Lagging drug innovation, variations in quality of care and rising health care costs remain major barriers in fight against cardiovascular disease

Circulation Journal Report-Presidential Advisory

January 24, 2019 Categories: Advisories & Comments

Study Highlights:

  • Despite decades-long reduction in heart disease and stroke death rates, cardiovascular disease remains the leading cause of death worldwide.
  • The Value in Healthcare Initiative, a collaboration between the American Heart Association and the Duke University’s Robert J. Margolis, M.D., Center for Health Policy, aims to address continued challenges in access and affordability of cardiovascular care.
  • Through learning collaboratives and demonstration projects, the initiative will develop roadmaps for affordable and innovative care to further reduce heart disease and stroke deaths.

Embargoed until 4 a.m. CT / 5 a.m. ET Thursday, January 24, 2019

DALLAS, January 24, 2019 — Despite unprecedented progress in reducing deaths from heart disease and stroke over the past 50 years, cardiovascular disease still takes the lives of more than 17.3 million people every year and remains the leading cause of death worldwide. In searching for new ways to address this challenge, the American Heart Association, the world’s leading voluntary organization focused on heart and brain health, and Duke University’s Robert J. Margolis, M.D., Center for Health Policy are embarking on an initiative to accelerate increased access to high value and affordable cardiovascular care.

The Value in Healthcare Initiative was introduced in a presidential advisory from the American Heart Association (Call to Action: Urgent Challenges in Cardiovascular Disease), published in the Association’s journal, Circulation. The advisory writing group consisted of four leaders from the Association and the Center.

The Value in Healthcare Initiative brings together leaders from over 40 organizations representing payers, public health, government, pharmaceuticals, devices, technology, health systems and providers, along with patients. Their goal is to model and test solutions in cardiovascular care and treatment, document impact and results and develop a framework for system-wide reform to support an equitable and affordable system of care.

“We can’t rest on our laurels applauding the substantial declines in the number of CVD deaths recorded in the past 50 years,” said John J. Warner, M.D., past president of the American Heart Association, executive vice president for Health System Affairs at the University of Texas Southwestern Medical Center in Dallas and a co-author of the advisory. “We’ve reached a disturbing plateau as CVD drug innovation is now lagging, gaps in quality of care among many populations are widening, our prevalence of risk factors such as obesity are rising and the cost of caring for heart disease and stroke is climbing to alarming and unsustainable amounts.”

From 1996 – 2014, total cardiovascular expenditures increased by 147 percent, and expenditures per person using care more than doubled over the past 20 years. The Association estimates that direct costs for CVD care reached $318 billion in 2015. Indirect costs related to lost work productivity, need for household help and people leaving the workforce topped $237 billion. Spending for both is only expected to rise. Almost a third of all health care spending is used on services and treatments that don’t directly improve patient outcomes.

“Patients tell us they are appreciative of life-saving and life-improving technology and treatments, but they have real and rising concerns about whether they can afford the cost of that care,” said Robert M. Califf, M.D., a co-author of the advisory, Vice Chancellor for Health Data Science at Duke University Medical Center in Durham, N.C., director of Duke Forge and a former commissioner of the Food and Drug Administration (FDA). “Often the care plans they receive are complex and hard for them to adhere to, especially as they’re struggling with tangible risk factors like diet, smoking and physical activity.”

The advisory notes several areas of missed opportunities in the current system for improving CVD care and avoiding unnecessary costs:

  • Risk Factor Modification: Optimal adherence to risk factors could reduce the odds of having CVD by 80 percent;
  • Better Diagnosis: 20-40 percent of heart attacks occur in people who were not previously diagnosed with a heart condition;
  • Improved Use of First-Line Treatments: After a heart attack, 20 percent of high-risk patients don’t fill the prescription for at least one of their heart medications and almost half don’t fill their antiplatelet therapy prescription; and
  • Improved Use of Advanced Treatments: Almost a third of patients who secure insurance approval for prescribed PCSK9 inhibitors never filled their prescriptions.

“The disturbing trends in cardiovascular disease outcomes and costs show that more of the same is not going to work for addressing the number one cause of death and disability in the United States,” said Mark McClellan, M.D., Ph.D., a co-author of the advisory, Director of the Duke-Margolis Center for Health Policy, former administrator of the Centers for Medicare & Medicaid Services and former commissioner of FDA. “This broad-based, action-oriented initiative aims to change that, through finding and implementing better ways to get more value out of the treatments we have – and accelerating progress and support for developing the ones we still need.”

The focus of the Value in Healthcare Initiative includes four collaborative teams, looking into the areas of: developing value-based payment models to incent appropriate use of existing and innovative treatments; designing more efficient clinical trial models and data requirements; emphasizing improved early detection to support prevention; and transforming authorization processes to better support medication and adherence.

The teams will roll out a series of pilots to measure and evaluate various reform measures in all four of these areas. The findings will be the basis for two roadmaps that will be presented at the end of the initiative: one to drive towards a more affordable and sustainable drug and device innovation process and the other to identify reforms in policy and care that better align quality and efficiency in cardiovascular care.

“This is a very ambitious agenda as we commit to ensuring every person has high value, high quality health care with the patient preferences in mind,” said Nancy Brown, Chief Executive Officer of the American Heart Association in Dallas. “But we have much to build on from the collective foundation of our diverse and committed group of stakeholders who join us in our sense of urgency to control costs, invest in prevention and ensure the patient’s view to improve care and outcome of our largest and costliest public health burden.”

Additional Resources:

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The American Heart Association receives funding primarily from individuals; foundations and corporations (including pharmaceutical, device manufacturers and other companies) also make donations and fund specific association programs and events. The association has strict policies to prevent these relationships from influencing the science content. Revenues from pharmaceutical and device corporations and health insurance providers are available at http://www.heart.org/corporatefunding.

About the American Heart Association

The American Heart Association is a leading force for a world of longer, healthier lives. With nearly a century of lifesaving work, the Dallas-based association is dedicated to ensuring equitable health for all. We are a trustworthy source empowering people to improve their heart health, brain health and well-being. We collaborate with numerous organizations and millions of volunteers to fund innovative research, advocate for stronger public health policies, and share lifesaving resources and information. Connect with us on heart.org, Facebook, Twitter or by calling 1-800-AHA-USA1.

For Media Inquiries and AHA/ASA Expert Perspective: 214-706-1173

Cathy Lewis: cathy.lewis@heart.org; 214-706-1324

For Public Inquiries: 1-800-AHA-USA1 (242-8721)

heart.org and strokeassociation.org