4 Strategies to Prevent Stroke and Other Cardiovascular Disease Events

Healthcare organizations are being urged to help patients address cardiovascular disease risk factors such as hypertension and smoking.

A national effort to reduce cardiovascular disease (CVD) events such as heart attack and stroke has made progress but is at risk of stalling, a recent article in the Journal of the American Medical Association says.

The Million Hearts initiative, which is a joint endeavor of the Centers for Disease Control and Prevention along with the Centers for Medicare & Medicaid Services, is designed to prevent CVD events including heart attack, stroke, heart failure, and related conditions.

CVD events are costly, deadly, and often preventable. In 2016, CVD events accounted for about 2.2 million hospitalizations and 415,480 deaths, according to the JAMA article. If the 2016 trends continue through 2021, there will be an estimated 2.2 million preventable deaths and 11.8 million hospitalizations with costs of about $170 billion.

Million Hearts was launched in 2012 with a goal of preventing 1 million CVD events over five years by focusing on the ABCS risk factors: aspirin when appropriate, blood pressure control, cholesterol management, and smoking cessation. "Projections using 2012-2014 data suggest that an estimated 500,000 events may have been prevented by 2016, although improvement in risk factors was slow," the JAMA article's authors wrote.

A recent CDC report detailed the limited success in addressing the ABCS risk factors.

"Appropriate aspirin use decreased between 2011-2012 and 2013-2014. From 2011-2012 to 2015-2016, small but statistically significant reductions were observed in combustible tobacco use and physical inactivity. No significant improvements were observed for hypertension control or statin use among eligible persons; sodium consumption remained high," the JAMA article's authors wrote.

Healthcare leaders have a key role to play in reducing CVD events, the lead author of the JAMA article told HealthLeaders this week. "Leaders are critical to achieving high performance by setting an expectation of excellence; establishing an aim, target, and timeline; and resourcing their teams to make and report progress," said Janet Wright, MD, executive director of Million Hearts.

Leaders can have a significant impact in addressing CVD risk factors, she said. "Healthcare leaders can make a difference in the population's health—for their employees, patients and families, and community—by creating the conditions for excellence in the ABCS."

Wright and her coauthors identified four efforts that healthcare organizations can embrace to prevent CVD events.

1. Run a quality improvement cycle
 

"We recommend starting by prioritizing a cardiovascular condition such as hypertension, abnormal cholesterol, or smoking; pulling together a small team led by a passionate champion; analyzing current performance and setting a target and timeline for improvement; and implementing one or more strategies that move the needle," Wright said.

This approach can be applied by a variety of organizations, she said. "We have seen systems large and small use this highly replicable quality improvement cycle to achieve excellence—and to build on success in one area like blood pressure control then tackle a challenge like in-clinic smoking cessation."

2. Capitalize on MIPS measures
 

Addressing the ABCS risk factors can be done in conjunction with the cardiology, general and family medicine, and obstetrics and gynecology specialty measure sets of the CMS Merit-based Incentive Payment System (MIPS). For example, high blood pressure control is a high priority MIPS measure.

3. Gain from real-time insights
 

Tools are available to help healthcare providers track risk-factor performance, Wright and her coauthors wrote.

"Population health management tools are widely available, permitting real-time insights into performance on the ABCS. Million Hearts partners and others have developed tools to identify patients with undiagnosed hypertension who are 'hiding in plain sight.' This approach can be adapted for other risk factors."

4. Adopt and adapt proven strategies
 

To prevent CVD events, there is no need to start from scratch, the JAMA article's authors wrote.

"A common strategy is a clinician-led, team-executed treatment protocol that incorporates the practice's preferred counseling language and medications, facilitates identification of patients who need customized attention, and enables more patients to be optimally treated."