Medication hesitancy when addressing patients’ obesity-related atherosclerotic risk
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Key takeaways:
- Cardiology health care professionals expressed hesitancy in prescribing FDA-approved obesity medications to reduce ASCVD risk.
- They preferred diet and lifestyle, but did not provide much tailored guidance.
BOSTON — In a survey, cardiology physicians expressed hesitancy to prescribe currently available obesity medications, preferring exercise and dietary interventions, but with little personalized tailoring for patients, researchers reported.
The results of two surveys of patients with atherosclerotic CVD and obesity, caregivers and cardiology health care professionals were presented at the Cardiometabolic Health Congress.
“We all talk about the link between negative health outcomes and obesity. I've dealt with obesity my entire life. As we start finally talking about it in the professional services and identifying obesity as a disease, we're going to start treating it,” Lyn Behnke, DNP, FNPBC, adjunct clinical lecturer in nursing at University of Michigan-Flint, told Healio. “When we talked to health care professionals, CV health care professions only listed obesity as No. 4 in the risk factor hierarchy. The problem is we don't understand obesity well enough to move it up, and we need to move it up because of the inflammatory problems that obesity causes ... It can't just be primary care physicians, it has to be cardiology, endocrinology, it has to be everybody.”
To better understand how obesity and ASCVD is navigated within the current health care system, Behnke, Pam R. Taub, MD, founder and director of the Step Family Cardiac Rehabilitation and Wellness Center and professor of medicine at the University of California, San Diego Health System, and colleagues conducted a two-part questionnaire.
Part 1 included interviews with 61 patients, 12 caregivers and 24 health care professionals to understand their respective insights into their experiences with ASCVD and obesity and their effects on home life, finances, clinical practice and barriers to treatment. Part 2 was administered to 120 cardiology health care professionals to establish key performance indicators of ASCVD treatment and evaluate their respective approach to treatment, both before and after an ASCVD event.
Results of survey part 1
All patient respondents were aged 45 or older and 38% were Black, while 29% were white, 20% were Hispanic and 10% were Asian. Each had at least one ASCVD event and 66% were diagnosed with obesity.
Among health care professional respondents, 71% were cardiologists, 21% were nurses and 8% were PCPs.
Overall, 70% of patients reported obesity as the main risk factor for CV health, followed by being physically out of shape, having a family history, poor diet and age, but most reported a lack of communication with their health care professionals about the link between obesity and CV health.
Moreover, patient survey respondents reported only receiving vague advice regarding diet and exercise and a lack of cultural awareness in their respective treatment plans, according to the study.
“We're not really paying attention to the racial health equity factor, and cultural factors are not really being considered,” Behnke told Healio. “For example, when talking about a healthy diet. What does a healthy diet look like? What are the economic implications? We want to complain about the cost of the medications, but what about regular groceries that are healthy? Some of that started to come out in our study and I think it will continue to come out.”
Results of survey part 2
Among part 2 respondents, 83% were cardiologists, 15% were cardiology nurses and 2% were nurse practitioners.
Although cardiology respondents estimated that approximately 43% of their patients had obesity, they ranked obesity as only the fourth-most important ASCVD risk factor, immediately preceded by blood sugar, LDL and BP.
The researchers reported that 53% of cardiologist respondents believed obesity management should be left to other health care providers, and just 12% reported recommending medication for weight management while 90% reported advising diet and/or exercise changes, but with limited tailoring to their patients’ lifestyle.
Moreover, 61% of cardiology health care professionals reported medication noncompliance as the primary treatment barrier among patients with obesity, according to the study.
“One thing I did notice is that we did not have a good representation of Native Americans. There's a very high-risk factor [burden] in the Native American population. Also having the time do the evaluation for education and health literacy. We couldn't really measure that. We ran out of time, but those social determinants of health are going to be critical,” Behnke said. “If we can just coalesce the whole group, the primary care people, the cardiologists and cardiac rehab, then I think we're going to move the needle.”
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Taub P, et al. Poster 3. Presented at: Cardiometabolic Health Congress; Oct. 17-19, 2024; Boston.
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