Calling all Cardiovascular Nurses

The Million Hearts is a national initiative to prevent 1 million myocardial infarctions and strokes over 5 years by focusing the nation on evidence-based community and clinical prevention actions.1,2 Million Hearts brings together communities, health systems, nonprofit organizations, federal agencies, and private-sector partners from across the country to make a long-lasting impact against cardiovascular disease.2 Launched by the Department of Health and Human Services in September 2011, it aligns existing efforts, as well as creates new programs, to improve health across communities and help Americans live longer, more productive lives. The Centers for Disease Control and Prevention (CDC) and Centers for Medicare & Medicaid Services (CMS) co-lead Million Hearts within the Health and Human Services. Key components of the initiative emphasize cardiovascular health and include community prevention to reduce the number of people who need treatment and clinical prevention to optimize care for those who do require care.2 Community prevention strategies aim to reduce the number of people who need treatment, such as blood pressure or cholesterol medications, to prevent myocardial infarctions and strokes by empowering Americans to make healthier choices by preventing tobacco use and limiting sodium and trans-fat consumption. Clinical prevention efforts to improve quality of care focus on the ABCS—aspirin for people at risk, blood pressure control, cholesterol management, and smoking cessation—which address the major risk factors for cardiovascular disease and can help to prevent myocardial infarctions and strokes.2 Strategies include aligning care goals with provider and system incentives, fully deploying health information technology (HIT) to report and improve ABCS performance, and innovating care delivery to improve adherence and control of ABCS.1 Current performance on Million Hearts–related measures varies widely across clinical systems, from well below 50% to nearly 90%.1 With this information in mind, the goals for performance on the Million Hearts measures in healthcare settings were set at 70%, rather than at an unrealistic or potentially harmful 100% (Table).1TABLE: Benchmarks for Million Hearts Program Success1,2Million Hearts brings together a number of programs, policies, and campaigns designed to make a positive impact across the spectrum of prevention and care, promoting the ABCS of clinical prevention as well as healthier lifestyles and communities.2 Some of Million Hearts’ wide-ranging activities include (1) educational campaigns to increase awareness about heart disease prevention and empower patients to take control of their heart health, (2) use of HIT and quality improvement initiatives to standardize and improve the delivery of care for high blood pressure and high cholesterol, and (3) community efforts to promote smoke-free air policies and reduce sodium in the food supply. Toolkits were designed to help partners incorporate Million Hearts into their everyday work and enhance their heart disease and stroke prevention efforts.2 They include messages for consumers and healthcare professionals and tools to support local events. A Partners Toolkit, Grand Rounds Toolkit, and Blood Pressure Toolkit are available for download and use in full or as individual components.2 The Partners Toolkit can be used to expand existing heart disease and stroke prevention programs and to recruit others to improve clinical preventive practice and community prevention. The Grand Rounds Toolkit features CDC Director Dr Tom Frieden, Million Hearts Executive Director Dr Janet Wright, and CMS Chief Medical Officer Dr Patrick Conway talking about the initiative’s focus on preventing myocardial infarctions and strokes through clinical preventive practice and community prevention with first-person accounts from 2 communities working to create healthier environments and to align healthcare professionals and systems to improve quality of care. The Blood Pressure Toolkit was designed to be used with patients to help address high blood pressure in your clinics and communities. In addition, the Million Hearts Web site provides numerous resources to support community and clinical prevention of heart disease and stroke. Successes and best practices in heart disease and stroke by the Million Hearts partner organizations are highlighted. Detailed progress notes are provided on select successful projects chosen based on their potential for implementations by other organizations. The selection criteria include their effectiveness, how easily they can be replicated, and their inclusion of lessons learned.2 The American Heart Association/American Stroke Association has also joined forces with Million Hearts providing tools including the Heart Attack Risk Calculator, My Life Check, and Life’s Simple 7. Other tools include videos with personal stories about heart disease and stroke prevention. Nurses, other healthcare providers, and health systems are vital to the Million Hearts mission. Specific actions to promote the goals of this ambitious initiative are listed in the Box. Box. Actions to Advance Million Hearts Focus on the ABCS with your patients Prioritize control of high blood pressure and cholesterol. Help your patients follow treatment instructions and improve medication adherence. Ask your patients about their smoking habits and provide smoking cessation counseling and tools for smokers. Prescribe appropriate aspirin therapy for those who would benefit. Track and improve ABCS performance through HIT and quality improvement Report on the ABCS-related Cardiovascular Prevention Measures Group in the CMS Physician Quality Reporting System. Use HIT, such as electronic health records with clinical decision support tools and a patient registry, to improve the delivery of care for ABCS in patients and populations/panels. For example, use electronic health record registry functionality regularly to detect those with uncontrolled hypertension or cholesterol and recall them for follow-up. Align provider education and quality improvement initiatives to focus on and improve ABCS. Recognize and reward healthcare providers who address and promote ABCS in their patients. Connect with other clinicians in your community in a learning and action network aimed at improving ABCS in your patients. Support team-based approaches to care to improve coordination and quality of care for patients. Implement innovative care models (patient-centeredmedical homes, accountable care organizations) that include a focus on the ABCS. Connect at-risk patients with community resources for self-management, diabetes education, and other community resources to address barriers to adherence. Decrease health disparities–use culturally appropriate education materials, patient navigators, community health workers to address barriers to care. Educate your patients and community about the most effective ways to control their risk factors for heart disease and stroke. Promote heart-healthy habits to your patients, such as regular physical activity and a diet rich in fresh fruits and vegetables. Reduce out-of-pocket costs for smoking cessation, blood pressure, and cholesterol medications and services. Drive awareness of the initiative. Include Million Hearts messages in newsletters, pledge your organization’s commitment on the Million Hearts Web site, and recruit at least 20 patients and partners to do the same. Convene partners, stakeholders and policy makers for Million Hearts events. Share success stories on the Million Hearts Web site. Monitor whether progress is being made in your community. Adapted from the Million Hearts CDC Grands Rounds Toolkit.3 Preventing 1 million myocardial infarctions and strokes in 5 years will require commitment to change not only in the cardiovascular health behaviors of the nation but also in our cardiovascular health promotion and risk factor management practices. Each of us can be 1 in a Million Hearts, taking action and making a positive impact toward this goal. To learn more about Million Hearts, visit http://millionhearts.hhs.gov.2