Heart Disease: Major Risk Factor for Many Rheumatology Patients


Dr. Guy Mayeda was interviewed by The Rheumatologist and quoted in their published article. An excerpt of the article by Vanessa Caceres is below. You may read the entire article here.

Rheumatic diseases, such as rheuma­toid arthritis (RA), systemic lupus erythematosus (SLE) and vasculitis, can affect the body in many ways, but perhaps the most serious is the increased risk of heart disease for many patients.

As the risk of atherosclerosis in autoimmune disease patients gains increased attention, rheumatologists and cardiologists are collaborating more often to refer patients to each other.

The ultimate goal is to decrease inflammation to control rheumatic disease and lower the risk for heart disease, says cardiologist Donna Denier, MD, Franklin Square, N.Y. “When you see a reduction in inflammation, you see a reduction in cardiac mortality as well,” she says.

Patients with RA or related diseases may not even know they are at greater risk for cardiovascular disease, but the risk is almost equal to the increased risk that diabetic patients have, Dr. Denier says. Additionally, cardiovascular signs may appear at an earlier age in these patients than in a normal patient population.

Another challenge is evaluating a patient’s medications that could further increase the risk for heart disease. For example, rheumatologists often prescribe steroids, which do not interact well with the aspirin or anti-platelet drugs a cardiologist might prescribe, Dr. Denier says.

When to Refer to a Cardiologist
Although it may have been common in the past to wait for a heart problem to emerge before referring a patient to a cardiologist, the emphasis now is on quicker preventive care, says cardiologist Guy Mayeda, MD, Good Samaritan Hospital, Los Angeles. He’s seen many patients who have damage to the heart or blood vessels but are not yet symptomatic. “The sooner they get referred to a cardiologist, the better the patient can improve with a collaborative effect,” he says. In that kind of patient, the cardiologist will recommend the rheumatologist prescribe aggressive therapy to get the inflammation under control, he adds. The cardiologist may also see early signs of such problems as a pericardial effusion, in which fluid accumulates around the heart and compresses it, leading to possible death if untreated, Dr. Mayeda says.

Four Essential Elements of a Healthy Doctor-Patient Relationship

Dr. Guy Mayeda’s interview with Fox News and was included in the following abridged article by Elizabeth Renter, who is a staff writer at NerdWallet, a personal finance website.

Dr. Mayeda, Dr. Economides and Dr. Fitzgibbons

It’s easy to focus on the basics when evaluating your doctor: Did he go to a good medical school? Does she have a good reputation with colleagues and patients? Is he in your insurance plan’s network? These questions are an important part of your calculations.

But there’s another equally important — and somewhat intangible — factor to consider: Will the two of you be able to build a relationship that works to keep you healthy?

Recent research shows a good doctor-patient relationship can improve health outcomes, so it’s worth investing the effort to determine how your connection with your doctor stacks up.

This process can take time, possibly several appointments. Whether you’re seeing a new doctor or evaluating one you’ve had for a while, weigh your exchanges against the following four elements, which are the keys to any healthy doctor-patient relationship.

  1. Communication: A Two-Way Street
    Communication with your doctor begins the moment she enters the exam room. Appropriate diagnosis and treatment depend on your ability to share your symptoms and concerns, along with her ability to listen. If she doesn’t listen, you may feel like she’s not interested in what you have to say and therefore say less. As a result, your doctor could end up making uninformed decisions.Likewise, your ability to understand and follow treatment recommendations depends on your doctor’s translation of complex medical topics into understandable, actionable advice. On both sides, if communication skills are lacking, the relationship suffers.
  2. Physician Empathy
    Empathy is the ability to share someone’s perspective, to mentally stand in their shoes and see the world from their point of view. Simply listening isn’t enough; a doctor who fully understands where a patient is coming from is better able to build trust and provide advice and treatments that align with the patient’s needs. Physician empathy is such a valuable part of the doctor-patient bond that some hospitals  are training doctors for it.
  3. Trust
    Even though only 23% of Americans have confidence in the health care system, more than two-thirds (69%) trust doctors’ honesty and integrity, according to a 2014 paper in the New England Journal of Medicine . Trusting that your doctor will deliver ethical guidance best suited to your particular health needs is another must-have in a healthy relationship.“As part of that trust, physicians need to present patients and family members with an honest assessment of the risks and realistic success rates with any recommended treatment or therapy,” says Dr. Guy Mayeda, cardiologist at Good Samaritan Hospital in Los Angeles.

    But your doctor must trust you, too, to follow her guidance, take your prescribed medications and follow up as needed.

  4. Professional Boundaries
    If you and your doctor need good communication, empathy and trust, should your doctor be your friend? Not so fast, experts say. Your doctor must walk a fine line between trusted confidant and friend, always keeping within professional boundaries.

Full article is available here.