Transcript for VitalSigns Teleconference: Preventing 1 Million Heart Attacks and Strokes

OPERATOR: Welcome and thank you for standing by. At this time, all guests will be on listen-only mode for the duration of today’s conference. At the end of the presentation, we will conduct a question and answer session and if you’d like to ask a question you may press star, then one. Today’s conference is now being recorded. If you have objections, you may disconnect at this time. I will turn the conference over to Kathy Harben. Thank you, ma’am. You may begin.

KATHY HARBEN: Thank you, Karen. Thank you for join us for the release of a new CDC Vital Signs. We are joined today by Dr. Anne Schuchat, who is Principal Deputy Director for the Centers of Disease Control and Prevention and also by Dr. Janet Wright. She’s a board-certified cardiologist and Executive Director of the Million Hearts initiative. Dr. Schuchat?

ANNE SCHUCHAT: Thank you. Good afternoon and thanks for joining us today. CDC works 24/7 to protect the health, safety and security of Americans. Each month in our Vital Signs report, we focus on an issue from the front lines of CDC science and what can be done to save more lives. Heart disease and stroke can be life-altering events, impacting the lives of hundreds of thousands of people each year including our friends, families and co-workers. Unfortunately, there’s been a plateau in our nation’s progress to curb cardiovascular disease and deaths. Today’s report shows heart disease and stroke are striking many middle-aged adults. Among those 35 to 64 years old, we report about 775,000 hospitalizations and 75,000 deaths in 2016. We know that middle age can be a ticking time bomb for heart disease because this is when many risks for heart disease begin to take their toll. These cardiovascular crises are all the more tragic because so many could have been prevented. About 80 percent of deaths from premature heart disease and stroke could be prevented by changes in physical activity, diet, smoking and management of common medical conditions. The good news is that it’s not too late to make small changes that matter to heart health. At any age as adults, we all need to find out if you need to take daily aspirin, get control of high blood pressure and cholesterol with changes in diet and by taking medicine. Stop smoking and be more physically active. Our report found differences across age groups and races in healthy practices like regular physical activity and reducing salt in our diet as well as in medical management with treatment for high blood pressure, cholesterol and tobacco use. All major contributors to heart attacks, strokes, heart and kidney failure and dementia. There are populations more at risk for heart disease and stroke. Blacks are more likely than whites to develop high blood pressure especially at earlier ages and are less likely to have blood pressure under control. People with mental health and have substance abuse disorders use tobacco more frequently and that places them at higher risk for developing heart disease. People who have already had a heart attack or stroke are at high risk for a second. A key feature of today’s report is the cardiovascular data for each state. The report found important geographic differences in the rates of heart disease and stroke. While rates are higher in the Southeast and Midwest, small changes to improve heart health are needed in all states. The solution to this national challenge does not depend on a major new discovery or a breakthrough in science. Solutions already lie within every person, community and health care setting across the country. My key message is this; small changes sustained over time can produce huge improvements in cardiovascular health. Catalyzing action to stimulate these changes is what the Million Hearts initiative is all about, Million Hearts of the national initiative with the collection of dedicated organizations and individuals. Together we’re aiming to prevent one million heart attacks, strokes and related cardiovascular events by 2022. CDC joins with the centers for Medicare and Medicaid services in leading the initiative. We bring the science and the evidence showing the small changes can lead to big improvements in America’s heart health. What are we trying to do? If cardiovascular events like heart disease and stroke were improved by just 6 percent by 2022, we can prevent one million heart attacks and strokes. It’s an ambitious, but achievable goal. How can we do this? Individuals, employers, insurers, health care professionals and communities can adopt heart healthy strategies that work and take small steps toward improving their health every day. Now Dr. Janet Wright, the executive director of Million Hearts, will share more of the details from today’s reports.

