In a partnership with other public and private organizations, the U.S. Department of Health and Human Services (HHS) launched a program Sept. 29 that is designed to prevent a million heart attacks and strokes over the next five years. Details of the Million Hearts Initiative appeared in the Sept. 29 issue of the New England Journal of Medicine.

Cardiovascular disease is the leading cause of death in the U.S., wrote co-authors Thomas R. Frieden, MD, MPH, director of the Centers for Disease Control and Prevention, and Donald R. Berwick, MD, director of the Centers for Medicare & Medicaid Services. Annually more than 2 million Americans suffer a heart attack or stroke, with more than 800,000 dying each year. The associated costs of medical care and lost productivity are nearly $450 billion annually.

To reduce that burden, HHS is collaborating with state and local agencies as well as the private sector on a strategy that combines evidence-based clinical practices and community-based interventions. “If used consistently, proven interventions could prevent more than half of heart attacks and strokes,” Frieden and Berwick wrote. “It’s time to take the next big step.”

Clinical interventions focus on four components, collectively called ABCS: aspirin for high-risk patients; blood-pressure control; cholesterol management; and smoking cessation. The five-year program will emphasize management of these components through a focused approach, health IT and clinical innovations. Anticipated activities include:

• Incorporating consistent ABCS indicators into the Physician Quality Reporting System, Medicare Part D and Medicare Advantage plan ratings, EHR meaningful use criteria, community clinic measures and guidelines;
• Adding clinical quality measures for hypertension and cholesterol control to meaningful use criteria;
• Leveraging health IT regional extension centers and Beacon communities;
• Patient counseling; and
• Dissemination by federal agencies of strategies to improve the delivery of care.

Community interventions will include public health warnings, grants, mass media campaigns, menu-labeling requirements for chain restaurants and data gathering.

The authors wrote that the Patient Protection and Affordable Care Act  (PPACA) lays the foundation for the initiative by reducing or eliminating burdens for both patients and providers. “Covering 32 million currently uninsured Americans will reduce financial barriers to preventive care, and expanding community health centers will increase access to care and reduce health disparities,” they argued.

Standardizing ABCS indicators across the public-private care continuum may save time and money for providers by facilitating and streamlining the reporting process, they continued. “The initiative will be linked to quality-recognition programs (e.g., the Physician Quality Reporting System and star ratings for Medicare Part D and Medicare Advantage plans),” they proposed, “and may eventually support approaches in which providers are paid more for better preventive care.”

They added that Million Hearts should be cost neutral for taxpayers but provide a huge payoff through improved public health.  “By focusing our initial efforts where they will save the most lives, we aim to make progress toward a health system that will serve Americans’ needs in the 21st century,” they concluded.