What is the plan of care for a patient with obesity and cardiac disease?

From the Guidelines

For an obese cardiac patient, the primary goal is to achieve gradual, sustainable weight loss while managing cardiac health, and the most effective approach is to combine a low-calorie, heart-healthy diet with regular exercise and monitoring, as recommended by the American Heart Association 1. The plan of care should start with a low-calorie diet rich in fruits, vegetables, whole grains, and lean proteins, limiting sodium intake to less than 2,300 mg per day and reducing saturated and trans fats.

• Aim for a weight loss of 1-2 pounds per week through a combination of diet and exercise.
• Begin with low-impact exercises such as walking, swimming, or stationary cycling for 15-30 minutes, 3-5 times a week, gradually increasing duration and intensity as tolerated.
• Always monitor heart rate and symptoms during exercise, as exercise training is recommended as safe and effective for patients with heart failure who are able to participate, including those who are obese 1. Consider medications like orlistat (120 mg three times daily with meals) to aid weight loss, but avoid stimulant-based weight loss drugs due to potential cardiac risks.
• For cardiac management, continue prescribed medications such as beta-blockers, ACE inhibitors, or statins as directed by the cardiologist. Implement regular monitoring of blood pressure, heart rate, and weight, and schedule follow-up appointments every 4-6 weeks to assess progress and adjust the plan as needed.
• Encourage the patient to keep a food and exercise diary to track adherence and progress. This comprehensive approach addresses both obesity and cardiac health, reducing strain on the heart and potentially improving overall cardiovascular function, as supported by the American Heart Association's guidelines for weight management in patients with obesity and cardiovascular disease 1.

From the FDA Drug Label

The study compared the risk of major adverse cardiovascular events between VICTOZA and placebo when these were added to, and used concomitantly with, background standard of care treatments for type 2 diabetes mellitus The primary endpoint, major adverse cardiac events (MACE), was the time to first occurrence of a three part composite outcome which included; cardiovascular death, non-fatal myocardial infarction and non-fatal stroke During the trial, investigators could modify anti-diabetic and cardiovascular medications to achieve local standard of care treatment targets with respect to blood glucose, lipid, and blood pressure, and manage patients recovering from an acute coronary syndrome or stroke event per local treatment guidelines

The plan of care for a patient with obesity and cardiac disease may involve managing cardiovascular disease and risk factors with:

• Non-diuretic antihypertensives
• Diuretics
• Statin therapy
• Platelet aggregation inhibitors
• Modifying anti-diabetic and cardiovascular medications to achieve local standard of care treatment targets with respect to blood glucose, lipid, and blood pressure 2
• Managing patients recovering from an acute coronary syndrome or stroke event per local treatment guidelines.

From the Research

Plan of Care for Patients with Obesity and Cardiac Disease

The plan of care for patients with obesity and cardiac disease involves a comprehensive approach that includes lifestyle modifications, behavioral interventions, and cardiac rehabilitation.

• Weight management is a crucial aspect of care, with a focus on achieving significant weight loss to reduce cardiovascular risk factors 3, 4.
• Cardiac rehabilitation programs can play a vital role in supporting weight loss and improving cardiovascular health, with a focus on exercise training, healthy lifestyle choices, and behavioral interventions 4, 5.
• A personalized approach to care is essential, taking into account individual patient characteristics, such as initial weight, age, employment status, and presence of comorbidities like diabetes and smoking 6.
• Setting realistic weight loss goals and providing behavioral weight loss support can lead to greater weight loss and improved outcomes 7.
• Factors that can impede effective weight management include psychological, social, cultural, and financial barriers, which should be addressed through comprehensive and tailored interventions 3.

Key Components of Care

• Lifestyle advice, including weight management, healthy eating, and regular physical activity 3, 4.
• Cardiac rehabilitation programs that incorporate exercise training, education, and behavioral interventions 4, 5.
• Behavioral weight loss support, including goal setting and counseling 7.
• Ongoing monitoring and evaluation to assess progress and adjust the plan of care as needed 6.

Considerations for Effective Care

• Patient-centered approach, taking into account individual needs and preferences 3.
• Multidisciplinary team involvement, including healthcare providers, dietitians, and behavioral specialists 5.
• Addressing social and environmental factors that can impact weight management, such as access to healthy food and physical activity opportunities 3.
• Ongoing education and support to promote sustainable lifestyle changes and weight loss maintenance 4, 7.