The document summarizes a discussion between health organizations about reducing cardiovascular disease in the Harlem community. It outlines the high burden of heart disease and stroke nationally and among African Americans. High blood pressure plays a large role and disproportionately affects people of color. The Million Hearts initiative was presented as aiming to prevent 1 million heart attacks and strokes over 5 years through community and clinical prevention focused on controlling key risk factors like blood pressure, cholesterol, smoking, diet and sodium intake. Local efforts in Harlem could start by increasing awareness, screening and lifestyle support programs involving faith and community groups.

1. Discussion with the New York State Health Foundation
4/17/12

2. Agenda
 Introductions
 the New York State Health Foundation
 the Harlem Health Promotion Center
 the Colin Powell Center for Social Justice
 the National Black Leadership Council on AIDS
(NBLCA)
 Racial Disparities in CVD
 Focus on the Harlem Community
 Synopsis of the Million Hearts Campaign
 Discussion

3. Magnitude of the problem -
nationally

4. Heart Disease and Strokes are
Leading Killers in the U.S.
 Cause 1 of every 3 deaths
 Over 2 million heart attacks and strokes each year
 800,000 deaths
 Leading cause of preventable death in people < 65
 $444 B in health care costs, lost productivity
 Greatest expression of racial disparities in life
expectancy

5. Age-adjusted death rates for stroke by sex and race/ethnicity, 2007.
Source: NCHS and NHLBI.
©2010 American Heart Association, Inc. All rights reserved. Roger VL et al. Published online in Circulation Dec. 15, 2010

6. CVD Leading Cause of Shorter Life
Expectancy Among African Americans
Life expectancy loss for blacks, in months
Source: CDC/NCHS, National Vital Statistics System, Mortality, 2007

7. Every 24 hours…
 131 men of color, and 148 women of
color will die from cardiovascular
disease (heart attacks, strokes, etc.)
American Heart Association, 2008

8. High Blood Pressure
Plays a significant role in contributing to:
 Heart attacks
 Strokes
 CDC. Health, United States, 2008. Hyattsville, MD: National Center for Health Statistics; 2008.

9. High Blood Pressure
One in three adults…
Or, about 75 million people, above the age of 20, in the United States have high blood
pressure

10. High Blood Pressure and
People of Color
 31% of all Americans affected
 29% of Hispanics
40% of African-Americans
 Among African Americans,
hypertension (HTN) develops earlier in
life and tends to be more severe,
therefore increasing the risk for HTN-
related complications

11. Age-Adjusted Prevalence Trends for HBP in Adults, ≥20 years of age by race/ethnicity,
sex and survey (NHANES:1988-1994, 1999-2004 and 2005-2008).
Source: NCHS and NHLBI. NH indicates non-Hispanic.
©2010 American Heart Association, Inc. All rights reserved. Roger VL et al. Published online in Circulation Dec. 15, 2010

12. High Blood Pressure and People
of Color
 In 2004, the mortality rates
from HTN related conditions
were disproportionate:
14.9% for white males,
compared to 49.7% for
black males
 14.5% for white females,
compared to 40.8% for
black females.
 (Heart Disease and
Stroke Statistics -- 2006
Update).

13. Community level perspective

17. High BP in Harlem
 Compared to national
prevalence rates, Harlem
residents had higher rates
of elevated BP (41%)
 (Rubin M, Chukwu E, Pultre F, Manheimer
E, College G. Screening and referral for
cardiovascular risk factors in Harlem, New
York. Paper presented at the American
Public Health Association; 2004.


18. Hospitalizations
due to HARLEM
Hypertensive
related
diseases
UPPER EAST SIDE

19. Emotional Costs???

20. So, what do we do?

21. Start with the end in mind…
 Vickie Powell
 Harlem resident
 Worships at Abyssinian
Baptist Church
 Told by physician that
she had high blood
pressure…

22.  What we eat
 What we drink
 What, how much we smoke
 How we exercise
 How we deal with stress
Play significant roles in the development of disease.

23. Management
 Lifestyle modification
 Pre-hypertension, Stage 1 and Stage 2 hypertension
 Weight loss (5-20 mmHg SBP reduction for every 20 lbs
lost)
 Reduce Sodium (8-14mmHG SBP reduction)
 Increase Physical activity (4-9 mmHG SBP reduction)
 Reduce Alcohol consumption (2-4 mmHG SBP reduction)
 Reduce Smoking (10-20 mmHG SBP reduction)
 Medications
 Stage 1 and Stage 2 hypertension

24. An “activated” Vickie…
 Changed her diet
 Began exercising
regularly
 Embraced yoga and
meditation
 Lost 20 lbs
 Normalized her blood
pressure…without
medication

25. Unfortunately…
 Vickie is unique

26. So, how are we doing?
 Of those people with high blood
pressure, 77.6 percent were aware of their
condition.
 AHA.org
 But…
 More than one in five (22.4%) people with high
blood pressure don't know that they have it.2
• Lloyd-Jones D, Adams RJ, Brown TM, et al.
Heart Disease and Stroke Statistics—2010 Update. A Report from the American Heart Association Statistics Committee and Stroke S
. Circulation. 2010;121:e1-e170.

