I had a great time in Barcelona last week at the European Society of Cardiology Heart Failure conference. There were over 6000 delegates, so a huge meeting and very well attended. My talk was well received, and it was great to catch up with colleagues from other heart centres that I don’t see regularly.
In a bid to cram in as much sightseeing in the small amount of time we had available, my friend suggested on Sunday afternoon we duck out late afternoon and take a Segway tour of the city. I’ve never been on a Segway and was slightly nervous about the risk of falling off, but it really was pretty intuitive and in no time we were whizzing about the city. I hadn’t realised how fast they go! My only reservation was you really need to leave your dignity at the door, especially by the beach where there were a great many beautiful sun-kissed young people having fun at the weekend, and in amongst them, wearing a helmet on a segway, was I. My son asked for a photo of me and on sending him one he replied ‘you look like a giant nerd’. He was right.
So what learning from the conference can I bring you? One of the trials that really resonated with me was actually one that was more ‘human factors’ than straight medicine. It related to patients with heart failure but I believe is applicable to any patient encountering a doctor. The trial involved surveying patients and cardiologists to ask their opinion on various details of their care. When asked what mattered most to them, the No1 answer was ‘to maximise my quality of life’. To increase life expectancy came second, but many votes behind, followed by symptom control, being less of a burden on others, more active, and finally, to improve mental well-being.
When asked, ‘what do you expect from the health-care professional looking after you?’ the No1 answer was that patients wanted a treatment plan to know what is planned for them if their condition deteriorates or they don’t tolerate current therapy. In second was more education about their condition, followed by more education about their medication.
And what about the format that information gets delivered in? Top of the pile was verbally, followed by printed documents, and then online content, with mobile apps in last place.
There was definitely a disconnect between the doctor responses and the responses of the patients. I feel that is disappointing. In my experience, if a patient has a plan to make a diagnosis, including whatever tests are needed, and then a treatment plan, even if we don’t have all the answers, they are in a much better place. It does beg the question though, how on earth are we supposed to cram all that into a short consultation? Also, good communication means checking understanding, which takes time too. As a profession we must strive to do better. The days of the ‘here take this pill and don’t come back’ consultation should be confined to the past.
I also firmly believe that a well-informed patient who has some agency about their care will fare much better. They are able to take steps to self-manage. They can improve their lifestyle to help themselves. They can have some ownership of their condition. With respect to heart failure, the issue nowadays is not the treatments. We have amazing drugs, monitoring and treatment devices that can fundamentally shift outcomes. They can reverse heart failure and make people normal again. No, the issue isn’t the treatments, it’s making early diagnoses and getting those treatments to the right patients at the right point in their journey. In fact, that’s one of the main reasons why I specialised in heart failure. It really frustrated me that so relatively few patients were able to access the therapy that would help them, so I decided I would become a specialist to change systems so they served patients better.
In this week’s research video I discuss a trial presented at the conference of something called a shunt. This was one of the most promising trials I heard about. Do watch the video if you would like to know more.