Transcript Million Hearts - National Forum for Heart Disease and Stroke

Million Hearts
Preventing 1 million heart attacks
and strokes in 5 years
What is Million Hearts?
• Goal: Prevent 1 million heart attacks and strokes
over the next 5 years
• Engage public and private sector partners in a
coordinated approach to:
– Reduce the number of people who need treatment
– Improve the quality of treatment for those who need it
– Maximize current investments in cardiovascular
health
Heart disease and strokes are
leading killers in the U.S.
• Cause 1 of every 3 deaths
• More than 2 million heart attacks and strokes
occur every year; 800,000 die
– Leading cause of preventable death among people
<65
• Treatment accounts for about $1 of every $6
spent on health care
• Accounts for the largest single portion of
racial disparities in life expectancy
Status of the ABCS
Aspirin
People at increased risk of cardiovascular
disease who are taking aspirin
47%
Blood
pressure
People with hypertension who have
adequately controlled blood pressure
46%
Cholesterol
People with high cholesterol who have
adequately controlled hyperlipidemia
33%
Smoking
People trying to quit smoking who get help
23%
Source: MMWR: Million Hearts: Strategies to Reduce the Prevalence of
Leading Cardiovascular Disease Risk Factors --- United States, 2011, Early
Release, Vol. 60
Key components of Million Hearts
• Clinical Prevention – improving care of the ABCS
through:
– Focus – simplify and align quality measures; emphasize
importance of improved care of the ABCS
– Health IT – use electronic health records to improve care
and enable quality improvement through clinical decision
support, patient reminders, registries, and technical
assistance
– Care innovations – team-based care, interventions to
promote medication adherence
• Community prevention – reducing the need for
treatment through:
– Prevention of tobacco use
– Improved nutrition – decrease sodium and
artificial trans fat consumption
Community prevention
Tobacco control
• Tobacco is leading preventable agent of death
• Strengthen tobacco control and reduce smoking
by discouraging smoking initiation and
encouraging cessation
– Warn people about harms of tobacco use through
package labeling, mass media, and other measures
– Create smoke-free public places and workplaces
• Comprehensive tobacco control programs are
most effective
– Synergies between individual program
elements
Reasons for hope:
Reduced smoking in New York City
21.5%
% of New York City Smokers
22
20
18.9%
19.2%
18
18%
16.9%
18.3%
16
14
12
10
8
17.5%
15.8%
15%
• 350,000 fewer adult smokers
• >100,000 fewer smoking-related deaths
in future years
11%
8.5%
Community prevention
Reducing sodium intake
• Most Americans consume far too much sodium, which
increases risks of hypertension and cardiovascular
disease
• Most (~80%) sodium comes from processed/restaurant
foods, which makes it difficult for Americans to limit
sodium consumption
• Federal procurement guidelines and school food
standards include a focus on sodium reduction
• FDA/USDA have issued a request for information on
sodium reduction
• CDC is increasing public and professional
education about sodium
• NHANES will begin collecting information
on sodium consumption
Community prevention
Eliminating artificial trans fat
• Trans fat increases LDL cholesterol, decreases
HDL cholesterol, increases risk of heart attacks
– IOM: reduce intake to as close to zero as possible
• Replacing artificial trans fat with heart-healthy
oils is feasible and does not increase the cost or
change the flavor or texture of foods
• Since FDA began requiring listing of trans fat
content on food labels, the food industry has
voluntarily reformulated foods
– Americans’ trans fat consumption has
decreased by at least half
What can be done
In the community
• Retailers
– Offer blood pressure monitoring and educational resources;
focus on improving ABCS care in retail clinics
• Government
– Support community and systems transformation to reduce
tobacco use and improve nutrition, including smoke-free policies
and food procurement standards; provide data for action; expand
coverage for the uninsured
• Foundations
– Support consumer and provider outreach and education
• Advocacy groups
– Monitor progress toward goal and promote actions
that prevent heart attacks and strokes
New CDC Community Supports
• Community Transformation Grants (CTG)
– >$100 M in prevention grants
– ~60 Communities
– All communities will address tobacco, physical
activity, nutrition, clinical preventive services –
specifically to control HTN, HBC
– Look for announcement of communities next
week.
