Wellness S Y M P O S I U M Darwin R. Labarthe, MD, MPH, PhD Director, Division for Heart Disease and Stroke Prevention

The national goal for heart disease and stroke prevention: - detection and treatment of risk factors - early identification and treatment of heart attacks and strokes - prevention of risk factors - prevention of recurrent cardiovascular events CO-LEAD AGENCIES: CDC AND NIH

The Present Reality

Fatal CVD Complica- tions/Decom- pensation Unfavorable Social and Environmental Conditions Adverse Behavioral Patterns Major Risk Factors First Event/ Sudden Death Disability/ Risk of Recurrence The Present Reality

A Vision of the Future

Good Quality of Life Until Death Social and Environmental Conditions Favorable to Health Behavioral Patterns Promote Health Low Population Risk Few Events/ Only Rare Deaths Full Functional Capacity/ Low Risk of Recurrence A Vision of the Future

Good Quality of Life Until Death Social and Environmental Conditions Favorable to Health Behavioral Patterns Promote Health Low Population Risk Few Events/ Only Rare Deaths Full Functional Capacity/ Low Risk of Recurrence A Vision of the Future Fatal CVD Complica- tions/Decom- pensation Unfavorable Social and Environmental Conditions Adverse Behavioral Patterns Major Risk Factors First Event/ Sudden Death Disability/ Risk of Recurrence The Present Reality

Fatal CVD Complica- tions/Decom- pensation Unfavorable Social and Environmental Conditions Adverse Behavioral Patterns Major Risk Factors First Event/ Sudden Death Disability/ Risk of Recurrence The Present Reality Good Quality of Life Until Death Social and Environmental Conditions Favorable to Health Behavioral Patterns Promote Health Low Population Risk Few Events/ Only Rare Deaths Full Functional Capacity/ Low Risk of Recurrence A Vision of the Future Action Framework for a Comprehensive Public Health Strategy To Prevent Heart Disease and Stroke Policy and Environmental Change Behavior Change Risk Factor Detection and Control Emergency Care/Acute Case Management Rehabilitation/ Long-term Case Management Intervention Approaches Intervention Approaches End-of- Life Care

Fatal CVD Complica- tions/Decom- pensation Unfavorable Social and Environmental Conditions Adverse Behavioral Patterns Major Risk Factors First Event/ Sudden Death Disability/ Risk of Recurrence The Present Reality Good Quality of Life Until Death Social and Environmental Conditions Favorable to Health Behavioral Patterns Promote Health Low Population Risk Few Events/ Only Rare Deaths Full Functional Capacity/ Low Risk of Recurrence A Vision of the Future Policy and Environmental Change Behavior Change Risk Factor Detection and Control Emergency Care/Acute Case Management Rehabilitation/ Long-term Case Management Intervention Approaches Intervention Approaches End-of- Life Care Action Framework for a Comprehensive Public Health Strategy To Prevent Heart Disease and Stroke Goal 1 Goal 3 Goal 4 Goal 2 Increase Quality and Years of Healthy Life Eliminate Disparities The Healthy People 2010 Goals

Fatal CVD Complica- tions/Decom- pensation Unfavorable Social and Environmental Conditions Adverse Behavioral Patterns Major Risk Factors First Event/ Sudden Death Disability/ Risk of Recurrence The Present Reality Good Quality of Life Until Death Social and Environmental Conditions Favorable to Health Behavioral Patterns Promote Health Low Population Risk Few Events/ Only Rare Deaths Full Functional Capacity/ Low Risk of Recurrence A Vision of the Future Policy and Environmental Change Behavior Change Risk Factor Detection and Control Emergency Care/Acute Case Management Rehabilitation/ Long-term Case Management Intervention Approaches Intervention Approaches End-of- Life Care Action Framework for a Comprehensive Public Health Strategy To Prevent Heart Disease and Stroke Goal 1 Goal 3 Goal 4 Goal 2 Increase Quality and Years of Healthy Life Eliminate Disparities The Healthy People 2010 Goals Target Population Total Population 300million TC 105million HBP 72million Smoking 46million Diabetes 20million CHD 1,200,000 CHF 550,000 Stroke 500,000 CHD 15.8million Stroke 5.7million CHF 5.2million CVD 871,000

Fatal CVD Complica- tions/Decom- pensation Unfavorable Social and Environmental Conditions Adverse Behavioral Patterns Major Risk Factors First Event/ Sudden Death Disability/ Risk of Recurrence The Present Reality Good Quality of Life Until Death Social and Environmental Conditions Favorable to Health Behavioral Patterns Promote Health Low Population Risk Few Events/ Only Rare Deaths Full Functional Capacity/ Low Risk of Recurrence A Vision of the Future Policy and Environmental Change Behavior Change Risk Factor Detection and Control Emergency Care/Acute Case Management Rehabilitation/ Long-term Case Management Intervention Approaches Intervention Approaches End-of- Life Care Action Framework for a Comprehensive Public Health Strategy To Prevent Heart Disease and Stroke Goal 1 Goal 3 Goal 4 Goal 2 Increase Quality and Years of Healthy Life Eliminate Disparities The Healthy People 2010 Goals PREVENTION $.05 Target Population Total Population 300million TC 105million HBP 72million Smoking 46million Diabetes 20million CHD 1,200,000 CHF 550,000 Stroke 500,000 CHD 15.8million Stroke 5.7million CHF 5.2million CVD 871,000 TREATMENT $.95

