Duane Davis, MD, Executive Medical Director of the Cardiovascular Institute at Florida Hospital, trained as a cardiac surgeon or heart surgeon, involved in transplant and end stage thoracic organ failure for the majority of his career, talks about a possible concept for taking the life-saving medications patients who suffer from heart failure are required to take.
Interview conducted by Ivanhoe Broadcast News in November 2017.
I want to talk specifically about medication for heart patients. How numerous could pills be for some people and how difficult is it to keep your patients on a regiment?
Dr. Davis: The average number of medications that somebody with cardiovascular disease has to take is going to be more than four and could be as many as twenty.
Every day?
Dr. Davis: Every day.
What kind of a challenge does that present to the patients that have gone through heart surgery and they are going through rehab?
Dr. Davis: Well undergoing heart surgery, having had a coronary artery event such as a heart attack or myocardial infarction, there are medicines we know that are associated with longer life. So we need to back it up and say that people are going to live the rest of their days with these diseases; we don’t have a magic treatment that’s able to eliminate the disease that causes the blood vessel blockage itself. We can slow down that blockage and that’s what we talk about secondary prevention. The medicines that we know such as aspirin, beta blocker, a statin or drugs that prevent clots from forming; that improve the blood vessel health and slow the heart demands are somewhat of the standards of what we put people on after any type of event. These have been again, shown to extend life. So trying to make sure that people take all those medicines is very important. Then when you throw on things like heart failure, which are often the result of the blood vessel disease, then you’re adding on things such as medicines that get rid of fluid or that maintain the electrolytes within the body, and then some things that will help the heart function better. Again we start running up more and more medicines and then when you start going towards patients who have certain treatment, surgical treatment; such as a transplant then you have anti-rejection medicines that are thrown on to it and a number of other medicines that are involved with preventing infection and other considerations. So that’s how we start getting to the very large number of medicines.
I know it’s different for every patient but if you could speak in general terms what are the risks if a patient is not following those orders and not taking all the medications, the prescribed medications?
Dr. Davis: The ones that are most short term is that they won’t feel as well. They will develop pulmonary edema or fluid that backs up in the lungs and makes it difficult to breath. Probably the bigger picture is it can shorten their lives.
The bottom line is these are life-saving medications.
Dr. Davis: They can be life saving medicines and not taking them can result in loss of life.
What is it that Florida Hospital is looking at in partnership to try to help patients?
Dr. Davis: Exactly that. It is how do we help patients take care of what is a chronic disease? If they have coronary artery disease or blood vessel blockage on their hearts, if they have heart failure, how do we better assist them to take care of themselves, to follow the medical regiment? Because it isn’t necessarily easy to take all these medicines and sometimes the difficulty swallowing pills, taking the number of pills that are necessary. We know that it is easier to be compliant or to follow the medical regiment if we simplify, and this is a strategy to actually simplify. To get all of the medicines that are necessary into something that actually isn’t bad to take, it actually may taste good to an individual. So trying to reduce the barriers to doing what’s right and improve the likelihood that they’re going to follow the regiment.
To that end can you speak a little bit to the company you partnered with and what you’re looking at down the road?
Dr. Davis: Yeah. Panaceutics is looking for ways to be able to do what we were talking about, of being able to put a number of medicines into a packet that is good tasting that is able to be given a month or beyond at a time so it’s not difficult to actually keep track of. They’re also looking at being able to tailor the drug dosaging to individuals so it is much more personalized. Most of the medicines we have come in sets, certain tablet sizes and the idea is that we would be much more directional or intentional about how we do drug dosaging based on the size of an individual. The future direction is taking all their genetic information and being able to better say that this is an individual that needs higher or lower dosaging or that they may be more or less benefitted by one drug versus another drug.
So it’s another step toward personalized medicine?
Dr. Davis: Absolutely. It’s trying to be able to eliminate barriers, to doing the right thing, and also to be able to assist both the patient and the physician to be able to do what’s best for an individual patient. Not in a more global sense of all patients.
Are you able to speak to where you are in the process in terms of product development and where you are in terms of studying it and development?
Dr. Davis: The company has made a lot of strides in terms of being able to demonstrate the drug availability. Meaning, that when you take a medicine in one form such as a pill that this compound will be similar in the amount of medicine that’s actually delivered to the individual. And they are active in being able to use genetic testing to be able to drive what will be the best medicines for an individual.
Is there any indication what form this could take down the road and the product that they have some current products potentially similar?
Dr. Davis: Yes, they have a number of products that come in little packets that are of various different flavors. The idea would be to one, choose flavors that an individual would like and then potentially be able to rotate the flavors so that they don’t get tired of the same type of flavor. They’ve done a lot of research on the stability of the product so that it is able to be stored for long periods of time. And they are continuing to try to understand what are things that will be best at in partnering with the patient to improve their compliance.
When I think heart medication I think capsule, I think pill and swallowing; this more of a liquid, more of a gel?
Dr. Davis: More of a gel. Somewhere between a gel and I would say a sauce, applesauce isn’t quite right. I think back to the days when I was doing marathons, the little packets that you would take on the run.
Goo?
Dr. Davis: Goo yeah.
So almost like a runners goo, easy to take, easy to swallow.
Dr. Davis: Easy to take, easy to swallow. Actually remembering back to those days it tasted pretty good at about mile thirteen.
Time frame?
Dr. Davis: We are looking to hopefully get started sometime in the first quarter of 2018.
You say get started, what would the process be?
Dr. Davis: To actually start enrollment and the clinical trials.
In the beginning of 2018?
Dr. Davis: Yes.
Is there anything I didn’t ask you that you want to make sure that people know?
Dr. Davis: Essentially the sky is the limit in terms of the number of medications that potentially could be put into a single pack. And again, from a standpoint of compliance, also using other technologies to be able to give feedback to the treatment team that an individual actually is taking that. So the goal of a lot of these strategies is one, reduce the burden but two, to be able to create somewhat of a log that everyone knows that an individual has or has not been taking their medications.
How many years do you have in heart medicine, cardiology?
Dr. Davis: I was at Duke for 31 years and I’ve been here for two years.
END OF INTERVIEW
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