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Welcome to Doctor Warrick’s Podcast Channel.
Warrick is a practicing cardiologist and 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 Bishop and I’d like to welcome you to my consulting room. Today, I’d like to touch on a concept of terminology. The terminology that we use in some of the reporting we undertake when we’re evaluating the heart. This is something I touch on in my book because I see it as a very important issue. What I’d like to do is remind you that there are two situations where we are interested in minimising risk for an individual patient. In the most obvious situation, someone who’s had a heart attack, we want to reduce the risk of that occurring again. We want to reduce the chance of them having a second episode. We call that “Secondary Prevention.” These are people who have had chest pain; shortness of breath; a heart attack. Some clear indication, which would be a symptom or a loss of function that demonstrates they’ve got coronary artery disease. And we want to reduce their risk of having another episode.
On the other hand, we also deal with people before they’ve had an event. This is called “Primary Prevention.” These are people who, when we’re looking after them, have not had an event; they’re basically fit and well. Now, in the primary prevention group is where I want to focus. What’s happened, in recent years, with the ability of scanning the heart, is that we can now see the health of the arteries. As a profession, we’re yet to come to a conclusion and a consensus on the best way to describe what we see in the arteries in the primary preventative setting. Now to my mind, in primary prevention, we’ve not yet had a disease. We’ve not had a disease because the definition of a disease is a symptom or a loss of function. In primary prevention we’re dealing with asymptomatic people. These are people without any signs whatsoever.
The crux of this discussion is that in modern time with the advantage of C.T. imaging to allow us to look at the arteries, we now see plaque build up. Now, many of my colleagues who report these studies when they see any plaque at all, whether it be in a primary preventative setting. Or in a secondary setting, will report that plaque as coronary artery disease. Now think about it.
In the secondary setting, that makes perfect sense. The patient has had a symptom or a loss of function and any plaque is part of the plaque burden that they’re carrying which is attributable to that disease. But in the primary prevention setting, our objective is actually to stop the disease. Now if we call coronary artery disease is present in someone in primary prevention, we’ve just blurred the line between primary and secondary prevention. Well, what’s the consequence; what’s the big deal? Why would I fuss about that? If you stop to think about it, the consequences can be significant.
Firstly, the patient who is seeking to be proactive about reducing their risk of a heart problem, suddenly gets labelled with a disease. They turn up looking to be proactive, and they get told even though I feel perfectly well, that they have coronary artery disease. Well, I have to say I would take that as a little bit of an emotional and psychological blow. So it doesn’t surprise me that some patients would find that a difficult pill to swallow.
Importantly, if we document the term ‘coronary artery disease’ in a patient report, then full disclosure in the setting of insurance means that person may be denied insurance i...