Cardiovascular disease is the leading cause of death in America with around 800,000 deaths yearly.1 Americans also suffer from over 2 million heart attacks or strokes every year, and the damage is nearly $444 million dollars to our health care system and losses in productivity.1 Therefore, in 2011, the Department of Health and Human Services and several federal, state, and local agencies collaborated on the Million HeartsTM initiative to target cardiovascular disease.1 The goal is to use both clinical and community interventions to prevent a total of 1 million heart attacks and strokes by 2017.2 This goal works in concert with the American Heart Association’s much more aggressive goal of preventing approximately 4 million cardiac events by 2020.2 These lofty goals show how important it is to collaborate on health quality measures with other professionals for the benefits of our patients.
The aim of the Million HeartsTM initiative is to impassion patients to care for their own heart health through healthy diet, exercise, and medication adherence, and to also get clinicians to target guideline indicated goals for measures of heart health.1 The Centers for Disease Control and Prevention (CDC) is recommending the use of four markers to promote better health: aspirin use when indicated, blood pressure control, cholesterol control, and smoking cessation (ABCS).1 The initiative also attempts to enhance health through policies: improvement of clinician reporting of goal-directed measures within the Physician Quality Reporting System, increasing insurance coverage of preventive services, and distribution of grant funding to implement local services to reduce chronic diseases through education and screenings.2 This is a massive undertaking for these agencies and requires the work of every health care professional to ensure all targets are met.
Several organizations in Missouri have teamed-up with the Million HeartsTM campaign, including the American Heart Association, the American Stroke Association, the Missouri Department of Health and Senior Services, the Missouri Primary Care Association, Primaris, and your very own Missouri Pharmacy Association.3 They have worked together to create some guidance on how providers and pharmacists can help achieve the 2017 goal. Since community pharmacists do not have access to health records and labs, it’s important not to over-step the physician-patient relationship when trying to assess medications for individual patients. However, pharmacists should be available for open conversations with patients about goal achievements, the meaning of blood pressure and cholesterol numbers, diet and exercise, and barriers to medication adherence.3
- Appropriate aspirin use: Aspirin use is not for everyone and the benefits must be weighed against the risks for every individual patient. The US Services Preventive Task Force has issued a recommendation on aspirin use that is gender and age specific.4 Many patients will pick aspirin up from over the counter, and this can be an important discussion to have with a patient, who can then discuss the recommendation with their doctor.
- Hypertension: According to the CDC, 1/3 of all Americans have hypertension, which equates to nearly 67 million people, and only 47% of those have their blood pressure under control.5 It is important for pharmacists to be educated on the new hypertension treatment guidelines to offer the most up to date information when needed by prescribers. It is also imperative to spend time with patients who need help controlling blood pressure. Some patients may need help with medication adherence and taking medications at the proper time of day. Some patients may not be able to understand what the diagnosis of hypertension really means or how it can affect their health. Other patients may need that extra push into incorporating a healthy diet and aerobic exercise into their daily routine. Whatever the issue, increased time with our patients allows our patients to realize that we are willing to help them, which will increase the likelihood of their return and willingness to discuss their health.
- Hyperlipidemia: According to the CDC, 71 million Americans have been diagnosed with high LDL and only 1/3 of those patients have their condition controlled. New guidelines for cholesterol management were released in 2013, and it’s important to note that these guidelines have done away with targeted goals and have suggested statins for first-line use.7 With this is mind, pharmacists should be ready to indicate the previous goals and to supplement physician knowledge with the new guidelines and how these differ. These are also important to take into account for discussions with patients, as their medications may have recently changed without much preamble from their doctor to reflect the new guidelines. As with hypertension, indicating proper diet, exercise, and medication adherence is appropriate for these patients as well.
- Smoking cessation: In 2011, the CDC reports that 19% of the adult population were smokers.8 Studies have shown that even a brief clinical encounter with a patient discussing smoking cessation increases the rate of successful cessation by 50%.1 Pharmacists should be prepared to offer counseling sessions and insight to nicotine replacement products to assist patients in a difficult journey. It’s important to familiarize yourself with the tools at your disposal to assist your patients in becoming ready to quit.
Using the ABCS that have been set forward by the Million HeartsTM initiative, health care professionals can assist and empower patients to better care for their own health in a way that is manageable. More opportunities exist for pharmacists and physicians who are looking for other ways to expand the reach of the Million HeartsTM campaign, because together, we’ve got a million hearts to save.
Jennifer Richter, PharmD Candidate 2015
University of Missouri – Kansas City, MU site
MPA Rotation Student, August 2014
- Freiden T, Berwick D. The Million HeartsTM initiative: Preventing heart attacks and strokes. N Engl J Med. 2011; 365:e27.
- Tomaselli GF, Harty M, Horton K, Schoeberl M. The American Heart Association and the Million HeartsTM initiative: a presidential advisory from the American Heart Association. Circulation. 2011; 124:1795-1799.
- Primaris. Million HeartsTM in Missouri pharmacy champion role. http://www.heart.org/idc/groups/heart-public/@wcm/@mwa/documents/downloadable/ucm_461052.pdf. June 2012. Accessed August 15, 2014.
- US Preventive Services Task Force. Aspirin for the Prevention of Cardiovascular Disease, Topic Page. http://www.uspreventiveservicestaskforce.org/uspstf/uspsasmi.htm. October 2013. Accessed August 18, 2014.
- Centers for Disease Control and Prevention. High blood pressure facts. http://www.cdc.gov/bloodpressure/facts.htm. July 7, 2014. Accessed August 18, 2014.
- Centers for Disease Control and prevention. Cholesterol fact sheet. http://www.cdc.gov/dhdsp/data_statistics/fact_sheets/fs_cholesterol.htm. July 26, 2013. Accessed August 18, 2014.
- Stone NJ, Robinson J, Lichtenstein AH, Bairey Merz CN, Lloyd-Jones DM, Blum CB, McBride P, Eckel RH, Schwartz JS, Goldberg AC, Shero ST, Gordon D, Smith Jr SC, Levy D, Watson K, Wilson PWF. 2013 ACC/AHA guideline on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular risk in adults. Circulation. 2013.
- Centers for Disease Control and Prevention. Trends in current cigarette smoking among high school students and adults, United States, 1965–2011. http://www.cdc.gov/tobacco/data_statistics/tables/trends/cig_smoking/index.htm. November 14, 2013. Accessed August 18, 2014.