Fatal CVD Complica- tions/Decom- pensation Unfavorable Social and Environmental Conditions Adverse Behavioral Patterns Major Risk Factors First Event/ Sudden Death Disability/ Risk of Recurrence The Present Reality Good Quality of Life Until Death Social and Environmental Conditions Favorable to Health Behavioral Patterns Promote Health Low Population Risk Few Events/ Only Rare Deaths Full Functional Capacity/ Low Risk of Recurrence A Vision of the Future Policy and Environmental Change Behavior Change Risk Factor Detection and Control Emergency Care/Acute Case Management Rehabilitation/ Long-term Case Management Intervention Approaches Intervention Approaches End-of- Life Care Action Framework for a Comprehensive Public Health Strategy To Prevent Heart Disease and Stroke Goal 1 Goal 3 Goal 4 Goal 2 Increase Quality and Years of Healthy Life Eliminate Disparities The Healthy People 2010 Goals Target Population Total Population 300million TC 105million HBP 72million Smoking 46million Diabetes 20million CHD 1,200,000 CHF 550,000 Stroke 500,000 CHD 15.8million Stroke 5.7million CHF 5.2million CVD 871,000

Fatal CVD Complica- tions/Decom- pensation Unfavorable Social and Environmental Conditions Adverse Behavioral Patterns Major Risk Factors First Event/ Sudden Death Disability/ Risk of Recurrence The Present Reality Good Quality of Life Until Death Social and Environmental Conditions Favorable to Health Behavioral Patterns Promote Health Low Population Risk Few Events/ Only Rare Deaths Full Functional Capacity/ Low Risk of Recurrence A Vision of the Future Policy and Environmental Change Behavior Change Risk Factor Detection and Control Emergency Care/Acute Case Management Rehabilitation/ Long-term Case Management Intervention Approaches Intervention Approaches End-of- Life Care Action Framework for a Comprehensive Public Health Strategy To Prevent Heart Disease and Stroke Goal 1 Goal 3 Goal 4 Goal 2 Increase Quality and Years of Healthy Life Eliminate Disparities The Healthy People 2010 Goals Target Population Total Population 300million TC 105million HBP 72million Smoking 46million Diabetes 20million CHD 1,200,000 CHF 550,000 Stroke 500,000 CHD 15.8million Stroke 5.7million CHF 5.2million CVD 871,000 ?

Fatal CVD Complica- tions/Decom- pensation Unfavorable Social and Environmental Conditions Adverse Behavioral Patterns Major Risk Factors First Event/ Sudden Death Disability/ Risk of Recurrence The Present Reality Good Quality of Life Until Death Social and Environmental Conditions Favorable to Health Behavioral Patterns Promote Health Low Population Risk Few Events/ Only Rare Deaths Full Functional Capacity/ Low Risk of Recurrence A Vision of the Future Policy and Environmental Change Behavior Change Risk Factor Detection and Control Emergency Care/Acute Case Management Rehabilitation/ Long-term Case Management Intervention Approaches Intervention Approaches End-of- Life Care Action Framework for a Comprehensive Public Health Strategy To Prevent Heart Disease and Stroke Goal 1 Goal 3 Goal 4 Goal 2 Increase Quality and Years of Healthy Life Eliminate Disparities The Healthy People 2010 Goals 1010 Target Population Total Population 300million TC 105million HBP 72million Smoking 46million Diabetes 20million CHD 1,200,000 CHF 550,000 Stroke 500,000 CHD 15.8million Stroke 5.7million CHF 5.2million CVD 871,000

Fatal CVD Complica- tions/Decom- pensation Unfavorable Social and Environmental Conditions Adverse Behavioral Patterns Major Risk Factors First Event/ Sudden Death Disability/ Risk of Recurrence The Present Reality Good Quality of Life Until Death Social and Environmental Conditions Favorable to Health Behavioral Patterns Promote Health Low Population Risk Few Events/ Only Rare Deaths Full Functional Capacity/ Low Risk of Recurrence A Vision of the Future Policy and Environmental Change Behavior Change Risk Factor Detection and Control Emergency Care/Acute Case Management Rehabilitation/ Long-term Case Management Intervention Approaches Intervention Approaches End-of- Life Care Action Framework for a Comprehensive Public Health Strategy To Prevent Heart Disease and Stroke Goal 1 Goal 3 Goal 4 Goal 2 Increase Quality and Years of Healthy Life Eliminate Disparities The Healthy People 2010 Goals Target Population Total Population 300million TC 105million HBP 72million Smoking 46million Diabetes 20million CHD 1,200,000 CHF 550,000 Stroke 500,000 CHD 15.8million Stroke 5.7million CHF 5.2million CVD 871,000

