Million Hearts initiative strives to address missed opportunities for CVD prevention
Click Here to Manage Email Alerts
The Million Hearts initiative utilizes evidence-based approaches to reduce MIs and strokes in the U.S., according to a presentation at the virtual American Society for Preventive Cardiology Congress on CVD Prevention.
More than 1.6 million people in the United States have MIs and strokes per year, in addition to more than 870,000 CVD deaths occur per year, Laurence Sperling, MD, FACC, FACP, FAHA, FASPC, executive director of Million Hearts in the division for heart disease and stroke at the CDC, Katz Professor in Preventive Cardiology and professor of global health in Emory University and past president of ASPC, said in a presentation, noting CVD costs hundreds of billions of dollars per year in the U.S. and is the greatest contributor to racial disparities related to life expectancy.
Over the past 70 years, the peak of CVD, CHD and stroke mortality occurred in 1970, which steadily declined until around 2010 and is now starting to increase again, especially among young adults, Sperling said. The southeast portion of the U.S. has the highest rates of heart disease and stroke mortality, he said.
There are 213.1 million missed opportunities when taking into account certain factors including not taking aspirin or statins as recommended, uncontrolled high BP, combustible tobacco use and physical inactivity, and more than 55% of these missed opportunities are in patients aged 35 to 64 years, Sperling said.
“We in the field of cardiovascular prevention need to change the conversation,” he said.
There is a disconnect between what people in the U.S. are dying from, what people are searching for on Google and what is being covered in the media, according to the presentation. Approximately 2% to 3% of media coverage of causes of death focuses on heart disease, Sperling said.
Million Hearts is a national initiative that has been in place since 2012 and aims to prevent at least 1 million MIs, strokes and CV events over a 5-year period. The second cycle of the initiative, which is co-led by the CDC and CMS, is currently in progress and will end in 2022.
The Million Hearts initiative is considered one of the six “winnable battles,” which are public health priorities where the CDC and other partners can make a significant progress in a short amount of time, Sperling said, noting other battles on this list include antibiotic resistance, HIV elimination, opioid overdose, vaccine-preventable diseases and viral hepatitis.
He said population-attributable risk needs to be considered when looking at relative contributions to this initiative. This includes improvements in BP control, cholesterol management and smoking cessation, in addition to environmental- and population-based approaches.
“This is where we’ll have the highest impact on American lives,” Sperling said.
This initiative strives to keep people healthy through reductions in sodium intake, tobacco use and physical inactivity. It also aims to optimize care through improving appropriate aspirin use, BP control and cholesterol management, increasing use of cardiac rehabilitation and engaging patients in heart-healthy behaviors.
“This is where members of ASPC and ASPC partners can make inroads,” Sperling said.
The Million Hearts initiative focuses on improving outcomes for several priority populations including Black patients with hypertension, those aged 35 to 64 years, patients who had a MI or stroke, and those with mental illness or substance use disorders who also use tobacco.
“Here we know that proven interventions and strategies can greatly impact these populations,” Sperling said. “Unfortunately, right now, there are gaps in care, but by using effective interventions and partnerships, we can make a significant difference.”
A push is needed to accelerate progress, according to the presentation. For more than a decade, hypertension control has been approximately 50%, and only 7.5% of patients were successful in smoking cessation in 2018. In addition, participation in cardiac rehabilitation increased from 18.7% in 1999 to 24.4% in 2017.
“We need all of you ... to jumpstart efforts related to cardiovascular prevention,” Sperling said.
The initiative has implemented several efforts to help accelerate progress, including evidence-based change packages, a hospitals and health systems recognition program and a project to increase use of cardiac rehabilitation, according to the presentation.
The future should focus on precision public health which incorporates precision medicine for both patients and the population. Sperling mentioned that there are three buckets of prevention: traditional clinical prevention, innovative clinical prevention and community-wide prevention.
“What we want to do is fill up all three of these buckets and have these buckets working together in an integrated and coordinated fashion,” Sperling said.
Collapse
Sperling L. Million Hearts – Moving the Prevention Needle for the Population. Presented at: American Society for Preventive Cardiology Congress on CVD Prevention; July 25-26, 2020 (virtual).
Read more about
Click Here to Manage Email Alerts