Understanding the journey of care for patients with cardiovascular, renal and metabolic disease

Journeys are often full of surprises: wrong turns, unforeseen obstacles and unexpected diversions can challenge the most experienced of travellers. The life of a patient with chronic disease can be described as going on a life-long journey without a map. The right path can be found, and useful advice is available, but as of yet, this comprehensive map doesn’t exist for patients or healthcare providers.

This is particularly true for diseases with complications from cardiovascular, renal and metabolic (CVRM) conditions. While there are well understood pathophysiological connections among all three conditions, it is seldom that shared risk factors are addressed. Often, focus is narrowed to the culprit organ and immediate symptoms, missing the chance to diagnose, treat and prevent related complications. It’s like everyone holds a different piece of the map, and the patient rarely gets to see where they are going.

That’s why at AstraZeneca we are changing how we approach the science behind these diseases. We work every day to potentially develop and grow a portfolio of medicines focused on addressing multiple risk factors or co-morbidities across CVRM.  We aim to change clinical practice, and through our research are demonstrating our commitment to creating a clear, understandable and actionable pathway for patients to manage their disease. Our priority is to accelerate change together with health-care providers to respond earlier, so that quality of life, morbidity and mortality outcomes are improved.

As part of our CVRM therapy area at AstraZeneca, we have four distinct, but interconnected disease areas on which we are focusing our potential solutions. For us to bring impactful change to disease management and how patients are treated, we need to understand exactly just what our patients are going through.

 

Chronic Kidney Disease

Take a patient with chronic kidney disease (CKD). Many of them won’t have symptoms until the disease has progressed to an advanced stage with irreversible damage.1 Even then, the symptoms are often non-specific, such as trouble sleeping, fatigue, poor appetite and swollen feet and ankles.1 On top of these symptoms, patients with advanced CKD can be shuffled through visits with various specialists and disease-management counsellors. Those unlucky enough to reach end-stage renal disease are dependent on dialysis for the rest of their lives or until they can undergo a kidney transplantation.2 And on top of all this, they need to be aware of other co-morbidities such as vascular disease and heart failure.3–5



Diabetes

The journey of patients with diabetes is similarly difficult to navigate. It often begins in a state of denial or bewilderment, as they begin to recall stories from family members going blind due to the disease.6, 7 After diagnosis they are confronted with several restrictions to their diet and a need to become more active.8 Patients often feel it’s too challenging or unnecessary to alter their habits so extremely, since many of them don’t even experience symptoms.9, 10 The need to provide strong support and education on self-management to avoid the cardio-renal complications of diabetes is paramount and we are determined to help patients actively manage their disease.



Cardiovascular Disease

Cardiovascular disease differs from CKD and diabetes in that it often manifests as an acute, life-threatening event. Patients fear dying from a second cardiovascular (CV) event such as a heart attack or stroke.11, 12 Very often, underlying kidney disease and diabetes are diagnosed as a result of the patient’s initial CV event,13, 14 highlighting the connection among these conditions and the need to prevent and diagnose them at a much earlier stage.



Heart Failure

Heart failure is one of the areas in medicine with a significant unmet need.15 Patients’ lives can be severely limited as they suffer from shortness of breath, lack of appetite, fluid retention, fatigue and the inability to exercise, restricting their capacity to do the things they used to do with ease.16 Many chronic heart failure patients are similarly overwhelmed by the number of medications and lifestyle changes they must now face.17,18 All this, combined with the severity of the disease, often results in depressive states with patients questioning what the point of living is, if it only entails endless doctor visits.19



All this is what CVRM disease looks like in real-life. Each patient diagnosed with one of these diseases will be affected in their own way and travel their own journey, but journeys may be interconnected. A CKD pathway may cross over with that of a CVD patient, a diabetes pathway with that of a heart failure patient. Complications related to other CVRM diseases are a distinct reality of their journeys.15,20-23

As the medical community gets a clearer view of how these conditions affect not just the organ of interest, but the whole body and the effects they have on patients’ lives, we are able to further investigate the science to better tailor the care we give them. We want to understand the full extent of what CVRM patients go through – not only with appointments and check-ups, but also recognise the physical and mental difficulties they endure, to improve outcomes. To do this we are:

  • Increasing awareness of the challenges that patients face living with chronic disease and helping HCPs and patients recognise the risk of related CVRM diseases
  • Evaluating real-world evidence to support the need for more effective treatment options
  • Hearing from patient groups to learn more about the tools we can provide patients to help support them on their journey
  • Collaborating with organisations to drive on-the-ground solutions for patients
  • Working with medical experts across disciplines to share insights and create a highly integrated team surrounding each CVRM patient to provide optimal treatment

We see the various complications each of these diseases cause and want to address our patients’ unmet needs. In keeping track of our patients and their disease progression, we are committed to helping patients move along their journey by better supporting them on managing their current disease and providing potential solutions to prevent additional complications along the way.

