, visit) | 58.1 | 57.7 |
| Convenience (ie, unable to get appointment when/where they want) | 27.8 | 36.1 |
| Trust in doctor | 5.6 | 4.3 |
| Other | 9.0 | 4.8 |
| No concerns or barriers | 1.3 | 0.5 |
| PCP = primary care physician | ||
For the most part, physicians perceive that the major obstacles to ideal CV health for their patients are issues beyond the physician's control (Table). Trust in the doctor was rarely mentioned as a concern. Instead, the majority of cardiologists and PCPs cited their patients' lack of motivation or financial issues (eg, cost of insurance or eating healthily) as the major barrier to them taking steps to lower their CV risk.
And not surprisingly, in our harried, multitasking, modern era, lack of time to attend appointments was also seen as an issue.
The American Heart Association (AHA) Strategic Impact Goal for 2020 is to improve the CV health of all Americans by 20% while reducing deaths from CV disease (CVD) and stroke by 20%. The document specifies 7 metrics for ideal CV health for US adults, defined by the absence of clinically manifest CVD and:
• Not smoking;
• Being sufficiently active (≥ 150 min/wk moderate-intensity or ≥ 75 min/wk vigorous-intensity exercise, or a combination);
• Eating a healthy diet;
• Body mass index < 25 kg/m;
• Total cholesterol < 200 mg/dL;
• Blood pressure < 120/<80 mm Hg; and
• Fasting blood glucose <100 mg/dL.
The latter 3 measures are ideal in the absence of drug therapy.
According to the most recent data for US adults, approximately:
• 92% have ≥ 1 metric at poor levels; and
• 35% have ≥ 3 metrics at poor levels.
Advising patients to make heart-healthy choices is one thing, but how can physicians address patient inertia? Dr. Henry Black (New York University School of Medicine) thinks that this is the Achilles heel of the latest AHA/American College of Cardiology (ACC) guidelines on lifestyle management to reduce CV risk, among others: "All these guidelines recommend lifestyle interventions, but they have no advice on how to do it.... How do you get someone to do something they don't want to do? It took us 25 years to make a significant change in smoking levels, and that required increased prices, taxes, and no-smoking policies."
Dr. Black was involved in the Women's Health Initiative Dietary Modification Trial, which showed no reduction in coronary heart disease or stroke in the almost 20,000 postmenopausal women assigned to a dietary intervention group, despite a lot of time and money invested in nutrition counseling.