sample_data/HCP_Cardiologist_Interview.txt

Interview Transcript - Cardiologist #2
Date: October 20, 2025
Interviewee Type: HCP (Cardiologist)
Location: Community Hospital
Years in Practice: 22 years

Interview Content:

Interviewer: Thank you for joining us. Can you describe your typical heart failure patient?

HCP: Absolutely. Most of my heart failure patients are over 65, often with multiple comorbidities - diabetes, kidney disease, hypertension. Many are on 10-15 different medications. Adherence is a constant challenge.

Interviewer: When you prescribe a new heart failure medication, what's your primary concern?

HCP: Honestly, my biggest concern is whether they'll actually take it. "I can prescribe the best medication in the world, but if it costs $500 a month out of pocket, they're not filling that prescription." I've learned to ask about insurance coverage upfront. About 60% of the time, I need to adjust my prescribing based on formulary restrictions or cost concerns.

Interviewer: How do you handle patients who can't afford their medications?

HCP: I work closely with our pharmacist and social worker. We look for patient assistance programs, manufacturer coupons, or sometimes switch to older, generic alternatives. It's frustrating because the newer SGLT2 inhibitors and ARNI medications have such strong evidence for reducing hospitalizations and mortality, but they're expensive. "I've had patients end up in the hospital because they couldn't afford their meds, which ultimately costs the system way more than the medication would have."

Interviewer: What percentage of your patients would you say are fully adherent to their heart failure regimen?

HCP: If I'm being honest, probably only 40-50%. And that's not just about cost. Some patients take 4-5 pills twice a day, and they get confused or overwhelmed. "I had an 80-year-old patient last week who was taking her morning meds at night and vice versa. She ended up with symptomatic hypotension and fell." Simplification is key, but it's hard when every medication addresses a different aspect of heart failure.

Interviewer: Have you tried any of the newer combination pills?

HCP: Yes, the combination ARNI/ARB medications have been helpful. Instead of two separate pills, it's one. Patients respond better to that. I'd say adherence improves by maybe 20-30% when we can reduce pill burden. The problem is those combination products are often more expensive than the individual components as generics.

Interviewer: What about monitoring and follow-up?

HCP: I like to see new heart failure patients every 2-4 weeks initially until we get their regimen optimized. Then maybe every 3 months for stable patients. But getting them to come in is another challenge. Many of my patients live 30-40 miles away, they're elderly, some don't drive anymore. Telehealth has helped during COVID, but there are still limitations. I can't examine them or draw labs through a computer screen.

Interviewer: If you could change one thing about managing heart failure patients, what would it be?

HCP: Better coordination of care. "These patients need their cardiologist, primary care doctor, pharmacist, sometimes nephrologist, endocrinologist. Everyone needs to be on the same page." I've had situations where the PCP changes a medication I prescribed without telling me, or the patient gets conflicting advice. A really good care coordinator or nurse navigator would be invaluable, but most practices can't afford that.