References:

1. National Health Service. Symptoms: Chronic kidney disease; 2016 [cited 20.08.19]. Available from: URL: https://www.nhs.uk/conditions/kidney-disease/symptoms/.

2. National Kidney Foundation. Dialysis; 2015 [cited 26.08.19]. Available from: URL: https://www.kidney.org/atoz/content/dialysisinfo.

3. House AA et al. Heart failure in chronic kidney disease: Conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference. Kidney Int 2019; 95(6):1304–17.

4. Titze S et al. Disease burden and risk profile in referred patients with moderate chronic kidney disease: Composition of the German Chronic Kidney Disease (GCKD) cohort. Nephrol Dial Transplant 2015; 30(3):441–51.

5. National Institute of Diabetes and Digestive and Kidney Diseases. Kidney Disease Statistics for the United States: National Institutes of Health [cited 2018 Aug 28]. Available from: URL: https://www.niddk.nih.gov/health-information/health-statistics/kidney-disease.

6. International Diabetes Federation. IDF Diabetes Atlas - 8th Edition. 8th ed.; 2017 [cited 2019 May 14]. Available from: URL: https://www.diabetesatlas.org/.

7. American Diabetes Association. Mental Health: Understanding diabetes and mental health [cited 26.08.19]. Available from: URL: https://www.diabetes.org/diabetes/mental-health.

8. National Health Service. Food and keeping active: Type 2 diabetes; 2017 [cited 20.08.19]. Available from: URL: https://www.nhs.uk/conditions/type-2-diabetes/food-and-keeping-active/.

9. American Psychological Association. Taking control of your diabetes; 2013 [cited 26.08.19]. Available from: URL: https://www.apa.org/helpcenter/diabetes.

10. National Institute of Diabetes and Digestive and Kidney Diseases. Symptoms & Causes of Diabetes; 2016 [cited 26.08.19]. Available from: URL: https://www.niddk.nih.gov/health-information/diabetes/overview/symptoms-causes.

11. Heart Foundation. Managing emotional stress [cited 26.08.19]. Available from: URL: https://www.heartfoundation.org.au/after-my-heart-attack/heart-attack-recovery/managing-your-emotional-and-social-life.

12. American Heart Association. Heart Attack Recovery FAQs; 2015 [cited 26.08.19]. Available from: URL: https://www.heart.org/en/health-topics/heart-attack/life-after-a-heart-attack/heart-attack-recovery-faqs.

13. Bartnik M et al. The prevalence of abnormal glucose regulation in patients with coronary artery disease across Europe. The Euro Heart Survey on diabetes and the heart. Eur Heart J 2004; 25(21):1880–90.

14. Wagner M et al. Prevalence of chronic kidney disease and its determinants in coronary heart disease patients in 24 European countries: Insights from the EUROASPIRE IV survey of the European Society of Cardiology. Eur J Prev Cardiol 2017; 24(11):1168–80.

15. Angermann CE. Comorbidities in heart failure: A key issue. European Journal of Heart Failure Supplements 2009; 8(Supplement 1):i5-i10.

16. American Heart Association. Warning Signs of Heart Failure; 2017 [cited 26.08.19]. Available from: URL: https://www.heart.org/en/health-topics/heart-failure/warning-signs-of-heart-failure.

17. American Heart Association. Lifestyle Changes for Heart Failure; 2017 [cited 26.08.19]. Available from: URL: https://www.heart.org/en/health-topics/heart-failure/treatment-options-for-heart-failure/lifestyle-changes-for-heart-failure.

18. American Heart Association. Medications Used to Treat Heart Failure; 2017 [cited 26.08.19]. Available from: URL: https://www.heart.org/en/health-topics/heart-failure/treatment-options-for-heart-failure/medications-used-to-treat-heart-failure.

19. Heart Failure Society Of America. Module 6: Managing Feelings About Heart Failure [cited 26.08.19]. Available from: URL: https://www.hfsa.org/patient/patient-tools/educational-modules/module-6/.

20. Arnold SV et al. Burden of cardio-renal-metabolic conditions in adults with type 2 diabetes within the Diabetes Collaborative Registry. Diabetes Obes Metab 2018; 20(8):2000–3.

21. Bello AK et al. Complications of chronic kidney disease: Current state, knowledge gaps, and strategy for action. Kidney Int Suppl (2011) 2017; 7(2):122–9.

22. Sharma A et al. Trends in Noncardiovascular Comorbidities Among Patients Hospitalized for Heart Failure: Insights From the Get With The Guidelines-Heart Failure Registry. Circ Heart Fail 2018; 11(6):e004646.

23. Buddeke J et al. Trends in comorbidity in patients hospitalised for cardiovascular disease. Int J Cardiol 2017; 248:382–8.

 

Veeva ID: Z4-19265
Date of prep: August 2019
Date of expiry: August 2021