Heart to Heart: A Heart Attack Inspired This Student Doctor to Devise a New Model for Treating Medicine’s Trickiest Patients

 

John Davis felt completely alone. Sitting in a hospital bed, the 24-year-old medical student was surrounded by people: his wife, his friends, and doctors and nurses who were working hard to save his life. Because he was studying cardiovascular disease, he could understand his own medical condition like few other patients in his position that night. But instead of taking comfort from the many checking on him, he felt isolated, studied like one of the statistics he was poring over in his first hours of recovery, hoping to find a data point that could tell him whether he would live or die.

He survived his heart attack with a few stents implanted to unblock his arteries. But the experience upended his life and forever changed how he viewed the medical profession. Today, Davis is applying the lessons of his own near-death episode to an inventive pilot program he launched last year to help some of the poorest people in Galveston, Texas, where he volunteers at a health clinic within St. Vincent’s House, a social services agency.

Working with a team of fellow medical students and staff from the University of Texas Medical Branch (UTMB), Davis aims to solve one of the U.S. healthcare system’s toughest and most expensive problems: helping indigent people suffering from heart failure to improve their health and stay out of the hospital, where they incur costly care. Davis and his colleagues are attacking the problem from two angles. They’re working intensively with patients to tackle everyday challenges — from transportation to anxiety — that prevent them from seeking and sticking to treatment. They are also utilizing the latest technology, including GE Healthcare’s advanced ultrasound scanners, to quickly and cheaply deliver care that would otherwise be denied uninsured patients.

 

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John Davis with Andrew, one of his heart patients.

 

Attacking a National Health Challenge on a Smaller Stage

Heart disease is the leading cause of death in the U.S. population, and it’s more prevalent among America’s socioeconomically disadvantaged,[1],[2] who, due to a combination of factors including lack of insurance and access to primary care, often wait until their condition is advanced to seek treatment, Davis says. When these patients do seek care, often at their local hospital, the healthcare system typically isn’t set up to serve them once they go home. As a result, they are often readmitted not long after, and each subsequent hospitalization can cost tens of thousands of dollars.[3] The costs add up: Readmission of just low-income patients who have suffered from heart failure costs $715 million in medical care in the U.S. each year.[4] Since many of these patients are uninsured, hospitals pass the costs on to those who can pay. In the end, says Davis, indigent heart patients often don’t see their health get better, while the community sees rising healthcare costs.

​“They have tried everything under the sun to reduce readmissions and to help people stay healthy and out of the hospital,” Davis explains of previous futile efforts. “Heart failure care costs an exorbitant amount, particularly for those who have very low insurance levels.”

Davis thought he could do better, and he made a pitch to UTMB: Give him some volunteers, ultrasound equipment and a small paid staff, and he’d reduce the number of patients bouncing in and out of the Galveston hospital. The student doctor admits he may have been naïve about the challenge he wanted to take on, but he had a reason to think he understood what these patients were going through better than most professionals in the healthcare system.

 

 

From Doctor to Patient

Davis’s heart attack struck in February of 2020, a month before the COVID pandemic would upend society. The young physician was playing pickup basketball with colleagues when he collapsed. Suddenly he was going through what many of his patients had, and it didn’t feel good. Doctors were telling him the likelihood of this or that outcome, but instead of being reassured, he felt treated like a number, not a person. Even worse, he realized that medicine was training him to interact with patients the same way. 

“I had begun to see death and disease as a thing to be studied, rather than an experience to be felt and grappled with,” Davis wrote in an essay about his experience.

He felt shame as well. As a teenager, Davis had been diagnosed with a genetic disorder that elevated his chances of early-onset coronary artery disease, a diagnosis he had shrugged off, since he played baseball nearly every week, felt healthy and had little continuity of care. (It was coincidence, not an interest in his own health, that had led him to study coronary disease in populations.) Davis regretted not taking the statin medication that could have prevented his heart attack — but he was also coming to understand some of the barriers patients face in caring for themselves.

“From a patient level,” he says, heart failure is “the hardest disease to understand and to be compliant with.”

