Integrative Approaches to the Management of Patients with Heart Disease

Utilization of Additional Therapies

In addition to a strong emphasis on nutrition and lifestyle-based interventions, integrative cardiology includes therapeutic modalities not typically used in conventional cardiac care. Examples include interventions focused on the connection between the mind and heart (i.e., breathing exercises, meditation, biofeedback, and guided imagery), acupuncture, and a select group of evidence-based over-the-counter products.

Cardiologists in particular need to be aware of these therapies frequently utilized by cardiac patients—often without disclosure of their use. Data from the 2017 National Health Interview Survey of over 26,000 adults documented that 31.8% of surveyed individuals with cardiovascular disease have used at least one form of “complementary” medicine within the previous 12 months. The survey also found that patients who utilize complementary approaches do so as an adjunct rather than a replacement for conventional care—presumably to fill a gap perceived by the patient to be deficient or absent in usual care. Factors that predicted higher utilization of complementary therapies include female gender and higher levels of education, income, and health literacy.

Why Is Integrative Cardiology Important?

Integrative cardiology is important because it addresses unmet needs in conventional care.

A report from the Centers for Disease Control reveals that after years of consistent decline, the death rate from cardiovascular disease has begun to plateau. This ebb in progress, despite advances in pharmacologic and procedural therapeutics, is largely attributed to unchecked increases in the prevalence of obesity and diabetes—diseases largely preventable through dietary intervention.

Paradoxically, despite the high burden of cardiovascular diseases rooted in diet and lifestyle, nutrition remains poorly emphasized in cardiology training and practice. For example, in the current 56-page document from the Accreditation Council for Graduate Medical Education that contains very detailed procedural specifications for fellowship training in cardiovascular disease, there remains no requirement for nutrition education. Accordingly, a recent survey found that 90% of cardiologists reported receiving minimal or no nutrition education in their training. An integrative approach seeks to address this deficiency in both education and practice by highlighting nutrition and lifestyle as integral components of cardiac care.

One of the tenets of integrative cardiology is an emphasis on patient empowerment and shared decision making. Apart from the clear right of patients to determine their health priorities and goals, there is substantial evidence that patients who actively engage in decision making and self-care have greater insight into their condition and are more likely to adhere to a mutually agreed course of treatment. Recent Medicare policy has transformed shared decision making from a best practice to a payment necessity for select cardiac intervention, including implantation of cardioverter-defibrillators and left atrial appendage closure devices. Although likely fiscally driven initiatives, these policy changes are consistent with the patient-centered focus characteristic of integrative cardiology.

Need for Interprofessional Collaboration

Communication between cardiologists and allied health professionals, including those not typically associated with conventional medical care, has historically been challenging. Despite differences in language and perspectives, mutual respect and open communication between all health professionals, conventional and alternative, is essential for coordination of care and optimal outcomes.

Ischemic Heart Disease (See Chapter 40 )