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Journal of Cardiovascular Nursing
Vol. 28, No. 2, pp 103Y105 x Copyright B 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Progress in Prevention
Calling all Cardiovascular Nurses: Be One in a
Million Hearts
Million Hearts Initiative
Cheryl R. Dennison Himmelfarb, PhD, RN, ANP, FAHA, FPCNA, FAAN;
Laura L. Hayman, PhD, RN, FAAN
T he Million Hearts is a national
initiative to prevent 1 million
myocardial infarctions and strokes
efforts, as well as creates new pro-
grams, to improve health across
communities and help Americans
technology (HIT) to report and
improve ABCS performance, and in-
novating care delivery to improve
over 5 years by focusing the nation live longer, more productive lives. adherence and control of ABCS.1
on evidence-based community and The Centers for Disease Control Current performance on Million
clinical prevention actions.1,2 Million and Prevention (CDC) and Centers HeartsYrelated measures varies widely
Hearts brings together communities, for Medicare & Medicaid Services across clinical systems, from well be-
health systems, nonprofit organiza- (CMS) co-lead Million Hearts within low 50% to nearly 90%.1 With this
tions, federal agencies, and private- the Health and Human Services. information in mind, the goals for
sector partners from across the Key components of the initiative performance on the Million Hearts
country to make a long-lasting im- emphasize cardiovascular health and measuresinhealthcaresettingswereset
pact against cardiovascular disease.2 include community prevention to re- at 70%, rather than at an unrealistic
Launched by the Department of duce the number of people who need or potentially harmful 100% (Table).1
Health and Human Services in treatment and clinical prevention to Million Hearts brings together a
September 2011, it aligns existing optimize care for those who do re- number of programs, policies, and
quire care.2 Community prevention campaigns designed to make a pos-
Cheryl R. Dennison Himmelfarb, strategies aim to reduce the number itive impact across the spectrum of
PhD, RN, ANP, FAHA, FPCNA, FAAN
Associate Professor, Department of Acute of people who need treatment, such prevention and care, promoting the
and Chronic Care, Johns Hopkins University as blood pressure or cholesterol med- ABCS of clinical prevention as well
School of Nursing, and Division of Health ications, to prevent myocardial in- as healthier lifestyles and commu-
Sciences Informatics, Johns Hopkins University
School of Medicine, Baltimore, Maryland. farctions and strokes by empowering nities.2 Some of Million Hearts’
Laura L. Hayman, PhD, RN, FAAN Americans to make healthier choices wide-ranging activities include (1)
Associate Dean for Research, Professor of by preventing tobacco use and limit- educational campaigns to increase
Nursing, College of Nursing and Health
ing sodium and trans-fat consump- awareness about heart disease pre-
Sciences, University of Massachusetts
Boston, and Director of Research, GoKids, tion. Clinical prevention efforts to vention and empower patients to
Boston, Massachusetts. improve quality of care focus on take control of their heart health,
The authors have no funding or conflicts of the ABCSVaspirin for people at (2) use of HIT and quality improve-
interest to disclose.
risk, blood pressure control, cho- ment initiatives to standardize and
Correspondence lesterol management, and smoking improve the delivery of care for
Cheryl R. Dennison Himmelfarb, PhD, RN,
ANP, FAHA, FPCNA, FAAN, Department of cessationVwhich address the major high blood pressure and high cho-
Acute and Chronic Care, Johns Hopkins risk factors for cardiovascular dis- lesterol, and (3) community efforts
University School of Nursing, Division of
ease and can help to prevent myo- to promote smoke-free air policies
Health Sciences Informatics, Johns Hopkins
University School of Medicine, 525 N cardial infarctions and strokes.2 and reduce sodium in the food sup-
Wolfe Street, Rm 527, Baltimore, MD Strategies include aligning care goals ply. Toolkits were designed to help
21205-2110 (cdennis4@jhu.edu).
