Getting Cardiovascular Patients to Change their Lifestyle

I have spent almost 20 years as a cardiology physician assistant, and a majority of that time was spent in the hospital, managing patients who have had myocardial infarctions, typically requiring percutaneous or surgical interventions.

Going through a cardiac event is a huge wakeup call for patients, and they typically leave the hospital motivated to lose weight and to incorporate healthy lifestyles changes. The problem is that they often struggle with how to actually make the changes.

Several years ago I had the amazing opportunity to work with an interventional cardiologist who encouraged me to start a lifestyle intervention clinic in our office, and I was excited at the prospect. I began providing patients with heart healthy diets and exercise plans. Unfortunately, it just didn't work.

Patients would agree to start the plan, but most failed to take action. My mistake was assuming they had the skills and understood how to execute the plan independently.

In time I learned that to facilitate lifestyle change, I couldn't just ask patients to comply with what I had outlined for them or what I wanted them to do. We succeed as providers when we help patients to discover the things that fit into their lives, align with their values and abilities, and empower them to have an active role in achieving optimal health.

In PA school, we are taught to take the time to educate patients about healthy habits. I have learned to not only teach the why but also to help patients figure out the how. Seemingly insurmountable goals should be broken down into small steps that are doable and that will instill self-confidence and provide patients with the quickest win. These early wins stimulate an intrinsic motivation to continue.

PAs in your office can follow these simple steps with your cardiovascular patients.

• Break down the walls! When you tell patients that you want to discuss healthy lifestyle changes, they often fear that you will make them do something they don't want to. It is important to let them know you would never do that. They need to know that they are in total control. Engage them further by asking them about their feelings around a heart healthy diet. Listen to what they are willing to consider and capable of doing. This lets them know you care about what they think and instantly breaks down the walls. Most patients will thank you for really listening them.

• Educate them about one issue that really concerns you. Focus on one thing to change so they don't become overwhelmed. For example, I might review that I am concerned about residual non-occlusive blockages found on their angiogram, and my top goal would be to stabilize those plaques so they don't rupture. Diagrams work great to help patients understand their issues.

• Explain the top thing they can do to help stabilize their plaques, taking into consideration what they have shared with you. I always try to add in healthy habits vs. telling them what they can't do. If I recommend adding more fruits and vegetables into their diet, I ask them how they want to do it. Some may only be open to adding in vegetables three times a week and others a small serving every day. Whatever it is, be sure that they are able to carry it out by confirming their motivation on a scale of 1-10. If they are less than an eight, the task is too big and should be made easier. Remind them that it's best to take small consistent actions for long-term success. Remember it is important to help them get quick wins so they can feel good that they are on the right track.

• Address any barriers that they have. In the case of eating more healthfully, patients may tell you they don't cook or cannot afford fresh vegetables. I encourage change that makes it easy - whether it's pre-bagged salads or frozen vegetables. I may share how other patients have overcome this barrier and discuss actionable tips. If we don't help them clear their barriers, it will be very difficult for them to succeed.

• Ask them to track their actions, whether they write it in a log or mark it on a calendar or track it on an app. This is a great way for them to see how well they are doing and provides positive reinforcement.

• Remind them to come to their follow up appointments even if they don't succeed with the plan. Help them realize your office is a "no judgement zone."

• Share success stories with other patients. In the past I have facilitated both women's and men's groups at 6 pm in the waiting room. These sessions were very informal, but the stories and ideas shared by patients always empowered the others to take action.

I help my patients understand that it's the small, consistent actions that will lead to long-term change. The goal is to sustain health and fitness forever. Slow and steady wins this race.

Michelle Gordon-Canning, PA-C, has spent almost her entire career caring for cardiovascular patients including running heart failure clinics and small group sessions. She currently works as a hospitalist in a rehab facility in the San Francisco Bay area and owns her own health coaching and fitness business.

This blog was written in partnership with the National Commission on Certification of Physician Assistants.