- Introduction: A Top-Level Look at the Future of Federal Medicine
- Military Health System in Time of Transition as Conflicts End
- Army Medicine: Redefining Its Role in the Generation of a Ready and Resilient Force
- Air Force Medicine: Averting an Identity Crisis
- Moving Forward with Reforming the Indian Health Service
- The Clinical Pharmacy Specialist's Growing Provider Role in VA
- Public Health Service Pharmacy: Accelerating Transformation
- Military Pain Management’s Future: Less Invasive, More Data-Driven Techniques
- Navy Medicine: Strong, Agile and Ready
- Telemental Health in VA: A New Source of Support for Veterans
CDC Tackles Heart Health And Winnable Battles In 2012
The CDC is the health sentinel for our nation. Monitoring and surveillance are among our key functions, allowing the country to know the extent of health problems, which populations are most affected and whether interventions are working. We also focus on prevention to maximize health and help people live longer, healthier, more-productive lives with lower healthcare costs – particularly important in light of the ongoing budget issues facing every federal agency.
Thomas R. Frieden, MD, MPH, CDC Director
Cardiovascular disease is our nation’s leading cause of death, claiming more than 800,000 Americans a year and costing $445 billion in medical expenses and productivity losses each year. CDC, the Centers for Medicare & Medicaid Services, other federal agencies, and public and private clinical, community and other partners have launched the Million Hearts initiative to prevent one million heart attacks and strokes during the next five years. Million Hearts will use both clinical and community-based prevention measures to reduce the number of people who need treatment and improve care and treatment for those who need it.
Improved management of the ABCS – aspirin, blood-pressure control, cholesterol management, and smoking cessation – can save more lives than other clinical interventions. Currently, however, only 47% of Americans at highest risk of cardiovascular disease take daily aspirin or another anti-platelet agent, 46% with hypertension have it adequately controlled, 33% with high cholesterol receive adequate treatment, and 23% of smokers get help to quit. Increasing use of these simple clinical interventions could save more than 100,000 lives a year.
Blood-pressure control in clinical practice may be the most important of these interventions, with the potential to save the most lives. Clinicians need to check patients’ blood pressure at each visit and prescribe or adjust anti-hypertensive medications promptly. Pharmacists can monitor medication-refill patterns to ensure drugs are taken as prescribed and actively engage doctors and patients in blood-pressure management. Home monitoring can help people know if their medications are effective and provide early warning if they are not.
Improved clinical prevention and management of the ABCS will require a tighter focus on the importance of ABCS care by simplifying and aligning quality measures to emphasize what will save the most lives. Advances in health-information technology will help clinicians improve preventive care and treatment. Expanding use of prevention-oriented electronic health records will enable providers and health systems to improve ABCS care and enable quality improvement through clinical decision support, patient reminders, registries and technical assistance. Electronic health records also can be linked to quality recognition programs that may support approaches in which providers are paid more for better preventive care. Innovations including increased use of team-based care and interventions to promote medication adherence also will help clinicians make progress. The VA has made substantial progress in this area and can serve as a model for both public- and private-sector health systems.
Community-based prevention, which helps facilitate healthy choices, also is important. Million Hearts focuses on restrictions in three areas – smoking, sodium consumption and trans-fat consumption – that can substantially and rapidly improve cardiovascular health. We are working with government and private-sector partners to warn people about the harms of tobacco, reduce sodium and eliminate trans fat from processed and restaurant foods.
Million Hearts leverages and aligns existing resources and investments, so will generally not require new public spending, and will use the dedication, ingenuity and collaborative efforts of government and private sectors to succeed. Million Hearts can quickly achieve substantial and measurable health improvements that will prevent more than a million heart attacks and strokes over five years.
At CDC, we also are focusing on “winnable battles.” These are health problems that present a large burden as leading causes of illness, injury, disability and death, and for which there are evidence-based, scalable interventions we already know will work and can apply today. By concentrating on the biggest problems, our efforts can make a difference and achieve measurable results within a few years. Success will not be easy; it will require substantial effort by all segments of society. CDC has identified six important winnable battles:
- Tobacco control
- Nutrition, physical activity, obesity, and food safety
- Healthcare-associated infections
- Motor vehicle injuries
- Teen pregnancy
- HIV prevention
Tobacco remains the leading preventable cause of death, killing more than 440,000 Americans and costing nearly $200 billion in medical expenses and lost productivity annually. More than two-thirds of our country’s 46 million smokers want to quit. Most try each year but need support to succeed. We continue to make important progress to reduce tobacco use through implementation of proven tobacco-control policies contained in the WHO’s MPOWER strategy. Clinical interventions, including providing cessation advice at every patient encounter and medications where appropriate, encourage quit attempts and increase the likelihood of success. Virtually every adult who smokes and wants to quit, other than pregnant women, should be offered medications approved by the FDA, which can double or triple quit rates.