Counseling patients on heart health

In this article:

• What is heart disease?
• Counseling patients
• When to refer

In this article

• What is heart disease?
• Counseling patients
• When to refer

The heart is the center of the circulatory system, according to the National Heart, Lung, and Blood Institute. It helps carry blood to and from all parts of the body, providing oxygen and nutrients that help organs function. A healthy heart gives your body just the right amount of blood at the rate it needs. However, a heart that develops damage or disease can struggle to pump blood efficiently. This can make it difficult for the body to work properly.

According to the Centers for Disease Control and Prevention (CDC), heart disease is the leading cause of death for men, women, and people of most racial and ethnic groups. Heart disease—or cardiovascular disease—is a general term that describes many different heart conditions. These include coronary artery disease, cardiomyopathy, and irregular heartbeats.

Fortunately, there are many ways to prevent heart disease. These include heart-healthy lifestyle changes, such as losing weight and implementing a healthy diet. Treatment for heart disease depends on the specific condition and severity, but medications are usually a mainstay. With their expertise in medications and counseling, pharmacists can help patients manage their heart health and identify situations when patients need further evaluation.

What is heart disease?

Heart disease is an umbrella term that refers to problems with the heart and blood vessels. There are many different types of heart disease. Some are congenital—or present at birth—while others develop over time. The most common type of heart disease in the United States is coronary artery disease (CAD). It occurs when a sticky substance called plaque accumulates in the arteries that supply the heart with blood. As plaque builds up, it starts blocking blood flow to the heart. This can lead to angina (chest pain), arrhythmias (heart rhythm problems), heart attacks, and heart failure. In some cases, there may not be any symptoms of heart disease until a complication, like a heart attack, occurs. Therefore, prevention and management of heart disease is key.

People may be more likely to develop heart disease if they have high blood pressure, high cholesterol, or smoke, according to the CDC. Other conditions that increase the risk for heart disease include:

• Diabetes
• Obesity or being overweight
• Unhealthy diet
• Physical inactivity
• Heavy alcohol use

How to counsel patients on heart health

Both heart disease and the conditions that can lead to heart disease, such as high cholesterol and high blood pressure, are chronic conditions. As one of the most easily accessible healthcare providers, pharmacists have an invaluable opportunity to help patients manage their conditions. In fact, there is evidence that pharmacist interventions can help improve major cardiovascular disease risk factors. Here are some ways pharmacists can help patients improve their heart health.

Recommend heart-healthy lifestyle changes

According to the American Heart Association, lifestyle is the best defense against heart disease. There are several heart-healthy lifestyle changes pharmacists can suggest, including:

• Quitting smoking: It’s well documented that smoking can harm your health. Smoking increases the risk of death in those with coronary heart disease. It’s also the main risk factor for atherosclerotic disease. Pharmacists can encourage patients to quit smoking by providing smoking cessation resources. If appropriate, they can also recommend smoking cessation drugs.
• Eating a healthy diet: A heart-healthy diet is key to fighting heart disease. It can also improve other risk factors, such as high cholesterol, high blood pressure, and high blood sugar levels. Pharmacists can educate patients about the importance of a healthy diet and recommend nutrient-rich foods. A healthy diet should consist of lots of vegetables, fruits, and whole grains. It’s also a good idea to include low-fat dairy products, skinless poultry, fish, legumes, and nontropical vegetable oils and nuts in the diet. Patients should limit saturated and trans fats, red and processed meats, added sugars, beverages with added sugar, and sodium.
• Engaging in regular physical activity: According to the American Heart Association, at least 150 minutes of moderate-intensity physical activity per week can help lower blood pressure and cholesterol levels and help with weight loss. Pharmacists can help motivate patients to stay active and provide examples of how to do so, such as brisk walking, dancing, tennis, and biking.
• Maintaining a healthy weight: Encouraging patients to aim for a healthy weight can reduce the risk of a heart attack, according to the American Heart Association. It may also improve high blood pressure, high cholesterol, and diabetes.
• Getting adequate sleep: Sleeping too much or too little can be harmful to your health. Adults need an average of seven to nine hours of sleep per night, according to the American Heart Association. Pharmacists can help patients improve their sleep hygiene and quality of sleep by incorporating physical activity during the day, having a bedtime routine, and limiting electronic devices in the bedroom.
• Reducing stress: Stress may increase the risk of cardiovascular disease. Chronic stress can lead to high blood pressure, which is a risk factor for heart disease. By discussing healthy ways to manage stress, pharmacists can help patients reduce their risk of heart disease. 
• Limiting alcohol: Excessive alcohol use can increase blood pressure, cause irregular heartbeats, contribute to obesity, and raise the risk of cardiomyopathy, stroke, and other disease. As a pharmacist, you can discuss safe alcohol use with patients. The American Heart Association recommends limiting alcohol use to one drink per day for women and two drinks per day for men.

Educate patients

Pharmacists can provide insight into the proper management of heart conditions, including the role of medications. Heart conditions, such as high cholesterol and high blood pressure, can lead to heart disease and other serious heart problems over time if not managed appropriately. Ensuring patients understand the importance of managing chronic conditions to lower the risk of complications—including heart disease, heart attack, and heart failure—is key. As a pharmacist, you can explain how to monitor blood pressure at home, how to make heart-healthy lifestyle changes, how medications work to manage your condition, and what signs and symptoms warrant medical care. Education can help promote medication adherence, which is crucial to maintaining heart health. You may also recommend ways to improve medication adherence, such as setting medication reminders or putting medication bottles near their toothbrush.

Manage medications

As medication experts, pharmacists can help patients keep their hearts healthy by reviewing and optimizing their drug regimens. People with chronic conditions, such as heart failure or high blood pressure, are often taking multiple medications. Pharmacists can help by ensuring medications are appropriately dosed, screening for potential drug interactions, and educating patients about possible side effects.

It’s also important to help optimize patients’ medications, as there is evidence that some classes of drugs are preferred for certain conditions. For example, angiotensin-converting enzyme (ACE) inhibitors, angiotensin II receptor blockers (ARBs), beta-blockers, mineralocorticoid receptor antagonists, sodium-glucose cotransporter 2 (SGLT2) inhibitors, and diuretics are preferred for heart failure according to the American Heart Association/American College of Cardiology heart failure treatment guidelines. But, for hypertension (high blood pressure), first-line medications include thiazide diuretics, calcium channel blockers, and either ACE inhibitors or ARBs, according to the American Heart Association/American College of Cardiology high blood pressure treatment guidelines.

Know when to refer

As frontline healthcare providers, pharmacists are easily accessible to patients. For this reason, patients may report side effects, unusual blood pressure readings, or other issues to you. Pharmacists should be aware of when someone needs medical care.

The following are examples of situations that warrant a referral to a healthcare professional:

• A blood pressure reading of 180/120 mmHg or greater
• Chest pain
• Shortness of breath
• Difficulty speaking
• Weakness
• Numbness
• Unexplained weight gain
• Worsening swelling in your ankles or feet

The bottom line

Pharmacists play a vital role in helping patients manage their heart health. By providing guidance on lifestyle changes, offering expert advice on medication management, and monitoring for potential drug interactions, pharmacists are integral members of the healthcare team. The strong, trusting relationships pharmacists have with patients make them a valuable resource in improving heart health outcomes. With their specialized knowledge, pharmacists can help empower patients to take control of their cardiovascular health, leading to better adherence to treatment plans, improved overall health, and a reduction in heart disease-related complications.