"The Million Hearts"

Perspective

The “Million Hearts” Initiative — Preventing Heart Attacks and Strokes

http://www.nejm.org/doi/full/10.1056/NEJMp1110421?query=OF&

Thomas R. Frieden, M.D., M.P.H., and Donald M. Berwick, M.D., M.P.P.

September 13, 2011 (10.1056/NEJMp1110421)

Article

References

Each year, more than 2 million Americans have a heart attack or stroke, and more than 800,000 of them die; cardiovascular disease is the leading cause of death in the United States and the largest cause of lower life expectancy among blacks. Related medical costs and productivity losses approach $450 billion annually, and inflation-adjusted direct medical costs are projected to triple over the next two decades if present trends continue.1

To reduce this burden, the Department of Health and Human Services (DHHS), other federal, state, and local government agencies, and a broad range of private-sector partners are today launching a “Million Hearts” initiative to prevent 1 million heart attacks and strokes over the next 5 years by implementing proven, effective, inexpensive interventions (see tableThe Million Hearts Initiative: Principles and Examples of Interventions.).

Cardiovascular prevention works in two realms: the clinic and the community. Clinical and community interventions each contributed about equally to the 50% reduction in U.S. mortality due to heart attacks between 1980 and 2000.2 If used consistently, proven interventions could prevent more than half of heart attacks and strokes. It's time to take the next big step.

In the clinical realm, Million Hearts will improve management of the “ABCS” — aspirin for high-risk patients, blood-pressure control, cholesterol management, and smoking cessation. As for community-based prevention, the initiative will encourage efforts to reduce smoking, improve nutrition, and reduce blood pressure. It will implement the cardiovascular-disease–prevention priorities of the National Quality and National Prevention Strategies and help in meeting targets set by Healthy People 2020./.../"The Million Hearts"http://www.nejm.org/doi/full/10.1056/NEJMp1110421?query=OF&

Here is the CDC report:

Million Hearts: Strategies to Reduce the Prevalence of Leading Cardiovascular Disease Risk Factors — United States, 2011

Early Release

September 13, 2011 / 60(Early Release);1-4

Cardiovascular disease (CVD) causes one in three (approximately 800,000) deaths reported each year in the United States (1). Annual direct and overall costs resulting from CVD are estimated at $273 billion and $444 billion, respectively (2). Strategies that address leading CVD risk factors, such as hypertension, high cholesterol levels, and smoking, can greatly reduce the burden of CVD (3). To estimate the U.S. prevalence of these three risk factors, CDC analyzed data from the National Health and Nutrition Examination Survey (NHANES) on uncontrolled hypertension, uncontrolled high levels of low-density lipoprotein cholesterol (LDL-C), and current smoking. This report summarizes the results of that analysis, which found that 49.7% of U.S. adults aged ≥20 years (an estimated 107.3 million persons) have at least one of the three risk factors. To reduce the prevalence of CVD risk factors among persons in the United States, the U.S. Department of Health and Human Services, in collaboration with nonprofit and private organizations, is launching Million Hearts, a multifaceted combination of evidence-based interventions and strategies aimed at preventing 1 million heart attacks and strokes over the next 5 years.

NHANES is a complex, multistage probability sample of the civilian, noninstitutionalized U.S. population that combines interviews and physical examinations.* Data from 2007–2008, the most recent NHANES survey data available, were used to estimate the current U.S. prevalence of uncontrolled hypertension, uncontrolled high levels of LDL-C, and current smoking among adults aged ≥20 years; five NHANES survey cycles (1999–2000, 2001–2002, 2003–2004, 2005–2006, and 2007–2008) were analyzed to examine changes in prevalence over time. Examination participation rates for the five cycles ranged from 75% to 80%. During 1999–2008, a total of 24,693 persons aged ≥20 years were interviewed and examined for NHANES. From that total, 1,154 pregnant women were excluded. Of the 23,539 remaining adults, 9,891 had been randomly assigned to a morning examination and had fasted for 8–24 hours. Of the 9,891 examined, 790 with missing blood pressure or LDL-C measurements were excluded (none were missing smoking status), yielding a final sample of 9,101./.../The "Million Hearts"