Federal health officials on Tuesday announced an ambitious plan to refocus health priorities in an effort to prevent one million heart attacks and strokes within five years. They plan to achieve the goal through partnership with organized medicine, health plans, pharmacists and a large drug store chain.
Called "Million Hearts," the effort seeks to create what Centers for Medicare & Medicaid Services administrator Donald Berwick, MD, called a new "alignment" between providers and others to get people to lose weight, stop smoking, control blood pressure, reduce cholesterol, and manage diabetes.
"There's hardly an American today who won't, without doubt, know somebody – a loved one, a friend, maybe even yourself – who will gain from this call to arms," Berwick said during a news briefing. "(This is) someone who will not have a heart attack or disabling stroke or another form of cardiovascular disability and therefore will live longer and a fuller and more joyous life" because of this campaign.
Added Health and Human Services Secretary Kathleen Sebelius: "With two million heart attacks and strokes a year, 800,000 deaths, just about all of us have been touched by someone with heart disease, heart attack, or stroke." But the cost of treatment is "a huge drain on our economy. Cardiovascular disease costs our country $444 billion every year in medical costs and lost productivity," or one of every six healthcare dollars.
"Yet we know that most heart attacks and strokes can be prevented with simple, low-cost care that's available today, but that sad truth is too any people who need that care don't get it."
Thomas Frieden, MD, director of the Centers for Disease Control and Prevention, also commented during the campaign rollout. "This will not cost a lot of new money but it will greatly increase our focus on getting value for our investments," he said. "We aim to reduce the number of people who need treatment and improve the quality of treatment for those who do."
The administration is focusing on what it calls the ABCs of heart disease and stroke:
• A – To make sure that everyone who is at high risk for cardiovascular disease takes an aspirin a day. At present, only 47% do, but the campaign's goal is to raise that to 65%.
• B – To make sure patients at high risk for high blood pressure maintain control. At present only 46% do. The goal is to raise that to 65%.
• C – To make sure people who need treatment for high cholesterol receive it. Currently, only 33% receive it but the Million Hearts drive seeks to raise that to 65%.
• S – Reduce smoking prevalence, currently at 19% of the population to 17%.
Additionally, the campaign seeks to reduce sodium intake by 20% from its current per person average of 3.5 grams per day, and cut by half the average American's consumption of calories from artificial trans fat.
HHS officials said they intend to "focus and align" measurement tools to simply reporting for healthcare providers on how well disease prevention benchmarks are being met. CMS plans to expand the role of the Physician Quality Reporting System (or PQRI), which provides bonus payments, and in the future payment reductions based on the reporting of quality information related to the ABCS. Currently no new reporting measures are planned but officials said that may change as the program gains momentum.
Additionally, they hope to use health information technology and electronic record systems to improve providers' tools to make sure patients receive appropriate care.
To learn new ways to prevent heart disease and stroke, the administration intends to focus on clinical innovations, perhaps through Medicare's 53 Quality Improvement Organizations or QIOs.
Other efforts tagged with the campaign include:
• The release by the CDC of $40 million total state health departments to find ways to improve cardiovascular health
• Efforts by the U.S. Food and Drug Administration and the Food Safety and Inspection Service to find ways to reduce sodium in processed and restaurant foods "to put more control into consumers' hands."
• A $2 million pharmacy outreach project from the CDC to help pharmacists provide additional advice to patients with high blood pressure.
• CMS is releasing $85 million for Medicaid Incentives for Prevention of Chronic Diseases, a project set forth by the Patient Protection and Affordable Care Act, for 10 states.
• $4.2 million from the CDC to seven national community-based organization networks.
The administration touted "alignment and support" from the following organizations and companies:
• Walgreens is offering free blood pressure testing and consultations with a company pharmacist or nurse practitioner.
• The American Heart Association will monitor progress of the initiative's goals and help patients access heart disease management tools online.
• The YMCA or The Y plans to expand diabetes prevention program and other efforts to address population risks for diabetes and cardiovascular disease.
• The American Pharmacists' Association and its foundation "will encourage its more than 62,000 members to engage in the Million Hearts Campaign by raising awareness with their patients and their communities." The National Alliance of State Pharmacy Associations and the Alliance for Patient Medication Safety will encourage state pharmacy association to plan supportive activities, according to an HHS news release.
Karen Ignagni, president of America's Health insurance Plans, said her group strongly supports the Million Hearts initiative and is "eager to collaborate with other stakeholders."
The National Institutes of Health is funding a five-year study that aims to establish the first set of standard procedures to diagnose and treat sepsis in the emergency room. Lead researcher Derek Angus, chair of the department of critical care at the University of Pittsburgh Medical Center, says the key to the project is determining whether there are "golden hours" during which specific procedures can halt the progress to severe sepsis. In June, the Centers for Disease Control and Prevention reported that hospitalizations for sepsis more than doubled between 2000 and 2008 to over one million. Treatment costs increased an average of 12% annually to $14.6 billion. The CDC cites an aging population with more chronic illnesses, greater use of drugs that suppress the immune system and invasive procedures that can carry microbes into the body, and bugs that are increasingly resistant to antibiotics. Some of the rise may be due to increased recognition of the disease.
The Veterans Health Administration, the largest integrated health care system in the country, has long employed many of the approaches Medicare is pushing on all hospitals to reduce unnecessary readmissions. But new data show VA hospital patients are just as likely to end up back in a hospital bed as are patients at private hospitals. The new statistics underscore how hard it may be for hospitals to stop patients from rebounding back through their doors, a major goal of Medicare as it seeks to curtail the nation’s ballooning health costs. VA hospital patients aged 65 or older suffering from heart failure, heart attacks or pneumonia returned to a hospital within a month at the same rate as did Medicare patients initially cared for at private hospitals, according to an analysis of the data. The data were published by Medicare last month on its Hospital Compare Web site.
As of Aug. 29, nearly 112,000 people in the United States are on the waiting list for an organ transplant. As many as a few hundred of those patients are HIV-positive. To address the extreme shortage of organs available for patients on the national transplant waiting list, four major organizations have joined forces to call for the end of the universal ban on transplants from HIV-infected deceased donors. Lifting the ban, they hope, will allow HIV-positive patients quicker access to suitable organs. That, in turn, could ease the wait, however slightly, for everyone else on the list. In July, the four groups -- the American Society of Transplant Surgeons, American Society of Transplantation, Association of Organ Procurement Organizations and the United Network for Organ Sharing -- released a joint statement urging for a change in the law that prohibits the procurement of organs from HIV-positive people.
Nearly 3,000 people died in the terrorist attack on the World Trade Center in New York on September 11, 2001. But the twin towers' collapse and their smoldering ruins also exposed thousands of rescuers, firefighters and cleanup crews to toxic ash and smoke. Ten years later, medical researchers say many of these people are suffering higher-than-normal rates of serious disease and psychological problems.
Care transitions — those times when someone enters a hospital, transfers from one department to another, gets discharged to a rehabilitation center or goes home — are risky times. Health care professionals have long known that these handoffs provide prime opportunities for mistakes, most often because of communication lapses.
One unnervingly common error for hospitalized patients was documented by a very large Canadian study of older adults recently published in The Journal of the American Medical Association: essential medications inadvertently get stopped.