Keeping Hearts Healthy

Behind every heart attack prevented or stroke avoided is the kind of steady, thoughtful outpatient care that often goes unnoticed. That’s the space where Antonio Giaimo, MD, thrives. An assistant professor of medicine (cardiovascular medicine) at Yale School of Medicine (YSM), Giaimo focuses on complex hypertension and lipid disorders as a member of the Yale Cardiovascular Prevention Program. He also enjoys caring for patients in his general cardiology practice while guiding YSM cardiovascular medicine fellows through their ambulatory training.

We spoke with Giaimo about his approach to prevention, the importance of strong outpatient care, and the innovations shaping the future of cardiovascular health.

Most medical training emphasizes caring for acutely ill patients inside the hospital, and cardiology’s critical care environment can feel especially rewarding. But over time, it has become even more clear to me that many of the emergencies treated in the hospital — heart attacks, heart failure, strokes — could have been prevented with timely outpatient care. Patients who lacked continuity with an outpatient physician or preventive guidance were often the ones returning to the hospital. That experience reinforced the belief that the true goal of a successful health system is to keep people healthy enough that they never need hospitalization, and if they do, to make sure they have the outpatient support needed to stay out once they’re discharged.

Motivation starts with understanding what matters most to each patient — whether it’s staying healthy for their children, maintaining independence, or preventing a painful experience they’ve seen in someone they know. From there, the work relies heavily on motivational interviewing and shared decision-making. These conversations help patients understand both their short-term and lifetime cardiovascular risks and engage them in choosing a path forward. Progress often takes time and requires a strong relationship. Patients are much more likely to follow through when they’ve participated in the plan rather than having one imposed on them.

Good prevention begins with simply checking: Many people do not know they have high blood pressure or high cholesterol, and even fewer receive the follow-up care needed to manage them. Once identified, prevention relies on shared decision-making and tools that help patients understand their risks. New instruments like the PREVENT calculator estimate both short-term and long-term risk of heart attack, stroke, and heart failure, making it easier to have meaningful, personalized discussions about why taking action now protects health decades into the future.

As an associate program director for the YSM General Cardiovascular Medicine Fellowship, one major focus has been on improving continuity in our fellows’ clinic. A team-based model was developed — pairing first-, second-, and third-year fellows with a supervising attending — so the same clinicians see the same patients, and the trainee experiences continuity with their preceptor. This structure creates a more realistic outpatient experience, allowing fellows to make diagnostic and treatment plans and then see how those plans unfold at follow-up. It also allows for a more productive and continuous learning environment. Looking ahead, the program is incorporating ambient AI documentation tools, dedicated teaching on motivational interviewing and shared decision-making, and training in emerging therapies, including novel lipid-lowering medications and GLP-1 drugs used to prevent heart attacks and strokes.

There has never been a more promising time for prevention. Over the past decade, new and highly effective therapies have rapidly expanded the options available to patients with high cholesterol or hypertension. In addition to multiple new medication classes, a recently approved procedure — renal denervation — offers another way to help patients with resistant hypertension. It is also quite unique that patients can receive focused attention on their risk factors at the Preventive Cardiovascular Health Program at Yale.

System-level change is also underway: Both nationally and at Yale, there is renewed recognition of the importance of ambulatory preventive medicine, with increased support for outpatient clinicians and models of care that prioritize time spent with patients. Together, these developments offer more tools to tailor care to each individual and ultimately prevent more cardiovascular disease.

Cardiovascular Medicine, one of 10 sections in the Yale Department of Internal Medicine, is dedicated to improving cardiovascular health by advancing groundbreaking research, training the next generation of experts in cardiology, and delivering world-class patient care to people with a range of cardiovascular issues. To learn more, visit Cardiovascular Medicine.