Implementing the National Forum Strategic Priorities ThroughLeadership & Collaboration

Facilitator: Thomas A. Pearson, MD, MPH, PhD

Presenters:Darwin Labarthe, MD, MPH, PhD Keith C. Ferdinand, MD, FACC, FAHALawrence J. Appel, MD, MPH

WelcomeIntroduction

2020 Goal

Thomas Pearson, MD

Vision

Working together for a heart-healthy and stroke world.

Mission

To provide leadership and encourage collaborative action

between organizations committed to heart disease

and stroke prevention.

• We must communicate to the public at large and to policy makers the urgent need and unprecedented opportunity to prevent heart disease and stroke in order to establish widespread awareness and concern about these conditions as well as confidence in the ability to prevent and control them.

• We must transform the nation’s public health infrastructure to provide leadership and to develop and maintain affective partnerships and collaborations for the action needed.

Action Plan – Fundamental Requirements

6

Moving Forward

Vision

Mission

2020 Goal

Strategic Priority

Strategic Priority

Strategic Priority

2020 Goal

Heart disease and strokewill no longer

be the leading cause of deathfor all Americans

by 2020.

1. Currently our leading cause of death2. Afflicting all racial, ethnic, socio-economic, and

geographic subpopulations3. Preventable and treatable4. Measurable5. Amenable to interventions that can yield mortality

reductions in the near term

Key Messages

Heart Disease and Stroke are:

1. Coronary disease by itself has been the #1 cause of death in the U.S. since 1911; stroke is #3.

2. Coronary heart disease and stroke are also significant causes of morbidity, disability, and healthcare costs.

3. Non-communicable diseases are the #1 cause of death worldwide (36 million deaths in 2008) with cardiovascular disease responsible for 48% (WHO, 2011)*.

Leading Cause of Death

1. Large disparities persist between U.S. communities defined by color, language, income, and location*.

2. All population subgroups have not benefitted equally in the decline in heart disease and stroke.

3. We cannot reach our BHAG unless all Americans reduce their burdens of heart disease and stroke.

Afflict Subpopulations

1. Surveillance is a driver of health policy.a. Provides messages to increase public awareness b. Identifies disparities in racial, ethnic, socioeconomic, and

geographic subgroupsc. Allows priorities for interventions to be setd. Informs policy makers regarding burdens of diseasee. Evaluates policy and program impacts

2. Recent IOM Report has been released

Measurable

1. Trends since 1968 for coronary disease and since 1900 for stroke demonstrate the preventability of mortality*.

2. The prevention of heart disease and stroke is cost-effective*.

3. Interventions targeting the entire society, communities, health system, and individuals will be needed*.

Preventable and Treatable

U.S. 1900-1997

0

100

200

300

400

500

600

700

800

900

Year

Dea

ths/

100,

000

Po

pu

lati

on

*

CVD

HeartDisease

CHD

Stroke

*Rates are age-adjusted to 2000 standard.

CV Disease Death Rates

Frieden TR. AJPH 2010; 100:590-595

Health Impact Pyramid

Population-wide cardiovascular risk behavior change

Pearson TA, et al. Circulation 2003; 107:645-651

Conceptual Framework

Can Yield Mortality Reductions in the Near Term

1. Some population subgroups have already reached the 2020 Goal.

2. Some organizations have demonstrated large, impactful reductions in heart disease mortality by implementing what are already known.

Amendable to Interventions

Incidence and Outcomes of Acute Myocardial Infarction*

• 46,086 hospitalizations for MI during 18.7 million person years of follow-up, 1999-2008 in Kaiser Permanente Northern California network.

• Incidence of acute MI fell from 287/100,000 p-y to 208/100,000 p-y in 2008 (24% decrease adjusted for age and sex).

• ST segment elevation MI decreased from 133/100,000 p-y in 2000 to 50/100,000 p-y in 2008.

• 30-day case-fatality rate for MIs reduced 24% between 2000 and 2008.

*Yeh RW, et al. NEJM 2010; 362: 2155-65

Population Trends – Acute MI

Yeh RW, et al. NEJM 2010; 362: 2155-65

Population Trends – Acute MI

• We must communicate to the public at large and to policy makers the urgent need and unprecedented opportunity to prevent heart disease and stroke in order to establish widespread awareness and concern about these conditions as well as confidence in the ability to prevent and control them.

• We must transform the nation’s public health infrastructure to provide leadership and to develop and maintain affective partnerships and collaborations for the action needed.

Action Plan – Fundamental Requirements

2020 Goal

Heart disease and strokewill no longer

be the leading cause of deathfor all Americans

by 2020.

Strategic Priority

Darwin Labarthe, MD

Key Words

SurveillanceSystem

Surveillance System – Past Efforts

1979The Decline Conference and the Working Group

2003The Action Plan

2007The AHA Scientific Statement

Issues

AssessmentThe first core function of public health

Attainment of 2020 GoalsHealthy People

National Forum Strategic Priority

Have in place a comprehensive cardiovascular

surveillance systemto prevent and manage

heart disease and stroke by 2020.

Surveillance System – Future Efforts

Priority metricsPriority populations

Priority strategy

Strategic Priority

Keith C. Ferdinand, MD

Key Words

HealthEquity

Health Equity – Past EffortsMedical Civil Rights Movement

Medicare and Medicaid

Report of the Secretary’s Task Force on Black and Minority Health

Civil Rights Act

Office of Research on Minority Health in NIH

Unequal Treatment: Confronting Racial and Ethnic Disparities inHealth Care

1960

1964

1985

1990

2002

1965

IOM Consensus Report

Healthy People 20102000

Healthy People 20202010

2011National Quality StrategyHHS Action Plan to Reduce Racial and Ethnic Health Disparitiesand National Stakeholder Strategy for Achieving Health Equity

National Prevention Strategy

Issues

Largest Portion of InequalityIncome and Hospitalizations

Industry Around HDs

National Forum Strategic Priority

Achieve health equity and eliminate cardiovascular disparities

via implementation of population-based interventions

by 2020.

Health Equity – Future Efforts

Access to Quality CareCommunity Resources

Address Social DeterminantsData, Evaluation, Research

Strategic Priority

Lawrence Appel, MD

Key Words

SodiumReduction

Sodium Reduction – Past EffortsEducation

• Patients with hypertension• General public with or without hypertension• Providers

Guidelines• Dietary Guidelines for Americans•Guidelines and recommendations from professional organizations

Voluntary Reductions by Industry• National High Blood Pressure Education Program

Issues

Scientific Issues Practical Issues

Commercial Interests

National Forum Strategic Priority

Reduce daily sodium intake

in the general population to 1500mgby 2020.

Sodium Reduction – Future Efforts

National Salt Reduction InitiativeIOM Report

CSPI, AMA, AHA, CDC

9th National Forum

Thomas Pearson, MD

Moving Forward

Vision

Mission

2020 Goal

Sodium Reduction

Health Equity

SurveillanceSystem

Your Input

Concurrent Sessions ISurveillance System

Health Equity Sodium Reduction

Concurrent Sessions IISurveillance System

Health Equity Sodium Reduction

One Word

What one word describes your reaction to the 2020 Goal and

Strategic Priorities?

Questions?