Introduction to Million HeartsTM
Hilary K. Wall, MPH
Health Scientist
Cardiac Learning and Action Networks
April 11, 2012
National Center for Chronic Disease Prevention and Health Promotion
Division for Heart Disease and Stroke Prevention
Burden of Heart Disease and Stroke


Cause 1 of every 3 deaths
>2 million heart attacks and strokes
occur every year; 800,000 die
 Leading cause of preventable death
among people <65
 Treatment accounts for about $1 of every
$6 spent on health care
 $444 B in health care costs and lost
productivity
Roger VL, et al. Circulation 2012;125:e2-e220
Heidenriech PA, et al. Circulation 2011;123:933–4
Improved cardiovascular care could
Burden
(cont’d)
save
100,000
lives/year in U.S.
80000
Blood pressure
control
60000
Cholesterol
control
50000
(per year)
Number of deaths prevented
70000
40000
30000
20000
Smoking
cessation
Aspirin
10000
0
20% 25% 30% 35% 40% 45% 50% 55% 60% 65% 70% 75% 80% 85% 90% 95%
Percent eligible using service
Farley TA, et al. Am J Prev Med 2010;38:600-9.
3
Status of the ABCS
Aspirin
People at increased risk of
cardiovascular events who are
taking aspirin
Blood pressure
People with hypertension who
have adequately controlled
blood pressure
People with high cholesterol
who are effectively managed
Cholesterol
Smoking
People trying to quit smoking
who get help
47%
46%
33%
23%
Valderrama AL; Loustalot F; Gillespie C; George MG; Schooley M. Million Hearts: Strategies to Reduce the Prevalence
of Leading Cardiovascular Disease Risk Factors — United States, 2011. MMWR 2011;60(36):1248-1251
Hypertensive Americans
65M hypertensives
 Uncontrolled and/or unaware – 37M
 Treated, not controlled – 17M
 Aware, not treated – 6M
 Unaware – 14M
National Health and Nutrition Examination Survey (NHANES), 2005-2008
Percentage of Medicare FFS Beneficiaries with
15 Selected Chronic Conditions, 2008
Centers for Medicare and Medicaid Services. Chronic Conditions among Medicare Beneficiaries, Chart book. Baltimore, MD. 2011.
Million HeartsTM


Goal – prevent 1M heart attacks and strokes in 5
years
Purpose – Engage public and private sector
partners in a coordinated approach to:
 Reduce the number of people who need treatment
 Optimize treatment for those who need it
 Realize the full value of prevention in cardiovascular
health
http://millionhearts.hhs.gov/
MH Public Partners

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

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

Centers for Disease Control and Prevention (co-lead)
Centers for Medicare & Medicaid Services (co-lead)
Administration on Aging
Agency for Healthcare Research and Quality
Food and Drug Administration
Health Resources and Services Administration
Indian Health Service
National Institutes of Health, National Heart Lung and Blood
Institute
National Prevention Strategy, National Quality Strategy
Office of the National Coordinator for HIT
Substance Abuse and Mental Health Services Administration
MH Private Partners







American Heart Association
America’s Health Insurance
Plans
American Medical Association
American Nurses Association
American Pharmacists’
Association and the American
Pharmacists’ Association
Foundation
The National Alliance of State
Pharmacy Associations and
the Alliance for Patient
Medication Safety
The National Community
Pharmacists Association









Kaiser Permanente
United Healthcare
Walgreens
The Y
Association of Black Cardiologists
American College of Cardiology
National Committee for Quality
Assurance
National Consumer League
American Association of Colleges
of Pharmacy
9
Key Components of Million HeartsTM
COMMUNITY
PREVENTION
Changing the context
CLINICAL
PREVENTION
Optimizing care
Focus on
ABCS
Health
Information
Technology
TRANS
FAT
Clinical
Innovations
Focus on the ABCS

Simple, uniform set of measures

Measures with a lifelong impact

Data collected or extracted in the workflow of
care

Link performance to incentives
Alignment of Clinical Quality
Measures
2012
PQRS
PQRS CV
Prevention
Measures
Group
PQRS Group
Practice
Reporting
Option
ACOs
Meaningful Use
NQF
Aspirin Use
PQRS
#204
Yes
Yes
Yes
S1 optional,
S2 core (prop)
NQF
#0068
BP Screening
PQRS
#317
Yes
Yes
Yes
BP Control
PQRS
#236
Yes
Yes
Yes
S1 optional,
S2 core (prop)
NQF
#0018
Chol Control – Pop
PQRS
#316
S2 core (prop)
TBD*

Chol Cont – DM
PQRS
#2
Yes
Yes
Yes^
S1 optional,
S2 optional (prop)
NQF
#0064

Chol Cont – IVD
PQRS
#241
Yes
Yes
Yes
S1 optional,
S2 optional (prop)
NQF
#0075
Smoking Cessation
PQRS
#226
Yes
Yes
Yes
S1 core,
S2 core (prop)
NQF
#0028
Million Hearts
Clinical Quality
Measures
* The Measure Applications Partnership recommended it be submitted to NQF for endorsement (Jan 2012)
Health Information Technology

Registries for population management

Point-of-care tools for assessment of risk for
CVD

Timely and smart clinical decision support

Reminders and other health-reinforcing
messages
14
Clinical Innovation

Embed ABCS and incentives in new models
 Health Homes, Accountable Care Organizations,
bundled payments
 Interventions that lead to healthy behaviors

Mobilize a full complement of effective team
members
 Pharmacists, cardiac rehabilitation teams
 Health coaches, community health workers, peer
wellness specialists
Role for Cardiac Learning and
Action Networks

Focus on the ABCS

Create unique partnerships

Be innovators

Share best practices
 Successful QI interventions
 “Progress Notes”
Million Hearts Resources




http://millionhearts.hhs.gov/
Frieden TR, Berwick DM. The “Million Hearts” Initiative –
Preventing Heart Attacks and Strokes. NEJM 2011;
365:e27.
Valderrama AL, et al. Million Hearts: Strategies to Reduce
the Prevalence of Leading Cardiovascular Disease Risk
Factors --- United States, 2011. MMWR
2011:60(36);1248-1251.
Tomaselli GF, et al. The American Heart Association and
the Million Hearts Initiative A Presidential Advisory From
the American Heart Association. Circulation. 2011;124:1-5.
Questions?
Hilary Wall – hwall@cdc.gov
For more information please contact Centers for Disease Control and
Prevention
1600 Clifton Road NE, Atlanta, GA 30333
Telephone, 1-800-CDC-INFO (232-4636)/TTY: 1-888-232-6348
E-mail: cdcinfo@cdc.gov Web: www.cdc.gov
The findings and conclusions in this report are those of the authors and do not necessarily represent the official
position of the Centers for Disease Control and Prevention.
National Center for Chronic Disease Prevention and Health Promotion
Division for Heart Disease and Stroke Prevention