Martha Gulati, MD

Martha Gulati, MD | Image Credit: Cedars Sinai

 sphere has been a double-edged sword in recent years. Often, every major advancement in treatment represents another drug or therapy that patients are obligated to take, adding to an already significant treatment burden. Additionally, patients are rarely fully aware of the reason for their prescriptions, resulting in unnecessary confusion and, in some instances, reduced adherence.

Research has encouraged patient education in heart failure treatment, with studies indicating a substantial improvement in both patient adherence and patient outcomes. Even brief interventions, such as a 1-hour nurse-delivered educational session at the time of hospital discharge from a 2014 trial, resulted in substantial improvements.

Martha Gulati, MD, associate director of the Barbra Streisand Women's Heart Center and director of cardiovascular disease prevention at the Smidt Heart Institute at Cedars Sinai Medical Center, gave a presentation during the 

American Heart Association’s Scientific Sessions 2025

 in New Orleans, Louisiana, addressing these issues.

For additional insight into how clinicians can improve patient education, the editorial team at 

 spoke with Gulati in the following Q&A:


: How can the heart failure industry as a whole approach reducing the treatment burden faced by most patients?


: Well, I think it’s a challenge. When people get a diagnosis of heart failure and we talk about these four pillars of treatment, as well as treating all the other risk factors associated with heart failure, the medication burden becomes quite a large amount for any individual. And that leads to misunderstandings from the patients about why they’re taking so many drugs. And sometimes that confusion arises then, but it can also be when they feel better. They start to ask why they need to keep taking all these drugs. The amount of medication can also cause great expense and pill burden; over time, it just wears the patient down.

I think one of the things we could do better is explaining the disease process, how these medications individually work, and why we’re giving them so many medications. How’s it going to benefit them in the long term and in the short term? Because when people understand fully how the medications work, they’ll be more informed and more understanding that some of these drugs are going to be lifelong medications for them. If we partner with the patients and understand the reasons why they don’t want to take so many medications, whether it’s due to side effects, expense, or misunderstandings about how the medications work, we can better address these issues. I think that’s the most important part. Rather than us dictating “take these medications,” it’s important for the patient to understand what they’re doing, how the drugs are going to protect them in the long term, and what might be expected as a side effect of the medication, so they can be prepared and not surprised.


: Do you believe patient education is a factor in this conversation, particularly given the rapid expansion of heart failure treatment over the last few years?


: I think patient education is the most important part of taking care of patients who are living with heart failure. This is a challenge, right? In our current day, when you see a patient, you not only have to examine them and prescribe for them, but there needs to be time to explain things to them. I think that patient education and doing shared decision making, understanding the role of therapies, is crucial. But so is understanding the role of lifestyle changes that they may need to make to improve their heart health. For instance, if they get referred to cardiac rehabilitation, how will that help them? Why are they being sent? Because I think sometimes people have different thoughts about cardiac rehab. Maybe they believe it’s only for people who’ve had heart surgery or heart stents. And yet, one of the main indications for cardiac rehab is also heart failure. Cardiac rehab is a major time commitment; it’s for 36 total visits generally, 3 days a week, for 12 weeks. That’s a lot to ask someone to do. But to understand how it might benefit them is really the missing piece. You can’t prescribe something, whether it’s cardiac rehab or medications or lifestyle changes, without explaining how that will impact them and keep them out of the hospital. In all the things we do for our patients, our goal is to keep them out of the hospital, reduce their disease burden, and hopefully prevent cardiac death. And understanding the burden of things from a patient’s perspective is so important, but we don’t spend enough time on patient education. We have a lot of tools out there.


: What advice would you give to patients regarding addressing these concerns and asserting themselves in their care?


 I think one place I often refer people to is our Cardiosmart hub at the American College of Cardiology, because we have tools to encourage patients to come back and ask their doctor questions. Sometimes the first visit can be, “here’s a whole bunch of medications and a whole bunch of things you have to do.” But when they get home, they realize they don’t understand. And then they write out those questions and come to the next visit prepared to ask those questions. A physician on our side should be ready for those questions. And again, I do think the team aspect is important because I think that sometimes a physician may not have all the time in the world to sit with our patients, but we can partner with other team members, the physician assistants or nurse practitioners, who can spend some time addressing our patients’ questions.


: On an individual level, how can clinicians work to incorporate the concerns and opinions of their patients?


: Well, that’s really the heart of shared decision making. It means putting the patient in the center and everyone else being outside that’s involved in that care, not outside the circle, just outside of the patient. And that we work to understand what impacts the patient, what is affecting their life, what their values are, what is hindering their ability to take certain medications or to do certain therapies that we advise. Any solutions that we can come up with can help the patient maybe improve their overall health. Ultimately, if we are not putting the patient at the center of their care, we will never be successful.


 How can patients avoid being pushed out of their own care processes? How can they keep from being bystanders?


: For the patient, that means understanding the decisions that are being made about them should involve them. You know that expression, “nothing about me without me?” It’s the key to how we care for patients, regardless of the disease. We should be talking with them about what they can do, what barriers are keeping them from doing these things, and how we can overcome these barriers. Do we have solutions? Do we need to do certain things stepwise? Because there is often hesitation on the patient’s end to take a lot of medications. How do we work with them to really make them understand? And I think that should be central to all care, particularly heart failure, but I would say it’s true for all disease states.

