million hearts preventing 1 million heart attacks and strokes in 5 years
TRANSCRIPT
Million Hearts
Preventing 1 million heart attacks and strokes in 5 years
What is Million Hearts?
• Goal: Prevent 1 million heart attacks and strokes over the next 5 years
• Engage public and private sector partners in a coordinated approach to:– Reduce the number of people who need treatment– Improve the quality of treatment for those who need it– Maximize current investments in cardiovascular
health
Heart disease and strokes are leading killers in the U.S.
• Cause 1 of every 3 deaths• More than 2 million heart attacks and strokes
occur every year; 800,000 die– Leading cause of preventable death among people
<65
• Treatment accounts for about $1 of every $6 spent on health care
• Accounts for the largest single portion of racial disparities in life expectancy
Status of the ABCS
Aspirin People at increased risk of cardiovascular disease who are taking aspirin
47%
Blood pressure
People with hypertension who have adequately controlled blood pressure
46%
Cholesterol People with high cholesterol who have adequately controlled hyperlipidemia
33%
Smoking People trying to quit smoking who get help 23%
Source: MMWR: Million Hearts: Strategies to Reduce the Prevalence of Leading Cardiovascular Disease Risk Factors --- United States, 2011, Early Release, Vol. 60
Key components of Million Hearts
• Clinical Prevention – improving care of the ABCS through:– Focus – simplify and align quality measures; emphasize
importance of improved care of the ABCS– Health IT – use electronic health records to improve care
and enable quality improvement through clinical decision support, patient reminders, registries, and technical assistance
– Care innovations – team-based care, interventions to promote medication adherence
• Community prevention – reducing the need for treatment through:– Prevention of tobacco use– Improved nutrition – decrease sodium and artificial
trans fat consumption
Community preventionTobacco control
• Tobacco is leading preventable agent of death
• Strengthen tobacco control and reduce smoking by discouraging smoking initiation and encouraging cessation– Warn people about harms of tobacco use through
package labeling, mass media, and other measures
– Create smoke-free public places and workplaces
• Comprehensive tobacco control programs are most effective– Synergies between individual program elements
Reasons for hope: Reduced smoking in New York City
18.9%
11%
% o
f N
ew Y
ork
Cit
y S
mo
kers
8
10
12
14
16
18
20
22
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
18.3%17.5%
• 350,000 fewer adult smokers• >100,000 fewer smoking-related deaths
in future years
15%
19.2%
21.5%
18%
2008
8.5%
16.9%
15.8%
Community preventionReducing sodium intake
• Most Americans consume far too much sodium, which increases risks of hypertension and cardiovascular disease
• Most (~80%) sodium comes from processed/restaurant foods, which makes it difficult for Americans to limit sodium consumption
• Federal procurement guidelines and school food standards include a focus on sodium reduction
• FDA/USDA have issued a request for information on sodium reduction
• CDC is increasing public and professional education about sodium
• NHANES will begin collecting information on sodium consumption
Community preventionEliminating artificial trans fat
• Trans fat increases LDL cholesterol, decreases HDL cholesterol, increases risk of heart attacks– IOM: reduce intake to as close to zero as possible
• Replacing artificial trans fat with heart-healthy oils is feasible and does not increase the cost or change the flavor or texture of foods
• Since FDA began requiring listing of trans fat content on food labels, the food industry has voluntarily reformulated foods– Americans’ trans fat consumption has decreased
by at least half
What can be doneIn the community
• Retailers – Offer blood pressure monitoring and educational resources;
focus on improving ABCS care in retail clinics
• Government – Support community and systems transformation to reduce
tobacco use and improve nutrition, including smoke-free policies and food procurement standards; provide data for action; expand coverage for the uninsured
• Foundations – Support consumer and provider outreach and education
• Advocacy groups – Monitor progress toward goal and promote actions
that prevent heart attacks and strokes
New CDC Community Supports
• Community Transformation Grants (CTG)– >$100 M in prevention grants– ~60 Communities– All communities will address tobacco, physical
activity, nutrition, clinical preventive services – specifically to control HTN, HBC
– Look for announcement of communities next week.
National Dissemination and Support for CTG’s
• Dissemination Networks• APHA• Asian Pacific Partners for Empowerment and Advocacy• Community Anti-Drug Coalition• National Farm to School Network at Occidental College
• Acceleration Networks– American Lung Association– National REACH coalition– YMCA of the USA
Pharmacy Outreach Program
• Objectives– Grow and strengthen community of orgs
focusing on HTN– ↑ awareness that poor adherence to HTN
meds is weak link in CVD risk reduction– ↑ # of pharmacists actively engaging in
counseling pts on adherence– ↑ # of pts who are discussing HTN meds with
their pharmacist.
Million Hearts Leadership
• Co-led by CDC and CMS• Quarterly reporting to HHS• All of HHS• Executive Director
– Janet Wright MD FACC– CDC Medical Officer housed at CMS
Innovations Center
Operating Values
How we shall work together and with others?
• Boundarilessness• Speed and Agility• Unconditional Teamwork• Valuing Innovation• Customer Focus
The Three Part Aim
Better Health forthe Population
Better Carefor Individuals
Lower CostThrough
Improvement
Reasons for hope
• HRSA Health Centers Collaborative Study increased daily aspirin intake from 53% to 67% after intervention
• KP Colorado high Blood Pressure and Cholesterol Management Program improved from having 26% of patients with cholesterol under control to having 73% of patients with cholesterol under control
• Rhode Island Cardiovascular Chronic Care Collaborative saw an increase in blood pressure control among participants from 20% to 60%
• Work by Medicaid Massachusetts yielded a drop from a smoking rate of over 38% to a smoking rate of 28% in 2.5 years
The question is not whether superb performance and sustainability is possible,
the question is whether it is possible at scale.