National Dissemination and Support for
CTG’s
• Dissemination Networks
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APHA
Asian Pacific Partners for Empowerment and Advocacy
Community Anti-Drug Coalition
National Farm to School Network at Occidental College
• Acceleration Networks
– American Lung Association
– National REACH coalition
– YMCA of the USA
Pharmacy Outreach Program
• Objectives
– Grow and strengthen community of orgs
focusing on HTN
– ↑ awareness that poor adherence to HTN
meds is weak link in CVD risk reduction
– ↑ # of pharmacists actively engaging in
counseling pts on adherence
– ↑ # of pts who are discussing HTN meds with
their pharmacist.
Million Hearts Leadership
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Co-led by CDC and CMS
Quarterly reporting to HHS
All of HHS
Executive Director
– Janet Wright MD FACC
– CDC Medical Officer housed at CMS
Innovations Center
Operating Values
How we shall work together and with
others?
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Boundarilessness
Speed and Agility
Unconditional Teamwork
Valuing Innovation
Customer Focus
The Three Part Aim
Better Health for
the Population
Better Care
for Individuals
Lower Cost
Through
Improvement
Reasons for hope
• HRSA Health Centers Collaborative Study increased
daily aspirin intake from 53% to 67% after intervention
• KP Colorado high Blood Pressure and Cholesterol
Management Program improved from having 26% of
patients with cholesterol under control to having 73% of
patients with cholesterol under control
• Rhode Island Cardiovascular Chronic Care Collaborative
saw an increase in blood pressure control among
participants from 20% to 60%
• Work by Medicaid Massachusetts yielded a drop from a
smoking rate of over 38% to a smoking
rate of 28% in 2.5 years
Getting to Scale
The question is not whether superb
performance and sustainability is possible,
the question is whether it is possible at
scale.
Getting to Scale
“I think when people look back at our time,
they will be amazed at one thing more than
any other.
It is this – that we do know more about
ourselves now than people did in the past,
but that very little of this knowledge has been
put into effect.”
Doris Lessing
Eleven Lessons from the Best
1.
They have shared, crisp, public aims, owned by leadership,
and they’re rabid about them.
2. They welcome everyone. (Unleash)
3. They get to the field. (It’s not a web site.)
4. Their work is rooted in actions and transactions. (Rhythm)
5. They are “brutally opportunistic.” (Jazz)
6. They play well with levers.
7. They tend to affection. (Value)
8. They have a shared story and they use the language of
creation (not avoidance).
9. They go broad and deep.
10. They examine and revise their rules base.
11. The patient is in the room…always.
Eleven Lessons from the Best
1. They have shared, crisp, public aims, owned by
leadership, and they’re rabid about them.
2. They welcome everyone. (Unleash)
3.
They get to the field. (It’s not a web site.)
4. Their work is rooted in actions and transactions.
(Rhythm)
5. They are “brutally opportunistic.” (Jazz)
6. They play well with levers.
7.
8.
They tend to affection. (Value)
They have a shared story and they use the language of
creation (not avoidance).
9. They go broad and deep.
10. They examine and revise their rules base.
11. The patient is in the room…always.
Clinical prevention
Focus on ABCS
• Improving management of ABCS can prevent more
deaths than other clinical preventive services
• Increasing utilization of these simple interventions
could save more than 100,000 lives a year
– Patients reduce risk of heart attack or stroke by taking
aspirin as appropriate
– Treating high blood pressure and high cholesterol
substantially and quickly reduces mortality among high-risk
patients
– Even brief smoking cessation advice from clinicians
doubles likelihood of successful quit attempt –
use of cessation medications increases
quit rates further
Improved cardiovascular care could
save 100,000 lives/year in U.S.
