Teamwork, rapid data monitoring needed to improve nation’s heart health

For cardiovascular health to improve in the general population, healthcare systems will need to collect and assess treatment data, establish collaboration between researchers and healthcare professionals, and evolve patient care in real-time based on those data, according to “Achieving Optimal Population Cardiovascular Health Requires an Interdisciplinary Team and a Learning Healthcare System,” a new Scientific Statement from the American Heart Association (AHA), published today in the Association’s flagship journal Circulation.

The progress in cardiovascular health improvements across the population has been slow, and recent mortality trends in the U.S. generate major concerns, according to the statement. In 2011, the rate of decline in cardiovascular disease mortality began slowing—indicating more deaths than the previous trends had predicted. The downward trends in deaths from heart disease and stroke also reversed course among middle-aged Americans.

“There is a need to implement innovative, integrated approaches to enhance cardiovascular health and overcome these adverse mortality trends,” said Randi Foraker, Ph.D., M.A., FAHA, FAMIA, associate professor at the Institute for Informatics at Washington University’s School of Medicine in St. Louis, Missouri, and chair of the writing committee for the Scientific Statement. “There are a number of evidence-based and actionable metrics for the treatment and control of heart disease risk factors. If we use the existing data that are commonly collected in electronic health records for ongoing monitoring, we could adjust health targets to complement and support the data and provide better preventive care.”

Performance measures or metrics are an agreed-upon set of health factors and comprise numbers that represent “good” health. The idea is that healthcare systems work to have as many patients as possible reach these performance measures.

Healthcare systems play an important role in cardiovascular health management. “Learning” healthcare systems use health information technology to guide evidence-based care and yield continuous improvements in healthcare delivery. In a learning healthcare system, cardiovascular health metrics are measured, evaluated, implemented, and re-evaluated. Researchers and health care professionals can get data on health metrics from sources such as patients’ electronic medical records, mobile devices, remote monitoring devices and wearable devices.

Improving the nation’s cardiovascular health requires reinforcing prevention efforts such as non-smoking, physical activity and eating a heart-healthy diet.

Other targets to broadly improve heart health include:

Body mass index <25kg/m;
Untreated blood pressure <120/<80 mm Hg;
Untreated fasting blood glucose <100 mg/dL; and
Untreated total cholesterol <200 mg/dL.
Leveraging the expertise of multidisciplinary healthcare professionals including epidemiologists and implementation scientists can ensure the success of cardiovascular health interventions. Epidemiologists are experts in study design, measurement and interpretation of results, and they can help define which outcomes of medical interventions are relevant. Implementation scientists devise ways to execute interventions equitably in various health care settings to ensure their effectiveness and sustainability, especially in communities with fewer resources. Scaling evidence-based interventions across healthcare systems has the potential to maximize their impact by reaching more patients.

Quality improvement programs are designed to help healthcare professionals implement guideline-guided treatment of important risk factors for cardiovascular disease prevention and help support multidisciplinary teams.

There are several recent programs aimed at reaching those at elevated risk. The AHA recently partnered with the American Diabetes Association to create Know Diabetes by Heart, a collaborative quality improvement program to reduce cardiovascular deaths, heart attacks and strokes in people with type 2 diabetes, and with the American Medical Association for Target: BP for improving blood pressure control. In addition, Million HeartsÒ 2022, a national initiative co-led by the Centers for Disease Control and Prevention and the Centers for Medicare & Medicaid Services, aims to prevent one million heart attacks and strokes within five years. Aligning performance measures across federal and partner programs like these encourages the consistent use of measures based on current treatment guidelines.

Ongoing collection and analysis of patient-level data can be used to assess performance and to improve cardiovascular disease prevention practices in a primary care setting. Clinical decision support tools embedded in the electronic health record can prompt health care professionals to provide evidence-based recommendations.

Foraker noted, “Healthcare systems must continue to meet the growing demand for data-driven strategies to optimize population cardiovascular health and to prevent chronic diseases. Successful intervention programs are designed to help healthcare professionals focus on modifiable risk factors that can prevent heart disease. Clinical decision support tools can be developed specifically to advance progress toward preventing cardiovascular disease, with an interactive interface allowing healthcare professionals to show patients how changes in their behaviors could result in improved cardiovascular health.”

AHA’s diverse advocacy efforts prioritize policies to maintain access to quality healthcare while addressing the upstream determinants of health. Changing the built environment to increase access to active transportation (i.e. walking, biking paths) and healthy, affordable food, is also key to achieving the organization’s impact goals to equitably increase healthy life expectancy.