STRONGER HEARTS™ PARTNERSHIP:
IMPROVING THE LIVES OF PATIENTS
WITH HEART FAILURE
12th Annual Meeting - National Forum for Heart Disease and
Stroke Prevention
Barbara Jordan Conference Center, Kaiser Family Foundation
Washington, D.C.
October 22,2014
Keith C. Ferdinand, MD FACC ,FAHA,FASH,FNLA
Professor of Clinical Medicine
Tulane University School of Medicine
Chair, National Forum
Partnership. Policy. Action. 1
Definition of Heart Failure
• A complex clinical syndrome that can result from any structural
or functional cardiac disorder that impairs the ability of the
ventricle to fill with or eject blood1
• Cardinal manifestations of HF are dyspnea and fatigue, which
may limit exercise tolerance and fluid retention, which may
lead to pulmonary congestion and peripheral edema1
Normal heart2
Hypertrophied heart
(diastolic HF)2
Dilated heart
(systolic HF)2
1. Hunt SA et al. Circulation.
2005;112:e154-e235.
2. Jessup M et al. N Engl J Med.
2003;348:2007-2018.
Partnership. Policy. Action. 2
Alignment with The Public Health Action Plan to Prevent
Heart Disease and Stroke: Ten-Year Update
• The 2014 Action Plan identified a need for action in the area of heart
failure (HF):
 High prevalence and mortality
 Deaths in 2009 from HF totaled 56,410
 5.1 million Americans currently live with the disease
 Disparities: Higher prevalence among black males and females
 HF prevalence believed to be steadily increasing and estimated to
reach over 8 million Americans by 2030
 High cost burden
 HF total cost burden projected to increase to $70 billion in 2030, a
120% increase from 2012
 Projected cost of HF treatment would exceed $160 billion in direct
costs when including the total costs of all cardiac care for HF patients
Labarthe D, Grover B, Galloway J, Gordon L, Moffatt S, Pearson T, Schoeberl M, Sidney S. The Public Health Action
Plan to Prevent Heart Disease and Stroke: Ten-Year Update. Washington, DC: National Forum for Heart Disease
and Stroke Prevention; 2014
Partnership. Policy. Action. 3
Etiology of Heart Failure
Hypertension
LVH
Coronary Artery Disease
Heart
Failure
More common cause
of HF cases in blacks
LVH = left ventricular hypertrophy
MI
More common cause of
HF cases in whites
HF = heart failure
MI = myocardial infarction
Adapted from Yancy CW. J Card Fail. 2003;9:S210-S215.
Partnership. Policy. Action. 4
Long-term Antihypertensive Therapy Significantly
Reduces CV Events
Average reduction in events (%)
0
Stroke
Myocardial
infarction
Heart failure
-10
-20
20%-25%
-30
-40
35%-40%
-50
n=201,566
>50%
-60
Blood Pressure Lowering Treatment Trialists’ Collaboration. Lancet. 2000;355:1955-1964.
Partnership. Policy. Action. 5
Target-Organ Damage Due to High Intake of Sodium
Chloride.
Kotchen TA et al. N Engl J Med. 2013;368:1229-1237.
Partnership. Policy. Action. 6
Projected HF: Race/Ethnicity 2012-2030
Heidenreich PA et al. Circ Heart Fail. 2013;6:606-619.
