APhA joins Million Hearts campaign

Public–private partnership uses “ABCS” to target heart attacks, strokes.

Seeking to translate science into action, federal health leaders and key health care groups today launched a 5-year effort to prevent 1 million heart attacks and strokes. Million Hearts seeks to empower Americans to make healthy choices, such as stopping smoking and reducing sodium intake, and improve care for those citizens who need it through the ABCS:

  • Aspirin for people at high risk
  • Blood pressure control
  • Cholesterol control
  • Stopping smoking

The cardiovascular challenge is a staggering one: 800,000 deaths, 2 million heart attacks and strokes, $444 billion in medical costs and lost productivity, each and every year, U.S. Department of Health and Human Services (HHS) Secretary Kathleen Sebelius told a news conference on the campus of George Washington University in Washington, DC.

“Heart disease takes the lives of far too many people in this country, depriving their families and communities of someone they love and care for,” Sebelius said. “A father, a mother, a wife, a friend, a neighbor, a spouse. Each loss deprives our society of their fullest contribution, their creativity, and their productivity.”

APhA was represented on stage at the event by Thomas E. Menighan, BSPharm, MBA, ScD (Hon), FAPhA. Student pharmacists from four Washington-area pharmacy schools sported white coats as they made sure that Sebelius, CMS Administrator Donald Berwick, MD, MPP, and CDC Director Thomas R. Frieden, MD, MPH, knew the profession was there. With a dozen APhA staff also present at the event, pharmacy took up most of several rows in the auditorium.

Pharmacists mix “the use of medicines and the use of lifestyle changes to get to better health,” Menighan told the group. In addition to medication therapy management services, Menighan pointed to food tours that grocery store pharmacists give to patients, helping them know what options they have for better eating habits.

Walgreens has committed its 26,000 health care providers at 7,760 pharmacies nationwide to the Million Hearts campaign. Kermit Crawford, President of the company’s Pharmacy Health and Wellness Division, told the news conference that the chain is making changes in its physical plants and workflow so that Walgreens pharmacists and Take Care Clinic Nurse Practitioners can provide free blood pressure testing for patients and provide other patient care services such as immunizations. In November, Walgreens will promote diabetes testing, and heart health will be emphasized in February, Crawford said.

Other pharmacy organizations involved in Million Hearts include the National Alliance of State Pharmacy Associations, Alliance for Patient Medication Safety, and the National Community Pharmacists Association. The American Medical Association, American Nurses Association, American Heart Association, America’s Health Insurance Plans, and the Y are also involved in the private-sector side of Million Hearts.

Within the government, the effort will be headed by Berwick and Frieden. Externally, Janet Wright, MD, Senior Vice President for Science and Quality at the American College of Cardiology will lead the effort.

Numerous federal agencies are involved in the campaign, providing staff as well as grants and other funding for Million Hearts. CDC has announced a $2 million Pharmacy Outreach Project that will enroll pharmacists to provide additional advice and support to patients diagnosed with high blood pressure. CMS will award $85 million over 5 years to 10 states to encourage Medicaid beneficiaries to participate in chronic disease prevention programs and take active steps to improve their health. The states receiving these grants are California, Connecticut, Hawaii, Minnesota, Montana, Nevada, New Hampshire, New York, Texas, and Wisconsin.

The interventions represented by the acronym ABCS are all ones that usually involve medication therapy. As evidence of the importance of a medication manager in treatment and prevention of cardiovascular disease, a new article, published this week in the Archives of Internal Medicine, shows that pharmacist-directed care improves the management of major cardiovascular disease (CVD) risk factors. Researchers compiled and analyzed results of 30 randomized controlled trials of 11,785 patients in which pharmacists either directed care or collaborated on health care teams. Interventions in the studies included patient educational interventions, patient-reminder systems, measurement of CVD risk factors, medication management and feedback to physician, or educational intervention to health care professionals.

Results of the meta-analysis showed that pharmacist care resulted in significant improvements in blood pressure, total cholesterol and LDL cholesterol, and smoking rates. “The traditional view of the pharmacist's role in primary care is medication distribution,” wrote author Valérie Santschi, PharmD, PhD, with colleagues from Canada and Switzerland. “Although this role remains an important part of the activity of a pharmacist, evidence documented in our systematic review and previous reviews demonstrates a transformation of pharmacy practice toward a more clinical, patient-centered role and a collaborative approach toward pharmacist-physician in patient care.”

Speaking to pharmacist.com about the opportunity afforded pharmacists by Million Hearts, CMS Administrator Berwick said that throughout his career, he has “seen pharmacists in the lead—whether we’re talking about patient safety, disease management, or prevention. I find the pharmacy community such a rich source of talent, investment, and intelligence about how to help people, how to get healthy, and how to stay healthy. Pharmacists have a real opportunity here for a leadership position, and I hope we can help them take it.”