JANET WRIGHT: Thank you, Dr. Schuchat. As Dr. Schuchat said, we are battling a fearsome foe and indications are strong that we’re losing ground. This report shows the magnitude of the problem including that these preventable events are now occurring in younger people and that in others, progress is slow or stalling. Let’s begin with the fact that about 80 percent of premature heart disease and strokes are preventable. Keep that statistic in mind as you hear more about the current situation and the opportunities before us to prevent cardiovascular events now and into the future. These events that million hearts is designed to prevent include hospitalizations, emergency department visits and deaths from heart attacks and chest pain, strokes and mini strokes, heart failure, high blood pressure and other largely preventable cardiovascular diseases. As Dr. Schuchat mentioned, the report delivers national as well as state-level event data made possible through CDC’s strong collaboration with the Agency for Healthcare Research and Quality. Looking across all age groups and all races, we found that each day in 2016 a thousand Americans lost their lives and more than 6,000 people were admitted to the hospital with events that million hearts is trying to prevent. These staggering numbers arrive with many small opportunities missed each day to find and treat the common and controllable causes of cardiovascular disease. We found that on adults 9 million are not taking aspirin as recommended to prevent a first or recurrent cardiovascular event. 40 million people with high blood pressure do not have it under safe control., 39 million of us who can benefit from a cholesterol-lowering medication are not taking it, 54 million adults smoke and most want to quit, and finally, 71 million of us are not getting the benefits that even a little bit of physical activity can bring. Over half of these 213 million missed opportunities occurred adults under the age of 65. These gaps jeopardize the health of our nation’s workforce, as parents and partners, employees and business owners. The good news is that it’s never too early nor too late to protect yourself and your families by making the small changes that matter. Million Hearts health systems and communities, clinicians and medical teams, employers, insurers and individuals adopt the most powerful actions to prevent heart disease and stroke. The initiative focuses on keeping people healthy, optimizing care and improving outcomes for priority populations at greatest risk for cardiovascular event. We know what works to prevent heart attack and stroke, and it turns out the little things are the big things. For instance, adding ten minutes of almost physical activity to most days of the week. Monitoring your blood pressure at home between office visits or raising concerns with your clinician about how to best manage high cholesterol. Also, for those who have had a heart attack, heart failure or surgery, spending an hour or two a week with a team of recovery experts in cardiac rehabilitation can help ensure a future free from ever having another event. One thing is clear. Preventing heart disease and stroke is everyone’s business. We each have a role to play in improving the cardiovascular health of the nation. So what can you do? If you represent a community organization or if you’re a civic leader you can ensure adoption of smoke-free policies that include electronic cigarettes, can offer safe, accessible and affordable places to be active. You can support peer groups that make being active fun and finally, you can find easy ways to raise the awareness of poor air quality days and the need for those that have had a heart attack to avoid exercising outside. If you’re a health care professional or work within a health system you can aim for excellence in the ABCS and that’s aspirin use when appropriate, blood pressure control, cholesterol management and smoking cessation, as well as, cardiac rehab. Again, sometimes it’s the small changes that can have a huge impact. Simple, but systematic changes like using clinician-lead and team-delivered treatment protocols for high blood pressure, cholesterol and tobacco cessation can help standardize medication and counseling advice and ensure that no opportunities to receive good care are missed. If you work in a state or local health department, you can use your state’s heart disease and stroke data, which we’re providing today to drive million hearts actions locally, reducing tobacco use and improving heart-healthy nutrition and physical activity. You can also connect health systems with community resources to help people adopt and practice healthy habits. If you’re an employer, you have a huge role to play through benefit design and incentives that make it easy for employees to get key medications and blood pressure monitors and services like the diabetes prevention program and cardiac rehabilitation. Work sites matter, too. The heart healthy ones are smoke-free. They offer high blood pressure monitoring, health coaches and places to be active. We don’t need a new widget or miracle drug to end cardiovascular disease, but we do need everyone to find a small step that they can start today. Start small and sustain that change over time and we’re guaranteed to see big returns in cardiovascular health across the nation. Thank you, and I’ll turn it back to the moderator now.

KATHY HARBEN: Thank you, Dr. Wright. Karen, we are now ready for the question and answer period.

OPERATOR: Thank you. At this time, if you’d like to ask a question please press star and then one and record your first and last name clearly when prompted. Again, please press star and then one if you’d like to ask a question at this time. One moment, please. First question comes from Mike Stobbe of the Associated Press. Your line is now open.

