Did you know your primary care provider (PCP) can also care for your heart? Many people don’t realize it, but your PCP is essential in determining your risk of cardiovascular disease and long-term management following a cardiac event. Drew Hosier, DO,  PPG - Family Medicine & Internal Medicine, addresses this common misconception while digging into the many ways a PCP can assist with your heart health.

Can PCPs assess someone’s heart and heart health?

Absolutely. Preventing cardiovascular diseases is our job. Cardiologists are rarely necessary for the initial stage of things. Primary care is the place to start if someone presents with some risk factors but has no active disease or has some mild active disease and family history. Our goal and the basis of what we’re trying to accomplish, especially early on, is to mitigate risk, assess risk factors and get people started on productively modifying those risk factors, so they don’t ever need to see a cardiologist.

There is often a stigma that patients must see a cardiologist about their heart. What do you do to combat that misconception?

Sometimes people are more comfortable seeing a cardiologist when they have a heart-related issue. While we always respect that choice, people need to understand that, like most providers, cardiologists have a lot to do, so we want to ensure we utilize their skills and time efficiently and effectively. However, if someone does have a more advanced disease, a complex arrhythmia, significant coronary disease or heart failure, they need a cardiologist. Cardiology’s role is to maintain and improve those specific outcomes.

To combat the misconception, we start by discussing what a primary care provider’s scope of practice is versus that of a cardiologist. As a primary care provider, one of the clear benefits we have is that we see the whole patient. We can address the other aspects that may hinder someone from improving their health. From there, we can help by getting an accurate picture of where an individual is and how we can improve their heart (and overall) health moving forward.

Another advantage is our accessibility. Once we determine the risks and how we can modify them, it’s just a routine part of everything we do from there on out. So, as we perform regular follow-ups, whether they’re disease-focused (hypertension, cholesterol, sugar issues, etc.) or general yearly checks, we can maintain and develop those relationships while keeping an eye on all aspects of the patient’s well-being.

How does a PCP help determine someone’s risk of cardiovascular disease?

The first step is getting the person into our office and in front of us. From there, we start by getting a good set of vitals, which provides us with a solid foundation and baseline. Then, depending on age and risk factors, we will incorporate some basic laboratory screenings, including a cholesterol/lipid panel, blood sugar screening and weight/obesity screening. This initial discovery phase allows us to look at things we know will increase somebody’s risk for cardiovascular disease. Then, we can peel back the layers and discuss the modifiable and non-modifiable risk factors.

What can a patient do to maximize their appointment with a PCP, especially regarding heart health?

Patients can do a few things to capitalize on their PCP appointments. One is to show up on a routine basis. Regular visits are critical to proactive care. They allow us the time to have those preventive discussions instead of being strictly reactive and problem-focused. The second is to have their labs and screenings done before the visit. This gives us a chance to dive in rather than talk in hypotheticals. The third is knowing your family history. While some people may not have access to this information for various reasons, for those that do, it can be a gigantic predictor for cardiovascular disease. These steps can help ensure more efficient use of the patient and provider’s time.

How can medications or supplements someone takes impact their heart health, and why is it important to disclose all medications to your PCP?

The biggest concern with supplements from a PCP perspective is that somebody could be taking something that may inadvertently give them difficulties. For example, workout or weight loss supplements can have stimulants that speed up the heart rate or cause arrhythmias. The second is that a lot of supplements or over-the-counter medications can have side effects and interact with other medicines you may be taking, which can make it more likely to have bleeding or affect the way your body processes the medication, causing it to be more effective or forceful than it needs to be or less effective than anticipated when prescribed initially. Also, disclosing all medications to your PCP allows for a straightforward risk versus benefits discussion about whether the medications or supplements you’re taking have enough benefits to justify those risks and if there is an alternative that could help limit or eliminate those dangers.

What common symptoms do people often ignore that can clue a PCP into a heart issue?

There are some significant symptoms that people often brush off or ignore that could be a sign of a heart-related issue. These include:

• Racing heart rate – If it’s not associated with physical activity or emotional distress, you should discuss it with your PCP.
• Chest pain or discomfort – Vague sensations of chest pressure or tightness with physical activity that you haven’t previously experienced is a red flag for a worsening issue, and medical intervention may be needed.
• Fatigue – Anything outside the norm could indicate a heart-related issue and should prompt a discussion or consult with your PCP.
• Shortness of breath – If you have painful or difficulty breathing while exercising or during physical activity, please speak with your provider.
• Swelling of the legs, hands and feet (edema) – If this doesn’t get better or go away with modifications like avoiding salt or propping your feet up, it could be a clue to something more, and you should get evaluated.

If someone has been diagnosed with a heart condition, what role does a PCP play in managing that condition long-term?

We help by continuing to modify those risk factors and taking diseases like hypertension, heart failure, arrhythmia or a valve condition and minimizing the secondary effects. For example, someone with heart-related issues or a heart attack will periodically follow up with a cardiologist. However, once they’re stable for about a year or so, they are usually referred back to us for long-term management through various strategies, including lifestyle changes, regular physical activity, eating well, getting quality sleep, stress reduction, mental health and more. It’s a beautifully messy mix of monitoring, adjusting, and then continuing to readjust as we move forward while making sure we’re maximizing everything so their risk of future events or processes that affect their quality of life is lessened.

What can patients do to keep their hearts healthy?

The best advice I can give patients for keeping their hearts healthy includes those strategies I mentioned previously.

• Physical activity – There is no better substitute. I know we all get busy, and exercise is often number 11 on our top 10 list, but prioritizing physical activity will give you more physical and emotional ability to navigate life better. This could be as simple as starting a walking program. Whatever your choice, your goal should be to do mild to moderate cardiovascular activity for about 30 minutes a day, five days a week, up to 150 minutes a week. Incorporating strength training can also improve cardiovascular health. Remember, something is always better than nothing.
• Monitoring your diet – Try to eat real food in proper portion sizes rather than overly processed products. It comes down to creating healthy habits and lifestyle choices that will fuel you and give you the energy you need to stay active.
• Good quality sleep and stress reduction - Being conscious of your sleep hygiene/habits and stress levels and how they affect your health will help you see where you need to make improvements.

By doing these things, you can keep moving in the right direction. With primary care, our goal is to continue to make progress while monitoring for significant events and avoiding those issues.

Final thoughts

I encourage everyone to have a primary care provider. We can assist patients in many ways, from routine preventative checkups and well-being visits to preventing and maintaining chronic diseases at a manageable level. Together we can improve your quality of life, creating a healthier community and you.