Decreasing Risk of Developing Cardiovascular Disease Jill Birnbaum, State Advocacy Consultant,...

Decreasing Risk of Decreasing Risk of Developing Cardiovascular Developing Cardiovascular DiseaseDisease

Jill Birnbaum, State Advocacy Consultant, Jill Birnbaum, State Advocacy Consultant, National Center, American Heart AssociationNational Center, American Heart Association

A complete version of this update is available on our Web site, www.americanheart.org/statistics

Click on “Heart Disease and Stroke Statistics — 2006 Update”

Risk FactorsRisk Factors

• TobaccoTobacco• High Blood PressureHigh Blood Pressure• High CholesterolHigh Cholesterol• Physical InactivityPhysical Inactivity• Overweight and ObesityOverweight and Obesity• DiabetesDiabetes• NutritionNutrition• Metabolic SyndromeMetabolic Syndrome

Preventing Cardiovascular Preventing Cardiovascular Disease RiskDisease Risk

• Primary PreventionPrimary Prevention– IndividualIndividual– EnvironmentalEnvironmental

• Secondary PreventionSecondary Prevention• Heart disease and stroke are disorders Heart disease and stroke are disorders

with complex etiologies and multiple risk with complex etiologies and multiple risk factors, so a multifaceted approach to factors, so a multifaceted approach to their prevention is crucial to success.their prevention is crucial to success.

Policy and Environmental Policy and Environmental ChangeChange

• We need to create policy and environmental We need to create policy and environmental changes that will support behavior change changes that will support behavior change and risk factor prevention and control.and risk factor prevention and control.

• To support behavior change, risk factor To support behavior change, risk factor control, and uniform access to high quality control, and uniform access to high quality health care, heart disease and stroke health care, heart disease and stroke prevention programs must address policy, prevention programs must address policy, environmental, and systems-level changes in environmental, and systems-level changes in multiple settings.multiple settings.

Preventing Cardiovascular Preventing Cardiovascular Disease RiskDisease Risk• In direct contrast with conventional thinking, 80% In direct contrast with conventional thinking, 80%

to 90% of patients with coronary heart disease to 90% of patients with coronary heart disease have at lease one conventional risk factorhave at lease one conventional risk factor

• Although research on nontraditional risk factors Although research on nontraditional risk factors and genetic causes of heart disease is important, and genetic causes of heart disease is important, clinical medicine, public health policies, and clinical medicine, public health policies, and research efforts must place significant emphasis research efforts must place significant emphasis on the four conventional risk factors and the on the four conventional risk factors and the lifestyle behaviors causing them to reduce the lifestyle behaviors causing them to reduce the epidemic of coronary heart disease.epidemic of coronary heart disease.

Trends in Cardiovascular Risk Factors Trends in Cardiovascular Risk Factors in the U.S. Population Aged 20-74 in the U.S. Population Aged 20-74

NHES: 1960-62, NHANES:1971-75 to 1999-2000NHES: 1960-62, NHANES:1971-75 to 1999-2000

Source: JAMA 2005. 293: 1868-74.

30.8

33.6

1.8

39.2

28.2

3.4

33.1

3.5

26.3

36.0

27.2

19.0

14.8

29.3

4.6

17.014.9

26.4

5.0

0

5

10

15

20

25

30

35

40

45

High Total Cholesterol High Blood Pressure Smoking Diagnosed Diabetes

Per

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1960-62 1971-75 1976-80 1988-94 1999-2000

TobaccoTobacco• MortalityMortality

– From 1997–2001, an estimated 437,902 From 1997–2001, an estimated 437,902 Americans died each year of smoking-Americans died each year of smoking-related illnessesrelated illnesses

– 34.7 percent of these deaths were 34.7 percent of these deaths were cardiovascular-related.cardiovascular-related.

– Cigarette smoking results in a two-to-three-Cigarette smoking results in a two-to-three-fold risk of dying from CHD.fold risk of dying from CHD.

