Do I Need to Accompany My Elderly Parent for Cardiology Visits?

Q: Do I Need to Accompany My Elderly Parent for Cardiology Visits?

Hello： For coronary artery disease with blockage in all three vessels, there are three treatment approaches： 1. <br>The most fundamental is lifestyle modification (diet and exercise) and pharmacotherapy (achieving target blood pressure, blood sugar, and cholesterol levels). <br>A

Is it necessary for the patient to be present for the consultation?

Hello, doctor.
My father is 78 years old and underwent a coronary angiogram in May.
The doctor informed us that: 1.
All three coronary arteries are severely blocked.
2.
One artery requires two stents.
3.
Another artery requires more than ten stents.
(The doctor did not mention how many stents the third artery would need...
At that time, I was quite flustered and apologize for keeping the doctor waiting too long.
I casually responded to the doctor that we should first address the artery that is easier to manage, which was the one requiring two stents.) Therefore, my father had two stents placed.
However, during each follow-up visit, I always ask the doctor when we will address the more complicated artery that requires over ten stents, but the doctor never responds.
The lack of response makes me doubt whether the doctor is confident in handling the situation.
I am considering switching hospitals.
I would like to ask the doctor: 1.
What is the appropriate blood pressure range for elderly patients? 2.
If we switch hospitals, can my father avoid in-person visits, and can I simply bring the original hospital's examination CD for the new doctor to review? (I feel reluctant to subject my father to the stress of travel.) 3.
If we ultimately return to the original hospital for treatment, will that offend the original doctor? 4.
For asymptomatic coronary artery disease, is it possible to avoid stenting? (Although the angiogram results show that my father's three arteries are severely blocked, he reports not experiencing any discomfort or symptoms.)

Rúhé shì hǎo, 30~39 year old female. Ask Date: 2019/07/31

Dr. Huang Yinghe reply Cardiology

Hello: For coronary artery disease with blockage in all three vessels, there are three treatment approaches: 1.
The most fundamental is lifestyle modification (diet and exercise) and pharmacotherapy (achieving target blood pressure, blood sugar, and cholesterol levels).
Additionally, one can choose 2.
coronary artery bypass grafting (CABG) or 3.
percutaneous coronary intervention (PCI) with stenting.
Traditionally, surgical procedures have shown better long-term vascular patency compared to stenting; however, the patient's age and associated risks must be considered, and the recovery time post-surgery is generally longer.

In recent years, advancements in catheterization techniques and materials have allowed many severe cases of coronary artery disease to be managed with stents.
However, the cost of multiple self-funded stents can be high, and complex vascular lesions may not be amenable to stenting.
Therefore, blood pressure control is absolutely essential.
According to the latest recommendations from the Taiwanese Society of Cardiology, for individuals over 75 years old, blood pressure should be maintained below 140/90 mmHg.
For patients with coronary artery disease, a stricter target of below 130/80 mmHg is recommended.

Seeking a second opinion at another hospital is perfectly reasonable, and most physicians understand the family's concern for the patient.
However, it is crucial for the patient to attend the first consultation in person so that the physician can make a comprehensive assessment.
Finally, regarding the choice of treatment strategy: if symptoms cannot be controlled with medication, it is advisable to consider stenting or surgery to improve the condition.
If there are no symptoms, there is currently no standard answer; both medication and stenting/surgery have their pros and cons, and the decision should be made collaboratively through thorough communication between the patient/family and the physician.

Reply Date: 2019/07/31

More Info

When considering whether to accompany an elderly parent for cardiology visits, there are several factors to take into account, especially given your father's complex medical history and current condition.
1. Blood Pressure Management: For elderly patients, maintaining a blood pressure within a target range is crucial. Generally, a systolic blood pressure (the top number) of around 130-150 mmHg and a diastolic blood pressure (the bottom number) of 70-90 mmHg is often considered acceptable for older adults. However, individual targets may vary based on overall health, comorbidities, and the presence of conditions like diabetes. Regular monitoring and adjustments to medications may be necessary to achieve these targets without causing adverse effects, such as hypotension (low blood pressure).

2. Hospital Transfer and Medical Records: If you decide to switch hospitals for your father's care, it is indeed possible for you to take his medical records, including the catheterization results and any imaging studies, to the new facility. Many hospitals will accept these records and may not require your father to be physically present for the initial consultation. However, it is essential to communicate with the new hospital beforehand to understand their policies and ensure a smooth transition.

3. Concerns About Offending the Original Hospital: It is natural to worry about the feelings of the healthcare providers at the original hospital. However, patient care should always come first. If you believe that your father would benefit from a second opinion or a different approach, it is within your rights to seek that care. Most healthcare professionals understand that patients may seek additional consultations, and it is a common practice in medicine.

4. Asymptomatic Coronary Artery Disease: Regarding your father's coronary artery disease, it is important to note that not all cases require immediate intervention, such as stenting, especially if the patient is asymptomatic. The decision to place stents typically depends on the severity of the blockage, the presence of symptoms, and the overall risk of future cardiac events. If your father is not experiencing any symptoms, his cardiologist may recommend a conservative approach, including lifestyle modifications and medication management, rather than invasive procedures.

In addition to these points, it is crucial to maintain open communication with your father's healthcare team. If you feel that your questions are not being adequately addressed, consider requesting a dedicated appointment to discuss your concerns in detail. This can help clarify the treatment plan and ensure that you and your father are comfortable with the decisions being made.

Moreover, supporting your father through lifestyle changes can significantly impact his heart health. Encouraging a heart-healthy diet, regular physical activity (as tolerated), and adherence to prescribed medications can help manage his condition effectively.
In summary, accompanying your elderly parent to cardiology visits can be beneficial, especially if they require assistance in understanding their medical situation or if they have difficulty communicating their concerns. Your involvement can help ensure that they receive the best possible care and support throughout their treatment journey.

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