Disclaimer: I have no financial ties to the products or services I discuss. The goal of this article is twofold: I aim to (1) educate you as a healthcare consumer about a policy change that will improve your access to preventative cardiology, and (2) discuss ways that technology can help facilitate your own health behavior change. The strategies and technologies I mention represent a tiny snapshot of all available options. I encourage you to explore what's out there to find what works best for you.
Many of us understand the various health behaviors that promote overall well-being. Physicians, researchers, and the general public are beginning to recognize the value in preventative medicine, though implementing such practices typically seems out of reach. Now, thanks to a new Medicare code and widely available smartphone apps, we can see a move towards preventing cardiovascular disease both in upcoming visits with our primary care physicians and in our daily lives.
As a graduate student in clinical health psychology researching cardiovascular behavioral medicine, I spend a great deal of time performing assessments on individuals with cardiovascular disease and, more specifically, heart failure. Extensive self-management rules burden these patients with uncomfortable, challenging, and time-consuming guidelines. These include, but are not limited to dietary and fluid intake restrictions, weight management, complex medical regimens, frequent doctors appointments, and exercise guidelines.
Most do not suffer from cardiovascular disease alone; many are hypertensive, have diabetes, are obese, and experience mild to moderate cognitive impairment that cumulatively degrades their quality of life. Although most understood the factors that promote health prior to developing cardiovascular disease (e.g., healthy BMI, diet low in saturated fats and sugars, regular physical activity, maintenance of normal-range blood pressure), few, if any, had guidelines tailored and explained to them by a health care professional before developing this chronic, life-threatening, burdensome illness.
Primary care physicians and staff can use a Medicare billing code (G0446) to tailor cardiovascular disease prevention recommendations to their patients in fifteen-minute counseling sessions once every year before, during, or after an annual wellness visit. To use this code, the sessions must cover blood pressure screening, appropriate daily aspirin use (when clinically indicated), and techniques to adopt a heart-healthy diet. This counseling can help prevent numerous forms of or contributors to cardiovascular disease, including hypertension, coronary artery disease, myocardial infarction (i.e., heart attack), heart failure, stroke, and peripheral arterial disease. This development uses recent literature asserting that brief counseling from providers can effectively improve health behaviors, and brief health-related counseling has demonstrated significant impacts on dietary intake and smoking cessation.
Three institutes in Cleveland, Ohio (University Hospitals Health System, Harrington Heart & Vascular Institute, The Center of Excellence in Self-Management Research at the School of Nursing at Case Western Reserve University, and Better Health Greater Cleveland) received a grant from the Ohio Partnership for Adherence through Collaborative Education to help educate health care providers about these new counseling options. Drs. Richard Josephson, Shirley Moore, Mary Dolansky, and Vanessa Maier, all from University Hospitals and Case Western Reserve University, spearheaded this project. You can check out their work at COUNSEL2preventCVD.org. The website includes FAQs for providers, a patient education materials toolkit, a presentation for providers, and general information about the project.
Additionally, there is a great chance that your provider is unaware of this opportunity. I highly recommend presenting the billing code information--and perhaps even this article--to your physician at your next wellness visit. Whether or not you receive Medicare, you can inform your physician that you want to take a proactive preventative approach to the nation's #1 killer: cardiovascular disease. I encourage you to advocate for the care you want and to find a physician who will collaborate with you in promoting health and preventing disease.
One key to improving health behaviors is self-monitoring, as it is nearly impossible to target a behavioral pattern if you cannot adequately describe it. This is an excellent opportunity to incorporate mHealth technology such as online trackers or smartphone behavior-tracking apps. Popular apps can measure dietary intake, exercise, smoking, and medication adherence. One way to help extend behavior change past these fifteen minutes of preventative counseling is to introduce convenient tools for self-monitoring, like mHealth trackers. It is difficult to change our behavior, but technology can help us a great deal to do so.
