Cardiovascular disease is the leading cause of death in the United States. Two million Americans have a heart attack or stroke every year and more than 800,000 of them die. The economic affect of these events is estimated to exceed $450 billion annually. A recent initiative to reduce these events, Million Hearts, is a joint venture involving governmental agencies together with private sector partners.
This effort will focus on the management of the ABCDS of heart disease - Aspirin for high risk patients - Blood pressure control - Cholesterol management - Diabetes - Smoking cessation. Management of these factors has more potential to prevent deaths and reduce morbidity than any other prevention program. Less than half of the individuals with hypertension who are being treated have it adequately controlled. The definition of hypertension has been refined and new limits for what is now considered prehypertension have been established. A review of recent studies suggests that young and middle-aged people with slightly elevated blood pressure, or prehypertension, are at much greater risk of stroke than those whose blood pressure is in the normal range. People under age 65 with prehypertension had a 68% increased risk of stroke compared with those with normal readings, independent of other known risk factors. Only a third of those with high cholesterol levels are receiving proper treatment. Fewer than half the individuals with pre and early diabetes are aware of it.
The increasing prevalence of obesity and diabetes demand that we attend to these identifiable and correctable issues in order to control the incidence of heart disease and stroke. The American College of Cardiology, American Heart Association and American Medical Association have established specific goals for treatment that may require patients to take one or more antihypertensive medications to achieve the desired blood pressure readings. Control of low-density lipoprotein cholesterol (LDL-C) to levels below 100mg/dl has been identified as a central issue in the management of high blood pressure. To achieve this a prescription for a statin drug is indicated. Stopping smoking is another goal of treatment of the patient with hypertension.
The Affordable Care Act (ACA) provides a foundation for the Million Hearts' project by increasing coverage and facilitating improved care. It waives patient cost sharing or insurance copays for preventive services, including blood-pressure and cholesterol screening and smoking-cessation counseling and treatment, for enrollees in new private insurance plans. While cost is a significant factor in establishing most preventive medical programs, the biggest hurdle for all efforts to identify those at risk of untoward events is the identification of those individuals for whom treatment is both possible and appropriate. For many conditions, population wide screening to identify those with important risk factors is not cost effective.
The New York Blood Center, NYBC, a community based, nonprofit, independent organization, is the central blood collection facility that provides blood components to 200 area hospitals serving more than 20 million people. With approximately 2000 blood donors a day being processed at the blood center's facilities, it has designed and implemented an extensive donor screening program for abnormal levels of cholesterol, blood sugar and blood pressure. The NYBC's Cardiovascular Disease Risk Assessment and Prevention Program is a demonstration project providing free screening, risk assessment, education, and referral of at-risk persons for further evaluation and treatment. The program is intended to advance cardiovascular disease prevention, motivate lifestyle changes, and ultimately improve the health of the people who provide blood donations each year to the NYBC. This screening program is integrated into their blood collection routines. The efficiencies of this program make it an appealing template for the identification of those at risk who would benefit from medical intervention to reduce their risk of heart disease and stroke.
Effective preventive medicine strategies rest on the identification and mobilization of efficient methods to capture the appropriate at risk populations. Only by employing the practices, procedures and processes of independent ancillary health organizations such as the New York Blood Center will it be possible to achieve the ambitious goals of the Million Hearts program.