The Worldwide Environment of Cardiovascular Disease: Prevalence, Diagnosis, Therapy, and Policy Issues: A Report From the American College of Cardiology

Perspective:

The following are 10 points to remember about this report:

1. The environment in which the field of cardiology finds itself has been rapidly changing. This report is intended to provide a timely snapshot of the socioeconomic, political, and scientific aspects of this environment as it applies to practice both in the United States and internationally.

2. Noncommunicable diseases have overtaken communicable diseases as the world’s major disease burden, with cardiovascular disease (CVD) remaining the leading global cause of death, accounting for 17.3 million deaths per year, a number that is expected to grow to >23.6 million by 2030.

3. Globalization and urbanization are key factors driving the worldwide increase in obesity and diabetes mellitus (major CVD risk factors), along with hypertension.

4. CVD-associated stroke mortality exceeded ischemic heart disease mortality in 74 World Health Organization (WHO) member countries in a global analysis of WHO cause-specific mortality data and World Bank national income data.

5. Addressing fragmented care through better coordination is considered an approach that may improve health care quality. Various health care reform efforts are underway to develop teams of allied health care practitioners who will be able to provide team-based care for chronically ill patients. Interdisciplinary teams are a key component to provide chronic disease management and transitional care delivered in newer models of care, such as accountable care organizations. The most significant model currently undergoing testing and development to understand the dynamics of team-based care is the patient-centered medical home.

6. The federal government has committed in excess of $27 billion over 10 years to increase the use of electronic health records (EHRs). The Centers for Medicare and Medicaid Services encourage use of EHRs through an incentive program that provides financial benefits for physicians and care centers that show ‘meaningful use’ of EHRs. The primary component of meaningful use is utilizing EHRs in a meaningful manner—in other words, to exchange health information electronically to improve care and to submit quality measures.

7. The American College of Cardiology and the Lewin Group’s 2009 workforce study found that a significant shortage of cardiologists working in the United States exists, and this shortage is projected to worsen over the next 2 decades.

8. The pharmaceutical and medical device industries are facing several challenges created by the cost-containment effects of health care reform efforts and slow economic activity, a changing regulatory environment, and increasing pressure to show value related to clinical outcomes.

9. A significant public private campaign launched in 2011 targeting CV prevention is the Million Hearts Initiative, the goal of which is to prevent 1 million CV events over the next 5 years. Through improved management of the four ‘ABCS’ indicators—aspirin for people at risk, blood pressure control, cholesterol management, and smoking cessation—the Million Hearts Initiative hopes to reduce the current annual heart attack and stroke rate by 10%.

10. The great majority of the population does not meet ideal CV health metrics, as defined by the American Heart Association (AHA). These seven behaviors or health metrics include not smoking; being physically active; having normal blood pressure, blood glucose levels, total cholesterol, and weight; and eating a healthy diet. For the select proportion of persons who did meet six or more of the AHA’s health metrics, all-cause mortality was 51% lower than for persons who achieved one or fewer CV health metrics; and CVD mortality was 76% lower for the highest achievers versus the lowest achievers.

Clinical Topics: Dyslipidemia, Lipid Metabolism, Nonstatins

Keywords: Physicians, Health Care Reform, Body Weight, World Health Organization, Blood Pressure, Centers for Medicare and Medicaid Services (U.S.), Electronic Health Records, Federal Government, Cholesterol, Blood Glucose, Accountable Care Organizations, Smoking Cessation


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