Transcript Preventing Heart Disease and Stroke: A Framework for Action

Wellness
SYMPOSIUM
Darwin R. Labarthe, MD, MPH, PhD
Director, Division for Heart Disease and Stroke Prevention
CO-LEAD AGENCIES: CDC AND NIH
The national goal for heart disease
and stroke prevention:
- prevention of risk factors
- detection and treatment of risk factors
- early identification and treatment
of heart attacks and strokes
- prevention of recurrent cardiovascular
events
The Present Reality
Unfavorable
Social and
Environmental
Conditions
The Present Reality
Adverse
Behavioral
Patterns
Major Risk
Factors
First Event/
Sudden
Death
Disability/
Risk of
Recurrence
Fatal CVD
Complications/Decompensation
A Vision of the Future
A Vision of the Future
Social and
Environmental
Conditions
Favorable to
Health
Behavioral
Patterns
Promote
Health
Low
Population
Risk
Few
Events/
Only Rare
Deaths
Full Functional
Capacity/
Low Risk of
Recurrence
Good Quality
of Life Until
Death
A Vision of the Future
Social and
Environmental
Conditions
Favorable to
Health
Unfavorable
Social and
Environmental
Conditions
Behavioral
Patterns
Promote
Health
Low
Population
Risk
Few
Events/
Only Rare
Deaths
Full Functional
Capacity/
Low Risk of
Recurrence
Good Quality
of Life Until
Death
Disability/
Risk of
Recurrence
Fatal CVD
Complications/Decompensation
The Present Reality
Adverse
Behavioral
Patterns
Major Risk
Factors
First Event/
Sudden
Death
Action Framework for a Comprehensive Public Health Strategy
To Prevent Heart Disease and Stroke
A Vision of the Future
Social and
Environmental
Conditions
Favorable to
Health
Policy and
Environmental
Change
Behavioral
Patterns
Promote
Health
Behavior
Change
Low
Population
Risk
Risk Factor
Detection
and Control
Few
Events/
Only Rare
Deaths
Emergency
Care/Acute Case
Management
Intervention
Approaches
Unfavorable
Social and
Environmental
Conditions
Full Functional
Capacity/
Low Risk of
Recurrence
Rehabilitation/
Long-term Case
Management
The Present Reality
Adverse
Behavioral
Patterns
Major Risk
Factors
First Event/
Sudden
Death
Disability/
Risk of
Recurrence
Good Quality
of Life Until
Death
End-ofLife Care
Fatal CVD
Complications/Decompensation
Action Framework for a Comprehensive Public Health Strategy
To Prevent Heart Disease and Stroke
A Vision of the Future
Social and
Environmental
Conditions
Favorable to
Health
Policy and
Environmental
Change
Behavioral
Patterns
Promote
Health
Behavior
Change
Low
Population
Risk
Risk Factor
Detection
and Control
Few
Events/
Only Rare
Deaths
Emergency
Care/Acute Case
Management
Intervention
Approaches
Unfavorable
Social and
Environmental
Conditions
Full Functional
Capacity/
Low Risk of
Recurrence
Rehabilitation/
Long-term Case
Management
The Present Reality
Adverse
Behavioral
Patterns
Major Risk
Factors
First Event/
Sudden
Death
Goal 2
Goal 3
End-ofLife Care
Fatal CVD
Complications/Decompensation
Disability/
Risk of
Recurrence
The Healthy People 2010 Goals
Increase Quality and Years of Healthy Life
Eliminate Disparities
Goal 1
Good Quality
of Life Until
Death
Goal 4
Action Framework for a Comprehensive Public Health Strategy
To Prevent Heart Disease and Stroke
A Vision of the Future
Social and
Environmental
Conditions
Favorable to
Health
Policy and
Environmental
Change
Behavioral
Patterns
Promote
Health
Low
Population
Risk
Behavior
Change
Risk Factor
Detection
and Control
Few
Events/
Only Rare
