How Population Health Can Help With Heart Disease | Health info
Heart disease has long been the number one cause of death in the United States, accounting for about 1 in 4 deaths each year, according to Data from the Centers for Disease Control and Prevention. As with many health conditions, heart disease can disproportionately affect certain demographic and socioeconomic groups, underscoring the sad adage that postcode is the biggest risk factor for poor health.
“Unless meaningful changes are made to reduce the growing incidence of cardiovascular disease, this burden risks overwhelming society,” especially among vulnerable populations, said Victor Bulto, head of US pharmaceuticals for Novartis Pharmaceuticals Corporation, during a recent US News webinar on “Taking a Population Health Approach to Combating Heart Disease. By 2030, research projects that more than one million Americans will die each year from cardiovascular disease, he said. “This is a very powerful call to action.”
To help, all institutions need to define what population health means to them and then address the gaps in their own systems, said Dr. Sumeet Mitter, assistant professor for advanced heart failure and transplant cardiology at Heart of Mount Sinai At New York. Then clinicians can “see which interventions can actually affect an outcome and create evidence-based guidelines to then implement treatment programs,” he said. A key question for all to consider: “How do we create these programs to provide care to people in their communities and ensure that they can also work with people who understand their backgrounds and cultural mores?” Mitter said.
Dr. Stephen Klasko, an executive-in-residence at General Catalyst who previously served as president and CEO of Thomas Jefferson University and Jefferson Health in Philadelphia, described a program at that institution aimed at reducing health inequities. which focused on five Philadelphia ZIP codes where there was a 10- or 15-fold increase in cardiovascular disease rates. The effort was to create a messaging campaign “no different from a political campaign” in local barbershops, homes and other places in the community so that people can be educated where they live and work.
Bulto said Novartis “quickly realized that our responsibility goes far beyond” the development of innovative medicines. “We can’t just develop a drug if it’s not for the population it’s supposed to help because of a lack of education, a lack of access to drugs, a lack of affordability.”
Big Pharma can also play its part by designing more inclusive clinical trials, Bulto said.
“Last year we announced a 10 year partnership with 26 historically black colleges and universities and medical schools in the United States to accurately design programs that address the root causes of these systemic disparities and create this greater diversity, equity and inclusion across the ecosystem research and development,” he said. The program includes faculty research grants and scholarships. By increasing diversity among researchers and clinical trial participants, “we hope these elements will also help bring more diversity and more equity to these treatments once we establish what interventions may be in different communities.” “, said Bulto.
Mount Sinai has a number of equity-focused initiatives at its Institute for Health Equity Research. Mitter described research on early intervention in lifestyle changes and its impact on people’s health, as well as the availability of language translation services. “To engage people in clinical care, we also need to break down those communication barriers so that we can build trust, and also engage them in clinical trials, so that our clinical trials truly reflect the diversity of our patient population,” Mitter said. .
Increasing diversity in the medical field itself is also essential. “A large part of the doctor-patient relationship is based on trust,” said Dr. Sharon Andrade-Bucknor, assistant professor of clinical medicine and associate director of the Cardiology Fellowship Program at the University of Miami. Studies have shown that outcomes improve when there is a racial match between patient and provider, she said. “Part of that, of course, is based on feelings of discrimination in the past, etc., and prejudices that exist.”
Promoting opportunities in the field, so that “the black population is more exposed to this as an option as a career”, and putting more minorities in leadership and leadership positions, “would encourage more medical students to look into it as a career,” Andrade-Bucknor says. “I think ultimately it will have a good impact on patient trust, communication and compliance and improve their outcomes when it comes to cardiovascular disease.”
And while the COVID-19 pandemic has highlighted already existing health disparities in the United States, it has also delayed care for many Americans. Given that many disease diagnoses will be delayed or have been missed entirely at the height of COVID-19, there is concern that “the ‘pan-didn’t’ could be worse than the pandemic – you know, I didn’t haven’t had my mammogram, I haven’t had my stress echocardiogram,” Klasko said.
And COVID itself is impacting heart disease, Andrade-Bucknor said. The virus can cause cardiovascular complications even in patients who have had minimal or asymptomatic infection. “It remains to be seen how much of that will manifest down the road,” she said.
That said, community interventions can make a real difference. Mitter mentioned a lawsuit published in 2018 in the New England Journal of Medicine which found that pharmacists’ blood pressure interventions in black hair salons resulted in reduced blood pressure levels after six months. “It’s actually amazing,” he said, “and I think it’s a great example of how we need to take care of the center and move it out to the community and work with other models community health workers. It simply cannot be a doctor in a main hospital or a large clinic.
Regardless of the response, if there’s another lesson to be learned from the pandemic, it’s that “we need much more radical collaboration,” Klasko said. “The one thing that really, really, really, really has to happen, I think, as we start to think about this stuff, is we have to find a way, within one state and across all counties, for public health professionals and physicians, cardiologists and the pharmaceutical industry to come together and come up with a consistent message. »
For Andrade-Bucknor, tackling inequities in all areas of health care depends on trust and communication. “It came out of COVID and I think it can be extrapolated very easily to heart disease, as well as many other conditions,” she said. “Having the right diversity in messaging to improve trust, communication and compliance.”