Implementing the National Forum Strategic Priorities Through

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Implementing the National Forum Strategic
Priorities Through Leadership
Collaboration Facilitator Thomas A.
Pearson, MD, MPH, PhD Presenters Darwin
Labarthe, MD, MPH, PhD Keith C. Ferdinand, MD,
FACC, FAHA Lawrence J. Appel, MD, MPH

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Welcome Introduction 2020 Goal Thomas Pearson,
MD
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Vision
Working together for a heart-healthy and stroke
world.
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Mission
To provide leadership and encourage
collaborative action between organizations
committed to heart disease and stroke
prevention.
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Action Plan Fundamental Requirements

• We must communicate to the public at large and to
  policy makers the urgent need and unprecedented
  opportunity to prevent heart disease and stroke
  in order to establish widespread awareness and
  concern about these conditions as well as
  confidence in the ability to prevent and control
  them.
• We must transform the nations public health
  infrastructure to provide leadership and to
  develop and maintain affective partnerships and
  collaborations for the action needed.

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Moving Forward
Vision
Mission
2020 Goal
Strategic Priority
Strategic Priority
Strategic Priority
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2020 Goal
Heart disease and stroke will no longer be the
leading cause of death for all Americans by 2020.
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Key Messages
Heart Disease and Stroke are

1. Currently our leading cause of death
2. Afflicting all racial, ethnic, socio-economic,
   and geographic subpopulations
3. Preventable and treatable
4. Measurable
5. Amenable to interventions that can yield
   mortality reductions in the near term

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Leading Cause of Death

1. Coronary disease by itself has been the 1 cause
   of death in the U.S. since 1911 stroke is 3.
2. Coronary heart disease and stroke are also
   significant causes of morbidity, disability, and
   healthcare costs.
3. Non-communicable diseases are the 1 cause of
   death worldwide (36 million deaths in 2008) with
   cardiovascular disease responsible for 48 (WHO,
   2011).

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Afflict Subpopulations

1. Large disparities persist between U.S.
   communities defined by color, language, income,
   and location.
2. All population subgroups have not benefitted
   equally in the decline in heart disease and
   stroke.
3. We cannot reach our BHAG unless all Americans
   reduce their burdens of heart disease and stroke.

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Measurable

• Surveillance is a driver of health policy.
• Provides messages to increase public awareness
• Identifies disparities in racial, ethnic,
  socioeconomic, and geographic subgroups
• Allows priorities for interventions to be set
• Informs policy makers regarding burdens of
  disease
• Evaluates policy and program impacts
• Recent IOM Report has been released

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Preventable and Treatable

1. Trends since 1968 for coronary disease and since
   1900 for stroke demonstrate the preventability of
   mortality.
2. The prevention of heart disease and stroke is
   cost-effective.
3. Interventions targeting the entire society,
   communities, health system, and individuals will
   be needed.

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U.S. 1900-1997
CV Disease Death Rates
Rates are age-adjusted to 2000 standard.
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Health Impact Pyramid
Frieden TR. AJPH 2010 100590-595
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Population-wide cardiovascular risk behavior
change
Conceptual Framework
Pearson TA, et al. Circulation 2003 107645-651
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Can Yield Mortality Reductions in the Near Term
Amendable to Interventions

1. Some population subgroups have already reached
   the 2020 Goal.
2. Some organizations have demonstrated large,
   impactful reductions in heart disease mortality
   by implementing what are already known.

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Incidence and Outcomes of Acute Myocardial
Infarction
Population Trends Acute MI

• 46,086 hospitalizations for MI during 18.7
  million person years of follow-up, 1999-2008 in
  Kaiser Permanente Northern California network.
• Incidence of acute MI fell from 287/100,000 p-y
  to 208/100,000 p-y in 2008 (24 decrease adjusted
  for age and sex).
• ST segment elevation MI decreased from
  133/100,000 p-y in 2000 to 50/100,000 p-y in
  2008.
• 30-day case-fatality rate for MIs reduced 24
  between 2000 and 2008.

Yeh RW, et al. NEJM 2010 362 2155-65
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Population Trends Acute MI
Yeh RW, et al. NEJM 2010 362 2155-65
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Action Plan Fundamental Requirements

• We must communicate to the public at large and to
  policy makers the urgent need and unprecedented
  opportunity to prevent heart disease and stroke
  in order to establish widespread awareness and
  concern about these conditions as well as
  confidence in the ability to prevent and control
  them.
• We must transform the nations public health
  infrastructure to provide leadership and to
  develop and maintain affective partnerships and
  collaborations for the action needed.

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2020 Goal
Heart disease and stroke will no longer be the
leading cause of death for all Americans by 2020.
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Strategic Priority Darwin Labarthe, MD
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Key Words
Surveillance
System
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Surveillance System Past Efforts
1979 The Decline Conference and the Working
Group 2003 The Action Plan 2007 The AHA
Scientific Statement
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Issues
Assessment The first core function of public
health Attainment of 2020 Goals Healthy People
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National Forum Strategic Priority
Have in place a comprehensive cardiovascular
surveillance system to prevent and manage heart
disease and stroke by 2020.
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Surveillance System Future Efforts
Priority metrics Priority populations Priority
strategy
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Strategic Priority Keith C. Ferdinand, MD
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Key Words
Health
Equity
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Health Equity Past Efforts
1960
Medical Civil Rights Movement
Civil Rights Act
1964
Medicare and Medicaid
1965
Report of the Secretarys Task Force on Black and
Minority Health
1985
Office of Research on Minority Health in NIH
1990
Healthy People 2010
2000
Unequal Treatment Confronting Racial and Ethnic
Disparities in Health Care
2002
IOM Consensus Report
Healthy People 2020
2010
National Prevention Strategy
2011
National Quality Strategy
HHS Action Plan to Reduce Racial and Ethnic
Health Disparities and National Stakeholder
Strategy for Achieving Health Equity
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Issues
Largest Portion of Inequality Income and
Hospitalizations Industry Around HDs
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National Forum Strategic Priority
Achieve health equity and eliminate
cardiovascular disparities via implementation of
population-based interventions by 2020.
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Health Equity Future Efforts
Access to Quality Care Community
Resources Address Social Determinants Data,
Evaluation, Research
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Strategic Priority Lawrence Appel, MD
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Key Words
Sodium
Reduction
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Sodium Reduction Past Efforts

• Education
• Patients with hypertension
• General public with or without hypertension
• Providers
• Guidelines
• Dietary Guidelines for Americans
• Guidelines and recommendations from professional
  organizations
• Voluntary Reductions by Industry
• National High Blood Pressure Education Program
  

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Issues
Scientific Issues Practical Issues Commercial
Interests
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National Forum Strategic Priority
Reduce daily sodium intake in the general
population to 1500mg by 2020.
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Sodium Reduction Future Efforts
National Salt Reduction Initiative IOM
Report CSPI, AMA, AHA, CDC
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9th National Forum Thomas Pearson, MD
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Moving Forward
Vision
Mission
2020 Goal
Sodium Reduction
Health Equity
Surveillance System
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Your Input
Concurrent Sessions I Surveillance System Health
Equity Sodium Reduction Concurrent Sessions
II Surveillance System Health Equity Sodium
Reduction
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One Word
What one word describes your reaction to the 2020
Goal and Strategic Priorities?
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Questions?