Advanced practice providers (APPs), including physician assistants (PAs), play an essential role in preventing and diagnosing cardiovascular disease, the leading cause of death over any other health condition.
Over 61% of Americans are estimated to have some type of cardiovascular disease by 2050, and there aren’t enough cardiology specialists to treat them all. That means many patients often don’t receive cardiovascular intervention until they’re critically ill.
“One of the biggest challenges in the U.S. is that our healthcare system incentivizes sick care rather than preventive care,” explains Viet Le, PA-C, DMSc, an associate professor of research and a preventive cardiology PA at Intermountain Health in Utah.
The role of PAs in cardiovascular health
Cardiology is a specialty with the oldest clinicians, with about 63% of practicing cardiologists over age 55 in 2019. Many will be retiring in the next decade.
That leaves an increasing number of primary care providers (PCPs) responsible for cardiovascular care. “Primary care providers aren’t just dealing with complex coronary disease — they’re also managing dementia, diabetes, hypertension, urgent care cases and more,” says Dr. Le.
And fee-for-service models incentivize sick care over preventative care, says Dr. Le. “By the time intervention happens, patients may be so far down the continuum of health that we’re just trying to retrieve them. But we still get paid for those procedures.”
APPs can help transition this system from sick care to preventative care.
Leveraging telehealth and technology for preventive care
Since the pandemic, healthcare professionals have embraced telehealth, proving that you don’t need to be physically present with a patient to provide effective care, says Dr. Le. Seeing patients in their home environment allows providers to ask deeper questions.
Instead of asking only about symptoms and prescribing medication, Dr. Le says APPs can ask questions such as:
- Do you have access to fresh food?
- How close is your nearest grocery store?
- Are you taking a bus or an Uber to get there?
- Can you afford to buy and prepare healthy food?
- Do you work long shifts that make meal prep difficult?
Telehealth can offer a window into real-life environments, facilitating deeper conversations into social determinants of health.
The case for early intervention
For years, Dr. Le has advocated for a more holistic cardiovascular approach, recognizing the interconnected nature of chronic diseases. In October 2023, the AHA issued a Presidential Advisory on Cardiovascular-Kidney-Metabolic (CKM) health that promotes a holistic approach to care for patients with cardiovascular-kidney-metabolic syndrome.
“Why are we waiting until a heart attack, stroke, dialysis, or transplant before intervening?” asks Dr. Le. Identifying patients in earlier disease stages can prevent progression with earlier screening and lifestyle interventions.
Primary care prevention
The challenges to providing adequate cardiovascular care in the primary care setting are significant –– but not insurmountable. Physician associates (PA) and nurse practitioners (NP) have limited time for cardiovascular risk assessment and many use outdated screening guidelines that delay early detection. Cardiovascular research and care are advancing quickly today, making it hard for busy PCPs to stay current on the latest standard of care.
One simple step PCPs can take is identifying risk factors so patients get screened earlier. Dr. Le recommends asking the following when taking a detailed family history, ask:
- Does your parent or any grandparent have hypertension?
- Does anyone in your family have heart disease?
- Is anyone in your family on a statin?
Answering yes to any of these should prompt additional screening, even in young patients. In pregnant patients, preeclampsia and gestational diabetes, for example, can be a risk enhancer for future heart disease. Patients in their 20s with a genetic predisposition for hypertension can already be showing signs of high blood pressure. Letting patients know their cardiovascular risk factors at a younger age allows them to make healthy lifestyle changes that can prevent heart disease later, like reducing sodium intake and getting screened more often.
The U.S. Preventive Services Task Force (USPSTF) recommends waiting until age 40 for lipid screening, which Dr. Lee says is too late. Instead, practitioners should go beyond standard lipid panels using:
- ApoB testing
- Lipoprotein(a), LP(a), testing
- High-sensitivity CRP (hsCRP) tests
How PAs can improve cardiovascular patient education
Dr. Le says there are some ways you can maximize patient education in your busy schedule:
- Refine the message by having a top-three points list for every major condition
- Instead of long text handouts, use infographics that can be placed on office doors, posted on social media and handed out
- Repurpose existing resources — the American College of Cardiology (ACC), AHA, and National Lipid Association have helpful patient education materials
- Train medical assistants to go over handouts with patients if time is limited
The future of cardiovascular prevention
“You don’t have to reinvent the wheel,” says Dr. Le. Instead, he reminds practitioners to be intentional about:
- Gathering family history early and identify risk enhancers
- Incorporating telehealth and digital tools for personalized care
- Using high-impact, simple education tools
One in three adults will experience cardiovascular disease, but we don’t have one cardiologist for every three patients. Primary care and APPs need to take on a greater role in prevention. This shift to upstream care can save lives — if we act now.
