Impact of Engagement with Outcome Sustainability using a Fluid Multidisciplinary Preventive Cardiology Center: Protocol and Methods

Abstract

IntroductionIntensive lifestyle interventions ameliorate cardiometabolic risk factors in the short term, however this effect decreases in subsequent years. The Center for Clinical Cardiovascular Health at Mount Sinai Heart (the “Center”) was built to apply interdisciplinary preventive care, lifestyle medicine, and guideline-directed medical therapy in one physical location. We posit that patient engagement within a fluid multidisciplinary preventive cardiology center is associated with increased guideline-directed medical therapy and lower rates of cardiometabolic based chronic disease (CMBCD) development and progression compared with published data. We also seek to determine a correlation between engagement scores and patient response/sustainability. MethodsPatient visits to the Center are tracked since March 1, 2017. This data will be curated according to variables that indicate specific coordinates of CMBCD at the initial visit. This classification will allow determination of the “dominant” or “target” metabolic driver, which is the driver at the most advanced stage at baseline for each patient. Logistic regression was used to analyze health care utilization and initial driver stage with odds of sustainability. Factor analysis was used to analyze the main variables associated with intervention response and sustainability. ConclusionsEarly management of cardiometabolic disease requires understanding and utilization of a three-dimensional approach. Dimension 1: CMBCD drivers exist along a pathophysiological continuum rather than as a dichotomous (absent/present) state. Dimension 2: key mechanistic drivers include adiposity, dysglycemia, hypertension, and dyslipidemia. Dimension 3: ascertaining structural/social determinants of health portends improved individualized sustainability. Increased patient engagement scores are also associated with both short-term and long-term reduction of CMBCD disease progression.