– An estimated 35,052 nonsmokers die from An estimated 35,052 nonsmokers die from CHD each year as a result of exposure to CHD each year as a result of exposure to environmental tobacco smoke.environmental tobacco smoke.

TobaccoTobacco

• Primary prevention goalPrimary prevention goal– Complete cessationComplete cessation– No exposure to secondhand smokeNo exposure to secondhand smoke

TobaccoTobacco• PreventionPrevention

– IndividualIndividual Stop smokingStop smoking Eliminate exposure to secondhand smokeEliminate exposure to secondhand smoke

– Environmental Change:Environmental Change: Increasing the price of cigarettes through Increasing the price of cigarettes through

tobacco tax increasestobacco tax increases Establish smokefree workplace lawsEstablish smokefree workplace laws Support tobacco control prevention and Support tobacco control prevention and

treatment programstreatment programs

TobaccoTobacco• The impact to CVD in the first year of making all The impact to CVD in the first year of making all

workplaces smoke free:workplaces smoke free:– 1540 myocardial infarctions and 360 strokes would be 1540 myocardial infarctions and 360 strokes would be

avertedaverted– Health care consumers would save $48.6 million in Health care consumers would save $48.6 million in

direct medical costs.direct medical costs.• And, by year seven:And, by year seven:

– More than 6250 cumulative myocardial infarctions More than 6250 cumulative myocardial infarctions would have been averted. would have been averted.

– More than 1270 strokes would have been averted.More than 1270 strokes would have been averted.– Total averted medical costs of $280 million, of which Total averted medical costs of $280 million, of which

$132 million (or 61%) are from former passive $132 million (or 61%) are from former passive smokers.smokers.

High Blood PressureHigh Blood Pressure

• Nearly one in three adults has HBP.Nearly one in three adults has HBP.• The prevalence of hypertension in blacks The prevalence of hypertension in blacks

in the United States is among the highest in the United States is among the highest in the world.in the world.

• Listed as a primary or contributing cause Listed as a primary or contributing cause of death in about 277,000 deaths in 2003.of death in about 277,000 deaths in 2003.

• The estimated direct and indirect cost for The estimated direct and indirect cost for HBP in 2006 is $63.5 billion.HBP in 2006 is $63.5 billion.


• Primary prevention goalPrimary prevention goal– Goal: <140/90 mm Hg; <130/85 mm Hg Goal: <140/90 mm Hg; <130/85 mm Hg

if renal insufficiency or heart failure is if renal insufficiency or heart failure is present;present;

– Or <130/80 mm Hg if diabetes is Or <130/80 mm Hg if diabetes is present.present.


• Promote healthy lifestyle Promote healthy lifestyle modificationmodification– Advocate weight reductionAdvocate weight reduction– Reduction of sodium intakeReduction of sodium intake– Consumption of fruits, vegetables, Consumption of fruits, vegetables,

and low-fat dairy productsand low-fat dairy products– Moderation of alcohol intakeModeration of alcohol intake– Physical activityPhysical activity

High Blood High Blood CholesterolCholesterol

A fat-like substance found in A fat-like substance found in animal tissue and carried in animal tissue and carried in the blood. Dietary the blood. Dietary cholesterol is present only in cholesterol is present only in foods from animal sources foods from animal sources such as whole milk dairy such as whole milk dairy products, meat, fish, poultry, products, meat, fish, poultry, animal fats and egg yolks.animal fats and egg yolks. Build-up (plaque) in

a blood vessel

High Blood CholesterolHigh Blood Cholesterol

• PrevalencePrevalence– About 10 percent of adolescents ages About 10 percent of adolescents ages

12–19 have total cholesterol levels 12–19 have total cholesterol levels exceeding 200 mg/dL.exceeding 200 mg/dL.

– Almost 100 million American adults Almost 100 million American adults have total blood cholesterol above 200 have total blood cholesterol above 200 mg/dL.mg/dL.


