Janet Wright

Janet S. Wright, MD, FACC, is executive director of Million Hearts. Photo by Million Hearts

Americans suffer 1.5 million heart attacks and strokes each year. It’s a staggering number, but one that our nation’s health leaders have turned into hope.

The U.S. Department of Health and Human Services released its Million Hearts® initiative in 2011, with one overarching goal: to prevent 1 million heart attacks and strokes by 2017. On the three-year anniversary of the initiative’s launch, Public Health Newswire caught up with Janet Wright, executive director of Million Hearts®, to find out how the agency has addressed one of the nation’s most pressing health crises — especially through the “ABCS” of heart health — and how close it is to reaching its goal.

The Centers for Disease Control and Prevention released a Vital Signs in 2013 showing that at least 200,000 deaths each year from cardiovascular disease in the U.S. could be prevented. Since this report, what progress have we seen in behaviors correlative to heart health? And what threats remain most prevalent?

Last year’s Vital Signs report found that about 80 percent of deaths from heart disease, stroke and hypertension can be attributed to unhealthy lifestyle behaviors like tobacco use, lack of physical activity, a poor diet and not keeping blood pressure and cholesterol under control. The findings provide a serious wake-up call as to how we all must work together to reduce the number of these avoidable deaths.

From health care providers and individuals to federal, state and community level efforts, we all have a role to play in improving heart health. And that is really the goal of Million Hearts®, a national initiative that aims to prevent one million heart attacks and strokes in the U.S. by 2017.

Since launching in 2012, Million Hearts® has made progress in addressing preventable illness and deaths from heart attack and stroke by focusing on community and clinical prevention strategies that improve both the environment and patient care. As a result, we have a stronger understanding about what is working and how to effect change.

For example, the CDC’s 2013 Tips From Former Smokers campaign produced more than 150,000 additional calls to 1-800-QUIT NOW, a number that links callers to their state quit-lines. The campaign also generated almost 2.8 million additional visitors to the Tips website. These figures represent a 75 percent increase in call volume and a nearly 38-fold increase in unique website visitors, potentially saving tens of thousands of lives and millions of dollars in health care costs. CDC has also continued funding the Sodium Reduction in Communities Program, helping another 10 communities find innovative ways to reduce daily sodium consumption. In addition, earlier this year CDC announced the nine winners of the 2013 Million Hearts® Hypertension Control Challenge, which recognizes exemplary practices and providers in blood pressure control. These champions cared for more than 8 million patients, 3.4 million of whom had hypertension – and collectively they achieved a control rate that exceeded 80 percent.

Although we are proud of this progress, we know there’s more that needs to be done. Million Hearts® is a five-year initiative, and while our goal is to prevent a million or more events, it is also to invest in changes that will return far more than that over time. Creating a healthier environment, adopting healthier habits, and making lasting improvements in how we deliver care will not happen overnight – and with the help of our public and private partners, we can sustain momentum through 2017 and beyond, making a real difference in the lives of Americans.

Million Hearts actively looks for partners, in health-related sectors, to reach the 1 million mark by 2017. Can you tell us how we all work together to reduce heart attack and stroke, and what new partners you’re looking forward to working with?

Million Hearts® has drawn support from many organizations, including more than 100 partners ranging from Walgreens, YMCA of America and Kaiser Permanente, to National Association for the Advancement of Colored People and Blue Cross and Blue Shield Association.

Through these public and private partnerships, we are able to bring together a wide range of heart attack and stroke prevention programs, policies and activities, united behind the goal of curbing the number of heart attacks and strokes in the U.S. Specifically, we promote evidence-based strategies at the community level such as increasing smoke-free environments, boosting the availability of lower sodium foods, and eliminating trans fats in the food supply.

To improve performance in cardiovascular disease prevention, we are partnering with health care professionals and their systems on prioritizing the ABCS of heart health:

  • Aspirin when appropriate;
  • Blood pressure control;
  • Cholesterol management; and
  • Smoking cessation.

