Cardio-renal-metabolic (C-R-M) conditions are a group of interconnected disorders, including cardiovascular disease, chronic kidney disease and type 2 diabetes. These conditions account for up to 20 million deaths annually in the U.S. and collectively rank as a leading cause of death worldwide.
Updated guidelines from the American Diabetes Association, American College of Cardiology and Kidney Disease: Improving Global Outcomes (KDIGO) call on healthcare professionals who treat C-R-M conditions to collaborate with other members of the patient’s care team. These guidelines outline how the cardiovascular, renal and metabolic systems are interconnected and how a change affecting one can impact the others.
Yet, studies show that while guidelines progress towards holistic outcomes, implementation of new guidelines can take more than 10 years and adoption lags. According to experts who spoke at a recent roundtable discussion hosted by Boehringer Ingelheim and Eli Lilly and Company (Lilly), as part of their CRMSynced™ educational program, this lag could be caused by challenges specialists may face in changing engrained behavior.
Recognizing potential barriers
“We’ve seen that there’s a convergence of these guidelines from the major organizations that really inform how we treat and take care of patients who are at high risk for life-threatening diseases,” said Dr. Eugene Wright, Primary Care Physician and Consulting Associate in the Department of Medicine at Duke University. “This evidence that we all agree to be true… hasn’t filtered its way into our practice yet.”
Dr. Janani Rangaswami, Nephrologist and Professor of Medicine at George Washington University, said that healthcare professionals can sometimes operate within “an imaginary territorial line.” Even though specialists may intellectually understand the need for better collaboration, she said, it can be difficult to break these behavioral patterns.
“It’s really hard as specialists, especially the more specialized they are, to actually realize they have these big blind spots,” said Dr. Rangaswami, adding that she came to appreciate the nuances of the links between kidney and heart disease only when she worked with cardiologists who acted as her mentors early in her career.
With her experience, Dr. Rangaswami urges other healthcare professionals to connect with other specialists.
“I challenge you in the academic year to go to a specialty society meeting that is not your primary specialty,” she said. “That is how multidisciplinary collaboration happens. You actually have to step out and do it.”
Dr. Janani Rangaswami, Nephrologist and Professor of Medicine at George Washington University
Taking a multidisciplinary approach to care
While the heart and kidneys serve different functions in the body, they have a profound impact on one another. In fact, 94% of people with type 2 diabetes presented with at least one cardiovascular or renal comorbidity. This overlap in C-R-M conditions underscores the need for a multidisciplinary approach to care.
Yet, 3 in 5 U.S. specialists agree they often see patients that are referred to them without receiving information on their conditions prior to the visit, according to an online survey by The Harris Poll on behalf of Boehringer Ingelheim and Lilly.
Moreover, more than 80 percent of endocrinologists, cardiologists and nephrologists wish they had the time to more closely track patients who see multiple providers, according to the survey. Additionally, a majority of healthcare professionals agree they would call another specialist to help treat these patients if they had the resources.
“There are now movements towards more multidisciplinary clinics and training pathways in which, early after general medical training, people are given the opportunity to spend some time in disciplines outside of perhaps their immediate specialty,” said Dr. Muthiah Vaduganathan, Cardiologist at Brigham and Women’s Hospital and Harvard Medical School. “I think those opportunities will grow,” he added.
The benefits of a little friendly competition
Dr. Vaduganathan says he’s also pleased that medical societies have banded together to support a collaborative and patient-centered approach to C-R-M care. He mentions even small changes that encourage collaboration can help improve patient outcomes, such as embedding friendly competition among clinicians. Dr. Vaduganathan explains, “We recently implemented a widespread game across our health system about lipid-lowering therapies, about who could get their patients to the most optimal set of lipids.”
“Even small changes that encourage collaboration can help improve patient outcomes, such as embedding friendly competition among clinicians. It’s with that friendly competitive spirit in mind that Boehringer Ingelheim and Eli Lilly and Company (Lilly) launched CRMSynced™, a browser-based game at cardio-renal-metabolic.com. ”
Dr. Muthiah Vaduganathan, Cardiologist at Brigham and Women’s Hospital and Harvard Medical School
It’s with that friendly competitive spirit in mind that Boehringer Ingelheim and Lilly launched CRMSynced, an online educational game in which players can engage as one of four avatar specialists — specifically a cardiologist, endocrinologist, nephrologist and primary care physician — and work with other healthcare professional game characters to build a fictional hospital. Players earn star ratings based on their answers to C-R-M related questions and how efficiently they complete the puzzle. CRMSynced reinforces the message that collaborating with other specialists is the way to create top quality patient care.
“We have recognized that the cardio, renal and metabolic systems are interrelated and interconnected, and I dare say interdependent. Therefore, our approach to the care, treatment and management of patients with these cardio, renal and metabolic systems, should equally be interrelated, interconnected, holistic and collaborative,” says Dr. Wright who has been playing and enjoying CRMSynced. “I would challenge you to see if you can beat my high score, as I’ve challenged my other colleagues. It’s really fun. It’s a great way to learn.”
For more information on collaborative C-R-M care and the CRMSynced program, visit cardio-renal-metabolic.com.