Beyond the Data – Million Hearts® 2022: A Compelling Call to Action

[Dr. John Iskander] Hello
I’m Dr. John Iskander, welcome to CDC’s
Beyond the Data. I’m here today with Dr. Janet
Wright executive director of the Million Hearts program. Welcome Dr. Wright. Thank you so much it’s a joy
to join you today. [Dr. John Iskander] For our
audience can you please remind us what the Million
Hearts program is? [Dr. Janet Wright]
Happy to John. It’s a national initiative
co-led by CDC and CMS. It’s founded on the idea
really, the groundbreaking idea that if you took the assets
and expertise of public health and combined it with the payment
policy that exists in healthcare and focused partners
on a common goal and you let a timeline
underneath it that you could get
a big goal done. And so the original million
hearts launched in 2012 and was a five-year initiative to prevent a million
cardiovascular events primarily heart attacks and strokes
over that five-year period. [Dr. John Iskander] So we
have some information now about what’s been achieved
in that first phase of Million Hearts, what
have…what have we learned from some of the studies
that have been published? [Dr. Janet Wright] Yeah, what we
know is that progress was made. We also know that progress
happens slowly We’ll still be getting data on that five-year
period for about another year and a half so final
report on the number of events prevented will
be available in 2019. But as all things true in science we can make
some predictions based on what’s happened
to date we think that by the time 2019 rolls
around somewhere close to 500,000 events will
have been prevented. The events are prevented when
the risk factors are controlled and what we know is
that progress was made in blood pressure control
about 1% improvement per year. In cholesterol management about 2% per year
improvement was seen, smoking prevalence did drop
through all the work that’s done by CDC as partners and really
many organizations and entities around the country but we
didn’t make any headway at all in sodium reduction
which has a huge impact on the numbers were
trying to control. So what I say in summary is,
not all the targets were met so we predict we are
going to fall short of the million prevented. [Dr. John Iskander] Although
still quite remarkable you know 500,000 heart attacks
and strokes prevented. Now, the Million Hearts
program is as we heard in today’s session is
about to enter another, another five-year phase, what
can you tell us about who some of the targeted risk
groups are for this program? [Dr. Janet Wright] Well and
even before what I’d say is that we learned a lot
in that five years. And what we found is there
was enormous engagement across the country by partners. Whether they were involved
in federal or state agencies, organizations, clinical
ones in public health ones and just many of the… we did a round of interviews
with people toward the end of million hearts
during that last year and asked people you how are
you doing with the work you have under way and reengage an
interest in their desire to pursue continue to
pursue this as a goal. And we heard uniformly we’ve
just gotten our group together or we we’ve gotten
our wheels rolling now or we’ve set our targets and
so they were as great deal of enthusiasm about
continuing the work. Our internal team both
at CDC and CMS felt that we hadn’t achieved our
mission but we did begin to move some of these
slower wheels. One of the things we were
most proud of is that millions of people were now
covered by health systems that were measuring themselves
by the ABCS measure so aspirin, blood pressure, cholesterol
and smoking. Just this one thing that
happened on the clinical side. So as a result of understanding
the depth of investment that many partners had made
in this work we did a new set of modeling exercises to make
sure that we were focusing on the actions with the greatest
impact and we rolled that and the stakeholder input into a new design that’s
called Million Hearts 2022. It kicked off in January of 2017 so we are now beginning
the second year, and as you said there
are some new aspects. On the clinical side we’ve
added cardiac rehabilitation. Lots to talk about there but
it basically saves lives, improves health and it
actually has a cost savings. Over on the public health side
we’ve added physical activity and as you know we wanted
to add physical activity in the first five years. So we are really excited
from the public health and community-based standpoint
to add in those factors that will help people
get and be more active. [Dr. John Iskander]
So very ambitious. We know that progress
has been made in preventing cardiovascular
disease events, heart attacks and strokes. But that progress for some
groups has stalled, who are some of those groups that might be
in some ways more at risk now? [Dr. Janet Wright] Yes. In fact it’s the data that keeps
me up at night and that is that, while we’ve seen a decrease in
events and death rates in those who are 65 and older, we’re
actually seeing an increase in younger age groups. So if we look at data coming
from the county level 35 to 64-year-olds from Maine to California we are seeing
an increase in death rates, not not just event rates,
but actual death rates from cardiovascular disease. We think that, and other
experts in the field believe that this is the impact of
decades of obesity and diabetes and physical activity those
things that are so interwoven but now they’re having an impact
on actual event and death rates. [Dr. John Iskander] So many of those folks will have
you know access to access to primary health care in
in some form or another and we saw a great
presentation today. What have we learned about how
to manage cardiac risk factors in particularly blood
pressure in a clinic setting? [Dr. Janet Wright] Yes, so I think especially the
presentation today shows that it takes a team. It takes commitment
at the highest levels in a practice or a system. It takes measurement. But, not only measurement it’s
actually analysis of the data. And, the practice that we heard
from today has gone so far as to share their data
publicly, as it comes in. They just post how they’re doing
on those key measures of health. I think the other thing that
we learned was reinforced by today’s presentation is that, developing health
cardiovascular health, and preventing events starts
at home and in the community. So the things you heard
from Leslie Meehan about how a community
can be structured to help people naturally become
more physically active, safely, affordably, I think
that what they’re doing in Tennessee we hope
to be seen scaled and spread across the country. [Dr. John Iskander]
Yes certainly from Leslie’s presentation
we saw I thought a lot of things come together that we’ve been hearing
about for a while. The idea of an exercise
prescription, the idea that healthcare has to go beyond just the
healthcare sector, yeah I thought there was a lot
of great information there. So, for those in our audience
whether they’re clinicians whether they’re public health
professionals whether they’re students of public health
medicine or nursing, where can they go to
find the resources to understand you
know what they can do to help prevent even more
heart attacks and strokes? [Dr. Janet Wright] Yes thanks
for that question John. There’s certainly
information available on the Million Hearts website
but I think in the Department of Health across the country
there are tremendous resources. It’s almost like a matchmaking
game to ask clinicians to date their public
health experts in their communities
and in their states. And likewise for the
public health experts across the country to get
to know the clinicians in their environment because
while tools and resources and things you can hold
in your hand or download from the Internet are extremely
helpful it is the relationships between these two
types of experts. We don’t need them to do what
the other person does we need them to do what they do best
but to do it in communion, and that’s how I
think we’re going to actually see improvements in
health and we’re going to take that curve of the 35
to 64-year-olds and, and flex it down again. [Dr. John Iskander]
Well, thank you very much for joining us today Dr. Wright. [Dr. Janet Wright] My
pleasure, thank you. [Dr. John Iskander]
Please join us for our next session
of Beyond the Data.

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