Hospital and Physician Update

July – August 2019

A message from Dr. S. George Kipa
How we can prevent a million cardiovascular events by 2022

I had the pleasure of speaking at the 2019 Blue Cross Blue Shield National Summit earlier this year as part of a presentation on the Million Hearts Initiative.

This ambitious program, a national initiative led by the Centers for Medicare & Medicaid Services and the Centers for Disease Control and Prevention, aims to prevent 1 million cardiovascular events over a five-year period. Janet Wright, M.D., acting director of science and policy with the Office of the Surgeon General and former executive director of Million Hearts, led the presentation.

The need for such an initiative is starkly apparent when you consider these statistics:

• More than 1.5 million people suffer from heart attacks and strokes each year.
• More than 800,000 people die each year from cardiovascular disease.
• CVD costs the U.S. hundreds of billions of dollars each year.
• CVD is the greatest contributor to racial disparities in life expectancy.

Perhaps the most important statistic of all is that about 80% of CVD is preventable.

Results of the first iteration of the program were impressive, although the program fell short of its goal of preventing 1 million CV events. We estimate that up to 500,000 events will have been prevented when final data is available later this year.

New objectives for 2020 have been established, with an aim of preventing 1 million heart attacks and strokes in five years. These are important for all of us to keep in mind:

*Aspirin use when appropriate, blood pressure control, cholesterol management, smoking cessation

Importance of cardiac rehabilitation
A key focus of the program is the role that cardiac rehabilitation plays in saving lives, restoring health and preventing disease. Compared to people who attend one cardiac rehabilitation session, individuals who attend 36 sessions have:

• 47% lower risk of death
• 31% lower risk of heart attack

Furthermore, cardiac rehabilitation reduces:

• Death from all causes by 13% to 24%
• Death from all cardiac causes by 26% to 31%
• Hospitalizations by 31%

It also improves medication adherence, as well as functional status, mood and quality of life scores.

We calculate that increasing CR participation from 20% to 70% would save 25,000 lives and prevent 180,000 hospitalizations.

Henry Ford Hospital’s innovative home-based program
My portion of the presentation detailed Henry Ford Hospital’s home-based cardiac rehabilitation program. It takes advantage of Blue Cross Blue Shield of Michigan’s telemedicine policy to allow home-based delivery of cardiac rehabilitation.

This approach removes many of the barriers to cardiac rehabilitation, including lack of transportation, dependent care responsibilities and the patient’s need to return to work. It offers all the elements of standard cardiac rehabilitation, including patient education and exercise supervision through synchronized audiovisual telemedicine. It also involves computer-based smart technology and makes use of community and workplace fitness facilities.

More than 300 cardiac rehabilitation telemedicine visits have been conducted through this program to date. Last year, Steven Keteyian, Ph.D., director of preventive cardiology with the Henry Ford Medical Group, received a grant from the National Institute of Health to test home-based CR among vulnerable Detroit-area residents. Recruitment began in March of this year.

The program shows how we can collaborate on payment and health care delivery solutions to address one of the most pressing health care problems: the prevalence of heart attacks and strokes in the U.S.

If you’d like any additional details, email me at GKipa@bcbsm.com.

S. George Kipa, M.D., is deputy chief medical officer for Blue Cross Blue Shield of Michigan.

No portion of this publication may be copied without the express written permission of Blue Cross Blue Shield of Michigan, except that BCBSM participating health care providers may make copies for their personal use. In no event may any portion of this publication be copied or reprinted and used for commercial purposes by any party other than BCBSM.

Blue Cross Blue Shield of Michigan and Blue Care Network are nonprofit corporations and independent licensees of the Blue Cross and Blue Shield Association.