Heart Disease : Medical intervention

Heart disease and stroke will kill 8,000 Americans a year and yet most of those deaths could be prevented. A million hearts initiative is an attempt to cross the federal government and with private ebt it tent entries throughout the country trough to reach ambitious and achievable goals. The model we have of health is socioeconomic factor, first and foremost, driving health status, chaps changing the context and doing things that can change the default values so individuals default decision is the healthier decision and doing things like making the air smoke-free and eliminating trans fat are examples of this. Long lasting protective interventions that require only a few brief clinical interventions, classically vaccination.

We don't yet have a vaccine against heart disease and stroke but we do have interventions that work well to improve risk factors, for example, reducing problem drinking or reducing tobacco use. Clinical interventions which require that clinical care systems to workday in, day out, around the year, and we're particularly pleased to have a very close collaboration with the centers for medicare and medicaid services in their implementation of the million hearts initiative. in fact, the ityies are the two leading ept ntities. We also have a lot of interventions and interactions between the two and counseling and education to encourage people to eat healthy and be active. Over the past few decades we've seen progress, so heart disease deaths have been cut by about half, were cut by about half,between 1980 and 2,000. About half of that decrease was from clinical intervention and the other half of that decrease was from community interventions. That, however, is far from good enough because our rates are still extremely high. we need to look not to our past, what the rate has been in the past, but to the potential of drastically reducing that. You will hear of one example of one ambitious approach in San-Diego later in the session. The key component of million hearts is two spheres. first, the clinical sphere to improve the a, b, cs, control blood pressure and better management of people with cholesterol, and the three keys we think to improving clinical care first is focus. and for groups at cdc that have worked on things like immunization or rational use of antibite tickses, we know that focusing clinician attention to the most important indicators is crucial to improve outcomes but it's not enough. we also need information technology so that the clinician has information that they can use and act on to improve their performance. and it's not enough to have focus and information technology we also need clinical innovation and particularly team-based care to improve the performance of the health care system in the service of helping patients live longer and healthier lives. In community prevention we change the context by reducing tobacco use, reducing sodium consumption, and eliminating artificial trans fat, and we think that with these interventions, we can have a very substantial impact, in fact, prevent a million heart attacks and strokes in the next five years. how do we do today?
well, despite spending $2. 5 trillion a year plus on healthcare each year, less than half of Americans who should get an aspirin, who would benefit from the aspirin without any clinical debate are on it. only 46% of Americans with high blood pressure haven't adequately controlled. only a third of those with high cholesterol have it effectively managed. and less than a quarter of smokers who want to quit and go to their health professional to get help get evidence-based assistance to quit. taking blood pressure is one example. there are 37 million Americans who have their blood pressure out of control. that's more than half of all Americans with high blood pressure. nearly half of those are in-care but not effectively treated. either because of clinical inertia or lack of information systems or lack of adequate access or lack of pace. one reason or the other they're not affectingly treat pend another near 40% say when asked at hand that they're not aware of having high blood pressure. whether they were told and didn't remember or weren't told or it wasn't measured, we don't know but they are currently unaware of it and, therefore, untreated, as well. and a much smaller number are aware of it but not being treated. so we need to address each of these slices of the pie if we're going to get to the very ambitious goals. for clinicians we say very simply, if you do one thing for your your patients, make it the effective care of the a, b, cs. there are evidence-based ways to prevent heart attacks and strokes and this is the way we can save the most lives and get the most health value out of our health care investments. thank you to your speakers, and i look forward to the rest of the session. as a dr. mentioned, million hearts is a national initiative with very explicit goals to prevent a million heart attacks and strokes. it is co-led by the centers of disease control and prevention and centers for medicare and medicaid services. the clock on this initiative started ticking on January 1st. the goal is audacious but it is achievable, only with the collective efforts of each of us as individuals, as members and leaders of the organizations in the communities and the workplace where's we live. while we've seen a gradual decline in mortality from cardiovascular diseases over the last 40 years, it remains the nation's leading cause of death and disability for women and men and for all races and ethnicities. each year 2 million people will have a heart attack or stroke. and 800,000 of them will die. the traumas of families and to communities and households is devastating. it's also costly for the economy. $444 billion, more than a billion dollars a day, and medical costs and lost productivity. cardiovascular disease is also the leading cause of health disparities by race. the evidence tells us that the pathway to preventing a million heart attacks and strokes in a five-year period is through focus of the a, b, cs. appropriate use of aspirin, blood pressure control, cholesterol management, and smoking cessation. The good news is that we know what works, and medications when they're required are low cost. That's good news, as you just heard from  a dr. is we're not hitting 50% as a population of achieving those evidence-based targets for the a, b, cs. million hearts is working along two pathways. We expect them to converge over time, but now the community efforts are to keep the population healthy and to reduce the number of people who actually need treatment. the clinical interventions are to optimize care for those who do need treatment. at the community level the prime movers are reducing tobacco use and sodium and eliminating trans fats, artificial trans fats in the food supply, as you know tobacco is the leading preventable cause of death in the united states. the combination of smoke-free laws, cigarette price increases,access to proven quitting treatments and services, and hard-hitting media campaigns reduces health care costs and is going to save lives. these comprehensive strategies are not yet being deployed in every community across the u. s. about 90% of us consume more sodium than is recommended for a healthy diet. most of the sodium we eat comes from processed foods and from foods prepared in restaurants. gradual reduction in the sodium content can have a profound effect on the prevalence and the control of hypertension. artificial trans fat, they're harmful. change in cholesterol patterns for the worse. the iom recommends reducing trans fat as close to possible to zero.