• PreventionPrevention– Eat foods low in saturated fat, trans fat and Eat foods low in saturated fat, trans fat and

cholesterol.cholesterol.– Lose weight if you need to.Lose weight if you need to.– Exercise for a total of at least 30 minutes on Exercise for a total of at least 30 minutes on

most or all days of the week.most or all days of the week.– Some people may also need to take Some people may also need to take

medicine, because changing their diet isn't medicine, because changing their diet isn't enough. enough.


• AftermathAftermath– Less than half of persons who qualify for Less than half of persons who qualify for

any kind of lipid-modifying treatment for any kind of lipid-modifying treatment for CHD risk reduction are receiving it.CHD risk reduction are receiving it.

– Less than half of even the highest-risk Less than half of even the highest-risk persons, those who have symptomatic CHD, persons, those who have symptomatic CHD, are receiving lipid-lowering treatmentare receiving lipid-lowering treatment

– Only about a third of treated patients are Only about a third of treated patients are achieving their LDL goal; less than 20 achieving their LDL goal; less than 20 percent of CHD patients are at their LDL percent of CHD patients are at their LDL goal.goal.

Physical (In)Activity

Physical InactivityPhysical Inactivity

• PrevalencePrevalence– 31.3 percent of U.S. adults age 18 and older 31.3 percent of U.S. adults age 18 and older

engage in any regular leisure-time physical engage in any regular leisure-time physical activity (PA).activity (PA).

– The relative risk of CHD associated with The relative risk of CHD associated with physical inactivity ranges from 1.5 to 2.4, an physical inactivity ranges from 1.5 to 2.4, an increase in risk comparable to that observed increase in risk comparable to that observed for high blood cholesterol, high blood for high blood cholesterol, high blood pressure or cigarette smoking.pressure or cigarette smoking.


• Goal: At least 30 minutes of Goal: At least 30 minutes of moderate-intensity physical activity moderate-intensity physical activity for adults.for adults.

• At least 60 minutes a day for At least 60 minutes a day for children.children.


• We cannot tell our citizens to walk and We cannot tell our citizens to walk and bike when there is no safe or welcoming bike when there is no safe or welcoming place to pursue these activities that place to pursue these activities that promote heart health. promote heart health.

• Promoting healthy and walkable Promoting healthy and walkable community environments is essential community environments is essential both for personal health and for the both for personal health and for the long-term health of our communities.long-term health of our communities.

Evidence Based Physical Evidence Based Physical Inactivity InterventionsInactivity Interventions• Support a comprehensive physical activity Support a comprehensive physical activity

program in schoolprogram in school– School-based physical education (the cornerstone)School-based physical education (the cornerstone)

Require 150 minutes per week of physical Require 150 minutes per week of physical education in grades K-6.education in grades K-6.

Require 225 minutes per week of physical Require 225 minutes per week of physical education in middle school. education in middle school.

Require physical education for graduation. Require physical education for graduation. Do not allow waivers and substitutions for Do not allow waivers and substitutions for

physical education.physical education. Develop quality physical education standards at Develop quality physical education standards at

the state level.the state level. Create PE Coordinators at the State LevelCreate PE Coordinators at the State Level

– Federal – NCLB/ESEA PolicyFederal – NCLB/ESEA Policy

Evidence Based Physical Evidence Based Physical Activity InterventionsActivity Interventions• Support a comprehensive physical activity program Support a comprehensive physical activity program

in schoolin school– Support Physical Activity Before, After, and During Support Physical Activity Before, After, and During

School – Support physical activity that is School – Support physical activity that is incorporated into the school day through elementary incorporated into the school day through elementary school recess, structured physical activity in school recess, structured physical activity in classrooms, physical activity breaks, physical activity classrooms, physical activity breaks, physical activity clubs, and special events.clubs, and special events.

– Promote walk/bike to school programs and the use of Promote walk/bike to school programs and the use of safe, well-maintained and close-to-home sidewalks, safe, well-maintained and close-to-home sidewalks, bike paths, trails, and recreation facilities.bike paths, trails, and recreation facilities.

