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An Interview with Dr. Bob Arnot

BA: It is so absolutely, critically important to make certain that they are taking all the medications; have them on the right kind of exercise program and a terrific diet; and look at this third component that we hit so hard on the Web site and that is soul.  You are looking at the emotional component because you need to take anxiety and decrease it for two reasons.  One, you do not want to set them up for another heart attack.  Two, life is just a lot more pleasant.  You have got to enjoy life. It is there for the living.  You do this if you are able to decrease stress and anxiety.

It has been shown that if people are pessimistic after a first heart attack, they are more likely to have and die from a second heart attack.  So, to be able to take that pessimism and replace it with optimism is an incredible trait and it is tough for caregivers to do that alone.

GB: So much of the support a caregiver can give their loved one who has had a heart event is actually understanding these emotional changes.  Another important aspect is something that we find in all disease states and illnesses and that is medication compliance.  Thirty percent of patients having acute coronary syndrome discontinue one of the heart medications.  What can you tell family caregivers about the importance of compliance?

BA: The moment you come out of the hospital is the most critical moment.  So, whether you have actually had a heart attack or you just had an angioplasty, doctors sometimes will not give you all the medications that you should have and, as you point out, up to 30 percent are apt to drop off. Well, that makes the critical difference.  Our Web site actually has a wonderful section in there on what you can do with medications.  For instance, having pill boxes, putting the pills in a certain place where you are going to notice them during your daily routine, whether it is getting food out of the fridge or washing dishes or whatever.  You actually have a calendar that you can check off.  Now my father had, I think, seven different medications and just counting them every day was overwhelming.  He really benefited tremendously from having a calendar and medicine boxes, and there are even timers out there to make certain you take your medicine.

GB: There are now so many medications you have to deal with as a family caregiver, things can just slip through the cracks.

BA: Gary, you make a very good point. Part of it is management.  A patient may come out of the hospital with four, five, six, seven different kinds of medications, but part of it is what I call the antibiotic theory of chronic disease. I put my mother on a cholesterol lowering medication and she would go, “Hey, my cholesterol is down.  I am all better.”  It is like two weeks and I go, “No, you do not understand.”  People do not understand the idea that this is a progressive disease and that every single day you are putting a little bit more cholesterol in there.  You are having a little bit more softening of plaques and that, regardless of whether you had bypass surgery or you have had angioplasty, it is still a progressive disease.  So it is only with medication that you are able to slow this progression.  Now there are studies that show the progression can be slowed, stopped, and even reversed.