Specialty preference for cardiovascular prevention practice in the Southeast US and role of a preventive cardiologist

INTRODUCTION

Cardiovascular disease (CVD) prevention is practiced concurrently by providers from several specialties. Our goal was to understand providers' preference of specialties in CVD prevention practice and the role of preventive cardiologists.

MATERIALS AND METHODS

Between 11 October 2021 and 1 March 2022, we surveyed providers from internal medicine, family medicine, endocrinology, and cardiology specialties to examine their preference of specialties in managing various domains of CVD prevention. We examined categorical variables using Chi square test and continuous variables using t or analysis of variance test.

RESULTS

Of 956 invitees, 263 from 21 health systems and 9 states responded. Majority of respondents were women (54.5%), practicing physicians (72.5%), specializing in cardiology (43.6%), and working at academic centers (51.3%). Respondents favored all specialties to prescribe statins (43.2%), ezetimibe (37.8%), sodium-glucose cotransporter-2 (SGLT2) inhibitors (30.5%), and aspirin in primary prevention (36.3%). Only 7.9% and 9.5% selected cardiologists and preventive cardiologists, respectively, to prescribe SGLT2 inhibitors. Most preferred specialists (i.e. cardiology and endocrinology) to manage advanced lipid disorders, refractory hypertension, and premature coronary heart disease. The most common conditions selected for preventive cardiologists to manage were genetic lipid disorders (17%), cardiovascular risk assessment (15%), dyslipidemia (13%), and refractory/resistant hypertension (12%).

CONCLUSIONS

For CVD prevention practice, providers favored all specialties to manage common conditions, specialists to manage complex conditions, and preventive cardiologists to manage advanced lipid disorders. Cardiologists were least preferred to prescribe SGLT2 inhibitor. Future research should explore reasons for selected CVD prevention practice preferences to optimize care coordination and for effective use of limited expertise.

Availability of Specialty Services for Cardiovascular Prevention Practice in the Southeastern United States

OBJECTIVES

A comprehensive cardiovascular disease (CVD) prevention approach should address patients' medical, behavioral, and psychological issues. The aim of this study was to understand the clinician-reported availability of a pertinent CVD preventive workforce across various specialties using a survey study in the southeastern United States, an area with a disproportionate burden of CVD and commonly known as the Stroke Belt.

METHODS

We surveyed physicians, advanced practice providers (APPs), and pharmacists in internal medicine, family medicine, endocrinology, and cardiology regarding available specialists in CVD preventive practice. We examined categorical variables using the χ2 test and continuous variables using the t test/analysis of variance.

RESULTS

A total of 263 clinicians from 21 health systems participated (27.6% response rate, 91.5% from North Carolina). Most were women (54.5%) and physicians (72.5%) specializing in cardiology (43.6%) and working at academic centers (51.3%). Overall, most clinicians stated having adequate specialist services to manage hypertension (86.6%), diabetes mellitus (90.1%), and dyslipidemia (84%), with >50% stating having adequate specialist services for obesity, smoking cessation, diet/nutrition, and exercise counseling. Many reported working with an APP (69%) or a pharmacist (56.5%). Specialist services for exercise therapy, psychology, behavioral counseling, and preventive cardiology were less available. When examined across the four specialties, the majority reported having adequate specialist services for hypertension, diabetes mellitus, obesity, dyslipidemia, and diet/nutrition counseling. Providers from all four specialties were less likely to work with exercise therapists, psychologists, behavioral counselors, and preventive cardiologists.

CONCLUSIONS

A majority of providers expressed having adequate specialists for hypertension, diabetes mellitus, dyslipidemia, obesity, smoking cessation, diet/nutrition, and exercise counseling. Most worked together with APPs and pharmacists but less frequently with exercise therapists, psychologists, behavioral counselors, and preventive cardiologists. Further research should explore approaches to use and expand less commonly available specialists for optimal CVD preventive care.

Clinicians' self-reported efficacy in cardiovascular prevention practice in the southeastern United States

Aim: We assessed self-reported efficacy in cardiovascular prevention practice among internal medicine, family medicine, endocrinology and cardiology clinicians. Patients & methods: We emailed a 21-item questionnaire to 956 physicians, nurse practitioners, physician assistants and pharmacists. Results: 264 clinicians responded (median age: 39 years, 55% women, 47.9% specialists). Most expressed high self-efficacy in lifestyle counselling, prescribing statins, metformin, and aspirin in primary prevention, but low self-efficacy in managing specialized conditions like elevated lipoprotein(a). Compared with specialists, PCPs expressed lower self-efficacy in managing advanced lipid disorders and higher self-efficacy in prescribing sodium-glucose cotransporter-2 inhibitors and glucagon-like peptide-1 receptor agonists. Conclusion: Self-efficacy in cardiovascular prevention varied across specialties. Future research should explore relevant provider, clinic and system level factors to optimize cardiovascular prevention.

A Descriptive Analysis of Patients With Attempted Suicide at a Rural Level I Trauma Center

Objectives

For patients with self-harm, suicide attempt, or suicide completion, the trauma bay is often the single point of contact. Regional differences and patterns exist for suicide that should be studied to enhance preventive strategies. Our goal was to critically evaluate the suicidal population of Southeast Georgia over a 9-year period.

Methods

A retrospective review of our trauma database from January 2010 through December 2019 was conducted at a Level I Trauma Center. All ages were included. All patients arriving with attempted suicide or death due to a suicidal complication were included. Patients with deaths highly suspicious for suicide were also included. Exclusion criteria included accidental motor vehicle death, accidental generalized deaths, and accidental drowning. Age, gender, race, ethnicity, mechanism of injury (MOI), death rates, length of stay (LOS), injury severity score (ISS), home zip code, day of the week, transfer vs. from scene, location of injury, alcohol levels, and urine drug screening results were analyzed.

Results

From 2010 to 2019, there were 381 total suicides with 260 survivals and 121 completions (mortality: 31.7%) at our Level I Trauma Center. The majority of suicides were performed by middle-aged White men with an average age of 40 years (SD: 17.2). This was true even if the White race was not the majority race in the patient's zip code. The majority of the time, these patients presented directly from the scene and, if the patient's suicide location was known, it usually took place at their home. Other common areas included secluded areas, such as wooded areas, and personal vehicles. Of the suicides, 11.6% were performed within the criminal justice system including jail and solitary confinement. The average LOS following admission was 7.51 days (SD: 22.1). The majority of suicides came from the metro Savannah district, which has higher unemployment and poverty rates than other parts of our study area. Gun violence was the most common MOI for suicide (75%). If suicide was attempted via a penetrating mechanism including glass, knife, or gun, there was an increased rate of death when compared to our general data (38% vs. 31%). When the gun mechanisms were analyzed as a group, there was a 57% rate of death after arrival at the hospital. Acute alcohol intoxication was present in 56.6% of patients and 80 (21%) had drugs in their system.

Conclusion

Our data demonstrate epidemiologic and socioeconomic trends in Southeast Georgia. This included increased alcohol intoxication, deaths related to gun use, and in a higher incidence of suicide among White males, including geographic locations where the White race is not the majority. Suicides and suicide attempts were also more common in areas with higher unemployment rates.