An Easier Consult for Heart Failure
Date: February 28, 2010
The problem with getting a second opinion for a heart failure patient is that it really requires a third, fourth and fifth opinion too. Because of the complex interactions among prescriptions, diets, exercise regimens and all the other variables that influence the ongoing management of this chronic condition, a thorough assessment requires participation by any number of specialists.
For the patient, that can mean six or more separate appointments. For the referring physician, it means a sheaf of reports and an entire team of professionals to manage—which is why Stuart Russell launched the Johns Hopkins Heart Success Multidisciplinary Clinic, a service designed to simplify the process and provide a comprehensive assessment.
Russell, clinical chief of heart failure and transplantation, knew only too well the frustration of trying to corral fellow experts for consults. “Finding a nutritionist or pharmacist who could drop everything to see my patient was impossible,” he says.
So he organized the clinic to gather the nutritionist, pharmacologist, exercise physiologist and other specialists together to give patients a thorough workup in one visit.
“At least once a month we find something that will have a significant impact for a patient.”
But the clinic is more than simply a one-stop shop. Russell and his colleagues also help match patients with clinical trials and closely track changes in protocols. For instance, Russell recently saw a 58-year-old patient with a remote history of breast cancer whose heart had been damaged by her chemotherapy eight years before. Because she’d had cancer, her doctor thought she wasn’t a candidate for a heart transplant. But a new, little-known standard now opens the way for transplants for cancer patients who have been in remission for more than five years.
“At least once a month,” says Russell, “we find something like this that will have a significant impact for a patient.”
While patients can choose to visit the clinic themselves, Russell views it as a resource for referring physicians.
“We really are a second opinion clinic,” he says. “We work with our referring colleagues so that we aren’t replicating studies. If the patient had a cardiac catheterization last week, for example, we don't want to be doing another one here. When we send the patients back to their doctors, both can be assured that everything that should be done has been, including an assessment of pharmaceutical, nutritional and physical needs.”