AHRQ Initiatives Support Better Heart Health for All Americans

September 29 is World Heart Day—an observance that aims to improve how we understand, prevent, and manage heart disease. This annual event brings together health organizations across all sectors to turn the spotlight on a condition that each year kills more than 17 million people worldwide. Heart disease is also the leading cause of death for both men and women in the United States.

While these statistics are troubling, the impact of heart disease in the U.S. is even more significant for people of color and underserved communities. For example, in 2018, Blacks were 30 percent more likely to die from heart disease than non-Hispanic Whites. And Black women are 60 percent more likely to have high blood pressure compared to non-Hispanic White women. These disparities clearly illustrate why AHRQ and other Department of Health and Human Services (HHS) agencies have put a high priority on initiatives to advance equity.

Over the past 18 months, the COVID-19 pandemic has intensified the challenges for people with heart disease. Heart disease patients who contract COVID-19 face higher risks of serious illness or death. Fear of contracting COVID-19 may dissuade heart disease patients from getting needed care, whether that’s screening for hypertension, managing their existing heart disease, or undergoing rehabilitation following a heart attack.

At AHRQ, we’re devoted to fighting heart disease via each of the Agency’s core competencies—funding health services research, support for practice improvement, and the pursuit of data and analytics to inform healthcare decisionmaking. Our ultimate goal is to provide patients with care that is safer, higher quality, more accessible, equitable, and affordable. Several large AHRQ initiatives support this mission:

• EvidenceNOW: Advancing Heart Health: Launched in 2015, this initiative used practice facilitators to support teams at more than 1,500 small- and medium-sized primary care practices to improve the delivery of heart health services to about 8 million patients. This external support model helped typically under-resourced practices increase their capacity to use evidence and improve care. Early results have been promising:  smoking screening and cessation counseling increased by 10.9 percent; prescribing aspirin for eligible patients to improve heart health rose by 6.7 percent; cholesterol management jumped 6.3 percent; and blood pressure control increased 2.8 percent in these practices at a time when blood pressure control across the nation was decreasing. These new videos help tell the story of this initiative.
• EvidenceNOW: Building State Capacity: This new initiative to advance equity in heart health, building on lessons learned from our first EvidenceNow initiative, is focused on improving heart health in communities with the greatest need.  It supports the development of State-based infrastructure, encouraging alignment of primary care and public health interventions to deliver and coordinate quality improvement in four States with a high prevalence of preventable cardiovascular events. Grantees will use the EvidenceNOW Model and Tools for Change with primary care practices to build quality improvement capacity and increase the delivery of evidence-based heart healthcare.
• TAKEheart Initiative: This program is providing training, coaching, and technical assistance to up to 100 hospitals to implement proven strategies to increase patient participation in cardiac rehabilitation (CR). It is also engaging many additional hospitals in peer-to-peer exchange of knowledge about improving CR with a focus on strategies for increasing participation among underrepresented populations.  The initiative aims to help increase patient participation in CR from today’s 20 percent of eligible heart disease patients to 70 percent—an increase that each year could save an estimated 25,000 lives and prevent about 180,000 hospitalizations. While training paused during the pandemic, TAKEheart conducted virtual learning sessions about addressing pandemic-related challenges facing CR programs.  Summaries of these sessions and all training materials are available here.

AHRQ’s contributions to improving heart health are by no means limited to these activities. The Agency has recently released a Notice of Funding Opportunity seeking innovative research that advances health equity in care delivery. Topic areas include care for people with multiple chronic conditions, common among people with heart disease. In addition, AHRQ is pleased to have joined the National Hypertension Control Roundtable, a multisector group of public, private, and nonprofit organizations to improve national hypertension control rates to at least 80 percent by 2025; that compares to about 50 percent today.

While heart disease rates remain unacceptably high in the United States, particularly for people of color and underserved populations, a growing body of evidence has led to new technologies and care strategies for improving patient outcomes. As a lead Federal agency for health services research, AHRQ is proud to be playing a key role in this effort by funding research to assess potential solutions and by developing tools and best practices for clinicians and other care providers. Working together, we can deliver safer, higher quality care for heart disease patients.

Arlene Bierman is Director of AHRQ’s Center for Evidence and Practice Improvement.

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