MIKE STOBBE: Hi, thank you for taking my call. I have a follow-up. My initial question is Dr. Schuchat talked about a — unfortunately, there is a plateau in the nation’s progress that curbs cardiovascular disease and death and Dr. Wright talked about you’re battling a fearsome foe and indications are strong that we’re losing ground. Why are we losing ground? Why is there a plateau? Is this related to obesity? Can you talk about different issues including the second report indicates that fewer people are taking aspirin as a preventive measure lately than compared to a few years ago. Why are we backsliding?

ANNE SCHUCHAT: Thanks so much, Mike. I’m going to let Dr. Wright answer that question for you.

JANET WRIGHT: Yes, thanks Mike. It’s a great question and really is the question. We believe that this plateau has a number of contributors. One, as you mentioned, is the several decades of obesity and diabetes and physical inactivity. Those three factors interweave to decrease health and eventually we knew they were going to have an impact on event rates. So that’s operating in the U.S. and actually globally, but in today’s report we see that individuals are not receiving or not taking medications that can support their health and can help specifically control blood pressure and cholesterol. We see very low levels of physical activity across all age groups and races, and we still have relatively, even though smoking has decreased across the country we still see subgroups of the population that continue to smoke. So, the fact that we are not exerting optimal control over those risk factors and not all of us are practicing healthy habits it’s showing up in event rates around the country.

ANNE SCHUCHAT: Did you have a follow-up, Mike?

MIKE STOBBE: I did, yeah. I need to ask. Million Hearts has been announced five or six years ago. What are the achievements of Million Hearts so far? These data seem to suggest that million hearts isn’t working. Can you speak more to that? Is the program failing or when do you expect that there will be an accomplishment? I want to understand the timeline and the goals that have been set.

ANNE SCHUCHAT: Yeah, let me begin and then let Janet provide some details. The first phase of Million Hearts made progress and not as much progress as we would have liked. We’ve learned from the experience in places where there were great success and have tried to roll those successes into the plans for the second phase. Million hearts 2022 really takes the best of that learning and focuses on the ways we think that we can make more of a difference through 2022.

JANET WRIGHT: Exactly right. As Dr. Schuchat said, what happened in the first five years when we look back is a tremendous amount of engagement and a focus on implementing the small set of interventions that have the highest impact. If I — if I can say there was one function of what Million Hearts has been to elevate those interventions that are high value and that are most likely to result in the impact that we all want on cardiovascular disease events. For this next five years, we have added a focus, as I mentioned to cardiac rehabilitation and we are sticking with ABCS because of the tremendous number of events that can be prevented when performance of those areas is high around the country. We are focusing on helping individuals monitor their blood pressures out of the office and there is strong evidence that that is a more reliable indicator of someone’s real blood pressure than pressures that might be measured in the office. From the public health standpoint, we’ve added a focus on physical activity and not so much in the individual encounter, although we encourage individual recommendations by clinicians with their patients, but we are talking about community design and support groups in the community. As it turns out, we are who we hang with and so developing friends and with groups both at home and at work can truly help build those healthy habits over time. I would say one of the things — one of the additional things that gives me great optimism about this phase of the work and all of the partners is that we have seen examples of high performance. For example, 83 places around the country have been recognized by CDC for achievement of excellence in hypertension control. Those range from small solo practices all of the way up to the VA with 70,000 clinicians. They’ve achieved control rates above 70 percent for their entire hypertensive population and a number of those champions are actually community health centers, who are serving people with a number of challenges and might be considered even more challenging or difficult to control from a blood pressure standpoint. So, we know high performance can happen and the goal in this five years is to help scale and spread those things so that everyone everywhere has the benefit of those successful interventions.

KATHY HARBEN: Next, question, please.

OPERATOR: As a reminder, please press star and then one, if you’d like to ask a question at this time. Again, star and then one to ask any questions. One moment, please. There are no questions at this time. One moment, please.

KATHY HARBEN: Karen, any questions in queue now?

OPERATOR: A question coming in from William Ford from the Washington Informer Newspaper in D.C. Sir, your line is now open.

ANNE SCHUCHAT: We can’t hear you if you’re asking a question.

WILLIAM FORD: I’m sorry. There it is.

ANNE SCHUCHAT: Thank you. We can hear you, go ahead.