Evidence Based Physical Evidence Based Physical Inactivity InterventionsInactivity Interventions

• Community-wide campaigns, Community-wide campaigns, including point-of-decision including point-of-decision promptsprompts

http://www.do-groove.com/

Evidence Based Physical Activity Evidence Based Physical Activity InterventionsInterventions

• Creation of or enhanced access to Creation of or enhanced access to places for physical activity combined places for physical activity combined with informational outreach activitieswith informational outreach activities

• Street-scale urban design and land use Street-scale urban design and land use policies and practicespolicies and practices

• Community-scale urban design and land Community-scale urban design and land use policies and practicesuse policies and practices

Overweight and ObesityOverweight and Obesity• PrevalencePrevalence

– An estimated 9.2 million children and An estimated 9.2 million children and adolescents ages 6–19 are considered adolescents ages 6–19 are considered overweight or obese.overweight or obese.

– Over 10 percent of preschool children ages Over 10 percent of preschool children ages 2–5 are overweight, up from 7 percent in 2–5 are overweight, up from 7 percent in 1994.1994.

– In 2003, an estimated 136,500,000 American In 2003, an estimated 136,500,000 American adults were overweight, and 64,000,000 were adults were overweight, and 64,000,000 were obese.obese.

– Since 1993, the prevalence of those who are Since 1993, the prevalence of those who are obese increased over 61 percent.obese increased over 61 percent.

Obesity Trends* Among U.S. AdultsObesity Trends* Among U.S. AdultsBRFSS, 1985BRFSS, 1985

(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)

No Data <10% 10%–14%



No Data <10% 10%–14%



No Data <10% 10%–14% 15%–19%



No Data <10% 10%–14% 15%–19% ≥20%



No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

ObesityObesity

• ImpactImpact– Obesity was associated with Obesity was associated with

nearly 112,000 excess deathsnearly 112,000 excess deaths– Abdominal obesity is an Abdominal obesity is an

independent risk factor for independent risk factor for ischemic stroke in all racial and ischemic stroke in all racial and ethnic groupsethnic groups

“the first generation where children will die before their parents”International Congress on Obesity. August 2002

-Actually, 8 million children and adolescents are overweight

- Over the last two decades the rates for overweight adolescents have tripled.

-Based on current trends 1 Based on current trends 1 in 3 children born in the year in 3 children born in the year 2000 will develop Type II 2000 will develop Type II Diabetes.Diabetes.

-A National Security IssueA National Security Issue

ObesityObesity

• Initiate weight-management program Initiate weight-management program through caloric restriction and increased through caloric restriction and increased caloric expenditure as appropriate.caloric expenditure as appropriate.

• Many obese and overweight people may Many obese and overweight people may have difficulty losing weight, but by have difficulty losing weight, but by losing even as few as 10 pounds, you losing even as few as 10 pounds, you can lower your heart disease risk.can lower your heart disease risk.

The Search for Evidence The Search for Evidence Based Obesity InterventionsBased Obesity Interventions• School-based interventions School-based interventions • Worksite interventions Worksite interventions • Healthcare system Healthcare system

interventions interventions • Community-wide interventions Community-wide interventions

Diabetes MellitusDiabetes Mellitus

• PrevalencePrevalence– In 2003, the prevalence of physician-In 2003, the prevalence of physician-

diagnosed diabetes was 14,100,000; diagnosed diabetes was 14,100,000; the prevalence of undiagnosed the prevalence of undiagnosed diabetes was 6,000,000.diabetes was 6,000,000.

– Since 1990, the prevalence of those Since 1990, the prevalence of those diagnosed with diabetes increased 61 diagnosed with diabetes increased 61 percent.percent.


• MortalityMortality– At least 65 percent of people with At least 65 percent of people with

diabetes mellitus die of some form of diabetes mellitus die of some form of heart or blood vessel disease.heart or blood vessel disease.

– Heart disease death rates among Heart disease death rates among adults with diabetes are two-to-four adults with diabetes are two-to-four times higher than the rates for adults times higher than the rates for adults without diabetes.without diabetes.


• First step is diet and exercise. First step is diet and exercise. • Second-step therapy is usually oral Second-step therapy is usually oral

hypoglycemic drugs.hypoglycemic drugs.• Third-step therapy is insulin.Third-step therapy is insulin.

