The federal government wants to prevent a million heart attacks and strokes over the next five years, a plan that will involve cardiologists, neurologists, and primary care doctors. The Department of Health and Human Services (HHS) is spearheading the campaign, called “Million Hearts,” in collaboration with the CDC and the Centers for Medicare and Medicaid Services (CMS). The federal agencies will partner with half a dozen advocacy organizations, health care associations, and community centers to increase awareness of ways to reduce risk factors for heart attacks and strokes.
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The campaign aims to cut heart attacks by 65 percent and stroke by 25 percent.
The initiative will include monetary incentives for clinicians to focus more on the management of the ABCs — Aspirin for high-risk patients, Blood pressure control, Cholesterol management and smoking cessation programs — and provide information to their patients on ways to reduce their risk factors for cardiovascular disease and stroke. There is also a national community outreach campaign to change behavior.
“It's ambitious,” said Gordon Tomaselli, MD, president of the American Heart Association (AHA) and professor of medicine at Johns Hopkins Medical Center, who noted that the AHA and the American Stroke Association are part of the collaboration. “We believe this is doable if we focus on primary and secondary prevention techniques.”
Dr. Tomaselli and others involved in the initiative said that they have received calls from neurologists asking the obvious: Where in the Million Hearts title is the brain? “It's there and it is a significant part of the campaign,” Dr. Tomaselli added.
Former AHA President Ralph Sacco, MD, professor and chair of neurology at the Miller School of Medicine at the University of Miami, said that neurologists should think more broadly about preventing heart attacks and strokes. “That means paying close attention to diet, exercise, blood pressure, cholesterol, and blood glucose,” he said. “Any initiative to prevent heart attacks and strokes will also improve brain health, including dementia.”
Walter Koroshetz, MD, deputy director of the NINDS, said his office is in touch with the HHS to see how the research institute can be more involved in the campaign.
The Million Hearts Initiative is not adding new measures but reinforcing existing ones, Joe McCannon, a senior advisor to the CMS Administrator Donald Berwick, MD, said during a press conference announcing the initiative on Sept. 13. Medicare and Medicaid programs now support cardiovascular wellbeing but federal agencies will strengthen the reporting of specific metrics that support prevention efforts in heart disease. For example, the Physician Quality Reporting System already offers incentive payments to Medicare providers who accurately report quality data on their patients, and the Medicare Shared Savings Program will also include quality measures for following ABCs preventions to reduce heart attack and stroke.
HHS set aside $200 million in new and refocused investments for the Million Hearts program. The CDC will spend $40 million for chronic disease prevention programs through health departments. The agency will also spend $4.2 million to community-based programs and another $100 million in grants in community projects centered on reducing smoking and improving diet and management of cholesterol. The FDA and the Food Safety and Inspection Service will work with food companies to reduce sodium in packaged foods and in restaurants. CMS will spend $85 million in Medicaid incentives in grants for prevention of chronic diseases.
STROKE SPECIALISTS WEIGH IN
“We as doctors know what is needed to reduce heart attacks and strokes,” said James C. Grotta, MD, professor and chair of neurology at the University of Texas in Houston, who is also a member of the Neurology Today editorial advisory board. “But telling a patient what to do does not guarantee that they will do it. We have to re-organize the medical system to be more proactive and figure out how to get people to adhere to a healthier lifestyle. If anything, with obesity on the rise, we are going in the wrong direction.
“We may have control over the patient when they are in the hospital or in our clinics but once they go home it is up to them to comply,” Dr. Grotta said. He said that he could see how neurologists would benefit from this initiative if they are compensated for having programs available in their practice that strengthen adherence to the ABCs.
Doctors working on the frontlines of stroke care wonder where the time will come for them to enhance the prevention effort. Given the current state of health care, physicians have far less time to spend with patients or to focus on preventive measures, said David S. Liebeskind, MD, associate neurology director of the University of California, Los Angeles Stroke Center. “Should neurologists talk to their patients about these things? Of course, but some of these risk factors are not specific to neurology. Stroke prevention should be implemented more broadly at the public level.”
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Helmi L. Lutsep, MD, professor and vice chair of the department of neurology at Oregon Health & Science University in Portland and associate director of the Oregon Stroke Center, said that UCLA has implemented a program called PROTECT that provides a model for stroke prevention — in essence, it tries to ensure solid implementation of preventative therapies upon discharge from the hospital (blood pressure medications, use of statins, lifestyle modification, etc.) with follow-up in the outpatient setting.
“Other institutions are moving in this direction, I think, but have room for improvement,” Dr. Lutsep said.
Neurologists wanting to learn more about getting involved in the initiative can visit http://millionhearts.hhs.gov/ for more information.
PUBLIC HEALTH GOALS
Among the public health goals, “ Million Hearts” campaign aims to:
* Increase aspirin use for high-risk patients to 65 percent from 47 percent;
* improve blood pressure control to 65 percent from 46 percent;
* increase effective high cholesterol treatment to 65 percent from 33 percent.
* Reduce smokers from 19 percent to 17 percent.
* Encourage Americans to drop sodium intake by 20 percent. Now, the average person consumes 3.5 g/day.
* Promote a 50 percent reduction in trans fats, which now make up one percent of the calories consumed by people every day.
For physicians, health insurance plans will develop programs that can be used to reduce cardiovascular disease and stroke, including adding beneficiary fitness programs and incentives to reduce ethnic and racial disparities. Pharmacists will be encouraged through their association groups to take part in the campaign to educate their patients about risk factors.
Frieden TR, Berwick DM. Perspective: The “Million Hearts” initiative — Preventing heart attacks and strokes. N Engl J Med 2011; E-pub 2011 Sept. 13.
©2011 American Academy of Neurology