International Collaboration in Cardiovascular Disease Prevention;

Atlanta-GA USA, Amman-JordanHebron-Palestine

July 12, 2015

Omar M Lattouf MD PHD FACC FACSProfessor of Surgery

Emory University

Conflict of Interest Statement

Speaker has interest in developing new mobile technologies for self-risk assessment, vital signs reporting, and clinical progress post clinic or hospital discharge.

What are Chronic Diseases ?

Long-lasting conditions that can be controlled but not cured. CD affect

populations worldwide and are leading causes of death and disability .

Georgia Wellness Leadership WorkshopFebruary 27, 2014

• Omar M Lattouf• Brenda Fitzgerald• Michael Johns• Heval Kelli• Brent Keeling• John Sweeney• Jean O’Connor• Jag D Sheth• Larry Sperling• Dave Cantin• Michael Staufacker

Case 1: 36 Yrs. old F, 36 Weeks Gravid

Aortic Dissection During Pregnancy

Case presentation #2:

A 21-year old female patient, 26 weeks gravid with twins, presented with back pain and shortness of breath. Past medical history was significant for paraplegia afte motor vehicle accident 6 years earlier.

Embolus – in - transit Embolus, surgically removed

Metabolic Syndrome

Obesity

Impaired blood glucose

Hypertension

Elevated lipids

Heart diseaseDiabetesStrokeCancer

Kidney disease & more

CMS: A Disease at Epidemic Proportion

(Grundy 2005)

34% USA4.2% among US adolescents37% Brazil 37% Gulf Countries29% M / 40% W Jordan25% Europe22-39% India20.7-37.2% MENA17% China

2-fold risk of CVD5-fold risk of DM-II3-fold risk of dying from colon cancer1.9-2.6 risk ratio for breast cancer3.38 odd ratio for chronic kidney diseaseAssociated with liver disease, sleep apnea and erectile dysfunction.

The Economist May 30 2015

In the United States of America 1% of Patients Account for 22.7% of Healthcare Spending

Cardiometabolic Syndrome (CMS) and Disease (CMD)Key Metrics

34%1

of adults have Cardiometabolic

Syndrome

7out of 10 patients discharged have CMS conditions2

$3T *

U.S. Health Care

$2T Chronic Disease

$1T CMS-Related

~$500B CardioMetabolic Disease

* 2013 projected costs

1 American Heart Association (2013)2 CDC (2013)

Cardiometabolic – U.S. Direct Cost Overview Summary

$192

$176

$78

Cardiovascular Disease2

Chronic Kidney Disease3

CM Disease$446B

Type-2 Diabetes1

4 of Top 5 most common chronic conditions in Medicare are Cardiometabolic4

• High blood pressure (58%) • High cholesterol (45%) • Heart disease (31%) • Arthritis (29%) • Diabetes (28%)

Source: 1 American Diabetes Association (2012)2 American Heart Association (2013)3 Journal of the American Society of Nephrology (2013)4 CHRONIC CONDITIONS AMONG MEDICARE BENEFICIARIES, CHARTBOOK: 2012 EDITION

$190B

$106$89

$24 $20 $15$3

Mix of cost ($B) based on 2010 MEPS data

47% of CMD or $210B are hospital costs

Projected Direct & Indirect Cost of All CVD in USA

Lloyd-Jones et al Defining and Setting National Goals for Cardiovascular

Health Promotion and Disease ReductionThe American Heart Association’s Strategic Impact Goal Through 2020 and Beyond .

Circulation February 2, 2010

Million Hearts® national initiative to prevent 1 million heart attacks and strokes by 2017, brings together communities, health systems, nonprofit

organizations, federal agencies, and private-sector partners from across the country to fight heart disease and stroke.

Colorado Kaiser Permanente Heart360 and Blood Pressure Control

Effectiveness of BP Control

Levels of BP Drop in Control vs. Rx Groups

Level of Satisfaction with Care

Better Care is Cost Effective

• Patient – self-empowerment, self-diagnosis• Physician – improved utilization of data at

point of care• Hospital – patient tracking, prevention of

costly re-admissions

Three-pronged Approach

• Self-Analysis tool• Cardio Metabolic Syndrome “Bulls Eye”• Simple, visual model to show where one

stands in terms of ideal Cardio Metabolic health

• What areas to improve.

Patient

From Cardiovascular Disease to Cardiovascular Health A Quiet Revolution?

Darwin R. Labarthe, MD, MPH, PhD (Circ Cardiovasc Qual Outcomes. 2012;5:e86-e92.)

Trust for America’s Health reported that: • Investment of $10 per person per year in programs to increase

physical activity, improve nutrition, and prevent smoking could save than $16 billion annually within 5 years; a return of $5.60 for every $1 invested.”