NutritionNutrition

• The Economic Research Service of the USDA suggests that the average daily calorie consumption in the United States increased by 12 percent between 1985 and 2000, or roughly 300 calories.

• Between 1977 and 1996, portion sizes for key food groups grew markedly in the United States, not only at fast-food outlets but also in homes and at conventional restaurants.

NutritionNutrition

• ImpactImpact– Each year over $33 billion in Each year over $33 billion in

medical costs and $9 billion in medical costs and $9 billion in lost productivity due to heart lost productivity due to heart disease, cancer, stroke and disease, cancer, stroke and diabetes are attributed to diet.diabetes are attributed to diet.

NutritionNutrition• Consumption of a variety of fruits, vegetables, Consumption of a variety of fruits, vegetables,

grains, low-fat or nonfat dairy products, fish, grains, low-fat or nonfat dairy products, fish, legumes, poultry, and lean meats.legumes, poultry, and lean meats.

• Match energy intake with energy needs and Match energy intake with energy needs and make appropriate changes to achieve weight make appropriate changes to achieve weight loss when indicated.loss when indicated.

• Modify food choices to reduce saturated fats Modify food choices to reduce saturated fats (<10% of calories), cholesterol (<300 mg/d), and (<10% of calories), cholesterol (<300 mg/d), and trans-fatty acids by substituting grains and trans-fatty acids by substituting grains and unsaturated fatty acids from fish, vegetables, unsaturated fatty acids from fish, vegetables, legumes, and nuts.legumes, and nuts.

• Limit salt intakeLimit salt intake• Limit alcohol intake among those who drink.Limit alcohol intake among those who drink.

Evidence Based Nutrition Evidence Based Nutrition InterventionsInterventions• School-based nutrition programs; School-based nutrition programs; • Food and beverage advertising to Food and beverage advertising to

children; and children; and • Community approaches to increase Community approaches to increase

fruit & vegetable intake fruit & vegetable intake

Metabolic SyndromeMetabolic Syndrome

• Metabolic syndrome (MetS) is Metabolic syndrome (MetS) is characterized by a group of metabolic characterized by a group of metabolic risk factors in one person.risk factors in one person.

• The syndrome is associated with obesity The syndrome is associated with obesity and insulin resistance.and insulin resistance.

• Metabolic syndrome is considered a Metabolic syndrome is considered a clustering of metabolic complications of clustering of metabolic complications of obesity.obesity.

Metabolic SyndromeMetabolic Syndrome• An estimated 1 million 12–19-year-old An estimated 1 million 12–19-year-old

adolescents in the United States have MetS, or adolescents in the United States have MetS, or 4.2 percent overall4.2 percent overall

• An estimated 47 million U.S. residents have An estimated 47 million U.S. residents have MetS. The age-adjusted prevalence of MetS for MetS. The age-adjusted prevalence of MetS for adults is 23.7 percent.adults is 23.7 percent.

• People with MetS are about two times more People with MetS are about two times more likely to have prevalent CHD than those without likely to have prevalent CHD than those without the syndrome after adjusting for established the syndrome after adjusting for established risk factors.risk factors.

Bottom LineBottom Line

• Primary prevention of CVD risk Primary prevention of CVD risk factors can help prevent 80 percent factors can help prevent 80 percent of coronary heart disease and 90 of coronary heart disease and 90 percent of type 2 diabetes percent of type 2 diabetes

Secondary Prevention of Secondary Prevention of Cardiovascular DiseaseCardiovascular Disease• There is a growing body of evidence confirms There is a growing body of evidence confirms

that aggressive comprehensive risk factor that aggressive comprehensive risk factor management improves survival, reduces management improves survival, reduces recurrent events and the need for interventional recurrent events and the need for interventional procedures, and improves the quality of lifeprocedures, and improves the quality of life

• The secondary prevention patient population The secondary prevention patient population includes those with established coronary and includes those with established coronary and other atherosclerotic vascular disease, other atherosclerotic vascular disease, including peripheral arterial disease, including peripheral arterial disease, atherosclerotic aortic disease and carotid atherosclerotic aortic disease and carotid artery disease. artery disease.

