elizabeth ofili, m.d., m.p.h., f.a.c.c. professor of medicine and chief of cardiology director,...
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Elizabeth Ofili, M.D., M.P.H., F.A.C.C.
Professor of Medicine and Chief of Cardiology
Director, Clinical Research Center
Associate Dean of Clinical Research
Morehouse School of Medicine
Atlanta, Georgia
Elizabeth Ofili, M.D., M.P.H., F.A.C.C.
Professor of Medicine and Chief of Cardiology
Director, Clinical Research Center
Associate Dean of Clinical Research
Morehouse School of Medicine
Atlanta, Georgia
Advances in Heart Attack Prevention and Treatment: Are Women and African Americans Reaping the Benefits?
Gnat Lines News Briefing, Lake Blackshear Resort, Cordele GA. Gnat Lines News Briefing, Lake Blackshear Resort, Cordele GA. Feb 20, 2006Feb 20, 2006
CVD Mortality Trends for Males and Females: US 1979–2002
American Heart Association. Heart Disease and Stroke Statistics — 2005 Update. Dallas, Tex: American Heart Association; 2005. ©2005, American Heart Association.
Years
Males Females
400
440
480
520
0
1979 81 83 85 87 89 91 93 95 97 99 01 02
Dea
ths
(th
ou
san
ds)
NCEP I NCEP II NCEP III
NCEP = National Cholesterol Education Program.
African Americans make up 29% of the population in Georgia, but account for 68% of CVD deaths before age 65
African Americans make up 29% of the population in Georgia, but account for 68% of CVD deaths before age 65
29 %29 %AA PopAA Pop
68 %68 %CVDCVDDeathDeath
Georgia Heart Report, 1998Georgia Heart Report, 1998Georgia Heart Report, 1998Georgia Heart Report, 1998
Leading Causes of Death Among US Women (2000)
* Number of deaths are rounded to the nearest thousand. COPD = chronic obstructive pulmonary disease. National Heart, Lung, and Blood Institute. The Healthy Heart Handbook for Women. 2003.
Cause of Death
Nu
mb
er
of
Death
s*
0
50,000
100,000
150,000
200,000
250,000
300,000
350,000
400,000 Heart Disease 366,000
BreastCancer42,000
COPD62,000
LungCancer65,000
Stroke103,000
National American Heart Association SurveyWomen’s Awareness 2003: Perceived Leading
Cause of Death by Ethnic Group
Mosca L et al. Circulation 2004; 109:573-9.
Per
cen
t (%
)
0
10
20
30
40
50
60
BreastCancer
Cancer(general)
HeartDisease
Unsure
White
Black
Hispanic
The Facts• Heart disease has been the top killer
of women for nearly 100 years
• It kills 65,000 more women than men each year
• It kills more women under 45 than any other disease– From 1989 to 1996 sudden cardiac
death climbed 31% among women age 15 to 34
x
NITRO0010 — AHeFT Slides — v11
11
Days Since Baseline Visit DateFixed-dose I/H 518 463 407 359 313 251 13
Placebo 532 466 401 340 285 232 24
A-HeFT: 43% Decrease in Mortality
A-HeFT: 43% Decrease in Mortality
0 100 200 300 400 500 60085
90
95
100S
urv
ival (%
)
P=.01
Fixed-dose I/H
Placebo
Hazard ratio=0.57
A-HeFT: Components of Composite Score
0
15
10
n=32
10.2%
6.2%
Death
P=.02
Placebo BiDil
First HF Hospitalization
10
30
20
n=85
n=138
24.4%
16.4%
P=.001
-6
0
-4
P=.003
-2
Change in QOL
-3.4 -7.6
n=545
Translational BlocksTranslational BlocksCareer disincentivesCareer disincentives
Regulatory burdenRegulatory burden Practice limitationPractice limitationFragmented infrastructureFragmented infrastructure Lack of fundingLack of fundingIncompatible databasesIncompatible databasesLack of qualified investigatorsLack of qualified investigators
“Lost” in Translation
Basic BiomedicalBasic BiomedicalResearchResearch
ImprovedImprovedHealthHealth
Clinical ScienceClinical Science++
KnowledgeKnowledge
Translation ofTranslation ofNew Knowledge New Knowledge
Into ClinicalInto ClinicalPractice + HealthPractice + HealthDecision MakingDecision Making
Translation ofTranslation ofBasic Sciences Basic Sciences
IntoIntoHuman SciencesHuman Sciences
11 22
JAMA 2003;289:1278-1287
CPNCPN
• Academic Leadership• Innovative Research• Clinical & Research Training•Guideline based CME
Comm
unity Physicians
ProgramM S MHlth Disp
• African American Patient base• Busy Practitioners
Morehouse Community Physicians Network©Morehouse Community Physicians Network©
Best Practice
Information - MeasurementTools and Outcomes
Patient Educated (Empowered)
Provider: 1. Physician 2. Mid-Level Providers 3. Pharm.D. 4. Educators A. Nurses B. Dieticians C. Wellness Team
CPNCPN
Cohen JD. Lancet. 2001;357:972-3.
B Beta-blockadeBlood pressure control
A AspirinACE inhibition
C Cholesterol management
D DietDon’t smoke
E Exercise
ABCs of coronary prevention
CPN has 130 practices in Metro ATLCPN has 130 practices in Metro ATL
Web Portal MD
Diabetes Registry
E-PrescribingProtocols, Guidelines,
Care Pathways
Community
MD
Archimedes
Pt.Champion
Pt Portal
Patient
21st Century Intelligent Diabetes Care Model
• Patient-Centered• Information Rich• Electronically-Based• Outcomes Focused• Quality Based
• Improved control of diabetes• Decreased health disparities• Development of new knowledge through:
– Evaluation of Protocols– Forecasting the health & economic effects of the project on the geographic
area
Creating a system that is:Resulting in:
THANK YOU!!!