Published: Oct 8, 2013

Full Story:  http://www.medpagetoday.com/Cardiology/Prevention/42140

Complementary Download Source PDF

Unhealthy behaviors — and not just biomarkers like blood pressure, lipid levels, and body weight — need to be targeted to reduce the burden of cardiovascular disease in the U.S. by the end of the decade, a science advisory from the American Heart Association stated.

Efforts are needed on both the individual and population levels to get people to make better lifestyle choices, and healthcare professionals have to be key players, according to a writing group co-chaired byBonnie Spring, PhD, of Northwestern University in Chicago, and Judith Ockene, PhD, of the University of Massachusetts Medical School in Worcester.

In the advisory, which was published online in Circulation: Journal of the American Heart Association, the authors called on healthcare professionals to perform two main functions….

“The first is to intervene directly and as members of an interprofessional healthcare team to help individual patients adopt healthier lifestyles. Providers’ efforts to champion a healthy lifestyle as the norm and healthy behaviors as the default in people’s lives are critical,” the group wrote. “The second is to advocate for healthcare system and policy improvements to address the behavior change needs of the entire population more effectively.”

The AHA’s previous 2010 goal of reducing coronary heart disease, stroke, and cardiovascular risk by 25% was achieved primarily “by medically treating cardiovascular risk biomarkers and the disease itself,” according to the advisory.

But annual costs related to cardiovascular disease are projected to balloon from $272 billion in 2010 to $818 billion in 2030, highlighting the need for more aggressive measures to meet the AHA’s 2020 goals: “to improve the cardiovascular health of all Americans by 20% while reducing deaths from cardiovascular diseases and stroke by 20%.”

“To avoid bankrupting the healthcare system,” Spring, Ockene, and colleagues wrote, “we must improve the distribution of cardiovascular health levels across the population by preserving cardiovascular health from childhood and by treating health risk behaviors to help more individuals improve their cardiovascular health into older ages.”

As part of the 2020 goals, the AHA introduced a definition of ideal cardiovascular health based on achieving optimal status on seven factors — smoking, diet quality, physical activity, body mass index, blood pressure, blood cholesterol, and fasting blood glucose.

Studies have shown that very few people — fewer than 5% — actually achieve that lofty goal.

Thus, there will be an emphasis on three areas to achieve the 2020 targets:

• Preservation of cardiovascular health through promotion of healthy lifestyle choices
• Treatment of unhealthy behaviors like smoking, poor diet, and physical inactivity in addition to risk biomarkers like adverse blood lipids, high blood pressure, hyperglycemia, and obesity
• A combination of individual-level and population-based health promotion initiatives to improve cardiovascular health

“Although full implementation of the goals requires a life-course approach, beginning from childhood, we focus this call to action primarily on needed behavior change for adults,” the authors wrote.

They turned to the medical literature to support the concepts that adopting healthier behaviors is possible and can improve outcomes and lower healthcare costs.

One study published last year, for example, showed that achieving all seven of the criteria that define ideal cardiovascular health could have prevented 59% of all deaths, 64% of cardiovascular deaths, and 63% of ischemic heart disease deaths over a period stretching from 1988 to 2010. The percentage of adults with ideal cardiovascular health, however, dropped from just 2% at the beginning of the study period to 1.2% at the end.

For healthcare professionals, the AHA recommends a framework for enhancing behavior counseling during regular medical visits based on the five “A’s”:

• Assess the unhealthy behavior
• Advise the patient how to change it
• Agree through a shared process on what the goals are and how to get there
• Assist with the treatment
• Arrange for follow-up

But that framework has not been consistently adhered to because of obstacles that include limited visit time, competing priorities, a lack of financial incentives, and inadequate training in counseling skills.

The document gives an overview of some of the ways in which physicians can better communicate and help their patients change their unhealthy behaviors, and also approaches at the level of the healthcare system that can support changes in behavior.

“We call on practitioners to encourage patients toward healthy lifestyle change, while recognizing that many systems changes needed to facilitate provision of such counseling are not under the clinician’s control,” Spring, Ockene, and colleagues wrote. “Consequently, we also call on the healthcare system, insurance companies, employers, and educational institutions to institute policies that align to help shift all sectors of the population toward a healthier lifestyle.”

• AHA Guide for Improving CV Health at the Community Level, 2013 Update

Primary source: Circulation: Journal of the American Heart Association