Million Hearts™: preventing a million heart attacks and strokes through public–private collaboration

▪ What attracted you to a cardiology career?

I fell for the physiology of the cardiovascular system in medical school. It is both fascinating and logical. The other strong attraction for me was the availability of treatments – lifestyle modifications, medications and catheter and surgical interventions – to prevent or reduce the impact of cardiovascular disease.

▪ What would you say is your greatest achievement to date?

Motherhood. From a professional viewpoint, I have been able to absorb lessons from so many people, from my family members, patients, colleagues and leaders. I hope that becoming a sponge is considered an achievement!

▪ What prompted you to make the transition from practising cardiologist to working in public health?

The opportunity has never been more right for an integrated approach to cardiovascular health, bringing the wealth of community- and population-level efforts to meet the pursuit of excellence in clinical care. I am overjoyed to get the opportunity to grow a public health sensibility.

▪ Can you explain a little about the Million Hearts™ Initiative?

Million Hearts™ is a national initiative that works to prevent a million heart attacks and strokes by 2017. The initiative is co-led by the CDC and the Centers for Medicare and Medicaid Services, within the US Department of Health and Human Services, and brings together communities, health systems, nonprofit organizations, federal agencies, and private-sector partners from across the country to fight heart disease and stroke. The initiative, which was launched in 2011, works to help improve Americans’ health and increase productivity by focusing on two goals: keeping people healthy through efforts to prevent tobacco use and to reduce sodium and trans fat consumption. This can reduce the number of people who need medical treatment, such as blood pressure or cholesterol medications to prevent heart attacks and strokes; and achieving excellence in the ‘ABCS’ – aspirin for people at risk, blood pressure control, cholesterol management and smoking cessation – will reduce heart attack and stroke rates.

▪ Why was there a need for this initiative?

Heart disease and stroke are two of the leading causes of death in the USA. Americans suffer more than 2 million heart attacks and strokes each year. Currently, cardiovascular disease costs more than US$312.6 billion annually in medical costs and lost productivity. By enlisting partners from across the health sector, Million Hearts created a national focus on combating heart disease and focuses on the areas that will save the most lives. When Million Hearts achieves its goals, 10 million more Americans with high blood pressure will have it under control, 20 million more Americans with high cholesterol will have it under control and 4 million fewer Americans will smoke.

▪ What were the initial steps taken to bring about this initiative?

CDC Director Tom Frieden, former Centers for Medicare and Medicaid Services Administrator Don Berwick and Farzad Mostashari, US Department of Health and Human Services National Coordinator for Health Information Technology, saw the ripe opportunity to focus the federal government, states and the private sector on an audacious goal, achievable through collaborative efforts. Their design and the execution of it across all sectors will save lives and prevent needless harm, while enhancing health for years to come.

▪ The initiative has received strong support from various organizations. Can you explain a little about who is involved?

Many public and private sector organizations are working to achieve the Million Hearts goals and we expect the number to grow throughout the initiative. To name a few: American Heart Association, American Medical Association, The Y, National Association of Community Pharmacists, American Nurses Association, Ohio State University and Surescripts and Medstar Health System.

These partners are building a strong foundation that will help us reach the goal. They are educating the public and healthcare professionals about the effectiveness of team-based care in helping to improve blood pressure control and requiring community health centers to report annually on the ABCS measures so that they are aware of, and can improve, their performance over time. Some private healthcare systems are integrating an ABCS evaluation and counseling into every adult patient visit.

▪ What changes have you already seen since the program started in January 2012?

We have built strong partnerships in several public and private sectors, and those partners have begun implementing practices that will help us achieve the goal. More than 15,000 individuals and organizations pledged to support Million Hearts in reducing heart attacks and strokes, and more than 60 public and private organizations made specific, actionable commitments to fight cardiovascular disease.

In 2012, these public and private partners integrated public health and clinical care by focusing on the ABCS, increasing use of health information technology including electronic health records, and integrating team-based care into everyday practice. We are seeing early successes with this model. It will be interesting to track the progress of this public health–clinical practice integration over the remaining years in the initiative.

As we enter year 2, we are challenging clinical health systems and doctors, and the public health community to further increase their collaboration to prevent cardiovascular disease. Public health helps clinical care by making the case for effective public policies, such as reducing salt and transfat in prepared foods, and establishing smoke-free environments, to help prevent heart attacks and strokes. Working together, public health and clinical experts are putting into practice systems changes and focused clinical quality measures to simplify reporting requirements, and help everyone pull in the same direction.

▪ Can you explain a little about the ‘one in a million hearts’ challenge?

The challenge encourages individuals, healthcare providers, pharmacists and pharmacies, community organizations, health officials, hospitals, employers, and private-sector organizations to take the pledge to support Million Hearts, and to take specific steps to achieve Million Hearts’ goal of preventing a million heart attacks and strokes by 2017.

▪ Can you explain a little about the recently initiated program ‘Team Up, Pressure Down’? What is this program and what impact has it already had?

‘Team Up, Pressure Down’ was developed by the CDC in collaboration with practicing pharmacists and national pharmacist organizations. The program includes educational videos, a blood pressure control journal and a wallet card to track medication use. The educational tools help pharmacists talk about current medications and ways in which patients can use the medications most effectively. More than 20 public and private pharmaceutical partners are encouraging their members to use these resources.

▪ The initiative aims to prevent a million heart attacks and strokes by 2017. What do you think the impact of this initiative will be beyond this time-frame?

Habits take a while to form and a bit longer to change. At its essence, Million Hearts is about behavior change, at the individual, clinical and health system, and community levels. A small but sustained change practiced over time results in big gains in health. Million Hearts is working with many organizations and individuals to make the case for change, to support and facilitate it, and to celebrate each step taken toward better heart health.

▪ Do you have anything else you would like to add?

If you are interested in finding out more please see the websites listed in ‘Information resources’ for new materials, stories and ways you can help keep hearts beating strong for years to come!

Information resources

More information on the Million Hearts Initiative can be found on the Million Hearts website [101], Facebook page [102] and Twitter profile [103]. Information on some of the routes being taken in order to meet the goals of the Million Hearts Initiative can also be found at [101]. A full list of the Million Hearts partners is available at [104]. More information on the ‘one in a million hearts challenge’ can be found at [105], including background information on the steps each sector need to take to support Million Hearts. More information on the ‘Team Up, Pressure Down’ program can be found at [106,107].