Has COVID-19 Caused You to Forget About Heart Disease?

John Whyte, MD; Nancy Brown; Tom Koutsoumpas

Disclosures

April 29, 2021

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JOHN WHYTE: Welcome, everyone. I'm Dr. John Whyte, chief medical officer at WebMD. We've been spending so much time talking about coronavirus over the past year, and that's important because it has led to a significant number of deaths. But you know what else has led to a significant number of deaths? Heart disease. It remains the number one cause of death.

So today, I want to talk about some advancements, some new strategies that we're trying to implement in addressing heart disease and heart failure. So I've asked two experts and two friends: Nancy Brown -- she is the CEO of the American Heart Association -- and Tom Koutsoumpas -- he is the president of the National Partnership for Healthcare and Hospice Innovation. Thanks for joining me. It's nice to see you, even if it's virtual.

NANCY BROWN: Hey, John. So good to see you. Thank you for having us.

TOM KOUTSOUMPAS: Yeah, thank you, John. So much. We're so grateful.

JOHN WHYTE: Nancy, I want to start off with what we've heard over the past year is the impact of COVID on heart disease, not just perhaps its impact on the structure and functioning of the heart, but the fact that we told people not to come in early on during the pandemic. And even though some people might have had chest pain or might have had atypical symptoms of heart attacks, we have to recognize that it has had a tremendous role in terms of how heart disease has impacted Americans last year. What's your perspective on the role of COVID in heart disease?

NANCY BROWN: The role of COVID in heart disease is very significant. I would probably put it in two buckets. We know, for example, that individuals who have the risk factors for heart disease -- hypertension, obesity, type 2 diabetes -- are more likely to have severe complications if they get that coronavirus, more likely to be hospitalized. And outcomes are worse. We have documented this in the American Heart Association's COVID-19 registry, which we stood up last April, and we have now over 140,000 days of serial labs of hospitalized patients. And we have a number of scientific publications that are demonstrating these points about the risk factors of heart disease.

We're seeing for the long haul, of course, long-term effects of cardiovascular disease broadly. We are hearing a lot about blood clotting that is appearing in younger people months after they've recovered from the virus. And these are issues we are concerned about, and we're tracking. And then, of course, John, to the point that you raised, during the heat of the pandemic, especially, individuals were not seeking care if they had the warning signs of a heart attack and of a stroke. And the care was down significantly last March, April, and May in hospitals across the country.

And we knew that heart attacks weren't down and strokes weren't down. And that's one reason that we launched the campaign at the American Heart Association called Don't Die of Doubt. The goal of that campaign was to make sure that people understood that hospitals were still the safest place to be in a medical emergency and the importance of calling 911 at the first sign of a heart attack or a stroke.

JOHN WHYTE: And sometimes, to be fair, that has been a challenging message that patients might have only heard one message or got confused. I mentioned at the beginning that you're both friends, and I didn't just invite you because you're friends. And I want to turn to you, Tom, because you and I have known each other in your instrumental role in Capital Caring Health, but also with the partnership for innovation in terms of hospice care.

So, on the surface, it doesn't necessarily make sense, perhaps that, hey, I'm talking about the American Heart Association. Don't people do pretty well nowadays with heart disease? And then I'm talking about hospice. So what major two organizations come together to talk about how we address some issues of heart disease, particularly heart failure?

TOM KOUTSOUMPAS: Well, and thank you again, John. Too many people die alone in hospitals with heart disease, end-stage heart disease. And it really doesn't have to be that way. And when we began talking with Nancy and her colleagues at the American Heart Association, we just had a wonderful discussion about, “How can we help Americans? How can we care for them to make sure they know that care is available in their homes? That they can be supported in a really comprehensive way and stay at home during that process.” And we decided that it was really important to create an advanced cardiac care handbook that would give them all of the information and the tools that would allow them to be able to recognize that they could stay home with the support of the care that we can deliver directly into the home.

It's a wonderful option that too many people don't know about. And we wanted to make sure that people did know about it and knew about the availability of that care.

JOHN WHYTE: Well, talk to us a little bit about that type of care, because people may be watching and thinking, “Hey, I have heart disease. I need to be treated at a hospital.” And let's be honest, no one wants to be in the hospital. We're not talking about symptoms of a heart attack. They need to go into the hospital. We're talking about people with longer-standing heart disease, heart failure. Has COVID changed our thinking about what we can accomplish in the home?

TOM KOUTSOUMPAS: Oh, there's no question. It's really opened up the entire dialogue and discussion about what can be delivered in the home. And we can deliver through our programs, our not-for-profit community-based programs throughout the nation. We can deliver a comprehensive set of services to support patients with heart disease in their home and support their families. We've taken this idea of team-based comprehensive care and delivering it right to the home, directly to patients and families in the home.

And it really eliminates the need for them to be going out to the hospital or to offices outside, particularly during these times like COVID, where people are reticent to leave at all. So one of the challenges that Nancy mentioned was people weren't getting care during this period. Well, we can absolutely deliver care in the home during this time and beyond, so people don't have to worry about that. And it really is extraordinarily important.

