Q&A with Janet Wright: Cardiac Health

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Photo of Janet Wright, Executive Director of Million Hearts®
Janet Wright, CMS

Janet Wright, MD, FACC is the Executive Director of Million Hearts®, a national public-private initiative, co-led by the Centers for Disease Control and Prevention, and the Centers for Medicare & Medicaid Services. The initiative is now in its second five-year phase with an aim to prevent a million or more cardiovascular events across America by 2022.

From 2008 to 2011, Dr. Wright served as Senior Vice President for Science and Quality at the American College of Cardiology (ACC). 

Dr. Wright practiced cardiology for many years in Chico, California, and during those years, she served on ACC’s Board of Trustees, the National Committee for Quality Assurance’s Physician Program Committee, and the Center for Information Therapy, a non-profit organization committed to the provision of personalized health information during each health encounter. 

Q. Million Hearts® started with the goal of preventing one million heart attacks and strokes by 2017. What progress has been made, and what are the next steps for the initiative?

While the overall numbers are still being tallied for the 2012 to 2016 time period, it’s clear that significant progress was made in many of our priority areas. This progress—and the 110 public and private partners that made it happen—should be celebrated. We saw improvements in blood pressure control and cholesterol management, a reduction in tobacco prevalence, and a pathway to eliminate unhealthy artificial trans fats from the food supply. Each of these advances will keep more people from suffering heart attacks, strokes, heart failure and kidney disease. 

The initiative’s 2017 goal was audacious but achievable if all the targets set were reached. With little headway made in reducing sodium consumption and slower than desired improvements in hypertension and cholesterol control, we predict that somewhere close to half a million events will have been prevented over the 2012-2016 time period when the final numbers are available in 2019. With five years of experience under our Million Hearts® belt, with exemplars from the Hypertension Control Champions, high-performing QIN-QIOs and others, and with a fresh set of modeling results to guide the design, Million Hearts® 2022 was launched in January 2017.

Q. As the initiative moves forward, what’s new and different about Million Hearts® 2022?

Million Hearts® 2022 sits on a tripod of three priorities. The first, Keeping People Healthy, focuses community action and public policy on achieving 20 percent reductions in tobacco use, sodium consumption and physical inactivity. The second priority, Optimizing Care, challenges health care teams and their systems to achieve 80 percent performance on the ABCS measures (Aspirin, Blood pressure control, Cholesterol management, and Smoking cessation) and, among those eligible, 70 percent participation rates in cardiac rehabilitation. The third priority is Improving Outcomes in Priority Populations, a deep dive into specific actions that address the obstacles to better cardiovascular health for several high-burden, high-risk groups.

The new emphasis on cardiac rehabilitation (CR) stems from data showing that only about one in three people who are eligible receive this outpatient, life-saving and life-enhancing set of services. Importantly, there are differences by age, gender, race/ethnicity and geography in terms of who is referred, enrolls and participates. CR typically involves a customized exercise training program, counseling and education to manage the patient's condition. CR helps people recover from their heart attack, surgery, heart failure or procedure; reduces unnecessary hospital readmissions; and greatly improves their quality of life. 

Another new component of Million Hearts® 2022 includes community-based actions to make physical activity more accessible, safe and affordable—and more fun by joining peer groups that can keep us motivated! We are also working with national experts to accelerate widespread adoption of self-monitoring of blood pressure outside the office setting. Evidence shows this practice, when closely coupled with timely advice from the treating clinician, helps people with high blood pressure achieve and maintain safe blood pressure control. Home-monitoring is strongly recommended in the recent national guidelines for hypertension management. 

Q. Can you share a recent Million Hearts® success story that demonstrates the importance of community involvement in cardiac care?

Success stories abound in the Million Hearts® program, but many of the best come from Hypertension Control Challenge Champions, which include clinicians, practice teams and health systems. More than 13 million adults have been served by the 59 champions that the program has recognized since its 2012 inception.

The Champions used innovations in health information technology and electronic health records, patient communication and team approaches to achieve blood pressure control for their patients. Together, these high-performers represent a range of small and large, urban and rural, as well as private, federal and tribal health practices and systems.

The 24 Champions for 2017 provided care to more than 1.2 million adults and achieved control rates of over 70 percent in their patients with hypertension.

The work being done by these champions is vitally important, as nearly one in three American adults suffer from high blood pressure, a leading cause of heart attacks, heart failure, kidney disease and stroke. Millions of Americans have as yet undiagnosed or untreated high blood pressure.

Q. Is there anything else you’d like to tell QIO News readers?

I want to specifically thank the Quality Innovation Network-Quality Improvement Organizations (QIN-QIOs) for their valuable contributions to the progress made over the first five years and to recognize the powerful roles they play in improving cardiovascular health and care. We look forward to continuing to work closely with QIN-QIOs in Million Hearts® 2022.