Pete Toogood presented a research update on moving heart failure treatment toward certain goals and away from other goals. The presentation outlined factors that motivate doctors to provide more aggressive "best" treatment for some patients over others. These include the patient's age, number of heart attacks, education level, and role in supporting others. Doctors may feel more compelled to try harder for younger patients who have families and much life left to live. The treatment approach can also be driven by protocols, outcomes, personal challenges, or a desire to help patients feel better and live longer.

1. SPEAKER NAME

2. Pete Toogood
Inspra UK Market
Senior Marketing
Research Update
Researcher

3. Doctor Aims: Move TOWARD
AWAY FROM TOWARD
• Death/preventable death (short term) • Appropriate medication
• 2nd MI, LV damage/negative remodelling, – Symptom relief and patient feels better
heart failure – Improve prognosis
– EBM/protocols: polypharmacy
• Blame/feeling bad because something – IV to oral, titrate to maximum tolerated dose
was not done/missed something
• Acting early (whilst damage is still reversible)
• Uncertainty • Preserving muscle/salvaging myocardium
• Breathlessness, oedema • Improvement in condition
• Restriction of activity/poor QOL • Additional benefits of added treatments
• Side effects/upsetting haemodynamics by • Doing everything possible
adding drugs/increasing doses • Mobilised patient who feels better/freedom
• Renal failure • Good Doctor/patient relationship
• Smoking; Poor diet/obesity • Happy collaborative patient: understands,
• Re-admission to hospital compliant, proactive re: lifestyle

4. “Success” is:
Improving mortality,
morbidity, prognosis
Symptom resolution:
breathlessness, swollen ankles, Minimise risk of future
chest pain events + readmission
Saving difficult patient:
especially if close to death, Prescribing optimum doses
cardiogenic shock of all drugs on protocol
“ticked all the right boxes”
Minimising LV damage: able
to act whilst damage reversible SUCCESS
Improved QOL: getting Established diagnosis and
patients mobile, back to cause of HF: nothing missed
‘normal’, optimise capacity
Address all Well informed patients who
modifiable risk factors are managing their lifestyle
because of your education
Bring order to chaos: Dx,
plan, simplify complex condition

5. Patient Aims/Fears
Need to feel Anxious, scared, Will I die? I don’t want it
Chest pain, to happen again? What
breathlessness, tired better/less ill frightened
are Drs going to do?
Need for reassurance
Devastated, depressed
and hope
Best is being done, no further Why did it happen?
events, can regain normal life How will it affect mylifestyle/
AIMS/ family/job? How long will I have
to stay in hospital?
FEARS
Need to Denial/angry
understand
Why so many tablets?
What has happened? Why so many tubes/people?
To get home, back to normal
(work, holidays, sex, driving), Confused
be a person again, not a patient

6. Patients For “Best” Management
PATIENT MOTIVATIONS FOR “BEST” TREATMENT
CHARACTERISTICS
Age - chronological Young: increased benefits to extending life expectancy; potential to be
→ disabled longer
Age - biological Young/fewer comorbidities/more active: more emotive but also
→ rational re: contraindications and side effects
Life Status → Breadwinner: has family so may have more concerns
Number of MI events 1ST MI: prevention better than cure so likely to be more aggressive,
especially if young
→ 2+ MIs: worse prognosis; likely to have some LV damage, may already
be on max dose of protocol-led drugs; more likely to feel need to be
seen to do something else/new
Patient Education Level of Education: more likely to understand and appreciate role of
→ each drug and thereby comply on Tx – doctor may have more empathy
toward these patients
NB. Best = more ‘aggressive’/earlier tx

7. Patient Type: Quotes
“A young patient with the worst prognosis, they ’re
the ones you relate to most... If they are well “There are groups of patients you feel beholden to… if
educated, bright, alert, interested, you are bound you are 50 and you have a big infarct the chances are
to explain more to them and think more about everything else is working all right, and you have got
what you are doing. ” the wife and 2 little kids and the job, and you thought
Cardiologist: ACS you had another 30 years of happy life tolook forward
to…you really feel you ought to be doing more. ”
Cardiologist: ACS
“I think patients with severe obesity, they often
have multiple health problems… we probably don’t
manage these individuals as we ought to as we
tend to blame the obesity.”
General Physician: CCU “You are more aggressive with some patients – partly
to do with age, quality of life and first event, as they
are more likely to be in a position where you can do
so much more for them.”
“By definition the 2nd MI means you’ve not been
General Physician: CCU
as successful. You need to think about doing
something more for the patient.”
Cardiologist: ACS

8. Customer Types
• Follow protocols as audited
• Spend time explaining to
on these
patient
• Doing right thing/tick
• QOL vs life expectancy:
all boxes
Protocol fewer drugs/lower doses
• Less likely to give Inspra Patient
as no ‘tick box’ for this? driven driven
• Meeting Govt targets (majority)
• Minimises risk for doctor if
adverse event occurs
(“blame culture”) – likely to • Aggressive Rx approach
give more drugs up to
limits of protocol? Personal • May consider Rx outside
challenge protocol
• More likely to be more
junior/Gen. Phys? Outcome • More likely to Rx Inspra?
driven
• Aggressive Rx approach
• May continue to do all for patient
rather than accepting death as
outcome (life expectancy vs QOL)
• Likely to give more drugs?

9. Laddering: Outcome Driven
Value Death is devastating to relatives, especially if patient was
enjoying life had a family to support and an important job
Live longer
Patient more likely to comply
Consequences
Better quality of life
Attribute Feel better

10. Laddering: Professional Recognition/
Personal Challenge
Value Professional recognition, everybody talking about it
Feel powerful, important
Feel excited
Consequences “Done wonderful job”
Patient/family impressed
Attribute Survival benefits