Fatal CVD Complica- tions/Decom- pensation Unfavorable Social and Environmental Conditions Adverse Behavioral Patterns Major Risk Factors First Event/ Sudden Death Disability/ Risk of Recurrence The Present Reality Good Quality of Life Until Death Social and Environmental Conditions Favorable to Health Behavioral Patterns Promote Health Low Population Risk Few Events/ Only Rare Deaths Full Functional Capacity/ Low Risk of Recurrence A Vision of the Future Policy and Environmental Change Behavior Change Risk Factor Detection and Control Emergency Care/Acute Case Management Rehabilitation/ Long-term Case Management Intervention Approaches Intervention Approaches End-of- Life Care Action Framework for a Comprehensive Public Health Strategy To Prevent Heart Disease and Stroke Goal 1 Goal 3 Goal 4 Goal 2 Increase Quality and Years of Healthy Life Eliminate Disparities The Healthy People 2010 Goals 1010 HP Target Population Total Population 300million TC 105million HBP 72million Smoking 46million Diabetes 20million CHD 1,200,000 CHF 550,000 Stroke 500,000 CHD 15.8million Stroke 5.7million CHF 5.2million CVD 871,000

Fatal CVD Complica- tions/Decom- pensation Unfavorable Social and Environmental Conditions Adverse Behavioral Patterns Major Risk Factors First Event/ Sudden Death Disability/ Risk of Recurrence The Present Reality Good Quality of Life Until Death Social and Environmental Conditions Favorable to Health Behavioral Patterns Promote Health Low Population Risk Few Events/ Only Rare Deaths Full Functional Capacity/ Low Risk of Recurrence A Vision of the Future Policy and Environmental Change Behavior Change Risk Factor Detection and Control Emergency Care/Acute Case Management Rehabilitation/ Long-term Case Management Intervention Approaches Intervention Approaches End-of- Life Care Action Framework for a Comprehensive Public Health Strategy To Prevent Heart Disease and Stroke Goal 1 Goal 3 Goal 4 Goal 2 Increase Quality and Years of Healthy Life Eliminate Disparities The Healthy People 2010 Goals Target Population Total Population 300million TC 105million HBP 72million Smoking 46million Diabetes 20million CHD 1,200,000 CHF 550,000 Stroke 500,000 CHD 15.8million Stroke 5.7million CHF 5.2million CVD 871,000

Fatal CVD Complica- tions/Decom- pensation Unfavorable Social and Environmental Conditions Adverse Behavioral Patterns Major Risk Factors First Event/ Sudden Death Disability/ Risk of Recurrence The Present Reality Good Quality of Life Until Death Social and Environmental Conditions Favorable to Health Behavioral Patterns Promote Health Low Population Risk Few Events/ Only Rare Deaths Full Functional Capacity/ Low Risk of Recurrence A Vision of the Future Policy and Environmental Change Behavior Change Risk Factor Detection and Control Emergency Care/Acute Case Management Rehabilitation/ Long-term Case Management Intervention Approaches Intervention Approaches End-of- Life Care Action Framework for a Comprehensive Public Health Strategy To Prevent Heart Disease and Stroke Goal 1 Goal 3 Goal 4 Goal 2 Increase Quality and Years of Healthy Life Eliminate Disparities The Healthy People 2010 Goals CONTINUUM OF CARE ‘upstream’ ‘downstream’ Target Population Total Population 300million TC 105million HBP 72million Smoking 46million Diabetes 20million CHD 1,200,000 CHF 550,000 Stroke 500,000 CHD 15.8million Stroke 5.7million CHF 5.2million CVD 871,000

Fatal CVD Complica- tions/Decom- pensation Unfavorable Social and Environmental Conditions Adverse Behavioral Patterns Major Risk Factors First Event/ Sudden Death Disability/ Risk of Recurrence The Present Reality Good Quality of Life Until Death Social and Environmental Conditions Favorable to Health Behavioral Patterns Promote Health Low Population Risk Few Events/ Only Rare Deaths Full Functional Capacity/ Low Risk of Recurrence A Vision of the Future Policy and Environmental Change Behavior Change Risk Factor Detection and Control Emergency Care/Acute Case Management Rehabilitation/ Long-term Case Management Intervention Approaches Intervention Approaches End-of- Life Care Action Framework for a Comprehensive Public Health Strategy For Chronic Disease Prevention and Health Promotion Goal 1 Goal 3 Goal 4 Goal 2 Increase Quality and Years of Healthy Life Eliminate Disparities The Healthy People 2010 Goals CONTINUUM OF CARE ‘upstream’ ‘downstream’ Target Population Total Population 300million Persons with increased risk Persons first identified with chronic conditions Persons living or disabled with chronic conditions Deaths due to chronic conditions

The national goal for heart disease and stroke prevention: - detection and treatment of risk factors - early identification and treatment of heart attacks and strokes - prevention of risk factors - prevention of recurrent cardiovascular events

The national goal for chronic disease prevention and health promotion: - management of risk factors - response to acute event or first diagnosis - maintenance of good health/low risk - reduction of disability, improvement in quality of life, and prevention of disease progression or recurrent events

The 1 st national goal for chronic disease prevention and health promotion: - maintenance of good health/low risk Wellness