A study published in the Archives of Internal Medicine demonstrated that apps can help individuals lose weight when used in a comprehensive strategy, according to a clinical trial conducted at Northwestern University's Feinberg School of Medicine. The research suggested that individuals are better able to change their behavior as they gain access to more tools.
If you do not want to wait until your next physician's appointment to evaluate and potentially change your cardiovascular health habits, then consider my top five tips and apps:
1. Stop smoking. Smoking cessation is one of the greatest changes that you can make to reduce your risk of developing cardiovascular or other life-shortening disease. Although the idea of quitting "cold turkey" is popular, many people find that formal support via smoking cessation classes and prescription medication can help them quit and stay free of tobacco long-term. LIVESTRONG MyQuit Coach - Dare to Quit Smoking is an app that will create your personalized quitting plan and helps you make attainable goals along the way.
2. Get moving. Physical activity is any sort of moving around (e.g., vacuuming, shoveling snow, walking up the stairs), while exercise is structured physical activity (e.g., lifting weights, running a mile, taking a fitness class). Both physical activity and exercise can improve your health and mood. If you think that you lack the time or money to join a gym, consider taking the stairs at work, finding a parking spot farthest away from your destination, taking a walk after meals, or picking up some cheap free weights to lift while watching TV. I personally enjoy using a weighted hula hoop, bouncing on an exercise ball, stretching, and using free weights during quick frequent breaks from work throughout my day. For challenging free workouts, check out the Nike Training Club.
3. Monitor your diet. Try monitoring your dietary intake with a smartphone app or online tracker. Use technology to your advantage in your own self-monitoring adventures. Many popular apps provide comprehensive free versions that can track your intake and provide daily breakdowns of what you are eating. You can track your weight using age- and activity-sensitive caloric goals, and you can receive support from others who are also trying to adopt healthier habits. Try the Calorie and Diet Tracker from MyFitnessPal.
4. Curb your sodium use. Foods that are high in sodium include pickles, cold cuts, canned soups, frozen meals, cured meats, and even packaged cookies. Always use minimal salt when you cook--you can always add more later--and be sure to taste your food before adding additional table salt. I recommend using no more than a "pinch"--literally!--of salt whenever you want to do so. When you use a salt shaker, it becomes extraordinarily difficult to monitor how much salt you are using. Cutting down on processed foods can also reduce your salt intake. My ultimate suggestion for reducing the need for salt is to use more fresh herbs and spices in your cooking, as their added flavor will replace the need for excessive salt. Sodium 101 has numerous helpful features including a sodium tracker, comparisons of sodium content in takeout food, and even a simulated salt shaker that helps you determine how much salt you are adding to your food.
5. Shop smart. Lastly, limit your time in the middle aisles of the grocery store to 10% of the time you spend shopping. I challenge you to consider what you find there: processed, fatty, sugary, salty foods. Obviously, many of these foods are fine in moderation. But if you concentrate your time in the grocery store on the store's perimeter, you will mostly find fresh produce, seafood, meat, tofu, dairy, and frozen items such as frozen fruits and vegetables. While in the center aisles, consider picking up beans and legumes, whole wheat pasta, quinoa, almond butter, and fresh whole wheat bread. Eat these in moderation as part of a heart healthy diet. Fooducate is an app that can be used to help you make good food choices in the grocery store as you shop.
Most individuals with whom I have worked are no longer candidates for preventative measures that I have outlined. They are already faced with the burden of attempting to self-manage a cumbersome illness that will likely contribute to their deaths. However, whether someone has already been diagnosed with a chronic illness or exhibits only a single risk factor, health behavior change is possible with adequate support from physicians and loved ones, with knowledge about problematic health behaviors, and most importantly with the motivation to contemplate whether the benefits of change ultimately outweigh the cost of maintaining problematic behavior. I hope you will find that small changes are not only possible, but also will motivate you to take action to improve your present and future health.
Image credit: Carly Goldstein