JOHN WHYTE: Nancy, I want to ask you about the fact that Tom mentioned that many people didn't get care. Let's be honest, the majority of those persons, in many ways, are people of color that are disproportionately impacted by heart disease, disproportionately impacted by COVID. When we talk about lack of awareness in terms of therapy in the home, we know that people of color, Brown and Black persons, often aren't familiar with it.

How do we help raise that awareness? You've been so good in raising awareness of symptoms of chest pain, including atypical symptoms of chest pain in women. How do we transport those lessons learned into a new strategy of helping everyone know about the awareness of these services that are available at home, particularly for minorities?

NANCY BROWN: Well, John, it's such an important question. And there's no doubt that disparities exist at every stage of care. And through our partnership, Tom and I and our teams are determined to provide information to make quality cardiovascular care available at each stage of life. As an example, only 50% of heart failure patients who would qualify for in-home hospice care are enrolled. In, among individuals of color, it's a much lower percentage.

And so, we know we have a big job to do to make sure that people are aware of these services, to make sure that individuals are in a health care system, to begin with, and you're exactly right: the need for education and awareness and just for all of us. You know, someone to help shepherd our care is very, very important. And this is a major fundamental priority that Tom and I share.

TOM KOUTSOUMPAS: Absolutely. It really is one of the most important things that we are taking on with this initiative.

JOHN WHYTE: Well, I want to ask you, Tom, about some misunderstandings. So people could be listening and saying, “I thought people were living longer with heart disease right now, doing better. You're telling me about hospice, and when I hear a hospice, I think I don't have long to live.” Help us understand who could be eligible for the services.

TOM KOUTSOUMPAS: We have hospice, but also we call it advanced illness care. We really incorporate a team-based approach that's comprehensive in the way it approaches the care delivery, but it really isn't limited to the very end of life. We can care for people in their homes for a much longer period of time. We absolutely go in and put the team in place to support the patient and family throughout this period with advanced illness, if they have advanced illness.

An end-stage hospice is at the very end. But we use the same model for providing advanced illness care. And that's really what's important about this, is that it's not just the last 6 months of life or the last 3 months of life, it's really the last period of life that we can provide the comprehensive support needed to make sure that they're able to stay in their homes.

We just told a story recently about a wonderful couple in Washington. In fact, the husband is 94. He helped start the Peace Corps, just an extraordinary person, extraordinary accomplished person. And his wife said, “You know, we have been in our homes 60 years, and he has advanced cardiac disease.” And she said, “We've been struggling about what to do. We didn't want to leave. We didn't want to go to any sort of facility, but we thought there was no option,” until they discovered the kind of care that we can bring into the home to support them.

And this story is touching because it really shows that when we come in with our care, with our advanced illness care and support, not just the patient, but the family, the wife, our comprehensive support, that they could stay at home and live those last years of life with that kind of care in their home. It's an extraordinary story, but it's not something that needs to be unusual. We do this throughout the nation, the providers that are part of NPHI throughout the communities in the United States. They provide this care, and it's available now.

And through working with Nancy and the American Heart Association, our desire is to get the word out, particularly as we've gone through COVID and people are nervous about getting out. Don't be. We can come into your home, and we can care for you there.

JOHN WHYTE: And it's not just about length of life. We have focused on that, but it goes to your point, doesn't it? It's about quality of life as well, and that's a measure we haven't always focused on.

TOM KOUTSOUMPAS: It really is about quality of life, how do we make sure that the last years of your life, whether you're -- when you're at home suffering with advanced cardiac disease, for instance, we can be there to support you; to support you not just clinically, but with social determinants support and make sure that you can remain in your home place and get the right kind of care that allows you to do that. Think about how powerful that is.

My mother and father both passed away from heart disease, and they did not have the option of having someone come in their home and care for them the way that we're now doing it. And when I look back on how they went through this, I often think, gosh, if they had only had this option, it would have been extraordinarily important to support them in their home.

JOHN WHYTE: Nancy, I have to ask you: How has COVID impacted what the Heart Association does? I mean, when we talk about awareness, how do you raise awareness of this benefit and service at a time when you're not being able to have the big walks, the big galas. I talked to several months ago. You and I have the same background.

We might not have moved much. So how much more difficult is it for you now to raise awareness? Do you have different tools in your toolbox now, the same number of tools? How has the COVID pandemic changed the way you do your advocacy?

NANCY BROWN: It's such an important question, and I'm really proud that for decades, the American Heart Association has really focused on what I always call the three core pillars of our work: our brand so positively recognized and trusted by the American public. Our science, the 40,000 science volunteers of the AHA. And our grassroots, millions of volunteers and communities. And you're absolutely right, John, although we couldn't gather people together face-to-face. What we have seen is that suddenly, health is at the top of everyone's agenda.