Editor's Note: Gulati reports disclosures with Novartis, Esperion, Boehringer Ingelheim, and Merck.

Prasun MA. Heart failure patient education. Heart Lung. 2014;43(6):485. 

Gulati M, Sharma K. Reframing Heart Failure Care: Amplifying Patient Voices in the Evolving Treatment Landscape. Presented at the American Heart Association’s Scientific Sessions 2025. New Orleans, Louisiana. November 8-10, 2025.

Articles

Heart failure treatment advancements have increased the treatment burden for patients, often leading to confusion and reduced adherence. Patient education is crucial for improving adherence and outcomes, as demonstrated by studies showing significant benefits from educational interventions. Martha Gulati emphasizes the importance of explaining the disease process, medication benefits, and potential side effects to patients. Shared decision-making and understanding patient perspectives are vital for successful care. Clinicians should encourage patients to ask questions and involve them in their care decisions to prevent them from becoming passive participants.

Gulati discusses how cardiologists should change their standard care practices to include and educate patients, which will reduce treatment burden and improve adherence.

Broaching the Issue of Patient Education in Heart Failure Care, With Martha Gulati, MD

The Future of Obesity Treatment with Martha Gulati, MD

 in Philadelphia, PA, Martha Gulati, MD, associate director of both Barbra Streisand Women’s Heart Center and the Preventive and Cardiac Rehabilitation Center at Smidt Heart Institute, presented her discussion on the challenges and advancements in the 

 has been well documented. Affecting millions of adults and children worldwide, it is associated with several adiposity-related complications, including hypertension, type 2 diabetes, dyslipidemia, obstructive sleep apnea, cancer, and cardiovascular disease.

Recent treatments, such as glucagon-like peptide-1 (GLP-1) receptor agonists and incretin therapies, have allowed for the medical treatment of obesity and other adiposity-related diseases. This, in turn, has led to a new degree of intervention surrounding the maintenance and treatment of its resulting complications.

Gulati praised recent studies and medications for highlighting the connection between obesity and a variety of life-threatening complications, indicating significant progress in the last few years.

“Obviously these medications started out as treatment for diabetes, and we’ve had that well established for a number of years,” Gulati told 

. “But the idea that we could use these medications for more than that, and particularly for obesity, was the first step, showing that they were effective at weight loss.”

Gulati also noted that the renewed focus on incretin therapies has also resulted in a much broader application for similar medications, potentially moving far beyond diabetes and obesity.

“We’ve looked at people with kidney dysfunction and we’ve seen the improvement in the kidney function,” Gulati said. “We’ve seen these drugs proven to be effective in reducing fibrosis of the liver, and so for our patients with MASH, that also gives us a therapy that we’ve really not had for that important disease, which was often advancing to both end stage liver disease and increased risk of liver cancer.”

In addition to a broader spectrum of treatable diseases, Gulati noted that incretin therapies are also capable of forestalling cardiovascular events by eliminating their precursors, such as sleep apnea.

“And for cardiac patients, I think that’s incredibly important because we know if you have obstructive sleep apnea, you’re putting yourself at a greater risk for heart disease of many different forms, including things like atrial fibrillation,” Gulati said. “So being able to stop these risk factors is a compelling clinical indication, and I think it has the potential to really change the effect that obesity has had on these rising rates.”

Gulati agrees with the pressing concern of figuring out how to consistently get these medications to patients in need; however, she also notes the comparative importance of focusing on prevention in addition to treatment.

“If we don’t keep focusing on prevention, we’re just going to continue the same way of treating advanced cardiovascular disease. Let’s keep putting in stents, let’s do ablations for atrial fibrillation, let’s do all these big expensive procedures because we aren’t able to provide these advanced therapies early enough,” Gulati told 

. “And I think that we have to change the medical paradigm of how we treat patients and how we think about prevention and how we invest in prevention at the forefront.”

Gulati also expressed excitement at the forward momentum of obesity studies, commenting on ongoing research and the drugs currently in the pipeline. She notes the necessity of expanding the mechanisms and methods of treatment in addition to new medications, in an effort to maintain cost-effectiveness and allow for the largest number of patients to receive care.

“And I think the other point is, can we change how we deliver it, too? And the reason that that’s important is not because it’s an injection, but it’s the reason these drugs have become so costly; they’re injectable, and they have to stay cool, and we have to deliver them in a mechanism that they built around it.”

Gulati reports the following disclosures: Boehringer Ingelheim Pharmaceuticals, Lilly, Medtronic, Merck & Co., New Amsterdam, Zoll, and others.

Gulati M. Obesity Management Role of Medical Management in CVD. Presented at the 9

 Annual Heart in Diabetes Conference in Philadelphia, PA, June 6-8, 2025.

Christensen S, Nelson C. Chronicity of obesity and the importance of early treatment to reduce cardiometabolic risk and improve body composition. Obes Pillars. 2025;15:100175. Published 2025 Apr 2. doi:10.1016/j.obpill.2025.100175

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