Impact Pyramid for Tackling Cardiovascular Disease. Counseling ... Enables health care team to advance patients safely a
From Calls to Action to Action:
Taming Hypertension, the World’s Leading Killer
Tom Frieden, MD, MPH President & CEO, Resolve
Cardiovascular Disease: World’s Leading Killer 2030
2004
(projected)
(actual)
RANK
CAUSE
%
RANK
CAUSE
12.2
1
Heart disease
14.2 12.1
1
Heart disease
2
Stroke
9.7
2
Stroke
3
Lower respiratory infections Chronic obstructive pulmonary disease
7.0
3
5.1
4
Chronic obstructive pulmonary disease Lower respiratory infections
4
World Health Organization
%
8.6 3.8
WHO Voluntary Global NCD Targets for 2025
Most People With Hypertension Globally Do Not Have It Under Control 100%
1.4 Bn
Less than 1 in 7 with hypertension worldwide have it under control
80%
734M
60%
489M
40% 20%
192M
0% Have high blood pressure Mills KT et al. Circulation. 2016 Aug 9;134(6):441-450.
Aware
Treated
Controlled
160 or diastolic >100 should be treated immediately. Those with blood pressure over 140 or 90 should be reassessed on a different day, and, if still elevated, treatment can begin.
Standard Protocols – Common Features
Standard Protocols – Common Features
Standard Protocols – Common Features
Community-Based Treatment Increases Patient Access • Health workers accessible to patients can provide and, following physician orders and/or protocols, adjust and intensify medication regimens • Non-physician health workers can accurately assess and manage cardiovascular risk in primary care • Every member of the healthcare team can be optimally involved supporting patent care
Care from pharmacists* is associated with significant reductions in cardiovascular disease risk CVD Risk Factor Reduction Systolic/diastolic blood pressure
–8.1/–3.8 mm Hg
Total cholesterol
–17.4 mg/L
LDL cholesterol
–13.4 mg/L
Smoking
23% reduction
Santschi V, et al. Arch Intern Med 2011;171:1441-53.
* Interventions exclusively conducted by a pharmacist or implemented in collaboration with physicians or nurses; may include patient educational interventions, patient reminder systems, measurement of CVD risk factors, medication management and feedback to physician, and/or educational intervention to health care professionals.
Making the Patient the Program VIP Patient-centered services reduce barriers to adherence • Reduction (preferably elimination) of costs for medications and medical visits • Increasing patient convenience of medical visits and medication refills (e.g., every 3 months for stable patients) • Use of once-daily treatment regimens • Use of fewer tablets, including through combination pills • Improving access to blood pressure monitoring including in public places • Public education to increase awareness of the importance of control of blood pressure
Information Systems Facilitate Continuous Program Improvement • Provide real-time feedback to • Improve follow-up of patients not under control • Measure program quality (quarterly, percent controlled per cohort) and coverage (annual, proportion of total burden adequately treated) • Data collection tools can be paper-based, hybrid electronic/paper-based, or fully electronic, depending on country resources • Continuous analysis of program data and use of analysis to improve patient care
What gets measured can be managed
Simple, Powerful and Standardized Core Indicators INDICATOR 1: Patient Hypertension Control
Percent of registered patients with controlled BP (
