This is particularly important in our
area, specifically in West Virginia, where not all the patients have access to cardiologists until they actually have an MI. So, therefore, these
patients should be taken care of by their primary care physicians. Probably a
dietitian because of the obesity. They need plus minus a rheumatologist, who’s
initiating and following up the treatment of the RA and very likely same
thing happens with a family practice or an internist who would follow that. Most
of them, they need physical therapists. So, you need a big group of people following
these patients. The patient will also feel more taken care.
therefore in the decision-making you would be more convincing to the patient in
terms of making the decisions. Then, if you refer the patients,
just because of having early symptoms and signs or evidence of coronary artery
disease to a cardiologist that’s better than referring them for a
CABG. So, the earlier the better this way they can be intervened on
early on—especially with the cardiac rehab programs and all of that. Bariatric
clinic, obesity clinic also needs to be involved especially that obesity clinic.
Almost every major hospital now or every major outpatient setting does have an
obesity clinic. So, that is someone that needs to be involved. There is not a day
where in the clinic you do not refer at least 2 patients to the obesity clinic.
Whether they are RA-positive or SLE-positive or whatever autoimmune disease they have.