Every day in my family practice I see patients with coronary heart disease (CHD). Treatment and complications of heart disease and stroke cost this country nearly half a billion dollars a year, according to the Triple Solution for a Healthier America . The cost of losing nearly half a million lives a year is immeasurable.
According to the CDC Health Disparities and Inequalities Report — United States, 2011, “Heart Disease and stroke are the first and third leading causes of death in the United States.” Despite overall decreases in CHD and stroke death rates, those for blacks and men remain particularly alarming. According to this report, “In 2006, CHD was the underlying cause of death for 425,425 persons (all ages) in the Unites States” and “the rates for males was 41.6% higher than females”. Blacks had higher age-adjusted rates than the other three racial/ethnic groups. "Among adults aged >45 years, a comparison of rates by race for the younger age groups reveals that black women and men aged 45-74 years had a much higher CHD death rates than women and men of the three other races. The proportion of CHD deaths that occurred among persons aged 45-74 years was higher for black women (37.9%) than white women (19.4%) and higher for black men (61.5%) than white men (41.5%)”.
The higher death rates for blacks are evident even when invasive treatment is provided. According to the study, Racial disparities in outcomes following coronary artery bypass grafting in “blacks are known to experience higher post-coronary artery bypass graft morbidity and mortality. The causes for racial disparities in post-coronary artery bypass graft outcomes are not well known but may include factors related to the individual, provider, system, and society/environment, either alone or in combination.” (J Cardiovascular Nurs. 2006 Sep-Oct;21(5):367-78)
According to a US Department of health and Human Services article, “There is evidence that women diagnosed with acute myocardial infarction (AMI), or heart attack, are less likely than men with AMI to receive certain treatments that have been reported to improve outcomes. Research also suggests that physicians are less likely to counsel women about modifiable risk factors, such as diet and exercise, and that after a first heart attack, women are less likely than men to receive cardiac rehabilitation, though the reasons for these sex disparities are unclear.”
Clearly, prevention is better than cure! It is therefore essential that physicians and the health care system do a better job preventing and treating obesity, diabetes mellitus, hypertension and hyperlipidemia (risk factors for atherosclerosis) among all population groups but especially among blacks and men. This includes increasing physical activity, improved nutrition, and tobacco cessation.
The new healthcare reform law (The Affordable Care Act) contains many features to improve quality outcomes and reduce the cost of chronic diseases such as Coronary Heart Disease and Strokes. A key feature allows physician wellness visits without insurance copayments starting January 2011. This gives primary care physicians like me more opportunities to diagnose earlier and discuss with patients steps to tackle the risk factors for coronary heart disease and strokes. The healthcare reform law also encourages the development of Accountable Care Organizations, a group of health care providers who give coordinated care, chronic disease management and thereby improve the quality of care patients get.
Perhaps the best action to take to reduce Coronary Heart Disease and Stroke death rates across the board is to increase public awareness and education. After all, February is American Heart Month. “Cardiovascular diseases, including stroke, are our nation's No. 1 killer. To urge Americans to join the battle against these diseases, since 1963 Congress has required the president to proclaim February ‘American Heart Month.”