Preventive Cardiology Clinic: An integrated approach to lifestyle medicine

Presented by: Shawn Hondorp, PhD, ABPPa,b

Co-authors: Emilee Ertle, B.A.a, Holly Dykstra, M.A.a, Lenora Eberhart, B.AS.a,b, Autumn Baldwin, B.S.N.a & Thomas Boyden, M.D.a,b

aPreventive Cardiology, Spectrum Health System, Grand Rapids, MIbCollege of Human Medicine, Michigan State University, Grand Rapids, MI

Course Speaker Disclosure Information

Shawn Hondorp, PhD, ABPP

Disclosures

None

Objectives

•Composition and flow of Preventive Cardiology clinic

•Case example

Clinic Overview

• Open for 3.5 years

• Board certified cardiologist: Thomas Boyden, MD (0.4 FTE)

• Registered dietitian: Holly Dykstra, MA (0.2 FTE)

• Clinical health psychologist: Shawn Hondorp, PhD (0.4 FTE)

• Registered nurse

• Medical assistant

• Program specialist

Referrals

• Cardiovascular risk assessment

• Family history of coronary heart disease

• Hyperlipidemia with statin intolerance

• Familial hypercholesterolemia

• Uncontrolled hypertension

• Obesity

Do you have access to a clinic like this?

• Yes, we have a similar clinic at my institution or nearby where I can refer for preventive services

• Not exactly, but we do have a weight management clinic

• No, we don’t have anything like this

• I am not sure

Screening Process

•Patient Health Questionnaire (PHQ-2)• Depressed mood, anhedonia

•Generalized Anxiety Disorder screener (GAD-2)• Anxiety, difficulty controlling worry

•Disordered eating:• Binge eating• Emotional eating• Food addiction

Mediterranean Diet Scale (MDS)Please answer each question below by circling the number in the box for yes or no. No Yes

1. I eat at least 2 cups of vegetables every day. 0 1

2. I eat 2 or more pieces of fruit a day. 0 1

3. I eat 2 or more servings of whole grains a day. 0 1

4. I eat a handful nuts or seeds almost every day. 0 1

5. I use olive oil as my main source of fat. 0 1

6. I drink a glass of red wine (but no more than 2) most days. 0 1

7. I eat fish 2 or more times a week. 0 1

8. I eat beans or legumes 2 or more times a week. 0 1

9. I eat red meat no more than 2 times a week. 0 1

Screening Data (chart review of 55 patients)

Measure Score

Binge eating 16%

Emotional eating 22%

Food addiction 18%

MDS 3.4 (SD = 2.3), minimally consistent with Mediterranean eating pattern

PHQ-2 > 0 33%

GAD-2 > 0 47%

Case example

• 67 y/o female

• PMH: a-fib, hyperlipidemia, hypertension, OSA, obesity (BMI = 37 kg/m2)

• MDS = 0

• PHQ-9 = 23 (severe depression)

• GAD-7 = 19 (severe anxiety)

• Longstanding emotional eating pattern

Case example (cont.)

• Saw dietitian 6 times and psychologist 12 times over ~12 months

• 27 lbs lost (11% weight loss, ended with BMI of 34 kg/m2)

• PHQ-9 = 6 (mild depression)

• GAD-7 = 3 (minimal anxiety)

• Minimal to no emotional eating

• Diet much more consistent with Mediterranean eating pattern

If you did have access to a clinic like this, how often would you utilize it?• Often

• Occasionally

• Rarely

• I am not sure

Discussion

• Consistent with 2019 ACC/AHA guidelines• Emphasis on patient-physician shared decisions

• Team-based approach

• Inter-clinic referrals reduce barriers and increase integrated care

• Lifestyle changes made by this patient and others would be expected to greatly reduce cardiovascular risk long-term