Despite decades-long improvement, heart disease and stroke remain leading causes of morbidity, mortality, and healthcare costs in the United States.
One year ago, the Centers for Disease Control and Prevention and the Centers for Medicare & Medicaid Services launched Million Hearts® 2022, a national initiative to prevent a million heart attacks, strokes, and other acute cardiovascular events during 2017–2021.
A predecessor program – Million Hearts® – aimed to prevent 1 million heart attacks and strokes in the United States over the course of five years, 2012 to 2016. During the first two years of that initiative, about 115,000 cardiovascular events were prevented, relative to the expected number of events. And although final numbers had not been reported at press time, Million Hearts estimates that up to half a million events may have been prevented from 2012 through 2016.
Million Hearts 2022 focuses on a small set of priorities selected for their impact on heart disease, stroke, and related conditions:
- 20 percent reduction in sodium intake
- 20 percent reduction in tobacco use
- 20 percent reduction in physical inactivity
- 80 percent performance on the ABCS Clinical Quality Measures (i.e., (i.e., Aspirin when appropriate, Blood pressure control, Cholesterol management, and Smoking cessation).
- 70 percent participation in cardiac rehab among eligible patients.
Every 40 seconds, an adult dies from a heart attack, stroke, or other adverse outcome of cardiovascular disease (CVD), reports the CDC. These deaths account for about one third of all deaths in the United States, or more than 800,000 deaths each year. About one in five of these deaths is a person younger than 65. Heart disease and stroke can also lead to other serious illnesses, disabilities, and lower quality of life.
The economic toll of CVD is high. More than $316 billion each year in the United States, with CVD treatment accounting for about one of every seven dollars spent on healthcare in this country.
And while cardiovascular deaths have been declining for the past 40 years, the reduction in these deaths has slowed since 2011, indicating the need for focused, sustained action by public and private partners to improve our nation’s cardiovascular health, says the CDC. Managing blood pressure and cholesterol levels is more important than ever. Cardiac rehabilitation programs, increased physical activity and healthy eating habits are other priorities.
In 2016, heart disease caused:
- 2 million hospitalizations (850.9 per 100,000 population).
- $32.7 billion in costs.
- 415,480 deaths (157.4 per 100,000).
The CDC reports that acute myocardial infarctions and strokes accounted for approximately half (47 percent) of hospitalizations (rates = 204.5 and 199.1 per 100,000, respectively) and approximately two thirds (61 percent) of deaths (42.2 and 53.7 per 100,000, respectively). Other cardiovascular events, which include those related to heart failure, contributed to 46 percent of hospitalizations and 38 percent of deaths (rates = 394.6 and 59.8 per 100,000, respectively).
Editor’s note: Refer your clinical customers to the Million Hearts website at www.millionhearts.hhs.gov
Special attention needed
Addressing heart disease is important for all Americans, but four groups require special attention, as heart disease and stroke events among them are increasing:
- Blacks/African-Americans with hypertension.
- 35-to-64-year-olds.
- People who have had a heart attack or stroke.
- People with mental and/or substance use disorders.
In 2016, hospitalization and mortality rates were highest among men (989.6 and 172.3 per 100,000, respectively) and non-Hispanic blacks (211.6 per 100,000, mortality only), and they increased with age, reports the Centers for Disease Control and Prevention. Among adults aged 18-64 years, 805,000 hospitalizations and 75,245 deaths occurred. Without preventive intervention, it is possible that 16.3 million events and $173.7 billion in hospitalization costs could occur from 2017-2021.
Source: Centers for Disease Control and Prevention, https://www.cdc.gov/mmwr/volumes/67/wr/mm6735a3.htm?s_cid=mm6735a3_w
Heart disease: Where you live matters
Aspirin use, blood pressure and cholesterol control, cardiac rehab and heart-healthy behaviors are effective healthcare strategies to combat heart disease. Nevertheless, adherence is inconsistent throughout the country, resulting in geographic variation in cardiovascular disease (CVD) outcomes, reports the Centers for Disease Control and Prevention.
In 2016, state-level mortality was higher in the southeastern United States, which aligns with the findings from previous studies. Rates for emergency-department visits and hospitalizations were higher in the Southeast and elsewhere, including many Midwestern states.
State-level variation in 2016 occurred in heart-disease-related rates of:
- Emergency department visits (a low of 56 per 100,000 in Connecticut, to 275 per 100,000 in Kentucky).
