Cardiovascular disease, or CVD, is responsible for 800,000 deaths in the United States -- or one in three people -- and an estimated $444 billion in overall costs each year. That's according to a recent article(www.cdc.gov) in Morbidity and Mortality Weekly Report, or MMWR.
To combat this public health scourge, HHS has launched the Million Hearts initiative(millionhearts.hhs.gov). With support from both public agencies and private organizations, including the AAFP, the initiative aims to foster strategies and evidence-based interventions that will prevent 1 million strokes and heart attacks in the next five years. Addressing the leading risk factors for CVD -- hypertension, hypercholesterolemia and smoking -- will be a key to accomplishing that mission.
In a letter to HHS Secretary Kathleen Sebelius(3 page PDF), (then) AAFP Board Chair Lori Heim, M.D., of Vass, N.C., expressed the Academy's support for the initiative's goals. "As community-based physicians who care for individuals, as well as the whole family, we are profoundly aware of the health and societal impact of preventable heart attacks and strokes," she said. "We have been working for many years to address the complex issues of prevention and treatment of conditions that lead to heart attack and stroke."
In her letter, Heim named a number of AAFP programs that directly support the Million Hearts initiative:
- The AAFP has pledged its support for the Million Hearts initiative HHS has launched to reduce the prevalence of cardiovascular disease, or CVD, in the United States.
- Primary risk factors for CVD are hypertension, high cholesterol levels and smoking.
- Million Hearts' goals are to provide greater access to care, increase public awareness of CVD and its risk factors, and promote healthy lifestyles.
- Americans in Motion-Healthy Interventions (AIM-HI);
- Ask and Act, the AAFP's tobacco cessation program;
- the AAFP Tobacco Cessation Office Champions Project(12 page PDF);
- Healthy Communities Collaborative;
- Cardiovascular Risk Reduction Learning Community in DARTNet;
- FamilyDoctor.org(familydoctor.org); and
- Tar Wars(www.tarwars.org), the Academy's tobacco-free education program.
Heim also lauded the initiative's call for action by a wide range of stakeholders -- from physicians and their practice teams to health care systems, payers and government. "Improvements or changes must occur not only in the health care setting but also in the community," she said.
Communities do, in fact, play a large role in the initiative. Million Hearts encourages community leaders to develop policies and programs that enhance patients' access to care, improve medication adherence, reduce smoking and second-hand smoke exposure, and promote the consumption of foods low in sodium and artificial trans fats.
Based on 2007-08 data from the National Health and Nutrition Examination Survey (the most current data available), an estimated 107.3 million Americans age 20 or older, or 49.7 percent, have at least one CVD risk factor, says the MMWR article. Of those, 21.3 percent have two of the three risk factors, and 2.4 percent have all three.
Those figures represent a slight decrease compared with 1999-2000 data, which the CDC attributes to improved treatment and control of hypertension and hypercholesterolemia. In addition, the introduction of smoke-free environments, smoking intervention programs and higher cigarette excise taxes has contributed to the decline.
According to an HHS news release(millionhearts.hhs.gov), the primary objectives of Million Hearts are twofold:
- empower Americans to make healthy lifestyle choices, with the goal of reducing the number of people who need medical treatment to prevent heart attack and stroke; and
- improve care for patients who do require treatment by stepping up the focus on the "ABCS" -- Aspirin for people at risk, Blood pressure control, Cholesterol management and Smoking cessation.
"By enlisting partners from across the health care sector, Million Hearts will create a national focus on combating heart disease," said Sebelius in the news release.
"An important step forward is the move to the patient-centered medical home, or PCMH, which reflects many of the changes called for in the initiative," Heim pointed out in her letter. "A team approach to care, quality improvement, use of health information technology, and the empowerment and education of the patient and family are foundations of the PCMH."
For individual family physicians, supporting the initiative largely means continuing to do what FPs do every day: Help patients avoid heart attack and stroke by addressing the three prime CVD risk factors.
Academy members who wish to voice their support for the initiative can pledge to "Be One in a Million Hearts(millionhearts.hhs.gov)," which asks health care professionals to
- treat patients' high blood pressure and cholesterol;
- educate patients about the most effective ways to control their risk factors for heart disease and stroke;
- promote heart-healthy habits to patients, such as regular exercise and a diet rich in fresh fruits and vegetables;
- ask patients about their smoking status and provide cessation advice and medication when appropriate;
- help patients follow treatment instructions and improve medication adherence; and
- use health information technology, such as electronic health records and decision-support tools, to improve the delivery of care and control of the ABCS.