WILLIAM FORD: Thank you. I wanted to know, it does mention in terms that not many people are taking aspirin. How come the report didn’t look in terms of aspects of why some people aren’t taking aspirin? Because in certain communities of color, some people are leery about going to the doctor and there’s still the aspect of I’ll be okay if I do better, but not take any medicine. In other words, was there any study of looking in terms of why some people still don’t feel right of taking medications.

ANNE SCHUCHAT: Thank you for the question. It brings up a lot of very important issues. Today’s report is just the numbers and the burden and we have this large group of adults that’s at very high risk and has more opportunities for prevention, but there’s a broader literature that has tried to study these missed opportunities. I think attitude, access to care, costs and influences are very important and maybe Dr. Wright wants to supplement that with more detail.

JANET WRIGHT: Thank you, Dr. Schuchat. I am so glad you brought this up and especially the trust issue or the reluctance to take medications. We certainly see that with the class of drugs called statins. A lot of information available through scientific sources and yet those drugs, in the right individual, have a huge benefit in addition to lifestyle modification. But we know with blood pressure control one of the ways to help individuals achieve and maintain safe blood pressure is to put the power of that pressure in their own hands by making sure they have access to a blood pressure monitor and helping them understand how to use it and most importantly or as importantly, developing that developer relationship with the clinician who wants to communicate with them, receiving their blood pressures from home and communicating good, clinical advice back to that individual. We know that that practice helps more people get to safe levels of blood pressure control, get there faster and help them maintain that level of control. So that’s called self-measured blood pressure monitoring, home monitoring or out of office monitoring and we are — we have a lot of resources available on our website and many partners of ours also make those resources available.

ANNE SCHUCHAT: Thanks for that question. Operator, is there another question?

OPERATOR: Thank you. Our next question comes from Steven Johnson of Modern Health Care Magazine. Sir, your line is now open.

STEVEN JOHNSON: Hello. Hi. Thank you for taking my question. I appreciate it. My question was really — it had to do with health care providers and what they can do in terms — has there been any, I guess, identification of any kinds of new population health measures and that the health care provider initiatives that they can do in order to address this issue. It seems as if by just adhering to the things that you suggested that we haven’t gotten much progress among health care providers. I’m wondering if there’s been any new kind of actions or use of data or such that can be — that can make and improving these health conditions?

JANET WRIGHT: That’s a great question, and it is so important because it’s not a mystery. We know, based on listening to champions, high achievers in blood pressure control. We understand now how they get there. First of all, as a system, a practice, they prioritize, for example, blood pressure control. What we have seen is that by making that a priority, everyone in that practice elevates their radar, and increases the sensitivity of their radar, so that no one slips through the cracks and they then identify everyone with the elevated pressure in that practice and institute what is called a treatment protocol or algorithm that clinicians in the practice helped design and team members execute. What that protocol does is allow individuals and patients to hear customized advice for them, receive customized treatment. The protocol allows the identification of individuals to get to the protocols and we understand what those outliers are quickly and so those people get more specialized attention. Something as simple as using a standardized treatment protocol either for hypertension or high cholesterol or smoking cessation helps everyone who needs a treatment and gets them on the right path. Let me just add a couple of more comments because that’s a critical audience that you’re serving. As a clinician, I can say that the second phase of Million Hearts emphasis on cardiac rehab was kind of eye opening to me. I had assumed that everyone who had a heart attack or stroke was getting cardiac rehab and was scared into adherence with it, having seen my mom go through that and so forth. What I understand is that many people may start, but not stick with it, and I think health care providers will encourage their patients to keep at it because it is partly the duration of time that you follow up that’s very important. There might be an emphasis when you’re leaving the hospital, you go back to your primary care clinicians and they can stress that that’s very important if you’ve had a heart attack or stroke. So, I think we all can do more as clinicians. The immunizations — the Million Hearts champions that are really getting hypertension control are showing us the way on how to do that, but it is these additional measures like cardiac rehab that people don’t often think about. Is it the last question?

KATHY HARBEN: We probably have time for two more questions.

STEVEN JOHNSON: Thank you.

OPERATOR: Our next question comes from Molly Walker of Medpage today. Your line is now open.