27. So, how are we doing?
 About 80% of those with high blood pressure,
were aware, were in treatment
 48% had their high blood pressure controlled
 But…
 52% were not controlled
 AHA.org

28. I have high blood pressure, but
no one has every told me what
high blood pressure is and how it
can affect my life. What are the
target numbers?

29. I already know I have high blood
pressure, it runs in my family. I know
it can cause a stroke, but what else?
How can I lower it?

30. There are so many things I don’t know
about high blood pressure. I don’t know
where to turn to. My doctor doesn’t have
time to teach me, and none of my friends
can help.

31. Doctor-Patient Communication
 The average visit length was 15 minutes.
 The average patient who came with one or
more concerns used only 32 seconds to
complete their review of concerns.
 In 24.6% of visits, the physician did not ask the
patient about his/her concerns.
Marvel, MK, Epstein, RM, Flowers, K & Beckman, HB (1999) Soliciting the patient’s
agenda: have we improved? JAMA, 281(3):283-287

32. Lifestyle Modification
 Providers have minimal time to provide
counseling and education with clients
 May not feel comfortable in providing
information and support
 Lack of resources for other types of clinic-
based supports
 Need for adjunctive measures

33. Response

34. Preventing 1 million heart attacks and strokes in 5
years

35. Key Components of Million Hearts
 Community Prevention
 Reduce the number of people who need
treatment
 Clinical Prevention
 Optimize care for those who do

36. Status of the ABCS
Aspirin People at increased risk of cardiovascular 47%
disease who are taking aspirin
Blood People with hypertension who have 46%
adequately controlled blood pressure
pressure
Cholestero People with high cholesterol who have 33%
adequately controlled hyperlipidemia
l
Smoking People trying to quit smoking who get 23%
help
Source: MMWR: Million Hearts: Strategies to Reduce the Prevalence of Leading
Cardiovascular Disease Risk Factors --- United States, 2011, Early Release, Vol. 60

37. Million Hearts: Getting to the Goal
Population metric Baseline 20171 Clinical target2
Aspirin for those at high risk ~50% 65% ~70%
Blood pressure control ~50% 65% ~70%
Cholesterol control ~33% 65% ~70%
Smoking prevalence ~20% 17% ─
Average sodium intake 3.5g/day 20% ↓ ─
Average artificial trans fat intake 1% of calories/day 50% ↓ ─
1 Population-wide indicators
2 Clinical systems

38. Multi-system Approach

39. Community Prevention
Reducing the Number who Need
Treatment
 Strengthen tobacco control and reduce smoking
 Improve nutrition

40. Clinical Prevention
 Uniform, simplified set of ABCS measures
 Getting the ABCS into federal and state
programs
 EHR meaningful use criteria
 Point of care clinical decision support
 Systematic assessment of cardiac risk
 Use of recall reminders and order sets
 Monitoring of medication adherence
 Insurers
 Measure and incentivise performance on the ABCS; collect and
share data for quality improvement; empower consumers

41. Medical System Messages
 Individuals
 Know your numbers—and goals
 Take aspirin, if advised
 Get aggressive with BP and Cholesterol
 Cut sodium and trans-fats
 If you smoke, quit

42. Getting the messages out
 Mobilize the best change agents
 Pharmacists, health coaches, lay workers, nurses,
community orgs, others

43. Community Messages
 Retailers and Employers
 Offer blood pressure monitoring and educational resources; focus on
improving ABCS care in retail and worksite clinics
 Government
 Support community and systems transformation to reduce tobacco use
and improve nutrition, including smoke-free policies and food
procurement standards; provide data for action; expand coverage for the
uninsured
 Foundations
 Support consumer and provider outreach and activation
 Advocacy groups
 Monitor and demand progress toward goal and promote actions that
prevent heart attacks and strokes

44. Million Hearts Outcomes
 10M more people with HBP controlled
 20M more people with high
cholesterol controlled
 4M fewer people will smoke
 20% drop in average sodium intake
 50% drop in average trans fat intake

45. Locally
 How do we start in Harlem?

46. I was scared to have my blood pressure taken…
But, my friends convinced me to have it taken.
Now I have work to do in order to keep it normal.

47. How do we promote awareness
and create opportunities
for success?

48. Community Outreach

49. Community Outreach

50. Community Outreach

51. Community-based Initiatives
 Involving the faith community
 Experiences of NYSHF with Diabetes
Program

52. Community-based Initiatives
 Involving health ministries, lay health workers
 Involving nursing students
 Involving College students

53. Faith-based initiative

54. Next Steps…