The Centers for Disease Control and Prevention (CDC), in partnership with the Centers for Medicare and Medicaid Services, is spearheading the Million Hearts initiative. We spoke with the CDC's director, Dr. Thomas R. Frieden, about how the initiative will improve the care of people with heart disease and those unknowingly headed toward it.
Do you think people realize just how much their health is affected by high blood pressure, smoking, lack of exercise, and other conditions or choices?
No. I think people are hit with a cacophony of voices and, understandably, have trouble tuning into things that are truly important for health. The Million Hearts initiative focuses on changes that have been proven to prevent disease and save lives.
How did you decide on the main problems the initiative would address?
It's important to identify areas where we can make progress rapidly. These are things that are going to be hard, but that are broadly agreed to be important and that can be accomplished and rigorously monitored. The six we chose are the ABCS: use of aspirin for people who have heart disease or have had a cardiac event, blood pressure control at a level everyone agrees upon, cholesterol control in high-risk individuals, and smoking cessation, along with reducing the intake of sodium and trans fats, both of which harm cardiovascular health.
Significant progress is possible in all of these areas. Achieving our goals will save many lives and could well save money.
Large-scale efforts to prevent heart attacks, strokes, and other cardiovascular diseases usually target what regular folks should be doing. The CDC's initiative focuses more on doctors and the health care system.
Preventing heart attacks and strokes requires a team effort. One of the things we hope the Million Hearts initiative will achieve is to get cardiovascular care right. As a country, we are doing very poorly: 47% of people with a prior cardiovascular event take aspirin, 46% have their blood pressure under control, 33% have their cholesterol under control, and only a small fraction of smokers who want to quit are getting evidence-based treatments proven to increase quitting. By supporting health care professionals and health care systems, we believe we can get aspirin use, blood pressure control, and cholesterol control up to 80% in clinical systems and 65% in the community, and further reduce the percentage of smokers.
Where does individual action by healthy people and those with heart disease fit into the Million Hearts initiative?
People can take simple steps to protect themselves and their loved ones from a stroke or heart attack by finding out if they have high blood pressure or high cholesterol and helping to get it under control, talking with their health care provider to see if they should be taking an aspirin a day, quitting smoking, and eating healthfully.
People should also expect more out of their health care, like expecting to have a whole team working to keep them healthy. They may also want to find out how their provider or health care system does on the ABCS.
The great thing about Million Hearts is that it is helping people and health care providers do what they all want to do — take sensible steps to stop heart attacks and strokes. We know what those steps are. Now is the time to take them.
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