Components of Secondary Components of Secondary PreventionPrevention

Cigarette smoking cessationCigarette smoking cessationBlood pressure controlBlood pressure controlLipid management to goalLipid management to goalPhysical activityPhysical activityWeight management to goalWeight management to goalDiabetes management to goalDiabetes management to goal

Antiplatelet agents / anticoagulantsAntiplatelet agents / anticoagulants

Renin angiotensin aldosterone system blockersRenin angiotensin aldosterone system blockers

Beta blockersBeta blockers

Influenza vaccinationInfluenza vaccination

Goal: Complete Cessation and No Exposure to Environmental

Tobacco Smoke

Cigarette Smoking Cigarette Smoking RecommendationsRecommendations

•Ask about tobacco use status at every visit.

•Advise every tobacco user to quit.

•Assess the tobacco user’s willingness to quit.

•Assist by counseling and developing a plan for quitting.

•Arrange follow-up, referral to special programs, or pharmacotherapy (including nicotine replacement and bupropion.

•Urge avoidance of exposure to environmental tobacco smoke at work and home.

Goal: <140/90 mm Hg or <130/80 if diabetes or chronic kidney disease

Blood Pressure Control Blood Pressure Control RecommendationsRecommendations

Blood pressure 120/80 mm Hg or greater:

Initiate or maintain lifestyle modification: weight control, increased physical activity, alcohol moderation, sodium reduction, and increased consumption of fresh fruits vegetables and low fat dairy products

Blood pressure 140/90 mm Hg or greater (or 130/80 or greater for chronic kidney disease or diabetes)

As tolerated, add blood pressure medication, treating initially with beta blockers and/or ACE inhibitors with addition of other drugs such as thiazides as needed to achieve goal blood pressure

Lipid Management Lipid Management RecommendationsRecommendations

Start dietary therapy (<7% of total calories as saturated fat and <200 mg/d cholesterol)

Adding plant stanol/sterols (2 gm/day) and viscous fiber (>10 mg/day) will further lower LDL

Promote daily physical activity and weight management.

Encourage increased consumption of omega-3 fatty acids in fish or 1 g/day omega-3 fatty acids in capsule form for risk reduction.

For all patients

Physical Activity RecommendationsPhysical Activity Recommendations

Assess risk with a physical activity history and/or an exercise test, to guide prescription

Encourage 30 to 60 minutes of moderate intensity aerobic activity such as brisk walking, on most, preferably all, days of the week, supplemented by an increase in daily lifestyle activities

Advise medically supervised programs for high-risk patients (e.g. recent acute coronary syndrome or revascularization, HF)

Goal: 30 minutes 7 days/week, minimum 5 days/week

Weight Management RecommendationsWeight Management Recommendations

Goal: BMI 18.5 to 24.9 kg/m2Waist Circumference: Men: < 40 inches Women: < 35 inches

Assess BMI and/or waist circumference on each visit and consistently encourage weight maintenance/ reduction through an appropriate balance of physical activity, caloric intake, and formal behavioral programs when indicated.

If waist circumference (measured at the iliac crest) >35 inches in women and >40 inches in men initiate lifestyle changes and consider treatment strategies for metabolic syndrome as indicated.

The initial goal of weight loss therapy should be to reduce body weight by approximately 10 percent from baseline. With success, further weight loss can be attempted if indicated.

*BMI is calculated as the weight in kilograms divided by the body surface area in meters2. Overweight state is defined by BMI=25-30 kg/m2. Obesity is defined by a BMI >30 kg/m2.

Diabetes Mellitus Recommendations

Goal: Hb A1c < 7%

Lifestyle and pharmacotherapy to achieve near normal HbA1C (<7%).

Vigorous modification of other risk factors (e.g., physical activity, weight management, blood pressure control, and cholesterol management as recommended).

