American Heart Association's Shared Focus

Robert H Eckel

The more that is learned about the causes, treatment, and prevention of heart disease and stroke, the more the importance of a shared focus is appreciated. The American Heart Association (AHA) is working toward a 25% reduction in heart disease, stroke, and risk by 2010, and needs the commitment of the entire cardiology community to achieve that goal. The fight against cardiovascular disease is not the AHA's alone, although it is a prime leader in the efforts.

Strategically Focused Research

It is known that the knowledge base needs to be increased.'Knowledge is power' may be a trite expression, but it speaks the truth for the AHA. The AHA research fund has traditionally been investigator-initiated—projects to increase knowledge of how to treat cardiovascular disease and stroke with topics selected and proposed by scientists. Investigators themselves know best what areas of cardiovascular disease and stroke science hold the greatest potential for discovering knowledge. The AHA is also interested in stimulating other areas of research in specific areas that hold promise. The plan for this research targets four areas:

women and cardiovascular disease;
stroke;
obesity; and
implementation of translational research.

The AHA is funding focused research initiatives in two of these areas—stroke and implementation research—and wants to develop initiatives in the other focused areas. It depends on large corporate, foundation, or individual gifts to fund its strategically focused research initiatives, which require the support of such donors to move forward.

Better Patient Care

To have practical significance, research must be translated into improved patient care. The AHA is vitally concerned about the medical care that heart and stroke patients receive, both in and out of hospital. Sometimes, proven science is not consistently put into practice. That is why the AHA is assisting hospitals through 'Get With The Guidelines'^SM (GWTG), a program to ensure that patients receive the highest standard of care for coronary artery disease (CAD), stroke, and heart failure. The program leverages the 'teachable moment' immediately after a patient has had an acute event—the time when patients are most likely to listen to and follow their healthcare provider's guidance. GWTG includes tools that healthcare providers can use concurrently to assess treatment compliance so appropriate action can be taken before the patient leaves the facility. Provider-to-provider communication helps reinforce these life-saving therapies and strategies, and provides an essential link in the circle of the healthcare team.

It has been estimated that GWTG could save up to 80,000 lives annually by closing the treatment gap in CAD alone. With modules for CAD, stroke, and heart failure, GWTG incorporates a multidisciplinary approach to risk factor management and acute treatment. It also provides resources to build consensus and optimize treatment protocols.

GWTG identifies hospital healthcare providers (champions) to lead, develop, and mobilize teams to implement treatment and discharge guidelines for patients in acute care facilities. The program begins with an assessment of the hospital's current acute treatment and discharge protocols. This assessment provides a baseline for measuring progress. By using the program's tools, a participating hospital can achieve continuous quality improvements in its treatment and discharge procedures.

To improve patient care out of the hospital setting, the AHA has programs such as the Heart/Stroke Physician's Recognition Program. The program, created in collaboration with the National Committee for Quality Assurance, recognizes physicians within certain health plans for providing high-quality cardiovascular patient care. Also, the association develops physician tool kits in support of new guidelines, and offers public education campaigns such as Go Red For Women.

The 'No-Fad DietÔÇÖ Book

Another approach is to offer tools for the millions of Americans struggling to maintain a healthy diet. Fad diets come and go, just like the weight loss they promise. According to current statistics, about 134 million Americans need to lose weight, which means they must burn more calories than they consume. Undoubtedly, effective weight loss is a message that should be presented to patients.

That is also the bottom-line, no-nonsense message of No-Fad Diet: A Personal Plan For Healthy Weight Loss,¹ the first diet and weight-management book from the AHA. The book—made possible through the collaboration of 25 US experts—enables readers to design their own plan using tools that help them think smart, eat well, and move more, the three key concepts that support safe weight loss.

The 'No-Fad Diet' approach is that everyone is unique, and, therefore, each person's weight-loss plan should be unique. By focusing on a positive attitude about food, physical activity, and body image, it encourages the dieter to create a workable individual plan for weight loss. Readers can adjust their 'calories in' by using one or more of the three basic eating strategies—the switch and swap approach, 75% solution and AHA menu plans. Along with the customized diet plan, the 'No-Fad Diet' includes three different programs to help readers move more. The increase in 'calories out' approach is based on three basic strategies, which include a lifestyle approach, a walking program, and an organized activity option. Simple questionnaires in the book help readers choose their weight-loss strategies.

The debut of the 'No-Fad Diet' comes at an important time in the national discussion on weight loss (65% of adults in America are overweight, and almost one-third of these are obese, which puts them at an increased risk for heart disease and stroke—the first and third leading causes of death among Americans).

The book includes practical tools and tips to help dieters. Over 190 recipes complete the menu-planning section, with delicious options for main dishes, desserts, and more.

