Advancing Heart Health and Equity during the COVID-19 Pandemic

During American Heart Month, we’re reminded that heart disease remains the Nation’s leading killer—claiming more than 600,000 lives each year and imposing considerable distress to millions of American families.

Despite effective interventions for the prevention and management of heart disease, too many Americans have yet to benefit from them. The toll is greatest among African Americans, who have higher rates of mortality from heart disease and a higher prevalence of hypertension than other racial and ethnic groups. Americans of lower socioeconomic status are also more likely to experience cardiovascular disease than those who are more affluent, and these disparities are widening.

The COVID-19 pandemic presented new challenges to people living with chronic conditions such as heart disease and their healthcare providers. People with heart conditions are at greater risk of complications from the virus and also continue to need assistance managing their heart health. Additionally, despite the pandemic, cardiac rehabilitation continues to be needed for people who experience heart attacks and strokes.

So in the face of the COVID-19 pandemic, AHRQ redoubled its efforts to advance heart health by synthesizing and implementing evidence to improve health outcomes and reduce health inequities.

The TAKEheart initiative, launched in 2019, is a robust effort to scale and spread nationally evidence-based strategies to increase participation in cardiac rehab among heart attack and stroke patients. The effort involves a partnership with the Million Hearts initiative—in particular its cardiac rehabilitation initiative—and cooperation with the American Hospital Association and Abt Associates.

The benefits of cardiac rehab are clear; participation significantly reduces morbidity and mortality from heart disease. But too few patients benefit from this intervention—particularly racial and ethnic minorities, low-income and rural Americans, and women.

During the pandemic, TAKEheart continued to support the national drive to increase cardiac rehab participation from 22 percent to 70 percent by 2022.  As hospitals reduced or temporarily closed rehab programs, TAKEheart redesigned its training activities. Through virtual peer-learning sessions, TAKEheart supported modifications of hospitals’ rehab services and their innovative efforts to combine traditional rehab with phone and electronic outreach to patients in their homes via telehealth.

In these learning sessions, TAKEheart shared strategies for supporting rehab patients between onsite visits; coping with staffing challenges; providing materials for remote patient support and education; and ensuring patient safety during in-person operations. These sessions sustained hospital engagement and helped them prepare to restart implementing practices to boost rehab referral, enrollment, and equity.

AHRQ’s EvidenceNOW: Advancing Heart Health in Primary Care Initiative, meanwhile, has helped more than 1,500 small- and medium-sized primary care practices across the U.S. improve the heart health of millions of Americans. Through improved use of evidence-based interventions, primary care practices increased their quality improvement capacity and reduced cardiovascular risk among their patients.

Compared to other practices, participating practices increased smoking screening and cessation counseling by about 11 percent; improved prescribing aspirin for eligible patients by almost 7 percent; increased cholesterol management by more than 6 percent; and increased blood pressure control by nearly 3 percent.  While the improvement in blood pressure control appears small, it was accomplished during a period when national rates of control worsened. 

This month, the AHRQ EvidenceNOW team begins a new initiative building on lessons learned and focused on improving heart health in communities with the greatest need. Grantees will work in States with the highest burden of heart attacks and stroke to build new, sustainable, multi-organizational partnerships—which will include public health organizations—to expand capacity to disseminate and implement patient-centered outcomes research findings into primary care practices. 

Understanding what is known about advancing heart health is the work of AHRQ’s Evidence-based Practice Centers (EPC) Program.  The EPC Program has synthesized evidence on prevention and management of cardiovascular disease into actionable findings. Among topics explored in EPC evidence reviews: achieving health equity in preventive services; the effects of dietary sodium and potassium intake on chronic disease; and stroke prevention in atrial fibrillation.

AHRQ is committed to both advancing heart health and reducing health inequities by supporting the uptake of evidence in practice to improve quality and outcomes of care for all. Our implementation initiatives are teaching us how to effectively transform care to achieve these goals. Working together we can make a difference.

Arlene Bierman is Director of AHRQ’s Center for Evidence and Practice Improvement.  David Meyers is AHRQ’s Acting Director.  They thank their AHRQ colleagues Michael Harrison, Robert McNellis, Dina Moss, and David Niebuhr for their contributions to this piece.

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