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Million Hearts improved CV risk factor prevalence; falls short of goals
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The evidence-based strategies implemented through the US Department of Health and Human Services’ Million Hearts initiative have yielded some positive trends toward decreasing CVD risk factors over time, but further improvements will be necessary to achieve the goals set by the program at the 2017 target date, according to recent findings.
Researchers collected data from the National Health and Nutrition Examination Survey between 2005 and 2012 to determine rates of LDL cholesterol management among hyperlipidemic adults aged at least 20 years and of controlled hypertension in adults aged at least 18 years. NHANES data from 2005-2010 also was assessed to determine daily sodium intake among adult patients. Data from 2005-2010 collected from the National Ambulatory Medical Care Survey (NAMCS) was evaluated to determine the frequency of visits to primary care physicians and cardiologists during which aspirin or other antiplatelet medications were prescribed, as well as the frequency of prescription of smoking cessation therapy.
Aspirin use, BP control, managed cholesterol and smoking status (ABCS) were the four clinical measures affected by the implementation of the Million Hearts program. The goal for the program is to achieve 65% prevalence or higher for each clinical measure, along with a 20% reduction to daily sodium intake and a 10% reduction to smoking prevalence, to prevent as many as 1 million incidences of MI and stroke between 2012 and 2016.
The NHANES data were divided into four survey cycles: 2005-2006, 2007-2008, 2009-2010 and 2011-2012, and evaluated using gender-, age- and race/ethnicity-adjusted linear trends analyses. Researchers compared the 2005-2006 cycle with the most recent cycle, with updated data for each clinical measure.
No statistically significant change was seen in aspirin use for secondary prevention between 2005-2006 and 2009-2010. As of 2011-2012, hypertension control increased to 51.9%, from 43.4% in 2005-2006, whereas the rate of cholesterol management increased to 42.8% from 33%. Although smoking prevalence decreased from 28.2% in 2005-2006 to 25.1% in 2011-2012, no significant change was observed in frequency of smoking cessation treatment, which had a prevalence of 22.2% as of 2009-2010. Mean sodium intake decreased from 3,619 mg/day in 2005-2006 to 3,594 mg/day in 2009-2010.
These results fall short of the prevalence rates necessary to attain the goals of the program during the 2012-2016 cycle, the researchers noted.
“Million Hearts strategies that address these CVD risk factors include promoting use of standardized hypertension treatment protocols, effective use of health information technology, and self-measured blood pressure monitoring with clinical support,” the researchers wrote. “… Additional focus on both clinical-level efforts that support consistent and coordinated patient care and community-level efforts that promote environments that encourage healthy behaviors and reduce unhealthy exposures is needed to continue progress toward meeting Million Hearts goals by 2017.”
Disclosure: The researchers report no relevant financial disclosures.
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