There Will Come a Day!

We are not there yet, but there will come a day when you will be able to receive best practice care after a heart attack anywhere in the United States. That day is here already in Colorado in America. If you live in Colorado, and you get your care from the Collaborative Coronary Care Service in the Kaiser Permanente healthcare system, you are ten times as likely to be alive in 5 years after a heart attack, and your care will cost thousands of dollars less per year. This care is best practice care. Clinicians call it optimal medical therapy (OMT). There is nothing magic about it.

The people at Kaiser Permanente did a very powerful translational research study. Heart disease is still the leading cause of death in the United States. You all know of people who have died of a heart attack. There is a huge body of scientific evidence that helps us understand the ten things that every patient should get after a heart attack. Kaiser Permanente set up a team of nurses and pharmacists to make sure that every patient received those treatments to the extent possible. That is all there was to it.

If you look at the care that most people receive (usual care), it does not come close to the care patients received from the Kaiser program. After a heart attack almost 40% of patients don’t take a statin at all, and nearly half don’t take a strong enough dose. Just over half of the people with known heart artery disease take a statin. At the Kaiser program, 91% of patients take a statin. That is the big difference. The entire job of the team of nurses and pharmacists is to see that every patient gets every proven treatment for heart artery disease every time. The huge difference in statin therapy is just one example.

There are several reasons why these teams of nurses and pharmacists are so much more effective than usual care—the care that most of us receive. One of the main ones is focus. A team does this work most effectively and efficiently, but I have done it myself and achieved twice the level of hypertension control at the time. I focused on patients with high cardiovascular risk in my practice. I made sure that they received everything that they should. These teams also use protocols and the information technology infrastructure to support providing care and measuring outcomes.

The people at Kaiser in Colorado were writing about their success over a decade ago. So, why don’t we have care for heart attack everywhere that is so excellent. It is because our healthcare policymakers don’t promote it and support it. Up until my last few posts, I have been writing about interesting features of best practice medical treatment (OMT) to help raise general awareness for four years, but we are still not making much progress. Now I am shifting my strategy. I have put courses up on my Substack homepage to help students, patients, and clinicians understand the promise of OMT. Now I am realizing that we don’t have OMT because healthcare policymakers don’t understand the value of best practice treatment, or they think they are already doing it. I decided to add education for policymakers to my site.

My last post had the rather uninspiring title Chronic Disease Education for Policymakers. I apologize for misleading you. Beginning with that last post, and over the next month I am going to lay out the proof that OMT protects you much more effectively if you have had a heart attack. You are ten times as likely to be alive in 5 years if you are on OMT compared with usual care—the care that most of us receive. OMT does not just assure you are much more likely to be alive in five years, it protects every cell and organ in the body to preserve your health and function over 5 years. And the benefits don’t end there.

OMT does not merely protect you from heart disease death. It reduces all-cause death. It provides better clinical and financial outcomes for people with diabetes, high blood pressure, high cholesterol, other artery disease, chronic kidney disease, and heart failure. I called this education for policymakers, but this course is for anyone who would like to learn how they can be healthier longer at lower cost. It is also for anyone who wants to see our healthcare system change to serve patients with chronic diseases better. If you use the information in this course, you will understand that OMT is a proven approach that can help you live a longer healthier life. These posts build a more organized story and I hope they help you find a path to better health at lower cost.

Healthcare policymakers are very important in our country because they decide what the priorities are for our healthcare. Healthcare brokers and advisors are healthcare policymakers. The people in human resources are healthcare policymakers because they decide what the priorities will be for your employee health plan. Your community leaders decide what the priorities will be for your town or county. State and federal leaders also decide healthcare priorities. Most of them don’t know about OMT. If you read this series you can help them understand. Bring the benefits of OMT to your community. Let’s get started.