Author + information
- Kim Allan Williams Sr., MD, FACC, ACC President∗ ( and )
- Gerard R. Martin, MD, FACC, Chair, ACC Population Health Committee
- ↵∗Address correspondence to:
Dr. Kim Allan Williams, Sr., American College of Cardiology, 2400 N Street NW, Washington, DC 20037.
Although technological and educational advances over the last few decades have resulted in significant reductions in cardiovascular disease mortality in the United States, the burden of cardiovascular disease is actually predicted to increase 57% worldwide by 2020 (1). Up until now, cardiovascular professionals have been laser focused on secondary prevention—improving survival in patients already diagnosed with cardiovascular disease. Yet, with the cardiovascular disease burden increasing both here at home and around the world, our focus must expand to include primary prevention and health promotion. If we are truly to remove cardiovascular disease as the leading cause of mortality worldwide, we must shift the paradigm from treatment to prevention and begin moving toward population health.
Population health is not easily defined, largely because it lies at the complex intersection of an increasingly diverse population, an evolving health care system, traditional public health, and complicated social issues. Yet, defining it is a key aspect in reducing the burden of cardiovascular disease in U.S. and global populations. As part of its strategic plan, the College is revving up efforts to lead in this area by engaging partners in pursuit of global cardiovascular-related objectives, supporting members in their efforts to improve the health of populations, and encouraging cardiovascular team-facilitated patient education.
On July 27 and 28, 2015, the newly formed Population Health Policy and Health Promotion Committee of the American College of Cardiology (ACC) hosted members and external stakeholders at the College’s Heart House headquarters in Washington, DC, for a first-ever population health policy retreat. Specifically, the retreat aimed to define population health and health promotion for the ACC, discuss whether the College is prepared to engage in primary prevention, and prioritize partners and targeted activities related to population health and health promotion in the College.
The meeting convened ACC members and a diverse array of experts from government agencies, universities, medical specialty societies, and private sector partners to discuss primary prevention, health equity and social determinants of health, the changing health care landscape, and the role of primary care professionals in advancing cardiovascular health. The impressive lineup of speakers, which included experts from the Centers for Disease Control and Prevention, Centers for Medicare and Medicaid Services, CVS Health, Harvard Medical School, Pan-American Health Organization, U.S. Department of Agriculture, U.S. Food and Drug Administration, U.S. Department of Health and Human Services, Walmart, the White House, and more, shared how their organizations are making strides in reducing heart disease. The presenters energized the room full of ACC members and representatives from partner organizations who are ready to hit the ground running to affect population health.
Valentin Fuster, MD, PhD, MACC, Editor-in-Chief of the Journal, received an award from the Population Health Committee at the retreat for his leadership in changing the landscape and improving patient health through the lifespan. Dr. Fuster noted in his keynote address that the needs for disease prevention and treatment are at different stages of life, and the biggest potential effect in prevention can come from efforts aimed at children. Dr. Fuster said that cardiovascular disease is primarily a behavioral issue, and habits related to diet, physical activity, and smoking are established early.
In a work session following the retreat, the Population Health Committee deliberated on the knowledge exchanged during the retreat and developed key recommendations that will be fleshed out over the coming months into a more formalized population health agenda and presented later this year to the ACC’s Board of Trustees.
In particular, the Committee agreed that the College should commit to working with partners inside and outside of the College to build a population health agenda that encompasses a holistic view of health promotion. In keeping with the holistic theme, they also recommended that the College continue to support efforts in related areas, such as tobacco control and prevention. If we are to successfully contribute to alleviating the cardiovascular disease burden, we must work with our partners to address critical risk factors and design and support policies that generate the greatest health benefit by improving cardiovascular health outcomes. Options include working in concert with schools, employers, insurers, nonprofit groups, and other strategic partners to improve nutrition-related policies and regulations at the state and national levels. Finding ways to engage clinicians in ongoing implementation efforts undertaken by partners like the American Heart Association will also be crucial.
Specific goals and targets related to diet, nutrition, and exercise will also be important elements of the agenda, as will identifying how best to leverage the ACC’s existing tools such as the PINNACLE Registry and CardioSmart. Advocacy is also a key effort, particularly when it comes to ensuring that the expertise of the College is reflected in national and international policies and regulations. The College can and should serve as a resource to Congress, the Administration, the World Health Organization, and others. Although our advocacy work has largely focused to date on access to the services that individual patients need to treat cardiovascular disease, expanding the College’s focus to include the socioeconomic and lifestyle factors faced by our patients is equally relevant. These factors contribute significantly to the burden of cardiovascular disease at the population level here in the United States and around the world. In the coming months, the ACC’s Advocacy and Communications departments will work on delineating opportunities to influence the policy-making process along with key messages to deliver.
It is clear that our ability to successfully improve cardiovascular health outcomes—to truly move the needle beyond what we can achieve solely with secondary prevention—depends on our ability to help change the environment that our patients exist in. As we have said before, we need to turn off the faucet instead of just mopping the floor. It is also clear that the changing reimbursement system—which is evolving from fee-for-service to reimbursement on the basis of overall health outcomes—will require cardiologists to work more closely with their fellow primary care physicians. Furthermore, to meet the needs of clinicians participating in new health care models like the ACC-endorsed Million Hearts Cardiovascular Disease Risk Reduction Model, we need to make a commitment to changing policies that will improve health outcomes in the long term.
Now is the time for the ACC to take the lead in the diet, nutrition, and exercise space. Although we have only just begun to dip our toes into the population health waters, there is tremendous enthusiasm from our members and partners, and there are numerous opportunities on the horizon for the College. We are excited by the future!
- 2015 American College of Cardiology Foundation
- ↵Mathers C, Loncar D. Updated projections of global mortality and burden of disease, 2002-2030: data sources, methods and results. World Health Organization. Available at: http://www.who.int/healthinfo/statistics/bodprojectionspaper.pdf. Accessed September 14, 2015.