GETTING TO THE HEART OF MEDICINE
is anywhere between 47 and 128. 1 For aspirin, the NNT to prevent
another non-fatal heart attack or death is quoted to be 333 and 77,
respectively. 2 The statistics for heart failure seem even more difficult.
For a practitioner wanting to make a meaningful impact on each
patient, this can seem like a long road to the inevitable.
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My lady told me that her favorite color was teal, that all three
of her children were grown, and her husband, which she fondly
referred to as her “fourth child,” was back at home on the farm. Her
favorite flavor of ice cream was orange creamsicle, which reminded
her of summers as a child at the public pool. Her biggest fear was
what would happen to her fourth child if her battle with cancer
were to end prematurely. Spreading kindness to all she could touch
in the meantime was her short-term goal. But as with all sessions,
this one flew by thanks to good conversation and we parted ways.
We exchanged “see you later,” which always was her preference to
“goodbye.” The latter felt too definitive for her taste.
Instead of walking her out this time, I stayed in my seat. The rays
of sunshine now shone down from higher up, changing the light,
helping me to reflect on how best to counsel my patients moving
forward. But I was interrupted by a strong, petite woman in a colorful
head scarf. She turned back before exiting the infusion center and
with a cautious smile and glistening eyes simply said, “Thank you.”
In that moment, I found my path. Cardio oncology has a unique
opportunity to participate in the multidisciplinary care of complex
patients who are going through the most difficult times in
their lives. However, the diagnosis and medical treatment are but
a small piece of a bigger puzzle. I hope never to forget the impact
a thoughtful conversation can have on the well-being of a patient.
With cardiovascular disease and cancer remaining the top two causes
of mortality in the US, a statistic very unlikely to change anytime
soon, there is plenty of opportunity to step in and have that impact.
It seems there is a chance to narrow the NNT to as low as one, just
with talking, which is a much-needed breath of fresh air. In these
dark days when many people feel alone and alienated, who am I to
reject that chance?
References
1
Roger Chou, MD; Tracy Dana, MLS; Ian Blazina, MPH; Monica Daeges, BA;
Thomas L. Jeanne M. Statins for prevention of cardiovascular disease in adults.
JAMA 2016; 97239 (19): 2008–2024.
2
Trialists A & Collaboration ATT. Aspirin in the primary and secondary prevention
of vascular disease : collaborative meta-analysis of individual participant.
Lancet 2009; 373 (9678): 1849–1860.
Dr. Chris Fine is a cardiology fellow-in-training and Chief Fellow at the University of
Louisville in the Department of Cardiovascular Medicine.
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