Cardiac care has seen significant enhancement in technology and addition of new medications over the last two decades. It has witnessed the sub-specialization of cardiology with development of interventional cardiology, electrophysiology, structural heart disease, cardiomyopathy/heart failure and more. Catheter-based aortic valve replacement, mitral valve clip, use of left ventricular assist devices in cardiogenic shock and left atrial appendage occluder device are a few of those. The traditional use of warfarin for anticoagulation has seen the advent of direct acting oral anticoagulants which alleviate the need for dietary restrictions and regular INR check. Treatment of heart failure has seen development of newer medications which have been game changers in terms of improvement in quality of life and mortality. For acute coronary syndrome, there is availability of newer and better stents.
We have seen the emergence of subspecialities like cardio-oncology with addition of immunotherapy and molecular level of treatment. The role of cardiac MRI in treatment of cardiomyopathy has become more established. Catheter-based ablation for arrhythmias like atrial flutter, atrial fibrillation and ventricular tachycardia have become very prominent. We have seen the convergence of treatment of diabetes and congestive heart failure with newer medications like SGLT2 inhibitor and impressive impact on morbidity and mortality in such patients. Treatment of hyperlipidemia has evolved beyond statins and now we have PCSK-9 inhibitors which are very well-tolerated medications. Permanent pacemakers, implantable cardiac defibrillators have witnessed improvement in technology and decrease in size of generators and compatibility with MRIs.
However, the philosophy of treatment and art of medicine remains the same. With advancement in technology and newer medications we have seen an exponential increase in cost as well. Procedures do not necessarily mean prolongation of a healthier life. Consequently, treatment has to be individualized and more often than not, cardiologists from different subspecialities have to work together to come up with the best plan for a particular patient. The role of preventative cardiology has consumed even more importance in the current scenario.
Patients and population in general need to understand the importance of eating healthy and eating less. We have also observed the importance of fasting. Four years ago, the Nobel Prize was granted to a scientist for determining the benefits fasting on cellular health at a molecular level. There is also a need for shifting our focus from animal-based proteins to a plant based protein diet. Studies have shown Mediterranean diet and vegetarian diet to have significant health benefits. Additionally, we cannot dissociate mild from body. Studies have shown the benefits of Yoga and breathing exercises which can increase vagal tone and help in controlling arrhythmias.
In a nutshell, we are living in the best times in terms of cardiac care. However, it has to start with a healthy lifestyle so that we can prevent onset of coronary artery disease and its complications like congestive heart failure and utilize treatments and/or procedures for inappropriate situations to get the maximum benefit out of it. Mitigation of risk factors like diabetes mellitus, hypertension and hyperlipidemia are equally important or even more so. We also need to understand that age conquers all and there is limitation to what we can achieve with medications and procedures as the body ages. We cannot change genetics yet, but we can definitely modify our habits and that still remains the first step in treatment of cardiac patients.
By: Providers at Foundation Cardiology, Southern New Hampshire Health