This article is more than 5 years old. Information may no longer be current.
Report: Cost, quality, development issues among barriers in fighting CVD
Click Here to Manage Email Alerts
Rising health care costs, variation in quality of care and lagging drug innovation are among the greatest barriers to combating CVD, according to a presidential advisory from the American Heart Association.
“We can’t rest on our laurels applauding the substantial declines in the number of CVD deaths recorded in the past 50 years,” John J. Warner, MD, past president of the AHA, executive vice president for Health System Affairs at the University of Texas Southwestern Medical Center and a co-author of the advisory, said in a press release. “We’ve reached a disturbing plateau as CVD drug innovation is now lagging, gaps in quality of care among many populations are widening, our prevalence of risk factors such as obesity are rising and the cost of caring for heart disease and stroke is climbing to alarming and unsustainable amounts.”
The report, part of the Value in Healthcare Initiative, “describes trends in cardiovascular care, identifies gaps in areas of cardiovascular disease prevention and treatment, highlights challenges with medical product innovation, and finally, outlines a series of learning collaboratives that will aid in the development of road maps for transforming cardiovascular care,” Warner and colleagues wrote.
According to the report, CV expenditures increased by 147% from 1996 to 2014 and expenditures per person using care have more than doubled in the past 20 years.
“Patients tell us they are appreciative of life-saving and life-improving technology and treatments, but they have real and rising concerns about whether they can afford the cost of that care,” report co-author Robert M. Califf, MD, vice chancellor for health data science at Duke University Medical Center, director of Duke Forge and former FDA commissioner, said in the release. “Often the care plans they receive are complex and hard for them to adhere to, especially as they’re struggling with tangible risk factors like diet, smoking and physical activity.”
Meanwhile, the authors wrote, CV mortality is no longer declining; CV health outcomes and quality vary greatly by race, sex and ethnicity; the value of CV care is declining; and there have been many missed opportunities in prevention and treatment of CVD.
Among the missed opportunities are failure to make risk factor modifications, failure to engage patients, failure to properly diagnose some patients with CVD, failure to use proven first-line treatments, failure to use advanced treatments such as PCSK9 inhibitors and failure to provide palliative care, according to the report.
One problem, according to the authors, is that the CV development pipeline is flat without a clear path forward. Only one new CV drug was approved by the FDA in 2017 and only 563 of the 7,293 drugs known to be in development in 2017 were of a CV nature, they wrote.
As a response to the problems, the Value in Healthcare Initiative will launch four learning collaboratives to address opportunities to transform CV care. According to the report, the collaboratives will identify and test potential solutions, with the goals of creating road maps for innovative and affordable CVD care and for affordable, sustainable drug and device innovation.
“The disturbing trends in cardiovascular disease outcomes and costs show that more of the same is not going to work for addressing the No. 1 cause of death and disability in the United States,” co-author Mark McClellan, MD, PhD, director of the Duke-Margolis Center for Health Policy, former CMS administrator and former FDA commissioner, said in the release. “This broad-based, action-oriented initiative aims to change that, through finding and implementing better ways to get more value out of the treatments we have — and accelerating progress and support for developing the ones we still need.” – by Erik Swain
Disclosures: Califf reports he holds equity in Verily Life Sciences and consults for Amgen. McClellan reports he holds equity in and consults for Alignment Health Care, Cigna and Johnson & Johnson and consults for Cota and Mitre. Warner reports no relevant financial disclosures.
Perspective
Back to Top
L. Samuel Wann, MD
This AHA call to action succinctly summarizes the challenges facing our community of scientists, practitioners, patients and our society in continuing to make progress in countering heart disease, still the leading cause of death in the U.S., and even rebounding despite technological and preventive advances of the past. Having framed the problem, we should all pay attention to counter this ominous trend. Health care reform is crucial to this enterprise and is now bubbling to the top of our political agenda. The AHA and all of us need to participate in this process.
Perspective
Back to Top
Jason H. Wasfy, MD
Mortality from CVD has decreased tremendously over decades. The key problems are that some groups of Americans are falling behind, and disparities are persistent. Furthermore, increases in costs are reducing patient access to needed therapies. Finally, we have not fundamentally shifted how we deliver health care enough to make substantial improvements to patient access.
We need to innovate more rapidly in how care is delivered. If half of patients who should be taking statins are not receiving them, we need to do more to change how we deliver care. Telehealth, community health coaches and registries are all potentially effective but have been underutilized. Part of the problem is that payment reform has not moved fast enough. If we allow providers and patients to define what they find valuable more freely, these new services will increase and we might be able to dramatically improve clinical outcomes.
This report recommends a very thoughtful path forward. In particular, the emphasis on learning collaboratives, patient voices, and scientific approaches to understanding how to approach payment reform and the development of novel therapies.
Persistent disparities, worsening outcomes in some groups of Americans, higher costs and too few new therapies pose a real threat to CV public health. Innovative public policy and care delivery solutions are urgently needed.
Click Here to Manage Email Alerts