You guys are an amazing audience, and we're gonna be finishing up with our last great talk from Martine Altieri, speaking to us about setting up cardiometabolic clinic, considering obesity and patient factors. And I hope the rest of you stay so that you can do the audience questions, because that's the best part of the program. Martine. Good evening, thank you for staying with us so late. So I'm going to talk to you about setting up a cardiometabolic clinic, considering the obesity and some patient factors. So after tonight, I hope that the goal is to understand the role of obesity management in cardiology, explore some of the benefits of a team-based approach, gain insights into the key steps for setting up a cardiometabolic clinic, and address some special considerations like women health or other barriers to care and strategies to overcome them. We have seen cardiometabolic disease are the leading cause of death in the United States, so my other colleagues already spoke about how it affects cardiovascular health in general, and the patients affected are at a very high risk of some complications and overall mortality, but many are still not on optimal medication regimens, and you've been asked that question, how do you base yourself to prescribe those medications, and there's a number of reasons why those patients don't get the proper care that they need. So basically, what is a cardiometabolic clinic? It is basically a specialized center focused on preventing, diagnosing, and managing conditions that affect both cardiovascular and metabolic health, and such as heart disease, diabetes, hypertension, and my objective tonight is to provide a practical, rapid overview of a clinic setup, discuss the challenges of having a patient-centered care model. I think you all got this at this point. So what is the biggest barrier to integrating obesity management into your cardiology practice? Is it a lack of provider training on obesity treatment, limited insurance coverage for some of those obesity medications, patient adherence to lifestyle modification, or time constraint in cardiology practice? Time constraint in cardiology practice, that's what I taught as well. I am going to set the stage. Typically, let's imagine a patient, or a typical patient in a cardiology practice, and this was actually an actual patient who comes to the clinic, an 82-year-old male patient with a past medical history of atrial fibrillation, cardiomyopathy, CAD, hypertension, hyperlipidemia, obstructive sleep apnea, obesity, newly diagnosed with type 2 diabetes, presents with an A1C of 6.6%, and the patient has an additional goal of weight loss. His current BMI is 35, so with class 2 obesity. What is the best option for initial management of this patient? How would you approach this patient in a cardiology setting? Basically, obesity management in a cardiometabolic clinic, the main goal is to have a team-based approach which is proven to make patient outcomes even more successful. We have seen earlier, obesity has negative impact on all disorder comorbidities, and several research studies actually have shown success with one retrospective study showing improved adherence to goal-directed medical therapy by 17-fold, and another showing a 10.8% reduction in A1C and a 2.7% reduction in body mass index. First, we start with a comprehensive patient assessment. So that patient that I just presented to you comes to my clinic and has an additional goal of weight loss, and I'm supposed to do that management. First, I get a full weight history, including lifestyle and behavior history, like we would assess diet, physical activity levels, sleep and stress levels, and I also ask them about what barriers they have to activity. Some patients might have arthritis, they're not able to walk, they just had surgery, so just to have a complete idea so my care can be patient-centered. I assess their barriers to weight gain, or for example, what their triggers might be, if they have any cravings, and also challenges they've had sustaining lifestyle modifications, because most of those patients have tried other diet plans or lifestyle modification, and it just has not worked. I ask them about their previous weight loss trials, family history, which is important in the world of GLP-1s if we are going to manage their obesity with these medications. Some other complications, pancreatitis, gastroparesis, and of course, we measure BMI and waist circumference almost at every visit, and if we don't have this information yet, we can obtain a metabolic panel to assess, to screen for diabetes, hypertension, dyslipidemia, and so on. So what is the cardiology team-based care look like? First, we built a multidisciplinary team, and this team is made of the cardiologists, who will be guiding risk assessment and cardiovascular optimization. A primary care physician is important also in that team. The primary care physician will coordinate overall patient management. Endocrinologists come into play, because sometimes patients have other metabolic disorders, or they might have thyroid disorders, any other disease that we don't manage in sterling cardiology. Registered dieticians, which is important in developing individualized meal plans and nutrition education. And in the ideal world, we can partner with exercise physiologists or physical therapists to help create safe and effective exercise programs, and behavioral health specialists can address emotional, eating, stress management, and to kind of gauge their adherence to treatment plans. And the second, first we build a team, we collaborate with other specialists, and then we implement a structured care model in the clinic. So a team-based approach can significantly improve those patient outcomes, that's why it's important we can consider doing group visits for patient education and for peer support. It is important to leverage technology for patient progress tracking, for example, we would patient monitoring for blood pressure, for blood glucose, and in this way, we increase patient engagement when they can actually see their numbers and they feel that they are being monitored. And also, I utilize a lot of telemedicine for ongoing patient support, and also to increase access to care, because a lot of patients, there's not a lot of obesity specialists, or a lot of specialists that patients can easily go to in their communities, so by using telemedicine, I see patients who come