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Welcome to Doctor Warrick’s Podcast Channel
Warrick is a practicing cardiologist an author with a passion for improving care by helping patients understand their heart health through education. Warrick believes educated patients get the best health care. Discover and understand the latest approaches and technology in heart care and how this might apply to you or someone you love.
Hi. My name is Dr. Warrick and I’d like to welcome you to my consulting room. Today I’d like to speak with you about a concept around treatment. When we come to treat a patient, I think it’s absolutely critical for that individual patient, that we have an understanding of the concept of risk and benefit and this is something that we should do with every medication. There is no medication available that has zero risk. If we gave people too much water, we can cause problems. If we give neonates; newborns, too much oxygen which can cause problems. There is no drug that we have that is completely free of any side effect.
So everything carries some sort of risk. Is inherent therefore that if we’re going to prescribe a therapy for an individual patient, we need to be clear about what that risk would be. When we think about the risk, we need to put in the context of the benefit that that patient will see when we’re considering benefit for an individual, that needs to generally be considered in two different components. One component is in regard to the symptomatic benefit that a patient may see by the therapy. The other benefit is a prognostic benefit.
I’ll give you an example. In the situation of hearts where I’m dealing with people on a regular basis regarding, say, atrial fibrillation. What we know is that if we reduce patients heart rate if they’re in atrial fibrillation, we can improve those patients symptoms. So the risk of the heart rate medication is weighed up against the improved symptoms for that individual, and so we’ll try therapy, and then check with the patient to see that they really are having a benefit. Because if they’re not, the benefit doesn’t necessarily stack up and outweigh the risk. If we have improved their symptoms then the benefit outweighs the risk for that individual, it’s a reasonable intervention.
That’s a symptomatic intervention. Prognostic intervention in a true fibrillation is to give someone an anticoagulant to reduce the risk of stroke. Taking an anti-coagulant or a blood thinner carries a risk; a risk of bleeding. So we have to match that up against a prognostic benefit. Now the individual patient won’t be able to report that to us, because if they don’t have a stroke they can’t report that they know they’re better or worse; they just haven’t had an event. So we have to weigh that up against the risk we believe that individual carries based on our research. Has this person got other associated conditions like cardiac failure, hypertension, increasing age, diabetes, have they had a previous stroke; all factors which really point to them being at very high risk, and therefore getting a lot of benefit from anticoagulation. Or is this a person who might be prone to tripping, bad eyesight, poor with taking medication; someone who is unreliable and could inadvertently make a mistake with their medication, in which case their risk of taking a blood thinning medication is, perhaps unacceptable.
So in the prognostic setting, are we able to demonstrate that the risk of our intervention – using blood thinners in this case – is our risk of bleeding outweighed by the reduction in the risk of stroke for this person. Really important to understand that this sort of conversation and this thinking is what determines every intervention and every medical therapy that we introduce for a patient’s care.