with provider and system incentives, partners incorporate Million Hearts
DOI: 10.1097/JCN.0b013e3182819dcc
fully deploying health information into their everyday work and enhance
103
Copyright © 2013 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
104 Journal of Cardiovascular Nursing x March/April 2013
TABLE Benchmarks for Million cruit others to improve clinical the Million Hearts partner orga-
Hearts Program Success1,2 preventive practice and commu- nizations are highlighted. Detailed
nity prevention. The Grand Rounds progress notes are provided on se-
Measure 2017 Goal
Toolkit features CDC Director Dr lect successful projects chosen based
Aspirin use for people 70% Tom Frieden, Million Hearts Ex- on their potential for implementa-
at high risk
ecutive Director Dr Janet Wright, tions by other organizations. The
Blood pressure control 70%
Cholesterol (LDL-C) 70% and CMS Chief Medical Officer selection criteria include their ef-
management Dr Patrick Conway talking about fectiveness, how easily they can be
Smoking cessation 70% the initiative’s focus on preventing replicated, and their inclusion of les-
Sodium intake (average) 20% reduction myocardial infarctions and strokes sons learned.2 The American Heart
Artificial trans fat 50% reduction
through clinical preventive prac- Association/American Stroke Asso-
consumption (average)
tice and community prevention with ciation has also joined forces with
Abbreviation: LDL-C, low-density lipoprotein first-person accounts from 2 commu- Million Hearts providing tools in-
cholesterol. nities working to create healthier cluding the Heart Attack Risk Cal-
environments and to align health- culator, My Life Check, and Life’s
their heart disease and stroke pre- care professionals and systems to Simple 7. Other tools include videos
vention efforts. 2 They include improve quality of care. The Blood with personal stories about heart
messages for consumers and health- Pressure Toolkit was designed to be disease and stroke prevention.
care professionals and tools to used with patients to help address Nurses, other healthcare pro-
support local events. A Partners high blood pressure in your clinics viders, and health systems are vital
Toolkit, Grand Rounds Toolkit, and and communities. to the Million Hearts mission. Spe-
Blood Pressure Toolkit are available In addition, the Million Hearts cific actions to promote the goals
for download and use in full or as Web site provides numerous re- of this ambitious initiative are listed
individual components.2 The Part- sources to support community and in the Box.
ners Toolkit can be used to expand clinical prevention of heart disease Preventing 1 million myocardial
existing heart disease and stroke and stroke. Successes and best prac- infarctions and strokes in 5 years
prevention programs and to re- tices in heart disease and stroke by will require commitment to change
Box. Actions to Advance Million Hearts
Focus on the ABCS with your patients
Prioritize control of high blood pressure and cholesterol. Help your patients follow treatment instructions and improve
medication adherence.
Ask your patients about their smoking habits and provide smoking cessation counseling and tools for smokers.
Prescribe appropriate aspirin therapy for those who would benefit.
Track and improve ABCS performance through HIT and quality improvement
Report on the ABCS-related Cardiovascular Prevention Measures Group in the CMS Physician Quality Reporting System.
Use HIT, such as electronic health records with clinical decision support tools and a patient registry, to improve the delivery
of care for ABCS in patients and populations/panels. For example, use electronic health record registry functionality
regularly to detect those with uncontrolled hypertension or cholesterol and recall them for follow-up.
Align provider education and quality improvement initiatives to focus on and improve ABCS.
Recognize and reward healthcare providers who address and promote ABCS in their patients.
Connect with other clinicians in your community in a learning and action network aimed at improving ABCS in your patients.
Support team-based approaches to care to improve coordination and quality of care for patients.
Implement innovative care models (patient-centered medical homes, accountable care organizations) that include a focus on the ABCS.
Connect at-risk patients with community resources for self-management, diabetes education, and other community
resources to address barriers to adherence.
Decrease health disparitiesVuse culturally appropriate education materials, patient navigators, community health workers to
address barriers to care.
Educate your patients and community about the most effective ways to control their risk factors for heart disease and stroke.
Promote heart-healthy habits to your patients, such as regular physical activity and a diet rich in fresh fruits and vegetables.
Reduce out-of-pocket costs for smoking cessation, blood pressure, and cholesterol medications and services.
Drive awareness of the initiative. Include Million Hearts messages in newsletters, pledge your organization’s commitment on
the Million Hearts Web site, and recruit at least 20 patients and partners to do the same.
Convene partners, stakeholders and policy makers for Million Hearts events.
Share success stories on the Million Hearts Web site.
Monitor whether progress is being made in your community.
Adapted from the Million Hearts CDC Grands Rounds Toolkit.3
Copyright © 2013 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
The Million Hearts Initiative 105
not only in the cardiovascular about Million Hearts, visit http:// 2. Centers for Disease Control and Pre-
vention. Million Hearts. http://million
health behaviors of the nation but millionhearts.hhs.gov.2
hearts.hhs.gov. Accessed December 4,
also in our cardiovascular health 2012.
promotion and risk factor man- REFERENCES 3. Centers for Disease Control and Pre-
agement practices. Each of us can 1. Wright JS, Wall HK, Briss PA, vention. Million Hearts CDC Grand
Schooley M. Million HeartsVwhere Rounds Toolkit. http://millionhearts.hhs
be 1 in a Million Hearts, taking ac-
population health and clinical prac- .gov/Docs/GR_Toolkit/Grand_Rounds_
tion and making a positive impact tice intersect. Circulation. 2012;5: toolkit.pdf. Accessed December 4,
toward this goal. To learn more 589Y591. 2012.
Copyright © 2013 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
