Implementing the National Forum Strategic Priorities Through Leadership & Collaboration Facilitator: Thomas A. Pearson, MD, MPH, PhD Presenters: Darwin Labarthe, MD, MPH, PhD Keith C. Ferdinand, MD, FACC, FAHA Lawrence J. Appel, MD, MPH

Welcome Introduction 2020 Goal Thomas Pearson, MD

Vision Working together for a heart-healthy and stroke world.

Mission To provide leadership and encourage collaborative action between organizations committed to heart disease and stroke prevention.

We must communicate to the public at large and to policy makers the urgent need and unprecedented opportunity to prevent heart disease and stroke in order to establish widespread awareness and concern about these conditions as well as confidence in the ability to prevent and control them. We must transform the nation’s public health infrastructure to provide leadership and to develop and maintain affective partnerships and collaborations for the action needed. Action Plan – Fundamental Requirements

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Moving Forward Vision Mission 2020 Goal Strategic Priority Strategic Priority Strategic Priority

2020 Goal Heart disease and stroke will no longer be the leading cause of death for all Americans by 2020.

1.Currently our leading cause of death 2.Afflicting all racial, ethnic, socio-economic, and geographic subpopulations 3.Preventable and treatable 4.Measurable 5.Amenable to interventions that can yield mortality reductions in the near term Key Messages Heart Disease and Stroke are:

1.Coronary disease by itself has been the #1 cause of death in the U.S. since 1911; stroke is #3. 2.Coronary heart disease and stroke are also significant causes of morbidity, disability, and healthcare costs. 3.Non-communicable diseases are the #1 cause of death worldwide (36 million deaths in 2008) with cardiovascular disease responsible for 48% (WHO, 2011)*. Leading Cause of Death

1.Large disparities persist between U.S. communities defined by color, language, income, and location*. 2.All population subgroups have not benefitted equally in the decline in heart disease and stroke. 3.We cannot reach our BHAG unless all Americans reduce their burdens of heart disease and stroke. Afflict Subpopulations

1.Surveillance is a driver of health policy. a.Provides messages to increase public awareness b.Identifies disparities in racial, ethnic, socioeconomic, and geographic subgroups c.Allows priorities for interventions to be set d.Informs policy makers regarding burdens of disease e.Evaluates policy and program impacts 2.Recent IOM Report has been released Measurable

1.Trends since 1968 for coronary disease and since 1900 for stroke demonstrate the preventability of mortality*. 2.The prevention of heart disease and stroke is cost- effective*. 3.Interventions targeting the entire society, communities, health system, and individuals will be needed*. Preventable and Treatable

U.S *Rates are age-adjusted to 2000 standard. CV Disease Death Rates

Frieden TR. AJPH 2010; 100: Health Impact Pyramid

Population-wide cardiovascular risk behavior change Pearson TA, et al. Circulation 2003; 107: Conceptual Framework

Can Yield Mortality Reductions in the Near Term 1.Some population subgroups have already reached the 2020 Goal. 2.Some organizations have demonstrated large, impactful reductions in heart disease mortality by implementing what are already known. Amendable to Interventions

Incidence and Outcomes of Acute Myocardial Infarction* 46,086 hospitalizations for MI during 18.7 million person years of follow-up, in Kaiser Permanente Northern California network. Incidence of acute MI fell from 287/100,000 p-y to 208/100,000 p-y in 2008 (24% decrease adjusted for age and sex). ST segment elevation MI decreased from 133/100,000 p-y in 2000 to 50/100,000 p-y in day case-fatality rate for MIs reduced 24% between 2000 and *Yeh RW, et al. NEJM 2010; 362: Population Trends – Acute MI

Yeh RW, et al. NEJM 2010; 362: Population Trends – Acute MI

We must communicate to the public at large and to policy makers the urgent need and unprecedented opportunity to prevent heart disease and stroke in order to establish widespread awareness and concern about these conditions as well as confidence in the ability to prevent and control them. We must transform the nation’s public health infrastructure to provide leadership and to develop and maintain affective partnerships and collaborations for the action needed. Action Plan – Fundamental Requirements

2020 Goal Heart disease and stroke will no longer be the leading cause of death for all Americans by 2020.

Strategic Priority Darwin Labarthe, MD

Key Words Surveillance System

Surveillance System – Past Efforts 1979 The Decline Conference and the Working Group 2003 The Action Plan 2007 The AHA Scientific Statement

Issues Assessment The first core function of public health Attainment of 2020 Goals Healthy People

National Forum Strategic Priority Have in place a comprehensive cardiovascular surveillance system to prevent and manage heart disease and stroke by 2020.

Surveillance System – Future Efforts Priority metrics Priority populations Priority strategy

Strategic Priority Keith C. Ferdinand, MD

Key Words Health Equity

Health Equity – Past Efforts Medical Civil Rights Movement Medicare and Medicaid Report of the Secretary’s Task Force on Black and Minority Health Civil Rights Act Office of Research on Minority Health in NIH Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care IOM Consensus Report Healthy People Healthy People National Quality Strategy HHS Action Plan to Reduce Racial and Ethnic Health Disparities and National Stakeholder Strategy for Achieving Health Equity National Prevention Strategy

Issues Largest Portion of Inequality Income and Hospitalizations Industry Around HDs

National Forum Strategic Priority Achieve health equity and eliminate cardiovascular disparities via implementation of population-based interventions by 2020.

Health Equity – Future Efforts Access to Quality Care Community Resources Address Social Determinants Data, Evaluation, Research

Strategic Priority Lawrence Appel, MD

Key Words Sodium Reduction

Sodium Reduction – Past Efforts Education Patients with hypertension General public with or without hypertension Providers Guidelines Dietary Guidelines for Americans Guidelines and recommendations from professional organizations Voluntary Reductions by Industry National High Blood Pressure Education Program

Issues Scientific Issues Practical Issues Commercial Interests

National Forum Strategic Priority Reduce daily sodium intake in the general population to 1500mg by 2020.

Sodium Reduction – Future Efforts National Salt Reduction Initiative IOM Report CSPI, AMA, AHA, CDC

9 th National Forum Thomas Pearson, MD

Moving Forward Vision Mission 2020 Goal Sodium Reduction Health Equity Surveillance System

Your Input Concurrent Sessions I Surveillance System Health Equity Sodium Reduction Concurrent Sessions II Surveillance System Health Equity Sodium Reduction

One Word What one word describes your reaction to the 2020 Goal and Strategic Priorities?

Questions?