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horror disaster struck theEach year, more than 2 million Americans have a heart attack or stroke, and more thanof them die; cardiovascular disease is the leading cause of death in the United States and the largest cause of lower life expectancy among blacks.

Cardiovascular prevention works in two realms: It's time to take the next big step. As for community-based prevention, the initiative will encourage efforts to reduce smoking, improve nutrition, and reduce blood pressure. It will implement the cardiovascular-disease—prevention priorities of the National Quality and National Prevention Strategies and help in meeting targets set by Healthy People Improving management of the ABCS can prevent more deaths than other clinical preventive services.

Treating high blood learn more here and high cholesterol substantially and quickly reduces mortality among high-risk patients.

Even brief smoking-cessation advice from clinicians doubles the likelihood of a successful quit attempt, and the use of medications increases quit rates further. Currently, less than half of people with ischemic heart disease take daily aspirin or another antiplatelet agent; less than half with hypertension have it adequately controlled; only a third with hyperlipidemia have adequate treatment; and less than a quarter of smokers who try to quit get counseling or medications.

As a result, more than million people — half of American adults — smoke or have uncontrolled high How To Write 1 1 Million pressure or cholesterol; many have more than one of these cardiovascular risk factors. Increasing utilization of these simple interventions could save more thanlives a year. Improving care is particularly critical in light of increases in the prevalence of obesity and diabetes.

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Obesity and physical activity are currently being addressed by complementary efforts designed to improve understanding, implement pilot or community-based programs, and evaluate outcomes. And link and private partners are working to expand the Diabetes Prevention Program, which promotes weight loss, improved nutrition, and increased physical activity among people at highest risk.

It waives patient cost sharing for preventive services, including blood-pressure and cholesterol screening and smoking-cessation counseling and treatment, for enrollees in new private insurance plans.

The new annual wellness visit for Medicare beneficiaries will help physicians focus on reducing cardiovascular risk and target interventions appropriately. Covering 32 million currently uninsured Americans will reduce financial barriers to preventive care, and expanding community health centers will increase access to care and reduce health disparities.

In addition, electronic health records EHRs will support improved clinical decision making. Additional means of go here control of the ABCS include reducing or eliminating copayments for medications, once-a-day dosing, team-based care approaches, stepwise care management, and new forms of payment and delivery for higher-quality, higher-value, and coordinated care, such as those envisioned for accountable care organizations.

Million Hearts will work to standardize core ABCS indicators across medical practices, insurers, institutional providers, and systems in public and nonpublic settings.

Standardization will facilitate public reporting and identification and diffusion of best practices and will reduce providers' burden by streamlining quality measurement and improvement.

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The initiative will be linked to quality-recognition programs e. Community-based prevention works by facilitating healthy choices. Important community-based prevention initiatives include those funded by the American Recovery and Reinvestment Act's Communities Putting Prevention to Work program and programs supported by the ACA's Prevention and Public Health Fund, including Community Transformation Grants, initiatives for tobacco control and chronic-disease prevention and control, many National Prevention Strategy initiatives, and state and local actions addressing tobacco use, nutrition, and the linkage between clinical and community-based prevention.

Reductions in smoking, sodium consumption, and trans fat consumption can substantially and rapidly improve cardiovascular health.

Warning people about the harms of tobacco use through mass media and other measures, as well as package labeling as enabled by the Family Smoking Prevention and Tobacco Control Act, and creating smoke-free public places and workplaces, as detailed in the National Prevention Strategy and facilitated through ACA-funded community grants, should further reduce smoking rates by discouraging smoking initiation and encouraging cessation. Reducing sodium intake, another key National Prevention Strategy intervention, reduces risks of hypertension and cardiovascular disease.

Because most dietary sodium comes from processed and restaurant foods, it's difficult for Americans to limit their sodium consumption. Procurement guidelines from the DHHS and the General Services Administration and proposed school-food standards from the Department of Agriculture include a focus on sodium reduction.

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Menu-labeling requirements in chain restaurants will help people make more informed choices. Consumption of artificial trans fat increases the risk of cardiovascular disease click to see more raising low-density lipoprotein LDL cholesterol levels and lowering high-density lipoprotein HDL cholesterol levels.

Replacing artificial trans fat with heart-healthy oils is feasible and does not increase the cost or change the flavor or texture of foods. Since the Food and Drug Administration began requiring listing of trans fat content on food labels, the industry has voluntarily reformulated foods, and according to CDC data, Americans' trans fat consumption decreased by at least half.

Elimination of such consumption could prevent 50, deaths per year. Million Hearts will leverage, focus, and align existing investments and generally not require new public spending.

Voluntary initiatives will simplify, harmonize, and automate clinicians' reporting requirements, decrease administrative burden, improve the quality of prevention and care, and inform the public more fully. Improvements in control of the ABCS, nutrition, and smoking are projected to prevent more than a million heart attacks and strokes over the initiative's first 5 years. By focusing our initial efforts where they will save the most lives, we aim to make progress toward a health system that will serve Americans' How To Write 1 1 Million in the 21st century.

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Disclosure forms provided by the authors are available with the full text of this article at NEJM. Forecasting the future of cardiovascular disease in the United States: Explaining the decrease in U. N Engl J Med ; Deaths preventable in the U. Am J Prev Med ; Performance measures have a major effect on cardiovascular outcomes: Am J Med ; The preventable causes of death in the United States: PLoS Med ;6: Principles and Examples of Interventions.

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