Counseling Patients on Disease Progression in ATTR-CM

Announcer:
This is Heart Matters on ReachMD. On this episode, Dr. Joban Vaishnav will discuss how we can effectively communicate with patients with transthyretin amyloid cardiomyopathy, or ATTR-CM. Dr. Vaishnav is an Assistant Professor of Medicine and Director of the Comprehensive Amyloidosis Center at Johns Hopkins Medicine in Baltimore. Let’s hear from her now.

Dr. Vaishnav:
So, when a patient comes to me and their markers suggest disease progression, those conversations take time. At the same time, they're individualized. I do try to just level with the patient and highlight what markers do suggest progression. I do try to focus on the positive. There's always positive in every patient encounter, and trying to find the positive in the midst of this is important.

And then, I highlight that once disease progression is identified, it usually doesn't suggest imminent mortality or imminent worsening. ATTR-CM tends to be more slowly progressive, even with progression. Patients can still expect to live for months to years after that, and I try to capture all that with them and make sure there's plenty of time for back-and-forth dialogue and questions.

A common misconception I hear from my patients when I explain to them that things may be getting worse in certain ways is, "This equates to treatment failure. I'm on the wrong treatment," or, "My treatment's not working." Most of the time, that's just not the case. With disease progression, probably the biggest risk for it is if a patient is identified at a later stage of disease at diagnosis, and we know that treatments don't reverse disease. So, I try to explain that nuance: "Actually, your treatment's working, but we haven't been able to, and nor would we expect to, rid your body of the amyloid that's already deposited or caused issues." That then factors into how we navigate decision making in terms of treatment. And if I do switch or alter treatment, it has to be with the appropriate counseling on what to expect, which may be no difference. We haven't really shown that switching or modifying treatment has any difference with disease progression. So, that's what I try to highlight or clarify with patients.

Announcer:
That was Dr. Joban Vaishnav discussing effective communication throughout disease progression in patients with ATTR-CM. To access this and other episodes in our series, visit Heart Matters on ReachMD.com, where you can Be Part of the Knowledge. Thanks for listening!