Davis had that experience with him when UTMB green-lit his proposal. Now he had to make good. The pilot unfolded at St. Vincent’s over the better part of a year, starting in early 2021, with 85 patients. St. Vincent’s got its start in 1954 as an outreach ministry serving an African American community that suffered from poverty and a lack of basic services, including healthcare. Today the agency serves a more diverse population that includes many Hispanics, and its free clinic, a partnership with UTMB begun in 1984, is one of America’s largest, staffed by medical students and providing everything from primary care to dentistry to vasectomies. 

 

Straight from the Heart: A Plan to Help

Davis’s idea was straightforward: Take uninsured heart failure patients as they are discharged from UTMB’s Galveston campus and overwhelm them with support. Davis had noticed that heart patients were often sent home with instructions to set up an appointment to see a cardiologist within two weeks, a preposterous suggestion to people with no insurance and little spare money. He set about finding ways to make it easy for patients to take care of themselves.

“There are social barriers to care. There are financial barriers to care. The medicine is unbelievably expensive and complicated,” Davis says. “You have to have good transportation, you have to have a good support network. And you have to be a little bit lucky.”

 

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Davis with his daughter.

 

Each of the participants spent two months in the program, meeting weekly or biweekly with cardiologists, nurses, occupational therapists, nutrition counselors and even mental health professionals to help with the anxiety and depression that can accompany a dire diagnosis that in some cases might include only months of expected life span. St. Vincent’s provided transportation for patients and their family members, free medicines and gift cards as an incentive to stick with their care. Technology played a big role, too. With a grant, the program purchased a Vscan Extend, a pocket-size ultrasound system. Using this, together with a Venue Go, a portable ultrasound machine with artificial intelligence tools, the team at St. Vincent’s was able to perform frequent echocardiograms on participants. In a hospital setting, such a procedure might cost thousands of dollars each time it’s performed, or, in the case of the uninsured, it might not be done at all. By conducting frequent echocardiograms, Davis and his colleagues were better able to closely monitor patients’ hearts to see how they were improving.

After the pilot’s first year, Davis and his team observed a reduction in hospital readmissions of 63% from the average, effectively turning a modest investment by the university into net savings, and without any payments from insurance or patients themselves.[5] The university is now considering whether to roll Davis’s program out across its health system, which includes four major hospitals and 90 clinics and outpatient facilities. There’s still work to be done: Much of the clinical care was performed by volunteer doctors and nurses, which may not work as the program scales up. Also, it was tricky to manage near-weekly visits for dozens of patients, never mind for hundreds or thousands. 

But Davis, who’s now also caring for a six-month-old daughter as well as numerous pets his wife has brought home from her job at the Houston Society for the Prevention of Cruelty of Animals, is confident he and his colleagues are onto something. The pilot has continued and now has 120 participants. Davis has seen his own health improve, and last year he ran two half marathons.

“This is an opportunity to kind of kill two birds with one stone, to do the right thing while also making things a little more fiscally solvent,” says Davis. “There's a lot of really cool technology out there that can help us prevent cardiac disease.”

 

REFERENCES

[1] Mortality in the United States, 2020, Centers for Disease Control, December 2021, https://www.cdc.gov/nchs/fastats/leading-causes-of-death.htm.

[2] Rita Hamad, Joanne Penko, Dhruv S. Kazi, et al., “Association of Low Socioeconomic Status with Premature Coronary Heart Disease in US Adults,” JAMA Cardiology 5, no. 8 (May 2020), https://jamanetwork.com/journals/jamacardiology/fullarticle/2766530.

[3] Yogesh N.V. Reddy and Barry A. Borlaug, “Readmissions in Heart Failure: It’s More Than Just the Medicine,” Mayo Clinic Proceedings 94, no. 10 (October 2019), https://www.mayoclinicproceedings.org/article/S0025-6196(19)30747-5/fulltext.

[4] Ibid.

[5] John W. Davis, “Cardiovascular Disease: Prevention and Management,” PhD dissertation, University of Texas Medical Branch, 2022.