Myocardial infarction, strokes, heart failure and other largely preventable conditions caused 2.2 million hospitalizations in 2016, resulting in $32.7 billion in costs, and 415,000 deaths occurred, according to a Vital Signs report released Sept. 6 by the Centers for Disease Control and Prevention (CDC).

Using data from the Agency for Healthcare Research and Quality's Healthcare Cost and Utilization Project databases and the National Vital Statistics System, the report looks at the national and state-level burden of cardiovascular disease events that are "most likely to be prevented by reducing sodium consumption, increasing physical activity, and improving 'ABCS:' aspirin when appropriate, blood pressure control, cholesterol management and smoking cessation."

Results showed that hospitalization and death rates were highest among men, non-Hispanic blacks and increased with age. Further, state-level variation occurred in rates of emergency department visits, hospitalizations and death. The researchers predict that without preventive interventions, "approximately 16.3 million events and $173.7 billion in hospitalization costs could occur during 2017-2021."

At the state level, the report stresses that with coordinated efforts, one million cardiovascular events could be prevented by 2022 if every state reduces these events by 6 percent. While rates are higher in the Southeast and Midwest, improvements are needed in all states.

In addition, a second Vital Signs report looked at the prevalence of key cardiovascular disease risk factors. Using data from the National Health and Nutrition Examination Survey, the National Survey on Drug Use and Health and the National Health Interview Survey, researchers found that:

• 9 million adults are not taking aspirin as recommended
• 40 million adults have uncontrolled hypertension
• 39 million adults are not managing their cardiovascular disease risk through recommended statin use
• 54 million adults are smokers and could benefit from cessation interventions
• 71 million adults are not physically active

Janet S. Wright, MD, FACC

William J. Oetgen, MD, MBA, FACC

"These national numbers are concerning," notes Janet S. Wright, MD, FACC, executive director of Million Hearts, a national initiative co-led by the CDC and the Centers for Medicare and Medicaid Services (CMS) to prevent one million heart attacks and strokes by 2022, et al., in a related viewpoint article published in the Journal of the American Medical Association.

Million Hearts was launched in 2012 with an aim to improve key cardiovascular disease risk factors. In 2017, Million Hearts 2022 began with "new and refreshed partnerships and a strengthened framework." Wright et al., explain that the two reports "highlight the challenges and opportunities to improve the nation's cardiovascular health."

"The College has been a partner with Million Hearts every step along the way and we are committed to helping the initiative achieve its goal," says William J. Oetgen, MD, MBA, FACC, executive vice president for Science and Quality, Education, and Publications of the ACC.

Of note, the U.S. government has provided funding to support all 50 states, the District of Columbia, municipalities, and tribal communities to ensure clinical and public health agencies are working together to prevent cardiovascular disease and stroke. To encourage this support, earlier this year, the College submitted written testimony urging Congress to continue to appropriate funds toward agencies doing vital work in cardiovascular disease treatment and prevention, including the Million Hearts initiative.

The reports specifically offer tips for health care providers and systems, noting that they can:

• Focus on the ABCS of heart health
• Take a team approach by using technology, standard processes, and the skills of everyone in the health care system to find and treat those at risk for myocardial infarction and stroke
• Ensure people who have had a myocardial infarction or stroke get the care they need to recover well and reduce their risk of another event; and
• Promote physical activity and healthy eating among patients and employees

To further incentivize health care professionals and systems, Wright et al., explain "the ABCS are embedded in more than a dozen quality reporting initiatives including the cardiology … sets of the CMS Merit-based Incentive Payment System (MIPS). Controlling High Blood Pressure (NQF 0018) is a 'high priority' measure in MIPS, and the ABCS measures are mandatory for large group reporting via the MIPS web interface."

The College's PINNACLE Registry and Diabetes Collaborative Registry can help practices track these metrics and improve outcomes as practices can report their MIPS data through these registries.

"Accountable care organizations and many commercial payers are using these measures in value-based arrangements," explain Wright et al. Further, "the Million Hearts CVD Risk Reduction model is the first pay-for-prevention approach, testing the impact of individualized risk assessment on event rates in Medicare beneficiaries. If successful, it could be scaled nationally."

"The College's mission – to transform cardiovascular care and to improve heart health – coupled with its Vision to create a world where innovation and knowledge optimize cardiovascular care and outcomes, aligns with Million Hearts' goals and objectives," says Tim Attebery, CEO of ACC. "Our collective efforts will enable this progress as we strive to change and improving cardiovascular care around the world."

"Small changes – the right changes, sustained over time – can produce huge improvements in cardiovascular health," adds Wright.

Keywords: ACC Publications, Cardiology Magazine, Health Policy, Hydroxymethylglutaryl-CoA Reductase Inhibitors, Aspirin, Accountable Care Organizations, Smoking Cessation, Motivation, Public Health, American Medical Association, Risk Factors, Centers for Medicare and Medicaid Services, U.S., Blood Pressure, Medicaid, Myocardial Infarction, Stroke, Heart Failure, Medicare, Risk Assessment, Diabetes Mellitus, Centers for Disease Control and Prevention, U.S., Hypertension, Registries, Cholesterol, Risk Reduction Behavior, Emergency Service, Hospital, Exercise, Financial Management, Health Services Research, Health Personnel, Health Care Costs, Hospitalization, Sodium