Several leading voices in cardiovascular medicine spoke out strongly at this year’s Congress about the looming crisis in health care and the need for the system to finally take prevention seriously. This message rang out from both sides of the border and took centre stage (that is “center” for our American friends) at the opening ceremony.
In his invited lecture, Dr. Clyde Yancy spoke passionately about “Reversing the Tide.” The Chief of Cardiology at Northwestern University and former President of the American Heart Association used American statistics to outline the current landscape, but emphasized that the Canadian situation is fundamentally similar.
Cardiovascular disease (CVD) costs the economy more than $22 billion dollars each year in lost productivity. The annual cost of treating CVD is $300 billion, and this is projected to rise to $1 trillion by 2030 if the incidence of disease grows as projected. This is the unsustainable picture despite the fact that mortality has declined by 30 per cent since the 1950s.
Of that decline, half is due to advances in treatment. The other half is due to prevention strategies, even though there has been no major emphasis on prevention, and only modest improvements in risk factors have been achieved. So, while epidemics in obesity and diabetes threaten these gains, the opportunity for prevention is huge.
As an example, Dr. Yancy cited a five-year randomized clinical trial on the use of the Mediterranean diet. This study showed that changes in diet alone can reduce incidence of CVD by 60 per cent. In addition, he offered the fact that 40 per cent of the burden for heart attack is due to high blood pressure and diabetes—both preventable conditions. Also important in these shaky economic times is the fact that the costs of prevention are far outweighed by the savings in health care expenditures and gains in productivity.
The American Heart Association is looking to a seven-point model of optimal health as a framework for achieving advances in CVD prevention. The seven points include favourable status in the following risk areas: smoking, weight, diet, physical activity, blood pressure, cholesterol and diabetes. Of the U.S. population, only 10 per cent meet this definition of optimal health. Dr. Yancy acknowledged that achieving the stated target of 20 per cent improvement by 2020 will require concerted effort and strong public health initiatives.
A public policy session, entitled “Delivering Cardiac Care Medicine in North America” continued the cross-border theme and mirrored much of the concern for embracing prevention that Dr. Yancy conveyed. As a follow-on activity from an American College of Cardiology (ACC) forum comparing and contrasting the continent’s two health care systems, the session brought together major figures from both countries. These included Dr. Eldon Smith, former President of Canadian Cardiovascular Society and point man for Canada’s national CVD strategy, and Dr. Thad Lewis, Chair of the ACC Board.
The discussion ranged widely among policy and professional concerns. While the U.S. and Canadian systems can trade pros and cons—widely available technology versus wait times for procedures, universal access versus millions of uninsured—two cons they have in common are spiralling costs and lack of emphasis on prevention.
The message about the Canadian system of cardiac care and beyond was clear from Canadian speakers. Fragmentation of care and the need to reimburse physicians for disease prevention are major hurdles to improving our system. Differentiation between health care and health promotion will be a significant issue in integrating prevention in a systematic fashion. Finally, and discouragingly, Dr. Smith made it clear that, in his years of working in public policy, no level of government has shown a willingness to initiate the discussion on how to address the problems inherent in the system.