“Compliance continues to be a big issue both related to taking medications as prescribed and adhering to a prescribed diet with salt restrictions,” says Dr. John Jefferies, an associate professor of pediatric cardiology and adult cardiovascular diseases within the University of Cincinnati College of Medicine, is the director of Advanced Heart Failure / Cardiomyopathy in the Heart Institute at Cincinnati Children's Hospital Medical Center.
Jefferies feels improved communication between patients and providers is needed in the future. His hospital is trialing some internally-developed phone apps that would “facilitate a dynamic, two-way dialogue between families and providers that help to bridge this gap,” he says.
Jefferies completed his combined pediatric and adult cardiology training at the Baylor College of Medicine in Houston at the Texas Children's Hospital and the Texas Heart Institute. He has authored or co-authored more than 120 peer-reviewed manuscripts and book chapters on cardiomyopathy, cardiovascular genetics, and adults with congenital heart disease.
His most recent focus as been on the management of heart disease in children and young adults, authoring two textbooks on the topic, “Heart Failure in the Child and Young Adult: From Bench to Bedside” and “Cardioskeletal Myopathies in Children and Young Adults.”
Both children and geriatric patients have some similar needs regarding access to care, medications, counseling, and longitudinal management. Perhaps it goes without saying, however, that the differences between children who suffer from cardiac ailments have unique health needs versus those of geriatric patients as it pertains to high quality delivery methods.
Children are different in that you are managing the patient and the family which adds a different layer of dynamics. And, children have a much longer potential lifespan ahead of them, therefore a different approach to decision making is required, Jefferies says.
“For example, if an ICD is placed in a child, the life-long care and replacement of that device is very different than that in a 70 year-old,” he says. “Geriatric patients also have their own unique sets of needs. Careful decision-making regarding the use of therapies have to be discussed in a thoughtful way and be considerate of patient wishes.”
Further, Jefferies notes that medication use needs to be approached carefully in older patients and typical doses may not be tolerated as well within this age group. Regardless, both groups are managed at the Heart Institute and receive the same opportunities for care coordination and education on self management.
Jefferies’ current research interests include heritable causes of cardiovascular disease, novel drug therapies for advanced heart failure, novel gene discovery in cardiomyopathy, characterization and management of left ventricular noncompaction (LVNC) and early diagnosis and management of chemotherapy-induced cardiotoxicity.
At the end of the day, the industry’s capabilities to reduce readmissions and provide quality care in the future fall on the shoulders of both hospitals and patients.
Jefferies is most concerned about the lack of patient and family awareness of the potential implications of having cardiomyopathy and heart failure.
“We have access to so much technology which we use for so many things that are not as important as health and well being,” he says. “We need to be more aggressive as a field in diagnosing and managing HF earlier in the course if we really expect to reduce cost and mortality.”