People who maybe didn't worry about being healthy or worry about the importance of physical health, and mental health, and well-being now are quite concerned about this. So it's been an important moment for us to ramp up our digital content and ways that we can connect with people virtually, which we have done very successfully. And to partner, you know, this partnership that Tom and I are speaking about today is an example. The partnerships that we have with so many organizations at the state, community, and federal level have all allowed the AHA to continue our work.

And I would say our work has never been more important and, truly, our organization was made for this moment of needing to be there for people with solutions that are based in science that are delivered in communities, as well as globally.

JOHN WHYTE: With these type of partnerships, the focus on care in the home, the focus of heart failure: Would it have happened without this pandemic, Nancy?

NANCY BROWN: I would say yes, it would have. The pandemic certainly has raised awareness of the importance of meeting people where they are and providing tools and solutions for people to access health care at home. And John, as you and I have talked in the past, this is a trend that we're quite excited about at the AHA broadly. And I think as it relates to helping people who are dealing with complex health issues, like heart failure, as an example, we have long been committed to create our portfolio of solutions.

And so, before the pandemic even started, Tom and I were talking about how we could work together to support patients with heart failure, patients who've had a stroke, individuals who have complex health care conditions that are taxing for the patient, and for the caregiver. And so --

JOHN WHYTE: Been 5 years from now, just to push it? To be honest, could it have been several years?

NANCY BROWN: I think on this particular initiative, I think, it probably, the pandemic timing didn't change it one way or the other. But I will tell you, four other strategies at the AHA we have accelerated, how we're thinking about embedding our science-based content into solutions that providers are using to connect with patients at home. That part of our work has absolutely accelerated.

JOHN WHYTE: And then, Tom, what's been some of the challenges or frustrations, because you really have to reach really three audiences in some ways. You have to reach patients. You have to reach caregivers in many ways. And you have to reach clinicians, all of whom can say that's not the way we do this. Right, we come into the home. We don't really do that. It's a mindset change, isn't it? How challenging has that been? And again, has COVID, in some ways, made it easier because there weren't a lot of options?

TOM KOUTSOUMPAS: COVID has certainly highlighted the issue and the need to go into the home. But as Nancy said, we've been talking about this for quite a while, and we've been really excited about introducing the advanced cardiac care handbook. So this has been front and center for us, and I think the COVID issue has certainly highlighted the need. But our focus on getting this done and getting the information out there has really never waned or never increased. It's always been on the forefront of our goal and objective to get the word out.

We've created this with the American Heart Association in this extraordinary handbook, called the advanced cardiac care handbook. And I think, John, it does exactly what you just asked me about. It addresses the needs and concerns for the patient, the family, and for the clinician. It's comprehensive. It really is an extraordinary tool that gives the right information, important information for each of those audiences to be comfortable with the availability of good care that's deliverable in the home.

And so, we've been working together to get that word out, to get everyone to be able to get a copy of the handbook, to see it, and to really understand after looking at it that all of this care is available and that it's something that we believe will make an extraordinary difference in the way that people are cared for.

JOHN WHYTE: I'm going to help you both get this handbook out. So we'll have the image of it on screen and tell viewers how they can get a copy of the handbook.

TOM KOUTSOUMPAS: Yeah, absolutely. Well, you can go to hospiceinnovations.org, or you can call 844-438-6744. And you call that number, and we'll send you a copy of it right away. We believe that, and we are so excited because of the difference this will make in the lives of people. And I just can't tell you how extraordinary the American Heart Association is, the opportunity that we've had at the National Partnership for Healthcare and Hospice Innovation to work together. We're going to make a difference in the lives of these people throughout the nation. And, to me, that goal and that mission is heartwarming.

JOHN WHYTE: Nancy, what does heart disease look like in 5 years?

NANCY BROWN: Heart disease, hopefully, will continue to have amazing innovations to allow people to live healthier lives if they are diagnosed with heart disease. And the American Heart Association is very committed to address issues of health care equity and access to health care for all. And we certainly hope that in the next 5 years, we will see a more equitable approach to delivering care and to assuring that all people have an equal opportunity for health and well-being, especially as it relates to the number one killer of Americans, heart disease.

JOHN WHYTE: I want to thank you both for sharing what you're doing, raising awareness of heart disease, heart failure, the options that are available in getting care at home, roll-up of hospice, and other resources. Truly, thank you both for what you're doing.

NANCY BROWN: John, thank you for the opportunity to visit with you today. It's always a delight to spend time together.

TOM KOUTSOUMPAS: Yeah, thank you. Thank you, Nancy. And thank you, John. I mean, this is a tremendous discussion. And we are so grateful for the opportunity to have it with you and to get the word out of this important tool that will help thousands and thousands of Americans throughout the nation.

JOHN WHYTE: And thank you all for watching. If you have questions about today's broadcast, please feel free to drop me a line. You can email me at drjohn@webmd.net or post on our social properties Twitter, Instagram, and Facebook. Thanks for watching.

This interview originally appeared on WebMD on April 28, 2021

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