Deaths
Emergency
Care/Acute Case
Management
Intervention
Approaches
Unfavorable
Social and
Environmental
Conditions
Full Functional
Capacity/
Low Risk of
Recurrence
Rehabilitation/
Long-term Case
Management
The Present Reality
Adverse
Behavioral
Patterns
Major Risk
Factors
First Event/
Sudden
Death
Good Quality
of Life Until
Death
End-ofLife Care
Fatal CVD
Complications/Decompensation
Disability/
Risk of
Recurrence
The Healthy People 2010 Goals
Increase Quality and Years of Healthy Life
Eliminate Disparities
Goal 1
Goal 2
Goal 3
Goal 4
Target Population
Total Population
300million
Total Population
300million
TC
105million
HBP
72million
Smoking 46million
Diabetes 20million
CHD
1,200,000
CHF
550,000
Stroke
500,000
CHD
15.8million
Stroke 5.7million
CHF
5.2million
CVD 871,000
Action Framework for a Comprehensive Public Health Strategy
To Prevent Heart Disease and Stroke
A Vision of the Future
Social and
Environmental
Conditions
Favorable to
Health
Behavioral
Patterns
Promote
Health
Low
Population
Risk
Few
Events/
Only Rare
Deaths
Full Functional
Capacity/
Low Risk of
Recurrence
Good Quality
of Life Until
Death
TREATMENT
$ .05
$ .95
PREVENTION
Policy and
Environmental
Change
Behavior
Change
Risk Factor
Detection
and Control
Emergency
Care/Acute Case
Management
Intervention
Approaches
Unfavorable
Social and
Environmental
Conditions
Rehabilitation/
Long-term Case
Management
The Present Reality
Adverse
Behavioral
Patterns
Major Risk
Factors
First Event/
Sudden
Death
End-ofLife Care
Fatal CVD
Complications/Decompensation
Disability/
Risk of
Recurrence
The Healthy People 2010 Goals
Increase Quality and Years of Healthy Life
Eliminate Disparities
Goal 1
Goal 2
Goal 3
Goal 4
Target Population
Total Population
300million
Total Population
300million
TC
105million
HBP
72million
Smoking 46million
Diabetes 20million
CHD
1,200,000
CHF
550,000
Stroke
500,000
CHD
15.8million
Stroke 5.7million
CHF
5.2million
CVD 871,000
Action Framework for a Comprehensive Public Health Strategy
To Prevent Heart Disease and Stroke
A Vision of the Future
Social and
Environmental
Conditions
Favorable to
Health
Policy and
Environmental
Change
Behavioral
Patterns
Promote
Health
Low
Population
Risk
Behavior
Change
0
1
Unfavorable
Social and
Environmental
Conditions
Risk Factor
Detection
and Control
Few
Events/
Only Rare
Deaths
Emergency
Care/Acute Case
Management
Intervention
Approaches
Full Functional
Capacity/
Low Risk of
Recurrence
Good Quality
of Life Until
Death
0
2
Rehabilitation/
Long-term Case
Management
0
3
The Present Reality
Adverse
Behavioral
Patterns
Major Risk
Factors
First Event/
Sudden
Death
End-ofLife Care
Fatal CVD
Complications/Decompensation
Disability/
Risk of
Recurrence
The Healthy People 2010 Goals
Increase Quality and Years of Healthy Life
Eliminate Disparities
Goal 1
Goal 2
Goal 3
Goal 4
Target Population
Total Population
300million
Total Population
300million
TC
105million
HBP
72million
Smoking 46million
Diabetes 20million
CHD
1,200,000
CHF
550,000
Stroke
500,000
CHD
15.8million
Stroke 5.7million
CHF
5.2million
CVD 871,000
Action Framework for a Comprehensive Public Health Strategy
To Prevent Heart Disease and Stroke
A Vision of the Future
Social and
Environmental
Conditions
Favorable to
Health
Policy and
Environmental
Change
Behavioral
Patterns
Promote
Health
Low
Population
Risk
Behavior
Change
Risk Factor
Detection
and Control
?
