What do Mary, Jackie, Joe and Peter have in common?
All of them do not have any symptoms or past history of heart disease but they are all at high risk for heart attack, stroke and sudden cardiac death. They are all eligible for preventive treatment that can reduce their risk by more than 50%. Mary and Jackie have diabetes. Joe does not have diabetes but has a high Framingham Risk Score of 22%. Peter has a high coronary artery calcium score on ultrafast Cardiac CT of 450 (normal is zero). Being high risk means having the same risk as someone who already had a heart attack or stroke - the likelihood of having a heart attack, stroke or sudden cardiac death within the next 10 years is higher than 20% or greater than 1 in 5.
In 2009, about 62% of all heart attacks (785,000 of 1,255,000 total heart attacks) and 76% of all strokes (600,000 of 785,000 total strokes) occurred in patients without previous heart attack or stroke. Unfortunately, although heart attacks and strokes are considered largely preventable for over a decade now, most Americans at risk are either not getting recommended treatment or no treatment at all. These preventable events consume expensive healthcare resources that amount to hundreds of billions, not to mention causing unnecessary deaths and disabilities.
Highest Per Capita Healthcare Expenditures in the World and Lack of Preventive Care
A paradox - the US spends two times more per capita on healthcare compared to any other industrialized country, nearly $2 trillion or 18% of GDP, and yet the recent study shown on the right slide continues to re-affirm the widespread lack of appropriate in the US. This is a problem not just for the uninsured but also for those with good insurance. The levels of appropriate care in the US is generally low. It is estimated that if 60% of eligible patients received appropriate care, 297,470 deaths from heart disease could be prevented. More primary and secondary prevention can reduce cardiac mortality by 45%. Preventable deaths from stroke and preventable disabilities were not calculated. The amount of expensive healthcare resources consumed and the potential savings from prevention were also not calculated.
Rising GNP due to increasing healthcare cost does not make the US a richer country. At nearly 20%, it is already very high. If the population is healthier, they are more productive and have lower consumption of expensive healthcare resources. People will have more spendable income for other things that contribute to the growth of the economy, rather than paying higher healthcare premiums.
Defining the Complimentary Roles of Primary Care Physicians and Specialized Clinics
A compliance study of primary physicians (L-TAP study) on the left slide, showed low treatment success rate of just 18%. Our specialized clinic on the right side, treated 85% to goal. With more than 40 million American adults at risk and eligible for heart attack and stroke prevention (slide - top, left) a new, innovative healthcare delivery system is required to provide evidence-based preventive treatment to a large segment of the US population. Such a system will involve both trained primary care physicians and specialized clinics. Using a nontraditional and more efficient delivery system, nationwide implementation of evidence-based preventive care can result in savings that more than offset the cost of prevention.
Some patients come to us for prevention of heart disease, some for diagnosis of cardiac symptoms and some for treatment of established heart disease.
For patients who come for prevention, we identify all cardiac risk factors and diagnose if subclinical heart disease is likely to be present. A comprehensive treatment plan is developed to significantly reduce the risk of cardiovascular events. The slide on the right compares our published performance data (NJPCCC) to four others. At 85% LDL-cholesterol treatment success rate, it is still the best published performance data. We are able to achieve is a large reduction in the rate of heart attack, stroke, sudden cardiac death, future need for heart bypass surgery, angioplasty and stent. From the time our aggressive prevention program started in 2001 to the present, our event rate and hospitalization rate had taken a marked and progressive decline. This treatment approach benefits our patients with improved clinical outcomes and lower healthcare cost.
For patients who come for diagnosis, we determine if heart disease is present or not. If it is present, we provide not only treatment, but at the same time, implement preventive therapy to halt or slow down disease progression. Even reverse heart disease in some cases.
For patients with established heart disease, we assess the severity of disease and treat to relieve symptoms while at the same time, institute aggressive therapy to halt or slow down disease progression.
Most heart attack and stroke are now considered largely preventable. Even in those cases where complete prevention is not possible, optimal treatment can delay them for 10 to 20 years. Treatment is safe, highly effective, evidence-based and covered by insurance. Take the first step to prevention - find out if you are at risk. Click here and take the heart risk test.
