Helping Healthcare Providers Prevent Heart Disease

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Thirteen key aspects of cardiovascular disease prevention are addressed in a new, comprehensive set of detailed steps to help healthcare providers reduce patients' risk for heart problems. The performance measures, developed by a joint task force of the American College of Cardiology and the American Heart Association, are simultaneously published in Circulation: Journal of the American Heart Association and the Journal of the American College of Cardiology.

The performance measures translate existing guidelines, or principles important to disease prevention, into practical steps for healthcare providers, said Rita F. Redberg, M.D., director of Women's Cardiovascular Services at the University of California, San Francisco Medical Center, and chair of the writing group. The goal is to provide practitioners and institutions with tools to measure and improve the quality of their cardiovascular care.

The writing group recommends the performance measures be used by healthcare professionals treating adults 18 or older at risk for heart disease. They aim to help providers identify and reduce risk factors for heart disease early, as well as to close the gap between optimal healthcare and the routine care that many patients receive. The measures include:

• lifestyle/risk factor screening
• dietary intake counseling
• physical activity counseling
• smoking/tobacco use assessment
• smoking/tobacco cessation
• weight and body fat assessment
• weight management
• blood pressure measurement
• blood pressure control
• blood lipid measurement
• blood lipid therapy and control
• estimation of a patient's global risk for developing heart disease
• aspirin use in at-risk patients

"If you're going to have a serious impact on heart disease, these are the specific timetables and the specific steps to make that happen," said Clyde Yancy, M.D., president of the American Heart Association. "As a performance measure, that puts it at our highest tier of importance and really should capture the attention of the practitioner."

The authors call for a comprehensive risk assessment for all patients at least every five years, and more frequently for patients with factors that elevate risk, such as obesity, diabetes or tobacco use.

Cardiovascular disease is the underlying cause of more than one-third of the deaths in the United States.

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"The risk assessment measures should be applied to every patient who visits a care provider regardless of the reason for the visit. The method for assessing cardiovascular risk is clearly outlined in these performance measures," said Alfred Bove, M.D., president of the American College of Cardiology.

The performance measures underwent a 30-day public comment period for health professionals last year, along with simultaneous peer and content review by the American College of Cardiology and the American Heart Association.

"We had very positive response," said Redberg, noting the group focused on practical matters including what a busy healthcare provider can accomplish in an office visit. Consequently, she said, the group believes the measures are achievable.

"There has to be a commitment [by primary care providers] that it's important and a priority in a healthcare visit," she said. "We believe that if these were widely used, there would be a reduction in deaths from heart disease."

The authors relied on top-level scientific evidence regarding what should and should not be done to prevent heart disease. The resulting measures are well-supported, interpretable, definable and valid in numerous circumstances, with a solid cause-and-effect link, Yancy said, noting this is especially important in an era of healthcare reform.

"The first step to obtaining high-quality care is to define ‘high-quality care.' It has to be measurable," he said.

Much of the progress in fighting cardiovascular disease has been made in the area of secondary prevention — deploying best practices to prevent progression of disease once heart problems arise.

"Now we're making a firm expansion into primary prevention where risk factors are monitored and treated — where healthy lifestyle behaviors are encouraged — to prevent a first, acute event from occurring," Yancy said. "If we can do that, ultimately the payoff from a public health perspective would be profound."

The performance measures also set the stage for an even broader focus on primary prevention, in which the risk factors themselves are prevented from arising. "When you get to that bubble, you talk about fundamentally changing the history of disease," Yancy said.

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