from very far, they can drive two hours to see me in the office, but at least with the follow-ups, they can continue their care with telemedicine. So another polling question, when establishing a cardiometabolic clinic, which factor is a key component and most critical for ensuring patient success? Is it a multidisciplinary team approach, access to advanced imaging and diagnostic tests, a focus solely on weight loss rather than overall metabolic health, or exclusive reliance on pharmacological treatments for obesity? This is correct. Everybody agrees that a multidisciplinary team approach is a key component of a cardiometabolic clinic, but it's also a key component of a multidisciplinary team. So the question is, when establishing a cardiometabolic clinic, is it a multidisciplinary team approach, access to advanced imaging and diagnostic tests, or exclusive reliance on pharmacological treatments for obesity? And the answer is, yes, it is a multidisciplinary team approach. So the question is, when establishing a cardiometabolic clinic, is it a multidisciplinary team approach, and the multidisciplinary team approach is very important here. So when we are setting up that cardiometabolic clinic, in the ideal world, if we could follow the cancer center models. In the cancer center care models, we've seen that they have patient navigator, pharmacist. Besides the oncologist, they have a behavioral specialist. So an ideal cardiometabolic clinic would have also these components. The pharmacist to address, for example, I think in one of the talks before, we've seen how the pharmacist can address some of the complications or side effects of the medications if they can provide patient education. A cardiometabolic nurse to do some follow-up check-ins regularly with patients. And a dietitian, we've talked about the important role of dietitians to provide tailored diet plans or nutrition plans. It is important as well to invest in some, the workflow design in the office itself. It is very important to invest, for example, in the physical office, having resources for patients that are, let's say, for example, the way the clinic is set up. Make sure we have the appropriate scales. The patients have the chairs that we use in the office that they don't have handles. And also, we could leverage the electronic health record system. For example, in my EHR system, I created some smart phrases for optimal and timely documentation. So when I'm seeing the patients, I'm not wasting time documenting because we will ultimately need that to get the patient's medications approved and all that. So I talked about the infrastructure. That's very important. Privacy for patients, accommodations for patients with obesity. Telemedicine capabilities we've talked about as well. How we did is very important. So successful implementation of a cardiometabolic clinic requires not only a multidisciplinary team approach to provide comprehensive care, as highlighted in the literature, but the options also can include comprehensive training program for the staff, for the staff to be used to managing patients with obesity, investment in physical A19, infrastructure integration of multidisciplinary care teams and patient education programs. For example, I created those educational resources for those patients. I have a guide to GLP-1 medications. It's probably not too clear here, but I kind of talk to them in layman terms about what GLP-1 medications are, how they work, the most common side effects to expect and how to mitigate them, when to go to the emergency room or when to contact me in the office if they have certain side effects to avoid complication. And also I provide them with a high-protein food list because we would tell them, yes, they need to exercise, increase their protein to preserve muscle mass. So when I give them this, I've found that a lot of patients find it very helpful because then you remove the guesswork out of them because they don't know which food is high in protein. So for 100 grams of each group of food, it tells you how many grams of protein and I tell them how much they need or custody. So these are resources I've developed in the office to help the patient. There are some special considerations for women's health. For example, we know that women have unique cardiovascular metabolic risk. They face distinct challenges, including pregnancy-related cardiovascular issues and menopause-related metabolic changes. So some tailored interventions we can provide are pregnancy safe weight and metabolic management strategies and menopause-related cardiovascular risk screening and gender-specific exercise and nutrition plan. There are also some considerations for patients who have obesity or are overweight. We have to use patient-centered language to make sure that we are managing health risk rather than losing weight. So the focus is on health improvement rather than just weight loss. And also some patients with other comorbid conditions, we have to consider some patients with diabetes or insulin resistance. We have to make sure that we partner with the endocrinologist in our community to help us treat those patients. And we've seen also with hypertension and heart failure some special considerations. And also there are mental health considerations. Patients with obesity and cardiovascular metabolic disease can experience depression and anxiety. So referral to mental health professionals can enhance treatment, adherence, and lifestyle change success. So some practical challenges. We have some patient adherence challenges, and usually it's insurance and medication coverage issues, staff training, and access to multidisciplinary care, which can be very challenging. So my key takeaway is to a multifaceted approach which is required for obesity management and as a team-based cardiology model can lead to better long-term outcomes. A focused cardiometabolic clinic creates best possible circumstances, and setting up a cardiometabolic clinic requires strategic planning and multidisciplinary collaboration. So today my call to action is for all cardiologists to implement this team-based strategy for cardiometabolic health because by embracing holistic multidisciplinary approach, cardiologists can enhance long-term cardiovascular outcomes in patients with obesity. Thank you. You were fantastic.

cardiometabolic clinic

obesity management

multidisciplinary team

patient-centered care

women's health