Unfavorable
Social and
Environmental
Conditions
Few
Events/
Only Rare
Deaths
Emergency
Care/Acute Case
Management
Intervention
Approaches
Full Functional
Capacity/
Low Risk of
Recurrence
Rehabilitation/
Long-term Case
Management
The Present Reality
Adverse
Behavioral
Patterns
Major Risk
Factors
First Event/
Sudden
Death
Good Quality
of Life Until
Death
End-ofLife Care
Fatal CVD
Complications/Decompensation
Disability/
Risk of
Recurrence
The Healthy People 2010 Goals
Increase Quality and Years of Healthy Life
Eliminate Disparities
Goal 1
Goal 2
Goal 3
Goal 4
Target Population
Total Population
300million
Total Population
300million
TC
105million
HBP
72million
Smoking 46million
Diabetes 20million
CHD
1,200,000
CHF
550,000
Stroke
500,000
CHD
15.8million
Stroke 5.7million
CHF
5.2million
CVD 871,000
Action Framework for a Comprehensive Public Health Strategy
To Prevent Heart Disease and Stroke
A Vision of the Future
Social and
Environmental
Conditions
Favorable to
Health
Policy and
Environmental
Change
Behavioral
Patterns
Promote
Health
Low
Population
Risk
Behavior
Change
0
1
Unfavorable
Social and
Environmental
Conditions
Risk Factor
Detection
and Control
Few
Events/
Only Rare
Deaths
Emergency
Care/Acute Case
Management
Intervention
Approaches
Full Functional
Capacity/
Low Risk of
Recurrence
Rehabilitation/
Long-term Case
Management
The Present Reality
Adverse
Behavioral
Patterns
Major Risk
Factors
First Event/
Sudden
Death
Good Quality
of Life Until
Death
End-ofLife Care
Fatal CVD
Complications/Decompensation
Disability/
Risk of
Recurrence
The Healthy People 2010 Goals
Increase Quality and Years of Healthy Life
Eliminate Disparities
Goal 1
Goal 2
Goal 3
Goal 4
Target Population
Total Population
300million
Total Population
300million
TC
105million
HBP
72million
Smoking 46million
Diabetes 20million
CHD
1,200,000
CHF
550,000
Stroke
500,000
CHD
15.8million
Stroke 5.7million
CHF
5.2million
CVD 871,000
Action Framework for a Comprehensive Public Health Strategy
To Prevent Heart Disease and Stroke
A Vision of the Future
Social and
Environmental
Conditions
Favorable to
Health
Policy and
Environmental
Change
Behavioral
Patterns
Promote
Health
Low
Population
Risk
Behavior
Change
0
2
0
1
Unfavorable
Social and
Environmental
Conditions
Risk Factor
Detection
and Control
Few
Events/
Only Rare
Deaths
Emergency
Care/Acute Case
Management
Intervention
Approaches
Full Functional
Capacity/
Low Risk of
Recurrence
Rehabilitation/
Long-term Case
Management
The Present Reality
Adverse
Behavioral
Patterns
Major Risk
Factors
First Event/
Sudden
Death
Good Quality
of Life Until
Death
End-ofLife Care
Fatal CVD
Complications/Decompensation
Disability/
Risk of
Recurrence
The Healthy People 2010 Goals
Increase Quality and Years of Healthy Life
Eliminate Disparities
Goal 1
Goal 2
Goal 3
Goal 4
Target Population
Total Population
300million
Total Population
300million
TC
105million
HBP
72million
Smoking 46million
Diabetes 20million
CHD
1,200,000
CHF
550,000
Stroke
500,000
CHD
15.8million
Stroke 5.7million
CHF
5.2million
CVD 871,000
Action Framework for a Comprehensive Public Health Strategy
To Prevent Heart Disease and Stroke
A Vision of the Future
Social and
Environmental
Conditions
Favorable to
Health
Policy and
Environmental
Change
Behavioral
Patterns
Promote
Health
Low
Population
Risk
Behavior
Change
0
1
Risk Factor
Detection
and Control
HP
Unfavorable
Social and
Environmental
Conditions
Few
Events/
Only Rare
Deaths
Emergency
Care/Acute Case
Management
Intervention
Approaches
Full Functional
Capacity/
Low Risk of
Recurrence
Rehabilitation/
Long-term Case
Management
The Present Reality
Adverse
Behavioral
Patterns
Major Risk
Factors
First Event/
Sudden
Death
Good Quality
of Life Until
Death
End-ofLife Care
Fatal CVD
Complications/Decompensation
Disability/
Risk of
Recurrence
The Healthy People 2010 Goals
Increase Quality and Years of Healthy Life
Eliminate Disparities
Goal 1
Goal 2
Goal 3
Goal 4
Target Population
Total Population
300million
Total Population
300million
TC
105million
HBP
72million
Smoking 46million
Diabetes 20million
CHD
1,200,000
CHF
550,000
Stroke
500,000
CHD
15.8million
Stroke 5.7million
