Who would have guessed that visualizing tell-tale evidence of CVD and showing it to a patient actually improves patient compliance with treatment? We know that patient compliance has been shown to be effective in preventing and treating heart disease. A pair of studies presented at the ACC’s 61st Annual Scientific Sessions revealed two interesting cases in which the patient knowing more about what is actually going on inside of them led to better compliance with treatment.

Seeing is Believing

The first study, from Nove Kalia, MD, and colleagues, suggested that patients with coronary artery calcium (CAC) scores >400 were 2.5 times more likely to adhere to statin therapy after viewing images of their heart. Coronary CT scans, which are most commonly used for risk stratification of individuals presenting with chest pain or suspected coronary disease, were the chosen imaging modality.

According to the data, patient compliance increased significantly as CAC scores increased (from 51.8% with scores of 1-99 to 59.1% with scores of 400 or more; p < 0.001). “Those with CAC scores of 1-99, 100-400 and >400, as compared to those with a score of 0, were 2.0- (95% CI, 2.0-3.5; p < 0.001), 2.4- (95% CI, 2.0-3.5; p <0.001) and 2.6-fold (95% CI, 2.0-3.5; p < 0.001), respectively, more likely to adhere to statin therapy when adjusted for age, gender, and race,” the researchers added.

When looking at the effect of visualizing CT scans on the probability of losing weight, the researchers found that patients with CAC scores of 1-99 were 2 times more likely (95% CI 1.0-3.9; p < 0.001), those with CAC scores of 100-400 were 3.6 times more likely (95% CI, 1.7-7.3; p <0.001), and those with scores >400 were 3.3 times more likely (95% CI, 1.6-6.9; p < 0.001) to lose weight compared with patients who had a CAC score of 0.

In addition to promoting behavioral changes such as exercise for weight loss, the findings from these initial large-scale studies were consistent with previous studies showing reduction in Framingham risk score. This visualization technique may also improve clinical outcomes, which requires further prospective studies.

Dr. Kalia and colleagues did not examine compliance data regarding side effects of statin therapies in conjunction with visualization scans, telling CardioSource WorldNews: “We did not delve so deep, but I know of the possible side effects reported in the literature, especially with reference to HMG-CoA reductase inhibitors.” He added that promoting compliance is the only way to achieve the target results.

Learning the Little Things

In the “knowledge is power” category, additional evidence presented by Kevin Chung, MD, of the University of Notre Dame in Fremantle, Australia, indicated that patient education is critical to improving compliance. The investigators found that when patients had increased awareness of the need to undergo exercise stress testing after presenting to the ED with chest pains, they were more likely to comply with physician recommendations.

According to the findings, patients waited longer to undergo the test, which monitors the electrical activity of the heart during exercise and helps physicians diagnose the risk of heart ailment and the need for prompt intervention. In addition, only 70% actually complied with their physician’s recommendation before leaving the ED.

Why did Dr. Chung and colleagues opt for the exercise stress test rather than other modalities? “The advantages [of the exercise stress test] include viability, technical feasibility, simplicity, cost, user-friendly features involving no radiation, and the fact that the test can be performed under the direct supervision of a physician,” he told CardioSource WorldNews.

Patients with chest pain but a low risk of heart disease are candidates for exercise stress testing as soon as practical, and ideally within 72 hours of an ED presentation since 2-3% of these patients experience an MI. However, Dr. Chung explained, less than one-third actually comply with this recommendation, with most patients reporting for the procedure after 2 weeks or more. Patients who understood the rationale and the risks and benefits involved, and who received a pre-booked appointment time for exercise stress test, increased the chances of their follow-up, Dr. Chung added.

—by Sridhar Nadamuni

Keywords: Heart Diseases, Follow-Up Studies, Chest Pain, Weight Loss, Hydroxymethylglutaryl-CoA Reductase Inhibitors, Coronary Disease, Probability, Risk Assessment, Patient Compliance, Calcium, Exercise Test

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