It can take 17 years for medical breakthroughs to move from the lab to the clinic, where patients can finally benefit. Why the lag?
A recent virtual discussion, Understanding Treatment Guidelines in a World of Comorbidities, aimed to answer that question.
One important checkpoint between the bench and the bedside is updating clinical practice guidelines. These are created by medical societies to outline best practices and strategies for optimal care. The rigor involved in updating and disseminating guidelines can make it challenging to keep pace with rapid innovation. But for prevalent and interconnected conditions such as heart disease and diabetes, allowing patients timely access to new treatments and optimal care is critical.
Mississippi cardiologist Dharmesh Patel, MD, emphasized that more than 800,000 Americans have a heart attack each year, and 1.5 million are newly diagnosed with diabetes. “If someone is diagnosed with diabetes, they are two to four times more likely to die from a heart ailment,” said Dr. Patel. “Deaths from heart disease stopped declining and started increasing.”
Yet patients and health care providers are not always aware of treatment options that would help them simultaneously address both diseases.
Massachusetts clinical research fellow of cardiovascular disease prevention, Kaavya Paruchuri, MD, emphasized how lack of public awareness affects quality of care. “Patients don’t understand that just because one medication helps diabetes, another, better medicine can treat both diabetes and cardiovascular disease,” she said.
Even if patients and providers are aware, health plans often complicate the process with utilization management practices such as step therapy and prior authorization, which can delay care. Cardiologist at Massachusetts General Hospital, Michael Honigberg, MD, said prior authorization for therapies that haven’t made their way into the guidelines can present a hurdle.
He noted, “Citing the guidelines can help get medicines approved for patients.”
Guideline experts Mindy Saraco, MHA, and Thomas Getchius emphasized the importance of moving providers from trained, learned habits to best practices as an important step for quality care. Saraco said, “We really want to think of creative ways to implement these guidelines into the clinical world.” Both panelists said their organizations are laser-focused on finding solutions to expand public outreach and awareness.
Transitioning to a multi-disciplinary approach can also help people with cardiovascular disease and diabetes, the physicians agreed. This might entail collaborative teams that include diabetologists, internal medicine specialists, interventional cardiologists, dietitians and other health care professionals.
Meeting the growing public health threat of Type 2 diabetes and cardiovascular disease requires a mindset shift from patients and providers, as well as policy actions that increase access to patient-centered care. That includes greater awareness, collaborative care and comprehensive health plan coverage.