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%

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Clinical interventions = ~50%

Risk factor reductions = ~50%

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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