Nine Kansas medical practices and collaborative groups will participate in an experiment to find out if doctors could do a better job preventing heart attacks and strokes.
The project is part of the Million Hearts federal initiative, which is trying to prevent 1 million heart attacks, strokes and heart disease deaths by 2017. Some of the participating practices will use a risk calculator adopted by the American Heart Association to try to pinpoint their patients’ risk of cardiovascular disease.
Jen Brull, a physician at Post Rock Family Medicine in Plainville, says her practice is among those that will try the risk calculator. She says Post Rock and other participating practices will get new “tools” beyond the current standard of care to reduce patients’ risk of a heart attack or stroke over five years.
“Hopefully at the end they’ll have lower cardiovascular risk,” she says.
Post Rock already uses electronic health records, Brull says, so she expects to incorporate existing information about patients to determine their risk of a heart attack or stroke. New methods to engage patients in reducing their risks should help Post Rock improve patient health outcomes, she says.
“Post Rock has a history of doing clinical improvement,” she says. “Those are things we’re trying to do here.”
Other Kansas practices will be part of a control group that will follow current guidelines for preventing heart disease. The Department of Health and Human Services chose 516 providers in 47 states and the District of Columbia to participate, with about half making changes and the others acting as a control group.
If patients in the treatment group have fewer heart attacks and strokes, the federal government could push more health care practices to start using the risk calculations — particularly if the financial savings outweigh the cost of any treatment used to prevent heart attacks.
Formal protocols
The risk calculator tries to determine a person’s risk of having a heart attack or stroke within the next 10 years. Risk factors include age, race, cholesterol levels and blood pressure, plus whether the patient smokes, has diabetes or takes medications for cholesterol or blood pressure.
Providers typically focus on blood pressure, cholesterol, smoking and possibly family history, says Robert Moser, executive director of the Kansas Heart and Stroke Collaborative. The collaborative, a grant-funded program of the University of Kansas Hospital, works with more than a dozen rural hospitals that will be part of the control group. Moser says those Kansas hospitals will continue with other efforts to improve cardiovascular care, such as helping patients keep up with their visits and medications.
The risk calculator will provide protocols for when a patient would benefit from a treatment, such as blood pressure medication, Moser says. The protocols also will address risk factors that not every doctor may consider, such as whether the person has diabetes, he says.
“This is really setting up a formal way of looking at those things,” he says.
The risk calculator can’t predict whether a patient actually will have a heart attack, but it can suggest that similar patients have in the past. For example, if a patient’s risk score is 10 percent, it would predict that 10 out of every 100 people with the same risk factors will have a heart attack or stroke in the next decade.
Not a miracle cure
Some studies have raised concerns that the risk calculators, developed by the American Heart Association and the American College of Cardiologists, overstate people’s odds of a heart attack. It isn’t entirely clear why that might be, but it does raise concerns that some patients might be exposed to unnecessary side effects from medication.
Elizabeth Jackson, an associate professor in the division of cardiovascular medicine at University of Michigan Health System, says she thinks the risk calculator would provide an adequate gauge of a patient’s odds of developing cardiovascular disease.
“We clearly need to do a better job of identifying people who are at increased risk,” she says.
Still, the risk calculator isn’t a miracle cure, because some people don’t have insurance or a primary care doctor to help them reduce their risk, Jackson says. Other people can’t easily make healthy changes like exercising or eating better, and some only begin worrying after unhealthy behaviors have started to cause problems, she says.
“A lot of people who are young or adolescent don’t know the risks of an unhealthy lifestyle or smoking,” she says.
Cardiovascular disease caused about 23 percent of U.S. deaths in 2014 and was the leading cause of death for both genders and most ethnic groups, according to the Centers for Disease Control and Prevention. But death rates have fallen substantially for heart disease in the previous 60 years.
Americans were about half as likely to die of heart disease in 2014 as they were in 1950, and the results are even more impressive when taking into account the aging of the population as a whole — which would place more people in the demographic spot where heart trouble is more likely to develop.
HHS estimates that heart disease still costs the health care system about $300 billion annually, however, and says the disease is a significant cause of disability for people who survive a heart attack or stroke.
Building knowledge
Some of the Kansas practices participating in Million Hearts says they hope to build the body of knowledge about how to prevent cardiovascular disease.
Andrea Hargett, office manager at Bluestem Medical in Quinter, says staff members there still are learning exactly how they will screen patients and come up with individual plans to reduce their risks of cardiovascular disease. But she says Bluestem Medical looks forward to treating patients more proactively.
“We have a large Medicare, older population, so we thought this was an opportunity to kind of wrap our arms around these patients before anything does happen” to their hearts, she says.
Janel Chilson, administrator at Sunflower Medical Group in Mission, says the practice is part of the control group. Patients will get the normal standard of cardiac care and Sunflower Medical Group will report its results. Even though the patients won’t receive any new interventions, they will benefit if Million Hearts discovers better ways to prevent heart attacks and strokes, she says.
“They’ll compare us with the intervention group to see if their intervention is working,” she says. “We’re always looking for opportunities to try to help with population health.”
Megan Hart is a reporter for KHI News Service in Topeka, a partner in the Heartland Health Monitor team. You can reach her on Twitter @meganhartMC
