reprinted from Issue 20, Spring 2015 of Frontiers of Medicine (PDF)
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Forty years ago, cardiologist William Grossman, MD, spent much of his time in the intensive care unit, pulling patients back from the brink of death. He developed close bonds with many of them, and worked with them after hospital discharge to try to prevent recurrent illness. “I realized that prevention was a lot of fun, and it was more satisfying in some ways,” says Grossman, now the Charles and Helen Schwab Endowed Chair in Preventive Cardiology. “It was very clear that you could often prevent recurring heart attacks and heart failure, if you had a cooperative patient.”
This longstanding interest led Grossman to envision the UCSF Center for Prevention of Heart and Vascular Disease (healthyheart. ucsf.edu). It was established in 2008 through a gift from the Charles and Helen Schwab Foundation, and receives additional support from other generous donors. Grossman, the Center’s director, along with co-director Anne Thorson, MD, and their colleagues Michael Crawford, MD, Nisha Parikh, MD, Eveline Oestreicher Stock, MD, and Ethan Weiss, MD, conduct more than 2,500 physician office visits annually.
Prevention is in the Details
A pillar of the Center’s approach is an intensive initial visit with a cardiologist to review medical and family history, diet and exercise habits, and medications, combined with thorough follow-up. Grossman asks patients to bring in pill bottles of every drug, herbal supplement and over-the-counter medication they take. “Going through all the details is the best way to uncover information,” he says. “Lots of times, things come out that the patient hasn’t told anybody.”
One patient was referred for resistant hypertension – high blood pressure that remained above target despite taking three or more medications to treat it. Grossman asked whether the patient was taking any over-the-counter medications. The patient said that his orthopedic surgeon recommended taking Advil, a nonsteroidal antiinflammatory drug (NSAID), for knee pain. “NSAIDs can cause severe hypertension in susceptible individuals,” says Grossman. After stopping the daily Advil, the patient’s blood pressure became normal. “The referring [primary care] doctor never asked the patient if he was taking NSAIDs, and the patient didn’t consider them medicine because they weren’t prescribed. Finding out some of these things can often explain why the patient is not responding to treatment.”
Since 2010, the Center has been located on the Mission Bay campus in the Smith Cardiovascular Research Building, which houses most of UCSF Medical Center’s cardiologists and cardiac diagnostic facilities. Patients can see their cardiologist, have their pacemaker checked and get a treadmill test or echocardiogram, all in one visit.
Healthier Patients and Communities
Although many of Grossman’s patients see him for secondary prevention – seeking to prevent another heart attack, for example – an increasing number seek help to prevent cardiac-related problems before they occur. “I was taking care of an 80-year-old man who’d had a heart attack, and his 50-yearold son just wanted a checkup,” says Grossman. “Another guy in his 40s went for a life insurance exam, and was shocked to find out his blood pressure was 230/120. A lot more people are self-identifying as needing primary prevention.”
In addition to prescribing medications to address hypertension and high cholesterol, Grossman and his colleagues help patients find ways to eat a heart-healthy diet, quit smoking and exercise regularly.
The Center also educates the community through its website, patient newsletters, and seminars on topics such as women’s heart health and the effect of sugar on health. In addition, the Center trains prevention cardiologists through a one-year fellowship program, and conducts prevention research, including developing an app to encourage exercise and healthy eating.
For Grossman, effective prevention all comes back to thoroughness and building trusting relationships. “My role model when I was growing up was our family doctor,” he says. “My patients respond to the idea of having their doctor really know them.”