— More targeted efforts needed to improve CV risk factors
Over two million preventable cardiovascular event-related hospitalizations and about 400,000 deaths occurred in 2016, including about 73,000 preventable deaths in middle-age adults, researchers found.
There were 2.2 million preventable hospitalizations and 415,480 deaths in 2016, costing the healthcare system over $32 billion, reported Janet S. Wright, MD, of the CDC, and colleagues.
Moreover, there were an estimated 775,000 hospitalizations and about 73,000 deaths among adults age 35-64, the authors wrote in a Vital Signsreport
In a conference call with the media, CDC principal deputy director Anne Schuchat, MD, warned there has been "a plateau in our nation's progress to curb cardiovascular disease and death." She noted the portion of cardiovascular events in middle-age adults, adding that "middle age can be a ticking time bomb for heart disease, when many risks for heart disease" begin to take their toll.
When asked the reason for the plateau in progress in event rates, Wright, executive director of the Million Hearts 2022 initiative, said there were a number of contributors, including "several decades of obesity, diabetes, and physical inactivity."
Schuchat emphasized that over 80% of deaths from premature heart disease and stroke could be prevented by changes in physical activity, diet, smoking, and management of medical conditions, and that preventing heart disease and stroke "does not depend on a major new discovery or breakthrough in science."
In the report, Wright and co-authors examined "mutually exclusive fatal and non-fatal cardiovascular events" using methodology related to Million Hearts 2022, which is led by CDC and the Centers for Medicare & Medicaid Services to prevent one million heart attacks, strokes, and other cardiovascular events by 2022.
The researchers found that both hospitalization and death rates were higher among men compared with women (age-standardized hospitalization rates of 989.6 and 725.1 per 100,000 population, respectively, and mortality rates of 172.3 and 143.0 per 100,000, respectively). By race/ethnicity, the highest mortality rates were among non-Hispanic blacks (211.6 per 100,000). Acute myocardial infarctions and strokes accounted for a little under half of hospitalizations and about 60% of deaths, the authors said.
On the conference call, Wright discussed the "small, missed opportunities" that patients have in preventing or treating common causes of cardiovascular disease, with over half of these missed opportunities occurring in adults <65. She cited statistics that were detailed in an additional Vital Signs report, including the following:
- 9 million American adults are not yet taking aspirin as recommended to prevent a first or recurring cardiovascular event
- 40 million adults with high blood pressure are not yet under safe control
- 39 million adults can benefit from managing their cholesterol
- 54 million adults are smokers
- 71 million adults are not physically active
In addition, Wright discussed clinical initiatives targeted by Million Hearts, including the "ABCS" strategy (aspirin when appropriate, blood pressure control, cholesterol management, and smoking cessation). She pointed to 83 places around the country, ranging from community health centers and small practices to the VA itself, that have seen achievement in hypertension control.
Schuchat characterized these efforts as "team sport medicine," using the example of home blood pressure monitoring -- an initiative stressed by Million Hearts. "Maybe a doctor or nurse doesn't have that much time, but the office manager can set up systems to make sure monitoring is tracked, and get the results an individual wants," she told MedPage Today.
Wright added that another initiative targeted by Million Hearts is cardiac rehabilitation following a cardiovascular event. She described the fact that not all patients receive this as "eye opening" to her: "Many people may start it and not stick with it, but healthcare providers can encourage patients to stick with it. We can all do more as clinicians."
Wright and co-authors concluded that unless more of an effort is made to improve cardiovascular risk factors, "an estimated 16.3 million nonfatal and fatal cardiovascular events and $173.7 billion in hospitalization costs are expected to occur during 2017-2021."
Both groups of researchers reported having no conflicts of interest.
Read the original article on Medpage Today: CDC: CV Event Prevention Stalls, Especially Among Middle-Aged Adults