Given the attention paid to the devastating impact of COVID-19, one might assume it was the leading cause of death in the US. But while the fatalities were stark – almost 1.2 million Americans died of COVID in the last 4 years – heart disease remains the largest cause of death and by a landslide. In 2021, the year with the most COVID-19 deaths (416,893), heart disease claimed 60% more lives (695,000) in the US. Perhaps more, striking, however, is that many, if most, of these deaths, were preventable.
High blood pressure or hypertension is the leading cause of heart attacks in the U.S. While hypertension and heart disease are often thought of as illnesses of older adults, they can affect people of all ages. Women are as much at risk as men. Heart disease and hypertension are major contributing factors to both maternal and infant deaths each year.
While we do not have a vaccine to protect against hypertension, there are preventive measures that can be effective. The risk of hypertension can be lowered by reducing salt intake, and heart disease can be reduced by not smoking, adopting a low-cholesterol diet, and exercising regularly. Certain medications can also reduce the risk of heart disease, including cholesterol-lowering medications; blood pressure medications; and antiplatelet medications. With the exception of newer weight-loss drugs, most of these medications are almost always covered and readily available.
So why, even with these prevention options, does heart disease remain the silent killer? Because we do not treat it like it’s preventable. Tens of millions of adults – including those at elevated risk – have not been screened for high blood pressure; prescribed the appropriate medication; or monitored over time. Less than half of those diagnosed with hypertension in the US control it with medication.
Such fatalities could dramatically change by making screening and treatment of heart disease ritualized and incentivized parts of health care. This is not just a theory – there is evidence that it works. Several years ago, the CDC recognized that the rate of hypertension control in Minnesota was about 70%, far higher than the national average. It wasn’t always the case: the state treads closer to the national average in the mid-90s. However, a combination of efforts, including widespread collaboration between healthcare providers and payers to set specific heart disease-related clinical guidelines for appropriate care; the ability to provide feedback on compliance with those guidelines; and financial incentives for clinicians to comply helped lead the way.
For several years, the CDC, in collaboration with CMS, has overseen the Million Hearts initiative, a multi-faceted effort to reduce heart disease. Among its efforts is a focus on promoting community-level health behaviors, such as increasing screening efforts; reinforcing the benefit of prescription and over-the-counter medications; and targeting communities that are at elevated risk for heart disease due to social and economic conditions.
Emerging technology can also be tapped to improve prevention efforts. Data sharing between the health care and the public health sectors can lead to a greater understanding of the communities at heightened risk. Artificial intelligence (AI) will likely prove useful in analyzing clinical, demographic and socio-economic data to refine efforts to treat patients and inform policymakers, clinicians and community members.
While prevention efforts have seen progress, the effectiveness of government initiatives like Million Hearts and the WISEWOMAN program has been inhibited by a lack of funding. This is a frustrating obstacle, especially given heart disease-related fatalities in the US. In the most recent fiscal year, the CDC’s Heart Disease and Stroke line item was approximately $155 million, an amount that pales in comparison to the billions spent on pandemic responses and is a fraction of the cost of paying for the consequences of heart disease.
During the pandemic, there was some regression around heart disease prevention, as fewer patients received annual physicals and screenings, and the healthcare system was, rightfully, focused on COVID prevention and health consequences. But now is the time to reverse those setbacks.
There are distinct roles individuals, government, and the private sector can assume to reduce heart disease. On the individual level, we should all take heed to eat healthfully, exercise, not smoke and talk to our health care providers about preventive measures.
Government agencies like the FDA can redouble the efforts of its National Salt Reduction Initiative to limit excessive sodium in packaged foods. Meanwhile, CMS can enhance the quality measures and financial incentives that reward clinicians for monitoring and treating hypertension and unhealthy cholesterol levels. There’s also ample opportunity for Congress to increase funding for CDC’s Million Hearts initiative.
At the same time, federal agencies can continue to modernize their data systems – including by tapping AI – to identify those at elevated risk, assess the interventions that are most effective and customize messaging to varied populations.
Meanwhile, the food industry should take the initiative to reduce sodium levels and demonstrate that it can be responsible for positive change without governmental enforcement and public upheaval.
The number one cause of preventable deaths may never receive the level of support dedicated to COVID. But it is not only viral pandemics that should mobilize the nation. With increased attention, resources and actions, we can finally begin to turn the tide.
About John Auerbach, SVP, Federal Health, ICF
John is ICF’s primary federal health expert and thought leader within the company’s public sector business. Amid tremendous global health and social challenges, ICF’s capabilities and solutions for federal health agencies have never been more relevant. John’s thought leadership advances ICF’s combination of proven domain and scientific expertise with leading-edge analytics and technology solutions to drive improved health outcomes for clients.
John came to ICF from the Centers for Disease Control and Prevention (CDC), where he most recently served as the director of intergovernmental and strategic affairs. In this role, he was the lead strategic advisor on CDC engagement with government agencies at the federal, state, local, tribal, and territorial levels, as well as public health and other external partners. He also had oversight of CDC’s health equity workgroup and served as the chief equity officer for CDC’s COVID-19 response.
