A Patient-Centered Outcomes Research Approach to Prevention Eduardo Sanchez, MD,MPH,FAAFP Chief Medical Officer for Prevention Chief, Center for Health Metrics and Evaluation American Heart Association
Causes of Death: USA (2017) Rank Cause Number Percent Total –all causes 2,813,503 100% 1 Heart diseases 647,457 23% 2 Cancer 599,108 21.3% 3 Accidents 169,936 6% 4 Chronic Lower Respiratory Disease 160,201 5.7% 5 Stroke 146,383 5.2% 6 Alzheimer’s disease 121,404 4.3 7 Diabetes mellitus 83,564 3% 8 Influenza/pneumonia 55,672 2% 9 Kidney disease 50,633 1.8% 10 Suicide 47,173 1.7% SOURCE: NCHS, National Vital Statistics System, Mortality. 2
American Heart Association 2020 Goal By 2020, improve the cardiovascular health of all Americans by 20% while reducing deaths from cardiovascular diseases & stroke by 20%. Life’s Simple 7 3
Top 11 risk factors contributing to death and disability combined in 2017 1. High body mass index 2. Tobacco 3. Dietary risks 4. High fasting plasma glucose 5. High blood pressure 6. Drug use 7. Alcohol use 8. High LDL cholesterol 9. Impaired Kidney Function 10. Occupational risks 11. Air pollution http://www.healthdata.org/united-states, Institute for Health Metrics and Evaluation (IHME), Accessed 4/14/2019 4
Improving Life’s Simple 7 has collateral benefits A high LS7 score (≥5 ideal metrics) is associated with lower risk for a range of disabling and costly disease conditions: • Heart disease and stroke (Lloyd-Jones et al, 2010, Ford et al., 2012) • Diabetes (Joseph et al, 2016) • Depression (Kronish et al, 2012) • Improved cognitive function (Reis et al, 2013) • Incident cancer (Rasmussen-Torvik et al, 2013) • Incident dementia (Gottesman et al, 2017) • Healthcare costs in a young, ethnically diverse working population (Osondu et al 2017) • Healthcare costs in Medicare population (Willis et al 2015) 5
2019 ACC/AHA Guideline on the Primary Prevention of Cardiovascular Disease A team-based care approach is an effective strategy for the prevention of cardiovascular disease. Clinicians should evaluate social determinants of health on individuals to inform treatment decisions. Address each of the 7 of Life’s Simple 7 All adults should be assessed at every visit for tobacco use. - Telephone counseling interventions are effective. All adults should consume a healthy diet. Adults should engage in regular physical activity. Arnett, D., Blumenthal, R., et al. Circulation, 2019 . 6
Ca Cardio iovascula lar ( (CV CV) Ris isk Factor T Targets and CV CV D Dis isease E Event R Risk isk in in Dia iabetes • Pooled analysis • Atherosclerosis Risk in Communities (ARIC) • Multi-Ethnic Study of Atherosclerosis (MESA) • Jackson Heart Study (JHS) • 2018 adults ages 28-86 with diabetes and no CVD initially Wong, et al. Diabetes Care 2016 May; 39(5) 668-676 . 7
Ca Cardio iovascula lar ( (CV CV) Ris isk Factor T Targets and CV CV D Dis isease E Event R Risk isk in in Dia iabetes • Percent at target levels for any one, two, or all three factors among the 2018 persons with diabetes: Any 1 of 3 Any 2 of 3 3 of 3 41.1% 26.5% 7.2% Wong, et al. Diabetes Care 2016 May; 39(5) 668-676 . 8
Ca Cardio iovascula lar ( (CV CV) Ris isk Factor T Targets and CV CV D Dis isease E Event R Risk isk in in Dia iabetes • Lower adjusted risk (%) of CVD events with one, two, or three risk factors at target level: Any 1 of 3 Any 2 of 3 3 of 3 36% 52% 62% Wong, et al. Diabetes Care 2016 May; 39(5) 668-676. *incident CVD was defined as a MI, CHD death, cardiac procedure (percutaneous coronary interventions, bypass surgery, or coronary revascularization), stroke, or HF. 9
Smoking Rates in US by State, Poverty, and County Population(2016) Rate Lowest state rate – Utah 8.8% Highest state rate – West Virginia 24.8% Below poverty 25.3% Above poverty 14.3% Rural County 28.1%% Large Metropolitan County 18.3% cdc.gov 10
Smoking Rates in US by Education Level (2016) Education level Rate Graduate degree 4.5% Undergraduate degree 7.7% Associate’s degree 16.8% Some college 18.9% High school diploma 19.7% No high school diploma 24.1% GED 40.6% cdc.gov 11
Number ber and p percent entage o e of o outpatient ent c chroni nic condition v n visits by by phy physician type pe i in n the he p past y yea ear: 2008 N 8 Natio ional A l Ambula latory Medic ical C l Care S Survey Sharma et al. Am Board Fam Med 2014;27:11–12
Hans Rosling (1948-2017) Celebrity statistician; Gapfinder co-developer “I’m not an optimist. I’m a very serious possibilist.” 13
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