Getting to Scale
“I think when people look back at our time, they will be amazed at one thing more than any other.
It is this – that we do know more about ourselves now than people did in the past, but that very little of this knowledge has been put into effect.”
Doris Lessing
Getting to Scale
Eleven Lessons from the Best
1. They have shared, crisp, public aims, owned by leadership, and they’re rabid about them.
2. They welcome everyone. (Unleash)
3. They get to the field. (It’s not a web site.)
4. Their work is rooted in actions and transactions. (Rhythm)
5. They are “brutally opportunistic.” (Jazz)
6. They play well with levers.
7. They tend to affection. (Value)
8. They have a shared story and they use the language of creation (not avoidance).
9. They go broad and deep.
10. They examine and revise their rules base.
11. The patient is in the room…always.
Eleven Lessons from the Best
1. They have shared, crisp, public aims, owned by leadership, and they’re rabid about them.
2. They welcome everyone. (Unleash)3. They get to the field. (It’s not a web site.)
4. Their work is rooted in actions and transactions. (Rhythm)
5. They are “brutally opportunistic.” (Jazz)
6. They play well with levers.7. They tend to affection. (Value)
8. They have a shared story and they use the language of creation (not avoidance).
9. They go broad and deep.
10. They examine and revise their rules base.
11. The patient is in the room…always.
Clinical preventionFocus on ABCS
• Improving management of ABCS can prevent more deaths than other clinical preventive services
• Increasing utilization of these simple interventions could save more than 100,000 lives a year– Patients reduce risk of heart attack or stroke by taking
aspirin as appropriate– Treating high blood pressure and high cholesterol
substantially and quickly reduces mortality among high-risk patients
– Even brief smoking cessation advice from clinicians doubles likelihood of successful quit attempt – use of cessation medications increases quit rates further
Improved cardiovascular care could save 100,000 lives/year in U.S.
Source: Farley TA, et al. Am J Prev Med 2010;38:600-9.
Smoking cessation
Blood Pressure control
Cholesterol control
Aspirin prophylaxis
Clinical preventionIncreasing focus
• Improving ABCS is top priority • Aligning incentives, communication, clinical
measurement, and reporting by physicians, health care facilities, and health care systems
• Simple, consistent ABCS indicators into:– Physician Quality Reporting System, – EHR meaningful use criteria, community clinic
measures, and guidelines from private-sector organizations
– Medicare Part D & MA/PD Plan Ratings– Quality Improvement Organizations
•
Clinical preventionInformation technology
• HIT will enable health care providers and facilities to improve cardiovascular care and target intervention to patients in need of intensified care– Registries, EHR functions used at point of care
• Include clinical quality measures for hypertension and cholesterol control in Meaningful Use criteria– Can include routine assessment of cardiac risk;
use of patient recall, reminders, decision support, order sets; and monitoring of medication adherence
Clinical preventionTeam-based approaches to care
• Team-based care can provide higher quality at lower cost– Allied health workers can provide support to
physician-directed efforts
• Increasing use of effective ABCS care practices through support, evaluation, and rapid dissemination of innovations including– Team-based care
– Patient-centered medical homes
– Interventions to promote adherence
Pharmacists can be key partners in CVD prevention
CVD Risk Factor ReductionSystolic/diastolic blood pressure –8.1/–3.8 mm Hg
Total cholesterol –17.4 mg/L
LDL cholesterol –13.4 mg/L
Smoking 23% reduction
Care from pharmacists* is associated with significant reductions in cardiovascular disease risk
* Interventions exclusively conducted by a pharmacist or implemented in collaboration with physicians or nurses; may include patient educational interventions, patient reminder systems, measurement of CVD risk factors, medication management and feedback to physician, and/or educational intervention to health care professionals.
Source: Santschi V, et al. Arch Intern Med 2011;171:1441-53.
What can be doneIn the medical system
• Health care providers – Focus on prevention of heart disease and stroke; improve
care of ABCS; use health IT, including decision supports and registries, to drive quality improvements
• Pharmacists– Monitor medication refill patterns; engage doctors and
patients in managing health
• Insurers – Include ABCS in performance measures; collect and share
data for quality improvement; empower consumers
• Individuals – Take aspirin, if appropriate; take blood
pressure and cholesterol medications as prescribed; if you smoke, quit
How will you help?
Monitoring progress of Million Hearts
Population Metric Baseline 2017
Aspirin for those at high risk1 ~50% 65%
Blood pressure control2 ~50% 65%
Cholesterol control2 ~33% 65%
Smoking prevalence3 ~19% 17%
Average sodium intake2 ~3.5g/day 20% reduction
Artificial trans fat intake2 ~ 1% of calories 50% reduction
1As measured in NAMCS2As measured in NHANES3As measured in NHIS
Note: Population-wide indicators – clinical performance goals higher
Public sector support
• Administration on Aging• Agency for Healthcare Research and Quality• Centers for Disease Control and Prevention • Centers for Medicare & Medicaid Services• Food and Drug Administration• Health Resources and Services Administration• Indian Health Service• Substance Abuse and Mental Health Services
Administration• National Institutes of Health, National Heart Lung and
Blood Institute• National Prevention Strategy• National Quality Strategy
Private sector support• American Heart Association • America’s Health Insurance Plans • American Medical Association• American Nurses Association• American Pharmacists’ Association and the American Pharmacists’
Association Foundation • Kaiser Permanente• The National Alliance of State Pharmacy Associations and the Alliance
for Patient Medication Safety• The National Community Pharmacists Association • UnitedHealthcare• Walgreens • The Y
http://millionhearts.hhs.gov
Million Hearts Publications
For More Information:
www.millionhearts.hhs.gov