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Control with follow-up, patient education
Controlling cholesterol can prolong life. This is both a simple truth and a complex challenge. Cardiovascular patients and their physicians understand the importance of lipid control in prevention of recurrent heart attacks. But the continuous monitoring, lifestyle changes, and follow-up required to manage lipid levels is daunting.
The Jackson (MS) Heart Clinic, P.A. staff responded to this dilemma by creating a Lipid Management Clinic. Physicians may start a patient on cholesterol-lowering medication, then send them to the clinic for follow-up.
Most of the Lipid Management Clinic’s patients are seeing one of the medical group’s 12 cardiologists because of a past heart attack, angioplasty, or documented heart disease, although some patients may come for primary prevention.
They begin with a six-hour course, held over three class sessions. Patients learn about the pathophysiology of cholesterol, stress, and exercise, how to read nutritional labels and select appropriate foods, and how to stay on a diet without giving up the enjoyment of food. The clinic even has a mini-grocery store with examples of healthier products that patients can substitute for their previous choices.
Patients have baseline blood tests, then periodic rechecks. Medications may be adjusted until patients reach the goal of low-density lipoprotein below 100. Each patient has a flow sheet with their lipid profiles, and patients return every two to six months, even after they have reached the goal, says clinic director Monica Massey, RN.
"Our job is to scour the lipid profile and to bring anything to the doctors’ attention that isn’t as it should be," says Connie Bassett, RN, case manager.
Group practice physicians could set up a similar tracking system by clustering the schedules of lipid patients on the same day each week, notes Massey.
The Lipid Management Clinic has just started using new software to track the number of patients who have reached their lipid goals, how long it took to achieve goals, emergency department admissions, and other indicators.
Much of the clinic’s work focuses on lifestyle changes that must accompany medication. Massey admits that altering old habits is a challenge, particularly in a region of Southern-fried chicken and vegetables cooked with bacon or fatback. "It’s behavior modification," she says. "People don’t want to quit smoking, stop drinking, eat differently, and exercise. You are trying to get people to have a healthier lifestyle when deep down they don’t want to."
Massey shows patients how to cook and achieve a similar taste of their favorite recipes with healthier ingredients. Several times a year, the clinic hosts social functions for patients such as a heart-healthy dinner, showing them that healthy food can still be tasty.
"You’re not going to get anybody down here to eat seaweed and bean sprouts," says Massey. "We take a diet they already like and help them achieve a healthy diet that’s [essentially] the same thing."
Here are some resources you can tap into for more information about cardiovascular guidelines.