MOLLY WALKER: Thank you for taking my question. It’s a follow-on on Steve’s question, so does this suggest the clinicians are targeting the wrong thing and they’re not emphasizing the right things. I can’t imagine a clinician that does not emphasize that you need to stop smoking and exercise more and take medication. I guess when you talked about community health is this implying it needs to be more of a collaboration, kind of similar to STDs where the clinician and the community help and work together where the community supplements what the clinician can’t. What’s the future that you see for these type of collaborations in the future.

ANNE SCHUCHAT: Yeah. There’s a lot that happens outside of the office and having ways to reinforce healthy habits really can help an individual stick with things. So, we know that diet and exercise isn’t happening just when you’re in the doctor’s office and sticking with your plans and your medications, you know, your peers and your loved ones can help reinforce that. That partnership between health care and the community is what we call public health and health care linkages are just vital, and I would say it’s not really a question of blame like our clinicians are doing the wrong thing. What we learned in medicine is it’s a team sport and it takes everybody in the practice working together from the receptionist all of the way through to making your next appointment. It may be that the doctor or nurse doesn’t have that much time, but the office manager can help set up systems that can make sure that we’re really consistent to recognize those with high blood pressure to make sure that the monitoring that’s going on in the office and out of the office is tracked and that we can really get the results that the individual really wants.

JANET WRIGHT: And I will just add to that. To your point, Molly, the linkage between the clinic and the community is critical for blood pressure, for example, the Y’s are now in many places offering blood pressure ambassadors who can help monitor blood pressure for folks in addition to physical activity. Making sure that as a clinician recommends tobacco cessation that that individual then is referred to a quit line, which is available in every state and e-referrals can be arranged from that electronic health record, so that a patient can get the resources that they need. Then there are many community-based programs like Girl Track or Walk With A Dog or Walk With A Mare, which someone in a clinical environment can make that referral or encourage the individual to tap into those community resources.

MOLLY WALKER: Thank you.

KATHY HARBEN: We have time for one last question.

OPERATOR: Our next question comes from Nancy Milleville from Medscape Medical News. Your line is now open.

NANCY MILLEVILLE: Yes, hi. Thanks for taking my call. I wanted to ask about this substantial variation in state level cardiac events and the report notes that differences in delivery of care is a likely factor. Can you give us examples of the most notable differences in in-care delivery and what are some of the reasons for these on the regional or state-based level?

ANNE SCHUCHAT: Yeah, let me begin and first say I think there’s a number of factors that contribute to regional differences. You know, when we looked at cardiac deaths, the lowest rate was in Vermont with 111 deaths per 100,000 population and the highest was in Mississippi with over 260 deaths per 100,000. With hospitalizations, lowest rate in Wyoming and highest rate in D.C. Some clarifications are that there are population differences, differences in smoking rates across the country, differences in demographic features and, of course, differences in access to care, physical activity and potential equality of care, but I wouldn’t put all of this particular issue on the health care quality. For instance, high hospitalizations in D.C. are probably related from so many people outside from D.C. getting hospitalized in D.C. and the way we tracked rates was based on where the hospital was and not where the person lived. The death data are strong in terms of the regional variation and I think they may help us recognize that the population risk factors are quite different and we know that southern states have had high rates of many risk factors and many chronic conditions.

NANCY MILLEVILLE: Okay.

KATHY HARBEN: Thanks, everyone, for your questions today. We’ll now turn it back to Dr. Schuchat for a few closing comments.

ANNE SCHUCHAT: Heart health is serious for everyone. We are disappointed to see progress preventing heart disease and cardiovascular death rates stalling and rates even increasing in some adults when 80 percent of heart disease and strokes are preventable. We have the evidence of what works and now is the time for health care professionals to do more, for health care facilities and partners to do more, for states and for all of us to do more. Preventing one million heart attacks, strokes and other cardiovascular events by 2022 is ambitious. It’s an ambitious goal, but the lives of our loved ones are in the balance and it’s the kind of goal that we really need to achieve.

KATHY HARBEN: Thank you, Dr. Schuchat and Dr. Wright and thanks to all of the reporters who called in. If you have follow-up questions, you can reach us at media@cdc.gov or 404-639-3286. Thanks very much.

OPERATOR: Thank you. This concludes today’s conference. You may all disconnect at this time.

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U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES