A new study notes serious deficiencies and substantial opportunities to improve cardiovascular care, save lives and reduce healthcare costs. The lead author is Dr. Stephen Devries, Executive Director of the nonprofit Gaples Institute.
Like most Americans, even cardiologists fail to eat enough fruit and vegetables. And, while cardiologists overwhelmingly believe their role includes personally providing patients with at least basic nutrition information, less than a third describe their nutrition knowledge as “mostly up to date” or better. These are among the findings from the A Deficiency of Nutrition Education and Practice in Cardiology, a report recently published by The American Journal of Medicine and authored by a dozen physicians and healthcare professionals in the United States and Spain.
“Although cardiovascular guidelines describe nutrition as a foundation of care, neither education nor practice among cardiologists and cardiovascular team members reflect that priority,” said lead author Stephen Devries, M.D., Executive Director, Gaples Institute for Integrative Cardiology.
The nonprofit Gaples Institute provides advocacy and education that empowers healthcare professionals and the public to promote heart health through greater attention to nutrition and lifestyle. One of its flagship offerings is a nutrition continuing medical education course for doctors, nurses, physician assistants, nurse practitioners, and dietitians. “While the report notes serious deficiencies, it highlights tremendous opportunities to improve cardiovascular care, save lives and reduce healthcare costs. We hope these findings serve as a call to action for much greater emphasis on nutrition in the training and practice of cardiovascular specialists.”
The report is based upon what is believed to be the largest survey of physicians and healthcare professionals—and the only such survey of cardiologists—on personal dietary habits, level of nutrition education, and attitudes and practices regarding nutrition and lifestyle medicine in patient care. Cardiologists, fellows-in-training, and cardiovascular team members completed 930 online surveys.
A Significant Nutrition Training Gap in Medical School and Beyond
Even though poor diet is the leading cause of premature death and disability in the U.S. with heart disease as the condition most responsible, cardiologists reported inadequate training in nutrition. Ninety percent reported receiving no or minimal nutrition education during cardiovascular fellowship training, 59 percent reported no nutrition education during internal medicine training, and 31 percent reported no nutrition education in medical school. Further, nearly two-thirds of cardiologists reported spending just three minutes or less per visit discussing nutrition with patients.
“Using nutrition as medicine is probably one of the most cost-effective ways to treat disease but is incredibly underutilized by healthcare providers,” explained Andrew Freeman, M.D., cardiologist, National Jewish Health, Denver, Colorado, and one of the study’s co-authors. “If we could empower healthcare providers with information on how to implement this in daily practice, we could transform healthcare rapidly, prevent healthcare cost explosions, and reduce morbidity and mortality.”
The report noted the total annual cost related to heart and vascular diseases in the U.S. is a staggering $315 billion. Given that dietary changes have reduced documented cardiovascular events between 30 and 70 percent, the potential cost savings to be realized through increased nutrition education is substantial.
Survey respondents agree. Nearly 90 percent believe that “dietary interventions are likely to provide substantial additional benefit to patients with cardiovascular disease who adhere to guideline-based pharmacologic therapy.”
Healthcare Pros Skimp on Fruits and Vegetables
The diets of the healthcare professionals surveyed were no better than the public at large, with only 20 percent of cardiologists noting they ate the recommended five or more daily servings of fruits and vegetables. The implication of this finding extends far beyond the cardiologists’ own heart health as the report notes strong evidence that physicians with healthier personal behaviors are far more likely to counsel their patients about lifestyle changes than physicians with less favorable lifestyle habits.
“Cardiologists with the most vegetable and fruit consumption were also more likely to believe it was their responsibility to discuss detailed dietary information with their patients,” explained Dr. Devries. “Therefore one way to possibly improve patient counseling and health is for physicians to first optimize their own diet.”
The report cited a concerning development that heightens the sense of urgency to improve nutrition education in medicine and patient counseling. For more than a decade, the mortality rate from cardiovascular disease had been on the decline but, because of the high prevalence of diet-related obesity and diabetes, the mortality rate has now plateaued.
The report, available at http://www.amjmed.com/article/S0002-9343(17)30527-2/abstract, outlines recommendations to improve nutrition education across all stages of cardiovascular specialist training and continuing education programs.
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