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The Initiative

Innovations & Progress Notes

These innovations highlight successes and best practices in heart disease and stroke by the Million Hearts® partner organizations. The progress notes are chosen based on their potential for implementations by other organizations. The criteria include their effectiveness, how easily they can be replicated, and their inclusion of lessons learned.

Controlling Hypertension and High Cholesterol: an Overview

High blood pressure, or hypertension, affects nearly 67 million adults in the United States, and every year hypertension contributes to one out of every seven deaths. About half of adults with high blood pressure don’t have their condition under control. Approximately $51 billion in health care services, medications, and lost productivity costs are attributed annually to high blood pressure.

In addition, an estimated 71 million adults have high levels of low-density lipoprotein (LDL) cholesterol (“bad” cholesterol), but only 34 million (48%) are treated and only 23 million (33%) have it controlled.

About 40% of African American adult men in the United States have hypertension. About 70%, or roughly 4.4 million, of these men do not have the condition under control. African American men suffer a higher death rate from hypertension than any other racial, ethnic, or gender group and have less frequent contact with physicians related to preventive care than do many other racial and ethnic groups, including African American women.

Taking antihypertensive medication is an important step that people with high blood pressure can take. Yet getting on the right medication, remembering to take it regularly, and adapting to new diet and exercise routines can be challenging. People often struggle to bring their blood pressure under control.

Doctors, too, are frustrated by the limited time they have to answer patients’ questions, work with patients to lower their blood pressure, and track patients’ progress. Practitioners may feel that treating disorders such as diabetes that may accompany high blood pressure are a more urgent or life-threatening concern.

Million Hearts® Epi-Exchange

Every year, Americans suffer approximately 1.5 million heart attacks and strokes at a cost of more than $315 billion in health care expenditure and lost productivity annually. Cardiovascular disease (heart disease and stroke) also causes premature death, serious illness, disability, and decreased quality of life. The good news, however, is that many of the major risk factors for these conditions can be prevented and controlled. For example, high blood pressure (hypertension) is one of the leading causes of heart disease and stroke. Lifestyle choices, such as eating healthy and exercising regularly, can help control blood pressure and health care professionals may prescribe other treatments (antihypertensive medication) if lifestyle changes are not enough. However, nearly 1 in 3 Americans, or about 67 million adults, have high blood pressure and, despite the significant benefits of lifestyle modifications on blood pressure and broad availability of antihypertensive medications, only half have it under control. The ability of people to continue using their medications as prescribed by their doctor—also known as medication adherence�is a key challenge.

To tackle this important issue, the Centers for Medicare and Medicaid Services (CMS) and the Centers for Disease Control and Prevention (CDC) teamed up to discuss how to improve antihypertensive medication adherence. This effort became known as the Million Hearts® Epi-Exchange because of the similarities to CDC's "Epi-Aid" program which provides epidemiological support within the United States and throughout the world to assist with emergency responses, investigate infectious and environmental disease outbreaks, and quantify impact of diseases. Find out more about the Million Hearts® Epi-Exchange [PDF-83K].

Million Hearts®: Scaling and Spreading Innovation—Strategies to Improve Cardiovascular Health

The Million Hearts® Scaling and Spreading Innovation event event (held April 19, 2012) was a collaboration among the Agency for Healthcare Research and Quality (AHRQ), Centers for Disease Control and Prevention (CDC), Centers for Medicare and Medicaid Services (CMS), and the American Heart Association (AHA), designed to inspire creative thinking about developing and sustaining successful community interventions for better cardiovascular health. In particular, the event highlighted the spread of innovations aimed at reducing blood pressure and cholesterol to prevent heart disease and stroke. Full descriptions of the innovations featured at the event are described in the AHRQ Health Care Innovations Exchange, which is the nation's largest publicly accessible, web-based collection of health care delivery innovations and QualityTools to help improve health care quality and reduce disparities.

In this pharmacist-led, home blood pressure monitoring program participants uploaded their home blood pressure measurements 3-4 times a week to the American Heart Association's Heart360 Web site. Clinical pharmacy specialists monitored the patients' blood pressure readings and adjusted medication therapy as needed. This program led to improved blood pressure control, increased reduction in blood pressure, and improved patient satisfaction with care for patients with uncontrolled hypertension.

Disease Management to Promote Blood Pressure Control among African Americans
The purpose of this innovation was to determine whether telephonic nurse disease management was more effective than a home monitoring program for controlling blood pressure among African Americans who were enrolled in a national health plan. The results of this program were decreased systolic blood pressure and an increased frequency of blood pressure self-monitoring among the participants.

Language Concordant Health Coaches
In this program, language-concordant health coaches (i.e., those who speak the patient's preferred language) were teamed with residents to improve the self-management skills and quality of care of patients who had limited English proficiency and health literacy. Coaches, who worked in tandem with a resident, conducted a pre-visit meeting, assisted during the medical visit, conducted a post-visit meeting, and followed up with the patient 1 to 2 weeks after the visit to offer additional support. The program has led to improvements in the treatment process and clinical outcomes of patients with diabetes, including improved blood pressure and cholesterol levels.

Medication Therapy Management
The American Pharmacists Association Foundation's Asheville Project created a community-based, medication therapy management (MTM) program for patients with hypertension/dyslipidemia. In this program, pharmacists provided both education and long-term medication therapy management to reduce the risks of hypertension and dyslipidemia. The program, provided over a 6-year period in 12 community and hospital pharmacy clinics in Asheville, N.C. resulted in both clinical and financial benefits. This program resulted in numerous clinical benefits, including reduced hemoglobin A1C levels, improved blood pressure control, and significant declines in cholesterol and serum triglyceride levels. The program also reduced costs across four targeted conditions (diabetes, asthma, cardiovascular disease, and depression) and produced a positive return on investment.

Note: The findings and conclusions in these presentations are those of the author(s) and do not necessarily represent the official position of CDC, CMS, AHRQ, or AHA.

Interventions: What Works?

Many private and public employers, insurance companies, and health care providers across the country have taken innovative steps to prevent hypertension and high cholesterol among their employees or patients and to bring these conditions under control for the long term. In many cases, these innovations can be scaled up to reach more patients and improve more lives through coordinated, focused efforts of Million Hearts® partners and stakeholders.

The following success stories highlight successful common strategies, including:

Submit a Progress Note

Do you have an initiative that is making a difference in heart disease and stroke outcomes? Submit a progress note by filling out the form below. The information can be emailed to, or faxed to (770) 488-8151 with "Million Hearts® Progress Notes" in the subject line. By submitting a progress note about your work, you are contributing knowledge and local experience to the national effort to prevent heart attacks and strokes using the Million Hearts® principles and approaches.

Read the Progress Notes

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