JAMA. Published online September 6, 2018. doi:10.1001/jama.2018.13326
Despite decades-long improvement, recent evidence suggests that rates of myocardial infarction, stroke, and other cardiovascular disease (CVD) events have plateaued and are increasing among certain groups, including adults aged 35 to 64 years.1,2 These events are common, costly, and largely preventable. Million Hearts, a national initiative co-led by the Centers for Disease Control and Prevention (CDC) and the Centers for Medicare & Medicaid Services (CMS), was launched in 2012 with a 5-year aim to prevent 1 million acute cardiovascular events by improving key CVD risk factors. Projections using 2012-2014 data suggest that an estimated 500 000 events may have been prevented by 2016,3 although improvement in risk factors was slow. To accelerate progress, Million Hearts 2022 began in 2017 with new and refreshed partnerships and a strengthened framework. This Viewpoint reflects 2 recent CDC reports that together highlight the challenges and opportunities to improve the nation’s cardiovascular health.
The first report4 describes the national and state-level burden of CVD events 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. The events that Million Hearts seeks to prevent include emergency department visits, hospitalizations, and deaths due to myocardial infarction, stroke, heart failure, and related conditions.5 In 2016 alone, these events accounted for an estimated 2.2 million hospitalizations (850.9 per 100 000 population) and 415 480 deaths (157.4 per 100 000); the burden was greatest in the Southeast and Midwest.4 Without intervention and if the 2016 event rates remain constant through 2021, an estimated 16.3 million potentially preventable events (3.3 million/year) are projected to occur, including 2.2 million emergency department visits, 2.2 million deaths, and 11.8 million hospitalizations resulting in projected estimated costs of $170 billion. Approximately one-third of these events are projected to occur among adults aged 35 to 64 years.4/.../
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