Blood Pressure control
Cholesterol
control
Smoking cessation
Aspirin
prophylaxis
Source: Farley TA, et al. Am J Prev Med 2010;38:600-9.
Clinical prevention
Increasing focus
• Improving ABCS is top priority
• Aligning incentives, communication, clinical
measurement, and reporting by physicians,
health care facilities, and health care systems
• Simple, consistent ABCS indicators into:
– Physician Quality Reporting System,
– EHR meaningful use criteria, community clinic
measures, and guidelines from private-sector
organizations
– Medicare Part D & MA/PD Plan Ratings
– Quality Improvement Organizations
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Clinical prevention
Information technology
• HIT will enable health care providers and
facilities to improve cardiovascular care and
target intervention to patients in need of
intensified care
– Registries, EHR functions used at point of care
• Include clinical quality measures for
hypertension and cholesterol control in
Meaningful Use criteria
– Can include routine assessment of cardiac risk;
use of patient recall, reminders, decision
support, order sets; and monitoring
of medication adherence
Clinical prevention
Team-based approaches to care
• Team-based care can provide higher quality at
lower cost
– Allied health workers can provide support to
physician-directed efforts
• Increasing use of effective ABCS care practices
through support, evaluation, and rapid
dissemination of innovations including
– Team-based care
– Patient-centered medical homes
– Interventions to promote adherence
Pharmacists can be key partners in
CVD prevention
Care from pharmacists* is associated with
significant reductions in cardiovascular disease
risk
CVD Risk Factor
Reduction
Systolic/diastolic blood pressure
–8.1/–3.8 mm Hg
Total cholesterol
–17.4 mg/L
LDL cholesterol
–13.4 mg/L
Smoking
23% reduction
* Interventions exclusively conducted by a pharmacist or implemented
in collaboration with physicians or nurses; may include patient
educational interventions, patient reminder systems, measurement
of CVD risk factors, medication management and feedback to
physician, and/or educational intervention to health care
professionals.
Source: Santschi V, et al. Arch Intern Med 2011;171:1441-53.
What can be done
In the medical system
• Health care providers
– Focus on prevention of heart disease and stroke; improve
care of ABCS; use health IT, including decision supports
and registries, to drive quality improvements
• Pharmacists
– Monitor medication refill patterns; engage doctors and
patients in managing health
• Insurers
– Include ABCS in performance measures; collect and share
data for quality improvement; empower consumers
• Individuals
– Take aspirin, if appropriate; take blood
pressure and cholesterol medications as
prescribed; if you smoke, quit
How will you help?
Monitoring progress of Million Hearts
Population Metric
Baseline
2017
Aspirin for those at high risk1
~50%
65%
Blood pressure control2
~50%
65%
Cholesterol control2
~33%
65%
Smoking prevalence3
~19%
17%
Average sodium intake2
~3.5g/day
20% reduction
Artificial trans fat intake2
~ 1% of calories
50% reduction
Note: Population-wide indicators – clinical performance goals higher
1As
measured in NAMCS
2As measured in NHANES
3As measured in NHIS
Public sector support
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Administration on Aging
Agency for Healthcare Research and Quality
Centers for Disease Control and Prevention
Centers for Medicare & Medicaid Services
Food and Drug Administration
Health Resources and Services Administration
Indian Health Service
Substance Abuse and Mental Health Services Administration
National Institutes of Health, National Heart Lung and Blood
Institute
• National Prevention Strategy
• National Quality Strategy
Private sector support
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American Heart Association
America’s Health Insurance Plans
American Medical Association
American Nurses Association
American Pharmacists’ Association and the American Pharmacists’
Association Foundation
Kaiser Permanente
The National Alliance of State Pharmacy Associations and the Alliance
for Patient Medication Safety
The National Community Pharmacists Association
UnitedHealthcare
Walgreens
The Y
http://millionhearts.hhs.gov
Million Hearts Publications
For More Information:
www.millionhearts.hhs.gov