CDC: Less than half of Americans get key heart attack and stroke prevention services

Nationwide survey data reveal care disparities linked to where patients live, their race or ethnicity and whether they have health insurance coverage.

By — Posted July 2, 2012

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The U.S. health system is underperforming in delivering care that could prevent heart attacks, stroke, cancer and the spread of HIV, says the Centers for Disease Control and Prevention.

For example, only 47% of Americans diagnosed with ischemic cardiovascular disease were prescribed aspirin or another antiplatelet, according to federal survey data from 2005 to 2008 analyzed in a CDC report published as a special supplement to the June 15 Morbidity and Mortality and Weekly Report.

Meanwhile, 44% of adults with hypertension had their blood pressure under control and fewer than 8% of tobacco users were prescribed medication to help them quit smoking. About 30% of patients who should be screened for hyperlipidemia were not, the report said. Improving systemwide use of aspirin, blood pressure control, cholesterol management and smoking cessation is a key aim of the Dept. of Health and Human Services’ Million Hearts initiative, a $200 million private-public project launched in September 2011.

The CDC undertook the analysis to get a nationwide baseline of performance in delivering preventive care, drawing on various sources that date through 2010. The plan is to measure how expanding access to insurance and reshaping care delivery affects the numbers.

“The findings of this report indicate that tens of millions of people in the United States have not been benefiting from key preventive clinical services, and that there are large disparities by demographics, geography, and health care coverage and access in the provision of these services,” CDC Director Thomas C. Frieden, MD, MPH, said in a foreword to the report.

One example of the many disparities outlined in the report is that 46% of white adults with hypertension have their blood pressure under control, compared with 32% of Mexican-American patients. The CDC also reported that 20% of patients who are HIV positive are unaware of their status, making it much likelier that they will spread the virus to others unknowingly. About a third of adults 50 to 75 years old are not up to date on their colorectal cancer screening, the data show.

“This [report] is a fabulous first look that highlights some of the challenges we knew were there in a comprehensive way,” said Jennifer Elston Lafata, PhD, co-leader of the Cancer Prevention and Control program at the Virginia Commonwealth University Massey Cancer Center in Richmond.

Many factors contribute to the health system’s suboptimal performance in delivering prevention, Lafata said.

“If we want to make preventive services more readily available, there are lots of different things that we need to be working on,” she said. “Certainly, the ability to financially access those services is one thing. Geographic access is another. And when people show up at a health care system or their clinician’s office with insurance, we know that barriers and hurdles still exist.

“How to overcome those is equally difficult — we have to overcome all these different kinds of hurdles. I don’t think working on any one thing is going to solve the problem. We need a multipronged approach.”

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How the U.S. is doing on preventive care

Nearly 90% of patients with diabetes have their blood glucose levels under control. However, the proportion of patients who receive other important preventive health services is not as high.

87.1%: Adult diabetics whose hemoglobin A1c levels are less than 9%
79.9%: Patients 13 and older who are HIV-positive and know it
70.1%: Adults who had recommended lipid screening done in last five years
64.5%: 50- to 75-year-olds who are up to date on colorectal cancer screening
46.9%: Adults with ischemic vascular disease prescribed aspirin or antiplatelet therapy
43.6%: Adults with hypertension whose blood pressure levels are under control
28.0%: Adults 64 and younger who received the influenza vaccine
20.9%: Adult tobacco users who got cessation counseling at physician office visit
7.6%: Adult tobacco users prescribed smoking cessation medication

Source: “Conclusions and Future Directions for Periodic Reporting on the Use of Selected Adult Clinical Preventive Services — United States,” Morbidity and Mortality Weekly Report, June 15 (link)

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External links

“Use of Selected Clinical Preventive Services Among Adults — United States, 2007—2010,” Morbidity and Mortality Weekly Report, supplement, June 15 (link)

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