• Investing in disease prevention is the most effective, common-sense way to improve health, spare millions of Americans from developing prevent- able illnesses, reduce health care costs, and improve the productivity.

OR• Build super expensive monuments for the treatment of sick

individuals, eg, a $7 billion 5-year construction in 1 medical center alone.

Differences in prevalence of selected risk factors and diseases, by socioeconomic status:

Australian Bureau of Statistics (ABS). Australian Health Survey: First Results, 2011–12. (unpublished data). Canberra: ABS, 2012

Kochanek KD, Xu JQ, Murphy SL, Miniño AM, Kung HC. Deaths: Preliminary Data for 2009. National vital statistics reports; vol 59 no 4. Hyattsville, MD: National Centers

for Health Statistics, 2011.

In the Middle East and North Africa, the leading causes of premature death and disability and their percentage changes

between 1990 and 2010 were:

• Ischemic heart disease: 44% increase• Lower respiratory infections: 47% decrease• Stroke: 35% increase• Low back pain: 77% increase• Major depressive disorder: 58% increase• Preterm birth complications: 23% decrease• Congenital anomalies: 36% decrease• Road injuries: 46% increase• Diabetes: 87% increase• Diarrheal diseases: 69% decrease

Published by the World Bank and the Institute for Health Metrics and Evaluation (IHME) at the University of Washington. September 4,2013

In Jordan • The cost of CV care increased from 645 million

in 2004 to 1 billion 200 million in 2010.

Petra – Jordan news agency.28-9-2013 .

In the Middle East and North Africa, the top 10 risk factors for premature death and disability and their percentage changes

between 1990 and 2010 were:

• Dietary risks: 64% increase• High blood pressure: 59% increase• High body mass index: 138% increase• Smoking: 10% increase• High fasting plasma glucose: 66% increase• Physical inactivity: percentage change unavailable due to lack of data• Ambient particulate matter air pollution: 4% increase• Occupational risks: 38% increase• Iron deficiency: 7% increase• High total cholesterol: 51% increase

Published by the World Bank and the Institute for Health Metrics and Evaluation (IHME) at the University of Washington. September 4,2013

In gulf countries• chronic diseases cost about 36 billion in 2013

and may reach 68 billion in 2022 .• every 10% increase in the chronic diseases the

yearly income for each country will decrease by .5% .

Aleqtisadiah news.22-1-2013.

Death rates from cardiovascular disease in selected countries in Africa and the Middle East

Drawn from data presented by the World Health Organization. Wael Almahmeed,1 Mohamad Samir Arnaout,2 Rafik Chettaoui,3 Mohsen Ibrahim,4

Mohamed Ibrahim Kurdi,5 Mohamed Awad Taher,6 and Giuseppe Mancia7, Coronary artery disease in Africa and the Middle East,2012 Feb.

• The UAE spends $272 million on diabetes treatment annually. A study by Abu Dhabi health authority estimated the overall social costs of the disease at about $1.9 billion.As mentioned in Reuters.

4-7-2012.

• While Saudi Arabia spend around $3 billion annually on treating diabetes and high blood pressure diseases.Published in news-bank.net

• For the Arab region it was expected to spend USD 8.7 billion as expenditure for diabetes in 2011.

• Abdesslam Boutayeb, Mohamed E. N. Lamlili, Wiam Boutayeb, Abdellatif Maamri, Abderrahim Ziyyat, Noureddine Ramdani.

The rise of diabetes prevalence in the Arab region .Open journal of epidemiology .Published 26-4-2012.

• Saudi Arabia could be spending over $800 million by 2020 on renal failure.

Alriyadh news.29-1-2015.

Diabetes in adults 20 years or older member countries of World Health Organization Eastern Mediterranean Region. (Blood Sugar ≥7 mmol/L)

Rajiv Khandekar,Screening and public health strategies for diabetic retinopathy in the Eastern Mediterranean Region,2012

Cholesterol in Hispanics

• Nearly Half Of Hispanic Individuals Who Have High Cholesterol Are Not Aware That They Have It.

• Only 29.5 percent who did know about it received treatment.

ACC CV News Digest June 25, 2015

The Solution:Technological Wellness: Using Point-of-

Care Analysis to Improve Patient Cardiometabolic Health

• As of January 2014:– 91% of American adults have a cell phone– 55% of American adults have a smartphone– 32% of American adults own an e-reader– 42% of American adults own a tablet computer

http://www.pewinternet.org/fact-sheets/mobile-technology-fact-sheet/

Technology in the US

Patient

http://www.pewinternet.org/fact-sheets/mobile-technology-fact-sheet/

Point-of-Care Analysis

The APP

The APP

The APP

Mobile Patient Screening and Tracking

Mobile Patient Screening and Tracking