Cardiac Health Q&A with Janet Wright

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Janet Wright, MD, FACC is the Executive Director of Million Hearts®, a U.S. Department of Health and Human Services (HHS) national initiative, co-led by the Centers for Disease Control and Prevention, and the Centers for Medicare & Medicaid Services, with the explicit goal to prevent one million heart attacks and strokes in the U.S. by 2017.

From 2008 to 2011, Dr. Wright served as Senior Vice President for Science and Quality at the American College of Cardiology (ACC). In that role, she provided medical and scientific oversight of clinical guidelines, performance measures, health policy statements, and appropriate use criteria; quality improvement projects; and the National Cardiovascular Data Registry, a suite of databases containing more than 12 million patient records in both inpatient and outpatient care settings

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. Her primary interests are the design and implementation of systems of care to achieve optimal outcomes for patients, and the full deployment of hooks, tricks, and cues that help people get and stay healthy.

Q. How are things shaping up as Million Hearts enters year five of its five-year sprint to prevent one million heart attacks and strokes?

It’s going great. The engagement is just extraordinary. Key people and organizations are activated around strategies and actions that will definitely have an impact. When you compare data from 2011 and 2014, we know that there are almost four million fewer cigarette smokers now, and that’s extremely exciting. To reach our goal of preventing one million heart attacks and strokes by the end of 2016, we need to help a total of 6.3 million people quit smoking, so we’re well on our way to achieving that goal. We also need to help 10 million people control their hypertension, and we need to reduce overall sodium intake by 20 percent. Our achievements to date have been a collective effort with many public and private collaborators. To cite some examples, the American Heart Association and Aramark have committed to reduce sodium, saturated fat and calories, and to increase whole grains, fruits and vegetables by 20 percent over five years in foods served in schools, businesses, sports venues and other places. This action will impact more than two billion meals that Aramark serves annually. The Food and Drug Administration has mandated that partially hydrogenated oils – a key source of trans fats linked to heart attacks and strokes – be removed from foods by 2018. And millions of Americans are now covered by health systems that recognize and reward high performance on the ABCS measures (Asprin when appropriate; Blood pressure control; Cholesterol management; Smoking cessation).

Q. What are the priorities for Million Hearts in 2016?

We’re sticking with our pursuit of excellence in the ABCS measures, as well as doubling down on our work in the areas of sodium reduction, smoking cessation and blood pressure control. For smoking cessation, we are in the process of implementing and disseminating tobacco cessation protocols and an action guide to help busy offices that don’t yet have a tobacco cessation program. For hypertension, besides focusing on blood pressure protocols, we are producing tools designed to help identify people with uncontrolled blood pressure that hasn’t yet been diagnosed. Estimates show that around 13 million people are hiding in plain sight” – that is, seeing their physician or nurse regularly, and showing consistently elevated blood pressures but not getting diagnosed. Their uncontrolled and untreated hypertension puts them at continued risk for heart attack, stroke, kidney and heart failure. For sodium reduction, we’re promoting the adoption of healthy food service guidelines. These guidelines haven’t been broadly implemented, but by following them, organizations can have a major positive impact on the health of their workforce because many people eat on-site.

Q. What are your perspectives on Million Hearts’ ongoing collaboration with Quality Innovation Network-Quality Improvement Organizations to improve the cardiac health of Medicare beneficiaries?

It’s been a glorious collaboration. The QIN-QIOs are the effector arms, helping busy practices improve their performance in a way that’s almost painless. They are a fantastic conduit for promoting and sharing Million Hearts strategies that otherwise might have sat on a shelf. They have been incredibly helpful in providing the stimulus for implementation and delivering effective strategies to practices.

Q. Tell us a bit about the Million Hearts Cardiovascular Disease Risk Reduction Model, which is being tested from 2016 through 2020.

Simply put, it’s the first model of pay for prevention. Practices will literally be rewarded for assessing the risk of their population and managing high-risk groups to help them avoid or prevent a heart attack or stroke. The model is ground-breaking and based on a risk calculator from the American College of Cardiology and the American Heart Association. We’re very excited about it.

Q. You’ve been a strong advocate of cardiac rehab for heart disease patients. What does it entail, and what is its impact on overall cardiovascular health and hospital readmissions?

I am an unabashed supporter of cardiac rehab. In short, it’s a medically supervised program to help people recover from heart attacks, heart surgery or other cardiac procedures. Cardiac rehab typically involves a tailored physical activity program and counseling and education for patients on how to manage their condition. The connection between cardiac rehab and Million Hearts is straightforward; we know that it actually can save lives. Moreover, it improves cardiac patients’ quality of life and functional status so they feel better and get stronger, and it reduces unnecessary hospital readmissions. We know that people who undertake cardiac rehab are more likely to stick to their medications and achieve good control of the ABCS. Utilization presently is very low among Medicare beneficiaries, even though Medicare provides strong benefits and coverage. Women and minority groups are even less likely to engage in cardiac rehab, so there’s a disparities issue. Currently, a Cardiac Rehab Collaborative of over 30 organizations is preparing to publish an action plan to help address this issue. Million Hearts is supportive of the collaborative, and we encourage QIN-QIOs to help raise awareness about cardiac rehab’s benefits. We know that home health agencies are a fantastic source of education and support for good habits, so they too could stress the importance of participation, particularly as more hybrid or home-based models of cardiac rehab emerge.

Q. What new or up-and-coming Million Hearts tools or resources would you like to tell us about?

The smoking cessation protocol and action guide I referred to earlier should be posted on our website by early Q2 (late March/​early April 2016). Our new Hiding in Plain Sight” assistive tools for identifying individuals with undiagnosed hypertension should be posted to the website in late January.

Q. Anything else you would like QIO News readers to know?

I’d like to thank everyone for the work they’ve done to get us to this point in achieving hypertension control and smoking cessation. And I’d like to ask for everyone’s continued help and focus in the coming months, so we can finish strong in achieving our Million Hearts goal by the end of 2016.