The Centers for Disease Control and Prevention (CDC) reports that heart failure affects 5.7 million adults in the United States. It is a contributing factor to 1 in 9 deaths each year. Heart failure is associated with 5.7 million deaths among adults in the United States.1 Worldwide, it is referred to as a growing pandemic, expected to show significant increases as the population ages.2 It is associated with coronary heart disease, heart attacks, hypertension, and diabetes. Lifestyle factors also influence disease risk. The growth of the pandemic has also led to the expansion of the field drawing many NPs and PAs.
“Many new graduates focus on primary care before specializing in heart disease or obesity … Even in primary care, however, NPs and PAs will see many patients with both heart disease and obesity,” says Mimi Secor an NP who specializes in women’s health.
Heart Failure Management and Discharge
The National Center for Health Statistics’ National Ambulatory Medical Care Survey shows that, for patients who see specialists, the involvement of NPs and PAs increased from 3.3% in 2001 to 6.9% in 2013 and NPs/PAs were heavily involved in the management of patients with complex conditions.3
In our 2018 survey, 21 PAs and 11 NPs discussed their roles in managing heart failure patients in the hospital/institutional setting. Of the responders, more than 50% treat 15 or more Class II-IV patients each month. In specialties that range from heart failure to cardiology to internal medicine to critical care, 94% of responders reported that they prescribe heart failure medications prior to discharge, 84% provide patients with education about the disease, and 72% diagnose disease progression. The majority (72%) define their primary role as “diagnosing the progression of the heart failure condition,” using echocardiograms (94%), chest x-rays (88%), patient history (84%), and T-pro BNP/BNP (72%). They interact with hospitalists, providing recommendations for treatment and recommendations for aftercare. With cardiologists, they discuss diagnostic results, patient medication, and provide recommendations for aftercare.
Obesity, too, represents a worldwide pandemic. In the US, rates have stabilized in most of the country, although between 2016 and 2017, rates increased in Iowa, Massachusetts, Ohio, Oklahoma, Rhode Island, and South Carolina. Adult obesity rates are at 30% in 29 states and topped 35% in seven states—Alabama, Arkansas, Iowa, Louisiana, Mississippi, Oklahoma, and West Virginia, which showed the highest rate of adult obesity at 38.1%.4
It is likely that NPs and PAs will continue to provide an increasing amount of care for patients with obesity, and major medical societies are preparing for the increasing role they will play. The American Academy of PAs, the American Association of Nurse Practitioners, and the Obesity Medicine Association have collaborated to develop a certificate program for PAs and NPs who want to develop expertise in managing patients with obesity.
The importance of NPs and PAs in the management of obesity is underscored by the results of a survey conducted by POCN which assessed the role of NPs and PAs in obesity management. It was completed by 48 NPs, 25 PAs, and 1 pharmacist. Of those clinicians, 43% practiced in primary care, 28% in family medicine, 12% in internal medicine, 7% in endocrinology, 4% in cardiology, and 1% in pediatrics, adult health, and pulmonary medicine.
Ninety-two percent of clinicians worked in practices in which NPs and PAs were most likely to diagnose patients with obesity. Seventy-two percent reported that they spend more time with patients than do their physician counterparts, 41% provide a more thorough evaluation than do physicians, and 33% treat more patients for weight issues than do physicians. Patients with obesity represent a significant part of their patient load: 65% see more than 20 patients a week whose BMI is more than 30; 75% see more than 20 patients whose BMI is more than 25.
- Centers for Disease Control and Prevention. Division for Heart Disease and Stroke Prevention. Heart Failure Fact Sheet. https://www.cdc.gov/dhdsp/data_statistics/fact_sheets/fs_heart_failure.htm. Accessed December 7, 2018.
- Savarese G, Lund LH. Global public health burden of heart failure. Card Fail Rev. 2017;3:7-11.
- Ray K. Study shows trends in visits to NPs and PAs for specialty care has increased. AmericanCollege of Cardiology website.https://www.acc.org/latest-in-cardiology/articles/2017/06/05/14/26/study-shows-trends-in-visits-to-nps-and-pas-for-specialty-care-has-increased. Accessed December 7, 2018.
- The State of Obesity. Obesity rates & trend data. https://stateofobesity.org/data/0. Accessed December 7, 2018.