Coordinate diabetic care with patient’s primary care physician or endocrinologist. I (C)

HbA1c = Glycosylated hemoglobin

Antiplatelet Agents / Anticoagulation Antiplatelet Agents / Anticoagulation RecommendationsRecommendations

Renin-Angiotensin-Aldosterone Renin-Angiotensin-Aldosterone System (RAAS) Blockers System (RAAS) Blockers

RecommendationsRecommendations

-blocker Recommendations-blocker Recommendations

Influenza VaccinationInfluenza Vaccination

Patients with cardiovascular disease should have influenza vaccination

The Need to Implement Secondary The Need to Implement Secondary PreventionPrevention

• Multiple studies of the use of these recommended therapies in appropriate patients continue to show that many patients in whom therapies are indicated are not receiving them in actual clinical practice.

• The AHA and ACC urge that in all medical care settings where these patients are managed that programs to provide practitioners with useful reminder clues based on the guidelines, and continuously assess the success achieved in providing these therapies to the patients who can benefit from them be implemented.

• Encourage that the AHA’s Get With the Guidelines and/or ACC’s Guidelines Applied to Practice Programs be instituted to identify appropriate patients for therapy

AHA GWTG ProgramAHA GWTG Program

GWTG is a national initiative of the AHA to improve guidelines adherence in patients hospitalized with cardiovascular disease.

GWTG uses collaborative learning sessions, conference calls, e-mail and staff support to assist hospital teams improve acute and secondary prevention care systems.

A web-based Patient Management Tool is used for point of care data collection and decision support, on-demand reporting, communication and patient education.

• Evidence confirms that aggressive comprehensive risk factor management improves survival, reduces recurrent events and the need for interventional procedures, and improves the quality of life for these patients.

• Every effort should be made to ensure that patients are treated with evidence-based, guideline recommended, life-prolonging therapies in the absence of contraindications or intolerance.

Secondary Prevention ConclusionsSecondary Prevention Conclusions

Quality and Availability of Care Quality and Availability of Care PolicyPolicy

• Promote Adherence to Clinical Promote Adherence to Clinical Guidelines & Treatment Protocols Guidelines & Treatment Protocols

• Promote Quality and Performance Promote Quality and Performance Indicators Indicators

• Promote Access to Health Coverage Promote Access to Health Coverage • Monitor Pay-for-quality and Non-Monitor Pay-for-quality and Non-

financial Incentives financial Incentives • Monitor Drug Formulary Policy Monitor Drug Formulary Policy • Monitor Health Information Technology Monitor Health Information Technology

What should we be working What should we be working towards in HIT? towards in HIT?

AHA HIT ChecklistAHA HIT Checklist

11 Includes Clinical Decision Support Tool (GWTGs)Includes Clinical Decision Support Tool (GWTGs)

22 Committees/Councils and TAPs include chronic care Committees/Councils and TAPs include chronic care representation & guidelines developerrepresentation & guidelines developer

33 Encourage the funding and evaluation of EHR and PHR Encourage the funding and evaluation of EHR and PHR studiesstudies

44 Ensure patient centric language is includedEnsure patient centric language is included

55 Activities at state level should not conflict with federal Activities at state level should not conflict with federal activities by the HHS, AHIC or AHRQ. activities by the HHS, AHIC or AHRQ.

66 Encourages interoperability and connectivity Encourages interoperability and connectivity

What should we be working What should we be working towards in HIT? (Cont.) towards in HIT? (Cont.)

AHA HIT ChecklistAHA HIT Checklist77 Additional research on how consumer incentives can be Additional research on how consumer incentives can be

used to encourage beneficiaries to utilize PHRsused to encourage beneficiaries to utilize PHRs

88 Minimize potential adverse affect of HIPAA and privacy Minimize potential adverse affect of HIPAA and privacy to clinical researchto clinical research

99 Watch for P4P language and refer to P4Q statementWatch for P4P language and refer to P4Q statement

1010 NFI statement (upcoming)NFI statement (upcoming)

1111 Cost effectiveness (misuse, under use, overuse) Cost effectiveness (misuse, under use, overuse)

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