Initiative Against Childhood Obesity

It is not enough to fight heart disease today. Prevention must start young, because childhood obesity is a major threat to the nation's children. The AHA has responded by forming an alliance with the Clinton Foundation and Governor Mike Huckabee (R-Ark.) to influence the decisions and health behavior of young people. Together, pre-emptive measures must be taken against obesity to ensure that future generations will not struggle with illnesses associated with poor food choices and lack of physical activity. Consider these facts: based on data from National Health and Nutrition Examination Survey (NHANES) (1999 to 2000), the prevalence of overweight in children ages six to 11 and adolescents ages 12 to 19 has more than tripled since the period between 1963 and 1965.

Today more than twice as many children—and almost three times as many teens—are overweight as in 1980.
Between 1977 and 1994, overall calorie consumption increased by about 9% in adolescent boys and about 7% in adolescent girls.²
Among high school students, only 23.6% of males and 20.3% of females eat five or more servings of fruits and vegetables per day.³
Obesity-associated annual hospital costs for children more than tripled between 1979 and 1999.⁴
A national study reports that only 8% of elementary schools, 6.4% of middle/junior high schools, and 5.8% of senior high schools provide daily physical education or its equivalent (150 minutes per week for elementary schools, 225 minutes per week for middle/junior and senior high schools) for the entire school year for students in all grades in the school.⁵
Most obese children already have at least one other major risk factor for cardiovascular disease, such as high blood cholesterol, high triglycerides, diabetes, or high blood pressure. These risk factors were previously found mainly in adults, not children.⁶
There is significant social stigmatization and poor self-image associated with childhood and adolescent obesity.⁷

The shared goal is to raise public awareness about the serious threat posed by this growing public health problem and to take steps to improve children's health. The Alliance for a Healthier Generation has set a goal of stopping the increasing prevalence of childhood obesity in the US by 2010.The aim is to foster an environment that helps all children pursue a healthy lifestyle.

It is necessary to engage children—all children—as advocates for their own health. This is not just about children who are already overweight or obese. It is about helping young people of all sizes to help control their health and establish lifelong healthy habits that emphasize balance, better nutrition, and increased activity. This will be a positive, optimistic, inclusive movement that speaks uniquely to this generation of young people. The new initiative targets several areas, including:

working with the food and restaurant industry to improve the quality and portion size of food products, and develop marketing and promotion strategies that support environmental change within the industry;
increasing physical activity and improving nutrition in schools across the nation;
exploring opportunities to work with the media to promote positive behavior;
creating a campaign to engage children to take steps to make healthy lifestyle choices;
creating tools and providing opportunities for healthcare providers to better recognize, prevent, and treat obesity in children; and
providing tools and information to parents to help them incorporate heart-healthy activities into routines.

Change Agents

Changing tomorrow requires vigorous change agents today—and their number is growing rapidly. Through the collaborative efforts of thousands of volunteers, the AHA helps shape public policies that relate directly and indirectly to heart disease and stroke. 'Safe Routes to School' concepts include violence prevention and a comprehensive approach to traffic safety that involves education programs for both motorists and children, better enforcement of traffic laws, and efforts to reduce the speed of residential traffic.

Strategic Alliances Create Synergy

Reaching the shared goal of reducing heart disease, stroke, and risk requires identifying where and how a greater impact can be made by partnering with others. Through strategic relationships with government and private or non-profit organizations, the AHA extends its reach and impact on the healthcare environment. Examples include work with the American College of Cardiology, the American College of Physicians, and the Center for Disease Control and Prevention, etc.

The AHA combined efforts with the Joint Commission on Accreditation of Healthcare Organizations to create the first-ever Primary Stroke Center certification program for hospitals.

A collaboration with the National Committee for Quality Assurance resulted in the Heart/Stroke Recognition Program, which identifies physicians who are treating patients with the highest standard of care to manage patients' risk for cardiovascular disease. A pilot program, 'Stick With The Guidelines' is under way in cooperation with the American Pharmacists Association Foundation. This initiative engages employers and healthcare providers in an effort to educate and motivate employees who are at risk for or have heart disease to better manage their condition. As the AHA looks to establish relationships with key players, it is also exploring its role in the realm of e-health or 'health IT.' It will host a summit with the Agency for Healthcare Research and Quality on 'Heart I', which will help determine the e-health roadmap as they drive into the future.

The strength of the AHA is in its reach. Its 12 affiliates in communities across the nation work with hospitals, state departments of health, and branches of local governments. It is not enough, however, to support good science and to collaborate with healthcare providers to bring the science from the laboratory to patients. It must also be ensured that the science is translated in ways consumers can understand so they can feel the urgency related to cardiovascular disease. It must be demonstrated how they can be helped (including helping themselves).

The credibility of the science and the wide range of the AHA's programs drive consumers toward the AHA every day. Examples of awareness programs and resources that help consumers include the AHA paid advertising campaign, Go Red For Women, partnership with the Ad Council and the American Cancer Society and the American Diabetes Association on the Everyday Choices campaign, The Cholesterol Low Down, Search Your Heart, AHA cookbooks, and more. Beyond the programs, the AHA offers consumers a warm, friendly voice—sometimes at critical moments in life—through its national contact center.