ACC Corner | Taking down Americas No. 1 Killer

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 - Thad Waites, MD, FACC
Thad Waites, MD, FACC

Albert Einstein said: “To raise new questions, new possibilities, to regard old problems from a new angle, requires creative imagination and marks real advance in science.” Over the past several decades, we have seen real advances in cardiovascular science and medicine, the result of cardiologists, nurses and other providers focusing on what’s best for patients, asking new questions and exploring fresh, innovative ways to attack our nation’s leading killer.

The 60 percent decline in the death rate from cardiovascular disease that has occurred since the 1950s is a significant achievement. This reduction is the result of a vast effort culminating in the development of new drugs and devices, improved medical imaging at the point of care and new treatment strategies for managing patients with both acute and chronic heart disease.

Recently, two studies highlighted the advances that are saving lives as well as healthcare dollars. The first reported that MI patients are receiving life-saving PCI just 64 minutes after arrival at the hospital—32 minutes faster than in 2005 (Circ 2011;124:1038-1045). More than 90 percent are now treated in less than 90 minutes, up from 44 percent in 2005. This was accomplished not because of mandates, but because it’s the right thing to do.

The second study, which examined trends in heart failure hospitalization rates in the U.S., found a 30 percent decline in the rate of admission between 1998 and 2008 (JAMA 2011;306[15]:1669-1678). This resulted in reduced expenditures of nearly $4 billion, demonstrating that early identification of risk factors, documentation of disease before complications occur and proper treatment of disease can reduce costs and improve health.

Considering these combined results, we begin to fully appreciate how far we have come in 30 years; proof that we are capable of taking on heart disease—the No. 1 killer of Americans—and winning.

Challenges now lie in sustaining and improving these gains cost effectively. For example, the American College of Cardiology (ACC) is exploring coordinated systems of care to determine which methods are best to ensure timely access to angioplasty in patients not initially presenting to PCI-capable hospitals.

We are far from done. There remain unacceptable disparities in care and inexplicable variation in the approach to care, even in similar locations. We need to follow Einstein’s words and examine these old problems from new angles that involve non-traditional partnerships among physicians, industry and government.

The Million Hearts Initiative, run by the Centers for Disease Control and Prevention and the Centers for Medicare & Medicaid Services, is a great example of non-traditional partners united around the common goal of saving one million lives from heart disease and stroke over the next five years. Not only are associations like the ACC, the Association of Black Cardiologists, the American Heart Association and others forthcoming, but business and other industry partners support this campaign as well.

Similarly, imagine if Medicare and private insurance companies would provide meaningful incentives for quality improvement and reward cost-reducing registry participation by providers across the U.S.? With heart disease currently representing more than 43 percent of Medicare costs, the potential savings are huge. We can achieve this simply by applying currently known medical science and proven best practices across the U.S. healthcare system.

Where will we be a decade from now? Unfortunately, an aging population with increasing rates of obesity and diabetes portend a rising prevalence of cardiovascular disease. We need to rise to the challenge—asking questions, advancing research, developing transformational therapies, finding new ways to streamline our care and searching for new paradigms of delivery to administer the highest quality care, efficiently, to all Americans.

Dr. Waites is chair of the ACC’s Board of Governors. Dr. May is the ACC’s Texas governor.