- Hospitalizations (from 484 per 100,000 in Wyoming, to 1,670 per 100,000 in Washington, D.C.)
- Mortality (from 111 per 100,000 in Vermont, to 267 per 100,000 in Mississippi).
Each state would need to realize an approximate 6 percent decrease in its expected event totals during 2017–2021 to collectively prevent 1 million events at the national level. For that to occur, the participants in Million Hearts® 2022 believe an 80 percent or greater performance on the ABCS (i.e., aspirin use, blood pressure control, cholesterol control and cessation of smoking) and at least a 20 percent reduction in physical inactivity, tobacco use, and sodium consumption are necessary.
Source: Centers for Disease Control and Prevention, https://www.cdc.gov/mmwr/volumes/67/wr/mm6735a3.htm?s_cid=mm6735a3_w
Heart disease testing: What’s new?
By Jim Poggi
(Editor’s note: In case you missed lab expert Jim Poggi’s January column on cardiac marker testing, here’s an excerpt that’s worth remembering during Heart Month.)
With the rapid proliferation of new tests, particularly molecular-based assays, in microbiology, infectious disease and respiratory testing categories, what’s new and what’s on the horizon for heart disease testing?
There are a TON of lipid fractionation and lipid phenotyping tests out there. Most of them are performed in specialty lipid testing reference labs and not applicable in our market yet. They try to identify, quantify and risk stratify less-well-understood lipids. Some examples include apo A-1, apoB-100, LDL subclasses and other even more esoteric markers.
There are a few new tests and test combinations that I THINK may become pertinent to us sooner rather than later. All are making their appearance in the acute care market first:
- Although high-sensitivity Troponin I is becoming available on an increasing number of chemistry system platforms we sell, it is clearly an acute-care marker and unlikely to become a mainstream factor in primary care.
- A new multi-test risk-assessment tool (high sensitivity Troponin I, glucose and glomerular filtration rate) is finding its way into the acute-care market to stratify risk of acute coronary syndrome. Due to the number and type of tests in this panel, I doubt it will make a meaningful impact on testing in primary care.
- Small dense LDL testing is entering the hospital and reference lab market as a newer risk stratification marker. Of all the new tests, it is my impression that this one is most likely to come into our market next. Depending on whether studies in process will demonstrate whether it is a better way to assess risk of a future heart attack, it could well become part of the routine lipid panel down the road.
While molecular has rapidly advanced in several other testing areas, it has yet to become a factor in heart disease testing. I predict that as things change, it is most likely to find its way in risk prediction and preventive medicine. So far, tests in this area are still in the early research stages.
Bottom line: February may be heart month, but heart disease is a year-round leading cause of death, and our customers deserve our best efforts to provide them with the right test mix to diagnose and manage this serious disease. So, stop reading and get selling cardiac tests!
The cost of heart disease, 2016
By gender Hospitalization/mortality rates Hospitalization cost ($)
| Men (total) | 1.18 million | $18.6 billion |
| Women (total) | 1.06 million | $14.1 billion |
Men by age Hospitalization/mortality rates Hospitalization cost ($)
| 18-44 years | 73,000 | $1.3 billion |
| 45-64 years | 426,000 | $7.4 billion |
| 65-74 years | 286,100 | $4.8 billion |
| 75 years and over | 395,000 | $5.1 billion |
Women by age Hospitalization/mortality rates Hospitalization cost ($)
| 18-44 years | 46,900 | $0.8 billion |
| 45-64 years | 258,700 | $4.1 billion |
| 65-74 years | 231,100 | $3.3 billion |
| 75 years and over | 520,500 | $5.9 billion |
Race/ethnicity Hospitalization/mortality rates Hospitalization cost ($)
| White, non-Hispanic | 320,200 | NA |
| Black, non-Hispanic | 52,200 | NA |
| Hispanic | 25,400 | NA |
| Other, non-Hispanic | 12,600 | NA |
| Asian/Pacific Islander | 10,600 | NA |
| Alaskan native | 2,000 | NA |
Sources: Agency for Healthcare Research and Quality’s Healthcare Cost and Utilization Project (HCUP) National Inpatient Sample (NIS); National Center for Health Statistics’ National Vital Statistics System Mortality Data. (https://www.cdc.gov/mmwr/volumes/67/wr/mm6735a3.htm?s_cid=mm6735a3_w)