Partnership. Policy. Action. 7
Eliminating Disparities
Social Determinants of Health
• The circumstances in which people are
born, grow up, live, work, and age, as
well as the systems put in place to deal
with illness
• These circumstances in-turn shaped by
a wider set of forces: economics, social
policies, and politics
www.cdc.gov/socialdeterminants
Partnership. Policy. Action. 8
Review of initiative goals
• The initiative began in Fall 2013 and is supported by an
unrestricted sponsorship from Novartis
• The goals of this 2-3 year initiative are to:
– Engage the right collaborators to carry out a set of high
probability strategies to improve outcomes for people with
heart failure
– Measure the outcomes and report on successes to
encourage their widespread adoption
Partnership. Policy. Action. 9
Steering Committee
Inder Anand, MD, FACC, FRCP, DPhil
Jerry Penso, MD, MBA
VA Medical System
American Medical Group Association
Javed Butler, MD, MPH
Sara Paul, DNP, FNP, FAHA
Emory University
Catawba Valley Cardiology
Marjory Cannon, MD
Ileana Piña, MD, MPH
Centers for Medicare and Medicaid Services
Albert Einstein College of Medicine
Keith C. Ferdinand, MD, FACC, FAHA, FASH
Gary Puckrein, PhD
Tulane University School of Medicine
National Minority Quality Forum
Gregg Fonarow, MD, FACC, FAHA
Rhodes Rigsby, MD, MBA
UCLA Division of Cardiology
Loma Linda University Medical Center
Laura Gordon
Joanna Sikkema, DNP, ANP-BC, FAHA
Edelman
University of North Dakota
David Kountz, MD, MBA, FACP
Frank Smart, MD, FACC, FACP
Jersey Shore Medical Center
LSU Health Sciences Center
Steven Manoukian, MD, FACC, FSCAI
Paul Underwood, MD, FACC, FACP
Hospital Corporation of America, Inc.
Boston Scientific Corporation
David Nilasena, MD, MSPH, MS
Clyde Yancy, MD, FACC, FAHA, MACP
Centers for Medicare & Medicaid Services, Region IV
Northwestern University Feinberg School of Medicine
Partnership. Policy. Action. 10
Tactic: Stronger Hearts™ Helpline pilot program
During Phase 1 of the project, Steering Committee worked to identify a
high probability tactic to address the burden of heart failure at a
community level:
• Vision: to provide the model for a scalable community-based tool to
help strengthen awareness around heart failure, heighten patients’
sense of empowerment over their disease and enhance their ability
to follow the treatment plan that their provider has laid out for them
– The Stronger Hearts™ Helpline will draw upon existing resources both
nationally and in the community, including the 2-1-1 call center
infrastructure
Phase 2 of the project will focus on implementation of the helpline,
measurement and preparation for publication
Partnership. Policy. Action. 11
Pilot site: San Bernardino, CA
Community snapshot:
– Largest county in contiguous US
– Highly diverse area:
• Both rural and urban areas
• Total population: 2.088 million
• “Majority minority” population:
49.9% Latino, 7.8% African
American
– High rates of cardiovascular disease
– Rising rates of high blood pressure
– Disproportionate rates of
hospitalization connected with CV
Partnership. Policy. Action. 12
Stronger Hearts™ Helpline pilot program
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Background on San Bernardino 2-1-1 system
History of nationwide 2-1-1
• The FCC established 2-1-1 permanently as a national network of health and
human service referral lines in 1997
San Bernardino 2-1-1 infrastructure highlights
• Launched in 2006, fielded over 69,000 calls in 2013
• Accredited by Alliance of Information and Referral Systems
• Experience serving as helpline for the Dept. of Behavioral Health (6+ years)
• Sophisticated call logging, messaging and recording capabilities
• Recognized as a trusted community resource, including by Hispanic, African
American and the elderly communities which face the highest HF disparities
Partnership. Policy. Action. 14
Launch plans
Stronger Hearts™ Helpline launch events targeted for December 2014
National Forum invites members who are interested in joining the publication
efforts related to the Stronger Hearts™ Helpline to contact Inside Edge
Consulting. Areas needed:
• Science writers
• Experienced authors
National Forum is actively recruiting San Bernardino area hospitals, health
groups, and other important stakeholders to join in participating in the
Stronger Hearts™ Helpline ---- please see our Executive Director if you would
like to become involved in:
• Representation of resources in the helpline
• Participation in awareness building
Partnership. Policy. Action. 15
Cholesterol awareness initiative
• Supported by an unrestricted grant from Sanofi / Regeneron
• Recruitment of Blue Ribbon Steering Committee to develop strategic
framework
• Dissemination of strategies and interventions
• Collection, analysis, and report of results
• Endeavor to connect and prioritize with the Million Hearts™
campaign
Partnership. Policy. Action. 16
THANK YOU
Partnership. Policy. Action. 17