f bruce coles - improving heart health in harlem
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Heart-2-Heart:
Improving Heart Health in Harlem
Winning the MillionHearts
Campaign
Poet Langston Hughes
And so the rootBecomes the trunkAnd then a treeAnd seeds of treesAnd springtime sapAnd summer shadeAnd autumn leavesAnd shape of poemsAnd dreamsAnd more than tree.
The issue:
There is anepidemic ofbroken heartsamong peopleyounger than 65
Heart Disease and Strokes:Leading Killers in the United
States • Cause 1 of every 3 deaths
• Over 2 million heart attacks and strokes each year– 800,000 deaths– Leading cause of preventable death in
people younger than 65 – $444 B in health care costs and lost
productivity
• Greatest contributor to racial disparities in life expectancyRoger VL, et al. Circulation 2012;125:e2-
e220Heidenriech PA, et al. Circulation 2011;123:933–4
4
Why?
Tobacco Use
Overweight and Obesity
Diabetes
High Blood Pressure
High Blood Cholesterol
InadequateNutrition
Physical Inactivity
Heart DiseaseRisk Factors
Economic
CulturalEnvironmental
Political
Author James Baldwin
Anyone who has ever struggled with poverty knows how extremely expensive it is to be poor.
Social Determinants of Health
Now is the accepted time, not tomorrow, not some more convenient season. It is today that our best work can be done and not some future day or future year. It is today that we fit ourselves for the greater usefulness of tomorrow. Today is the seed time, now are the hours of work, and tomorrow comes the harvest… Sociologist, historian,
civil rights activist, author and editor
W.E.B Du Bois
Million Hearts™ Initiative
• A national initiative
• Co-led by CDC and CMS
• Supported by many sister agencies and private-sector organizations.
9
http://millionhearts.hhs.govCMS, Centers for Medicare and Medicaid Services
What is Million Hearts
• Strategies: Engage public and private sector partners in a coordinated approach to:
– Reduce the number of people who need treatment
– Improve the quality of treatment for those who need it
– Maximize current investments in cardiovascular health
Goal: Prevent 1 million heart attacks and strokes nationwide over the next 5 years
0g trans fat, salt, smoke-free laws, tobacco tax
Socioeconomic Factors
Changing the ContextTo make individuals’ default
decisions healthier
Long-lasting Protective Interventions
ClinicalInterventions
Counseling & Education
Poverty, education, housing, inequality
Approach to Impacting Health
LargestImpact
SmallestImpact
Brief intervention for alcohol, cessation treatment
Rx for high blood pressure, high cholesterol
Eat healthy, be physically active
Examples for cardiovascular
health
Clinical Emphasis: Status of the ABCS
AspirinPeople at increased risk of cardiovascular events who are taking aspirin
47%
Blood pressure
People with hypertension who have adequately controlled blood pressure
46%
CholesterolPeople with high cholesterol who are effectively managed
33%
SmokingPeople trying to quit smoking who get help
23%
MMWR: Million Hearts: Strategies to Reduce the Prevalence of Leading Cardiovascular Disease Risk Factors — United States, 2011, Early Release, Vol. 60
The Message: Prioritize the ABCS!
• If you do one thing for your patients, make it the ABCS
• These evidence-based measures are proven to prevent heart attacks and strokes
• This is how we can save the most lives and…
• …get the most health value out of our current health care investments ABCS
Series1
-15%
-10%
-5%
0%
5%
10%
15%
20%
25%
30%
12% 11% 10% 9%
5%
24%
20%
12%
5%
-8%-10%
Phy
sica
l in
activ
ity
Sec
onda
ry p
reve
ntiv
e th
erap
ies
Initi
al tr
eatm
ents
for
hear
t att
ack
or
acut
e an
gina
Trea
tmen
ts fo
r
hear
t fai
lure
Rev
ascu
lari
zatio
n
for
chro
nic
angi
naHTN
,st
atin
s
Cho
lest
erol
re
duct
ion
Sys
tolic
BP
red
uctio
n
Sm
okin
gre
duct
ion
Clinical interventions = ~50%
Risk factor reductions = ~50%
BM
I inc
reas
esD
iabe
tes
incr
ease
s
Clinical and Public Health Progress Each Contributed About Half to the 50% Reduction
in Heart Disease Deaths, US, 1980−2000
Ford ES, et al. NEJM 2007;356(23):2388-97HTN, HypertensionBP, Blood pressureBMI, Body mass index14
Key Components of Million HeartsCOMMUNITYPREVENTIONChanging the
context
CLINICALPREVENTION
Optimizing care
Focus on ABCS
Health information technology
Clinical innovations
TRANSFAT
15
Barr V, et al. Hospital Quarterly 2003; 7(1): 73-82
ActivatedCommunity
PreparedProactive
CommunityPartners
InformedActivated
Patient
PreparedProactivePractice
Team
ProductiveInteractions and
Relationships
Expanded Chronic Care Model
Health Care System
CreateSupportive
Environments
BuildHealthPolicy
StrengthenCommunity
Action
Community
SelfManagement
Skills
DeliverySystemDesign
ClinicalDecisionSupport
InformationSystems
Population Health OutcomesFunctional and Clinical Outcomes
HealthInsurancePrograms
Health InformationTechnologyTransformation
Primary Care
Public Health
HealthSystems
Management
Health Care System Change
InfrastructureReform
ReimbursementQuality Improvement
Workforce Development
Agencies• Agriculture and Markets• Environmental Conservation• Health• Labor• State• Taxation and Finance• Transportation• Dormitory Authority• Environmental Facilities Corporation• Power Authority• Energy Research and Development Authority• Homes and Community Renewal• Parks, Recreation, and Historic Preservation• State Education
Purpose• 5-yr strategic plan for long-term, sustainable economic growth• coordinate economic development• leverage public and private resources• identify and eliminate obstacles to growth• evaluation –performance measure
New York StateRegional Economic Councils
HEALTHIN
ALLPOLICIES
The present was anegg laid by the pastthat had the futureinside its shell.
Author Zora Neale Hurston
“The main thing is the YOU beneath the clothes and skin – the ability to do, the will to conquer, the determination to understand and know this great, wonderful, curious world.”
W.E.B Du Bois
Creativity Innovation
Leadership
Dr. Louis T. Wright
Dr. Godfrey Nurse
Dr. Richard CarmonaAlice Cardona
Harlem HospitalNursing School
(Lurline Vassals DeShields)
I have discovered in life that there are ways of getting almost anywhere you want to go, if you really want to go.
Langston Hughes
Take the ABCS TrainYou write the score…
Duke Ellington
Frankie Manning
VISION
winnable
associationsnetworks
project teamscoalitions
strategicpartners
jointventures
Independent Interdependent Dependent
GOALS
clearlydefined
sharedvalue
leadto
actionsustain
-able
Fires can't be made with dead embers, nor can enthusiasm be stirred by spiritless men. Enthusiasm in our daily work lightens effort and turns even labor into pleasant tasks.
Langston Hughes
In recognizing the humanity of our fellow beings,we pay ourselves the highest tribute
U.S. Supreme Court JusticeThurgood Marshall
ThankYou