CHF
5.2million
CVD 871,000
Action Framework for a Comprehensive Public Health Strategy
To Prevent Heart Disease and Stroke
A Vision of the Future
Social and
Environmental
Conditions
Favorable to
Health
Policy and
Environmental
Change
Behavioral
Patterns
Promote
Health
Low
Population
Risk
Behavior
Change
0
0
Unfavorable
Social and
Environmental
Conditions
0
1
Risk Factor
Detection
and Control
Few
Events/
Only Rare
Deaths
Emergency
Care/Acute Case
Management
Intervention
Approaches
Full Functional
Capacity/
Low Risk of
Recurrence
Rehabilitation/
Long-term Case
Management
The Present Reality
Adverse
Behavioral
Patterns
Major Risk
Factors
First Event/
Sudden
Death
Good Quality
of Life Until
Death
End-ofLife Care
Fatal CVD
Complications/Decompensation
Disability/
Risk of
Recurrence
The Healthy People 2010 Goals
Increase Quality and Years of Healthy Life
Eliminate Disparities
Goal 1
Goal 2
Goal 3
Goal 4
Target Population
Total Population
300million
Total Population
300million
TC
105million
HBP
72million
Smoking 46million
Diabetes 20million
CHD
1,200,000
CHF
550,000
Stroke
500,000
CHD
15.8million
Stroke 5.7million
CHF
5.2million
CVD 871,000
Action Framework for a Comprehensive Public Health Strategy
To Prevent Heart Disease and Stroke
A Vision of the Future
Social and
Environmental
Conditions
Favorable to
Health
Policy and
Environmental
Change
Behavioral
Patterns
Promote
Health
Low
Population
Risk
Few
Events/
Only Rare
Deaths
CONTINUUM
‘upstream’
OF
CARE
Behavior
Change
Risk Factor
Detection
and Control
Emergency
Care/Acute Case
Management
Intervention
Approaches
Unfavorable
Social and
Environmental
Conditions
Full Functional
Capacity/
Low Risk of
Recurrence
‘downstream’
Rehabilitation/
Long-term Case
Management
The Present Reality
Adverse
Behavioral
Patterns
Major Risk
Factors
First Event/
Sudden
Death
Good Quality
of Life Until
Death
End-ofLife Care
Fatal CVD
Complications/Decompensation
Disability/
Risk of
Recurrence
The Healthy People 2010 Goals
Increase Quality and Years of Healthy Life
Eliminate Disparities
Goal 1
Goal 2
Goal 3
Goal 4
Target Population
Total Population
300million
Total Population
300million
TC
105million
HBP
72million
Smoking 46million
Diabetes 20million
CHD
1,200,000
CHF
550,000
Stroke
500,000
CHD
15.8million
Stroke 5.7million
CHF
5.2million
CVD 871,000
Action Framework for a Comprehensive Public Health Strategy
For Chronic Disease Prevention and Health Promotion
A Vision of the Future
Social and
Environmental
Conditions
Favorable to
Health
Policy and
Environmental
Change
Behavioral
Patterns
Promote
Health
Low
Population
Risk
Few
Events/
Only Rare
Deaths
CONTINUUM
‘upstream’
OF
CARE
Behavior
Change
Risk Factor
Detection
and Control
Emergency
Care/Acute Case
Management
Intervention
Approaches
Unfavorable
Social and
Environmental
Conditions
Full Functional
Capacity/
Low Risk of
Recurrence
‘downstream’
Rehabilitation/
Long-term Case
Management
The Present Reality
Adverse
Behavioral
Patterns
Major Risk
Factors
First Event/
Sudden
Death
Good Quality
of Life Until
Death
End-ofLife Care
Fatal CVD
Complications/Decompensation
Disability/
Risk of
Recurrence
The Healthy People 2010 Goals
Increase Quality and Years of Healthy Life
Eliminate Disparities
Goal 1
Goal 2
Goal 3
Goal 4
Target Population
Total Population
300million
Total Population
300million
Persons with
increased risk
Persons first
identified with
chronic conditions
Persons living or
disabled with
chronic conditions
Deaths due to
chronic
conditions
The national goal for heart disease
and stroke prevention:
- prevention of risk factors
- detection and treatment of risk factors
- early identification and treatment
of heart attacks and strokes
- prevention of recurrent cardiovascular
events
The national goal for chronic disease
prevention and health promotion:
- maintenance of good health/low risk
- management of risk factors
- response to acute event or first diagnosis
- reduction of disability, improvement in
quality of life, and prevention of disease
progression or recurrent events
Wellness
The 1st national goal for chronic disease
prevention and health promotion:
- maintenance of good health/low risk