The Million Hearts Initiative—Targeting Key Drivers of Cardiovascular Mortality from a Medical Specialty Society Perspective

Nathan Glusenkamp, William J Oetgen, Brendan Mullen
US Cardiology, 2012;9(1):66-70
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Abstract

The past decade has seen impressive advances in cardiovascular (CV) care and reductions in patient mortality from CV disease. However, despite impressive gains, there is still considerable room for further improvements in CV care. In September 2011, the US Secretary of Health and Human Services Kathleen Sebelius announced the creation of the ‘Million Hearts’ initiative. The overall goal of the Million Hearts initiative is to prevent a million cardiovascular events across the next five years. The American College of Cardiology (ACC) has long supported the goals articulated in Million Hearts. We believe that these goals are achievable. However, success will not be automatic. It will require focus, resources, and, most challengingly, some level of behavioral change on the part of physicians, patients, organizations, and government entities. To help meet the goals of Million Hearts, the ACC will, in partnership with the initiative, deploy three distinct assets. We will increase awareness among our 39,000 members by regularly communicating with them via our various communication channels; we will drive clinical quality improvement using our clinical registries—for example, the PINNACLE Registry®; and we will engage patients with relevant, patient-centered offerings and information through our CardioSmart™ program.
Keywords
Million Hearts initiative, American College of Cardiology, PINNACLE Registry®, PINNACLE Network™, CardioSmart™, cardiovascular care, quality improvement, ABCS
Disclosure The authors are employees of the American College of Cardiology. The PINNACLE Registry® is supported by a grant from Bristol-Myers Squibb and Pfizer Inc. CardioSmart™ receives support from The Coca-Cola Company® and the SUBWAY® restaurant chain.
Received: January 05, 2012 | Accepted February 02, 2012 | Citation US Cardiology, 2012;9(1):66-70
Correspondence: Nathan Glusenkamp, MA, American College of Cardiology, 2400 N Street NW, Washington, DC 20037. E: nglusenkamp@acc.org

The past decade has seen impressive advances in cardiovascular (CV) care and reductions in patient mortality from CV disease (CVD). Between 1997 and 2007 (the year for which most recent final data are available), the death rate from CVD declined by 27.8 %. The actual number of CVD deaths per year declined by 14.2 % over this period. Meanwhile, the death rate for stroke fell by 44.8 % in the same decade-long period.1

Despite these impressive gains, there is still considerable room for further improvements in CV care. The same article that reported the past decade’s reduction in CV mortality contained the following sobering facts:

  • Blood pressure control remains elusive for many hypertensive people: 33.5 % of adults who are 20 years or older in the US have high blood pressure; 80 % are aware of their condition but less than half have their condition under control.1
  • Decades of public health campaigns have produced considerable successes, but tobacco-use rates could be reduced still further: 23.1 % of men and 18.1 % of women are cigarette-smokers. More alarmingly, 19.5 % of students in grades 9–12 report current tobacco use.1
  • A significant minority of US adults have high cholesterol: 15 % of people who are 20 years or older have total serum cholesterol levels of 240 mg/dl or higher.1
  • Diabetes, a key risk factor, already afflicts many people, and there is the potential for this population to grow significantly: 8 % of adults have been diagnosed with diabetes mellitus; 36.8 % of adults are pre-diabetic.1
  • Lastly, more than 67 % of adults in the US are overweight.1


Despite a decade of reduction in CV death rates, the economic impact of CVD in the US is staggering. One credible estimate of the total cost of heart disease and stroke in the US in 2007 (including health expenditures and lost productivity) was $286 billion, a higher toll than for any other diagnostic group.1 Another estimate put medical costs and productivity losses as high as $450 billion annually.2 Current projections are grim, with direct medical costs from major cardiac events set to multiply in the coming 20 years.1–3 Faced with an aging population, the US can and must address the clinical, the economic, and, most importantly, the human costs exacted by preventable major cardiac events.

References:
  1. Roger VL, Go AS, Lloyd-Jones DM et al., Heart disease and stroke statistics—2011 update. A report from the American Heart Association, Circulation, 2011;123:e18–e209.
  2. Frieden TR, Berwick DM, The “Million Hearts” Initiative – preventing heart attacks and strokes, N Engl J Med, 2011;365:e27.
  3. Heidenreich PA, Trogdon JG, Khavjou OA, et al., Forecasting the future of cardiovascular disease in the United States: a policy statement from the American Heart Association, Circulation, 2011;123:933–44.
  4. Ford ES, Ajani UA, Croft JB, et al., Explaining the decrease in U.S. deaths from coronary disease, 1980–2000, N Engl J Med, 2007;356:2388–98.
  5. Centers for Disease Control and Prevention (CDC), Million Hearts: strategies to reduce the prevalence of leading cardiovascular disease risk factors—United States, 2011, MMWR Morb Mortal Wkly Rep, 2011;60:1248–51.
  6. Glusenkamp N, Mullen B, Million Hearts initiative offers health IT opportunity, but challenges remain, December 12, 2011. Available at: www.ihealthbeat.org/perspectives/2011/million-hearts-initiative-offers-health-it-opportunity-but-challengesremain. aspx (accessed January 18, 2012).
  7. American College of Cardiology, CardioSource. Available at: www.cardiosource.org/ (accessed January 18, 2012).
  8. American College of Cardiology, PINNACLE Network. Available at: www.pinnaclenetwork.org/ (accessed January 18, 2012).
  9. Erb BD, Allen J, Chambers L, et al., The PINNACLE Network— facilitating quality of care in outpatient cardiovascular medicine, US Cardiology, 2011;8:12–5.
  10. Drozda JP, Glusenkamp N, ACCF joins Million Hearts Initiative, offers ambulatory quality improvement opportunities, Cardiology, 2011;40:32–3.
  11. CardioSmart Program, Available at: www.cardiosmart.org/ (accessed January 18, 2012).

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