Transcript
Announcer:
You’re listening to Heart Matters on ReachMD. On this episode, Dr. Joshua Mitchell will discuss shared decision-making strategies in transthyretin amyloid cardiomyopathy, or ATTR-CM. He’s the Director of the Cardio-Oncology Center of Excellence, Director of the Cardio-Oncology Fellowship, and Co-Director of the Amyloid Center of Excellence at Washington University School of Medicine in St. Louis. Let’s hear from Dr. Mitchell now.
Dr. Mitchell:
When considering treatment decisions, there are a few things that we would want to consider beyond efficacy alone. Now, efficacy really means the most to us, and I think it's really important to review findings from the different trials. Ultimately, there's no head-to-head trials, and so we'll pull out some of the potential discriminating factors from the trials. But then we'll also focus on other things that are important for the patient, and those things include whether the patient prefers pills or injections, as an example. It also certainly includes things like insurance. We usually take insurance out of the first decision because I want to understand what works best for the patient, insurance aside, and then we'll move through the approval process. Most of the time these days, we're able to get the patient the preferred prescription that works best for them. But if we have to pivot, we can always pivot with something that aligns better with the particular insurance that the patient is contracted through.
In order to help patients navigate an increasingly complex array of therapeutic options for ATTR-CM, I always start out with a description of the disease. I think it's really helpful to talk a little bit about the pathophysiology of the disease in terms that the patient can understand, and that helps put everything into perspective. So I walk them through how ATTR-CM develops—how the tetramer initially forms, how it can become unstable and dissociate, and how it ultimately forms spirals. That then helps them understand how these medications work, and it helps you be able to discriminate them as you talk about the different options.
As we go through the different options, we then discuss how they're administered. We discuss some of the highlights from the various trials and some of the potential distinguishing characteristics. Then we ultimately turn it back to the patient to see which factors seem to resonate the most with them to find the treatment that best aligns with their goals and wishes.
Announcer:
That was Dr. Joshua Mitchell sharing his perspective on treatment decision-making in 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!
