Nutrition services are at the heart of the Preventive Cardiology Clinic

For more than 30 years, the Preventive Cardiology Clinic at Boston Children’s Hospital has evaluated and treated children with abnormal cholesterol and high blood pressure. Developed within the Outpatient Cardiology Department, the clinic was the first of its kind and is one of the largest programs in the country, with about 1,400 visits a year.

Nutrition is an integral part of the clinic, and with two dietitians on staff — Skylar Griggs, MS, RD, LDN, and Caroline Brantley, MS, RD, LDN — the team has been able to take their program to the next level, developing educational materials and partnering with cardiologists and the preventive team on research.

Lifestyle screening tool is streamlining visits

One clinical research study that’s currently wrapping up involves a life screening tool that evaluates lifestyle behaviors — including food intake, activity level, and sleep and meal patterns — specific to kids with high cholesterol and hypertension. The team began using the screening tool in 2013, a couple of years after Griggs started.

“We learned that I was asking some of the same questions as the clinicians, so we wanted to come up with a way to help streamline our visits,” says Griggs. “We thought it would reduce visit time and increase patient satisfaction. We also hope it can help group certain behaviors with different types of cholesterol abnormalities to better understand pediatric cardiovascular risk factors.”

To create the screening tool, the team reworked available, more cumbersome research tools, adapting them for their pediatric audience and refining the questions over time. The clinical study was launched in 2015.

“We’re excited to wrap up the study and understand whether it works or if it needs to be tweaked,” says Sarah de Ferranti, MD, MPH, chief of the Division of Outpatient Cardiology at Boston Children’s. “From my perspective, the tool provides me with useful information about the patient’s behaviors and where they’re at when I walk into the room, so I can get right into counseling, rather than spending time gathering data.”

De Ferranti says the team is adapting the tool into electronic different formats, like the TriVox online portal.

Virtual visits will add convenience and support

Since Brantley joined Griggs in the clinic two years ago, the program has been able to expand their nutrition services even more. The two dietitians not only see patients at the main campus, but also at most of the Boston Children’s satellites, and hope to expand further by the end of the year.

“Our goal is to bring our care to more patients and families,” says Brantley. “One way we’re hoping to do this is by implementing virtual visits. We will add additional virtual visits between clinic visits and track progress and improvements through a study.”

In addition to the added convenience of virtual visits for patients, de Ferranti sees possible clinical benefits as well.

“It’s a way for us to formalize the counseling we’re providing by phone, but this would also allow us to see right into their kitchens, so they can show us their food labels and ask us questions about what’s in their pantry.”

Griggs adds that virtual visits could also be another tool to help patients who are starting college. “It’s a huge transition for many our young adult patients, and we want to make sure they have the support they need.”

Working to support all cardiac patients

In the future, de Ferranti hopes to be able to offer more nutrition services to all patients in the Heart Center.

“As patients are living longer with heart disease, promoting heart health is increasingly important,” she says. To that end, the outpatient Cardiology providers are currently working on a quality improvement project identifying and counseling patients about elevated body mass index (BMI) for all heart patients.

“It’s part of the American College of Cardiology’s new effort emphasizing quality improvement nationwide and we’re one of the sites,” says de Ferranti. “So, if a patient’s BMI is high, we can provide counseling and offer next steps.”

The project is a team effort working with the general cardiologists in the Heart Center in conjunction with Susan Saleeb, MD, and Lauren Hartwell.

Preventive Cardiology collateral

“Some general cardiologists may feel uncomfortable talking about obesity, so we created a one-page handout that offers tips to help raise and discuss the issue,” says de Ferranti. “Many of these kids were born with a history of having trouble gaining weight, so if their BMI ends up high, they may need to take a new approach to nutrition and we can help get that conversation started.”

Looking to the future

In the future, de Ferranti also hopes to pursue more partnerships with pediatric primary care providers, offering cardiovascular nutrition consultations.

“It’s pretty rare that we need to prescribe medications for these conditions (hyperlipidemia and hypertension), and even when we do, there’s a lot of lifestyle work that goes on in between clinical visits,” she says. “We can work with our colleagues in general pediatrics on that.”