Preventing One Million Heart Attacks and Strokes: Start With the ABCS

By Bob McNellis, M.P.H., P.A., AHRQ‘s Senior Advisor for Primary Care
Twitter: @AHRQNews

Let’s start with some numbers:

  • 415,480 deaths.
  • 2.2 million hospitalizations.
  • $32.7 billion in hospital costs.

What do these data have in common? Each provide a different perspective on the staggering impacts associated with preventable heart attacks, strokes, and other cardiovascular disease-related events in 2016.

These data are highlighted in “State-Level Variation in Nonfatal and Fatal Cardiovascular Events Targeted for Prevention by Million Hearts 2022” and supplemental data tables published this month in the Centers for Disease Control and Prevention’s (CDC) MMWR Vital Signs. Based on data from AHRQ’s Healthcare Cost and Utilization Project (HCUP) and the CDC’s Vital Statistics System Mortality data, the article delivers an urgent message: despite considerable progress in reducing the burden of heart disease and stroke in the United States over the past 50 years, including reductions in hospitalizations, there is much work yet to be done.

The Department of Health and Human Services has launched Million Hearts® 2022 as a national strategy to reduce the tragic toll of preventable cardiovascular events. Million Hearts, launched by the CDC and the Centers for Medicare and Medicaid Services (CMS), utilizes a network of partners focused on preventing one million heart attacks, strokes, and other cardiovascular disease (CVD) events by 2022.

AHRQ stands as an enthusiastic Million Hearts partner. Through its EvidenceNOW grant initiative, the Agency is helping small- and medium-sized primary care practices across the Nation use the latest evidence to improve the heart health of millions of Americans. EvidenceNOW is having a positive impact on practices and their patients not only in reducing patients’ risk of heart disease, but also increasing the capacity of these small practices to engage in quality improvement.

The 2016 data in the new Vital Signs publication are notable for several reason. First, the analysis underscores the important ongoing contributions of AHRQ’s HCUP resource, a family of robust health care databases that quantify hospitalizations in 46 States and the District of Columbia and emergency department visits in 34 States.

In addition, the Vital Signs analysis stratifies State-specific rates for Million Hearts-related preventable CVD events by age, sex, race, and Hispanic ethnicity. That’s important because the data show considerable variation by State and considerable disparities by age, sex, race, and ethnicity. Among the article’s most provocative findings:

  • States with the highest rates for preventable hospital costs, hospitalizations, and deaths are more than double the rates for States with the lowest rates.
  • States with the highest rates for preventable emergency department visits are five times higher than rates for the lowest States.
  • Non-Hispanic blacks continue to experience the highest CVD mortality rates.
  • Particularly troubling is that across the country younger populations, persons aged 35–64, are experiencing worse heart health outcomes.

Given these challenges, how will we prevent one million heart attacks and strokes over the coming years? The good news is we know what works. Decreasing cardiovascular risk starts with the ABCS of heart health—that is Aspirin for those at high risk when appropriate, controlling Blood pressure, managing Cholesterol, and Smoking cessation.

Encouraging people, especially younger adults, to follow recommendations for screening for high blood pressure, starting statin use, and counseling for tobacco cessation from the U.S. Preventive Services Task Force is a good start. Decreasing sodium intake and increasing physical activity are also key.

Health care professionals, meanwhile, can use standardized, evidence-based protocols for hypertension treatment, cholesterol management, and tobacco cessation. Practices can optimize patient outcomes through the use of team-based approaches to care. Referring appropriate patients to cardiac rehabilitation is another essential step to preventing unnecessary CVD events, hospitalization, and deaths.

Improving outcomes for priority populations is another goal of Million Hearts. These priority populations include:

  • Blacks/African Americans with hypertension.
  • 35- to 64-year-olds.
  • People who have had a heart attack or stroke.
  • People with mental and/or substance use disorders.

Using national data (like that from HCUP) as well as State and local data can help identify areas and populations with the greatest need, focus efforts to address those challenges and, ultimately, reduce disparities.

In support of Million Hearts partners at the CDC and CMS, AHRQ will continue to work to decrease the burden of preventable cardiovascular disease on patients and their families in three ways. First, AHRQ research will continue to generate evidence to make health care safer and improve the quality and value of care delivered, a priority demonstrated by the EvidenceNOW initiative. Second, AHRQ will continue to support data resources such as HCUP that can be used to track and improve performance and evaluate progress of the U.S. health system. And third, AHRQ will create tools and resources, such as the TeamSTEPPS for Office-Based Care, which support health care systems’ and professionals’ efforts to improve care for their patients.

As with many challenges in health care, the key to reducing preventable cardiovascular events is collaboration; collaboration between patients and clinicians, primary care practices and their communities, and State and Federal agencies. As the recent Vital Signs article shows, AHRQ is an enthusiastic partner for improving the heart health of the Nation.

This article was originally published on AHRQ Views Blog and is republished here with permission.