We welcome all potential partners, whether you are an insurer willing to prioritize performance in the ABCS or a retailer interested in offering blood pressure screening and monitoring. Even if you’re not a formal partner, you can support our goals by:

  • sending a clear signal that heart attacks and stroke are preventable;

(because despite sometimes popular belief, heart attacks and strokes are not inevitable – they are preventable through good habits and good care. Everyone can take specific actions to help prevent heart attacks and strokes.)

  • measuring and reporting progress on heart attack and stroke prevention;

(because timely data can help accelerate the pace of progress, focus our actions over the next few years, and inform course corrections. We ask partners to share their reach and results to date and plan now to achieve results and celebrate with us in 2017.)

  • and helping to detect, connect and control.

(because we must find individuals at risk for heart attack and stroke — both in the community and within health care settings — and connect them to care. For example, electronic health records can help to identify patients with uncontrolled hypertension or poorly managed cholesterol, while community organizations and faith-based groups can employ detection efforts such as blood pressure screening events that teach people how to monitor their blood pressure at home. )

On that note, how can public health professionals – like those at APHA – help you reach these and several other lofty goals?

Public health professionals play a key role in helping prevent heart attacks and strokes — both through the ability to identify promising public health interventions, as well as unique opportunities to link with clinical care.

What can you do? There are a number of steps to take, from promoting smoke-free air policies, effective tobacco package labeling, restricted tobacco advertising and higher tobacco prices to help smokers quit and keep nonsmokers tobacco-free; supporting education programs, tobacco prevention incentives, wellness programs and recognition programs, as well as efforts to reduce sodium and eliminate trans fats in the food supply; increasing awareness of the specific actions that empower your community residents to take control of their heart health; and building local collaboration and help convene area partners to enhance effectiveness and efficiency of efforts to prevent heart attack and stroke.

For example, since committing to serve as an initiative partner, members of the Association of Public Health Nurses have been urged to promote healthy diets and physical activity, support smoke-free environments, provide blood pressure screening, and identify and ensure access to care for individuals at cardiac risk.

Million Hearts® provides a focused set of clinical quality measures for the ABCS to monitor and improve the care reflected by these measures. Now that the measures have been widely adopted by quality reporting initiatives, it is time to put these actionable data to work, driving improvement and preventing more acute cardiovascular events every day. To showcase progress on the ABCS and understand gaps, Million Hearts® has developed the Clinical Quality Measures dashboard. This dashboard displays data from select quality reporting initiatives at the state, HHS region and national level including performance on the ABCS, demographics and state-level comparisons.

Public health practitioners can encourage groups of providers and payers to use these measures, implement evidence-based systems changes or conduct recommended quality improvement activities to improve performance on the measures, and report publicly on their performance. In addition, we encourage you to explore your community’s data on the Million Hearts® Clinical Quality Measure dashboard and to focus your actions on ways to improve it.

What other wellness activities does Million Hearts promote?

Although we focus on the ABCS, we encourage wellness activities that can reduce the number of heart attacks and strokes occurring in the U.S. each year.

For example, we partner with the American Dental Association to raise awareness of the relationship of oral health and cardiovascular diseases and encourage blood pressure monitoring and the smoking cessation counseling in the dental office. We also encourage employers to provide workplace wellness programs and employee health incentives.

We also work with various partners on sodium reduction efforts. Earlier this year, we launched the Million Hearts® Healthy Eating and Lifestyle Resource Center, which was developed in partnership with CDC and EatingWell. The robust online tool features lower-sodium, heart-healthy recipes and family-friendly meal plans designed to help consumers better manage their sodium intake. For example, visitors can quickly download a calorie-controlled, 28-day heart-healthy meal plan with a printable shopping list. In addition, search and filter options make it easy to quickly find the right meal based on preparation time, cuisine, breakfast-lunch-dinner item, dietary needs and number of servings.

Nearly 800,000 people die in the United States each year from cardiovascular diseases; that’s one in every three deaths. Hundreds of thousands more survive heart attacks and strokes, but they may suffer lasting side effects and reduced quality of life — contributing an estimated $315 billion dollars a year in direct and indirect health costs.

High blood pressure, high cholesterol and smoking are major risk factors, so we’re confident that Million Hearts® is the right thing to do and we are focusing on the right approaches.