Target Audience (click to view)
This activity is designed to meet the needs of physicians.
Learning Objectives(click to view)
Upon completion of the educational activity, participants should be able to:
- Discuss the American Heart Association’s scientific statement on social determinants of risk and outcomes for cardiovascular disease.
Method of Participation(click to view)
Statements of credit will be awarded based on the participant reviewing monograph, correctly answer 2 out of 3 questions on the post test, completing and submitting an activity evaluation. A statement of credit will be available upon completion of an online evaluation/claimed credit form at http://akhcme.com/akhcme/lessons/6. You must participate in the entire activity to receive credit. If you have questions about this CME/CE activity, please contact AKH Inc. at email@example.com.
Credit Available(click to view)
CME Credit Provided by AKH Inc., Advancing Knowledge in Healthcare
This activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of AKH Inc., Advancing Knowledge in Healthcare and Physician’s Weekly’s. AKH Inc., Advancing Knowledge in Healthcare is accredited by the ACCME to provide continuing medical education for physicians.
AKH Inc., Advancing Knowledge in Healthcare designates this enduring activity for a maximum of 0.5 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Commercial Support(click to view)
There is no commercial support for this activity.
Disclosures(click to view)
It is the policy of AKH Inc. to ensure independence, balance, objectivity, scientific rigor, and integrity in all of its continuing education activities. The author must disclose to the participants any significant relationships with commercial interests whose products or devices may be mentioned in the activity or with the commercial supporter of this continuing education activity. Identified conflicts of interest are resolved by AKH prior to accreditation of the activity and may include any of or combination of the following: attestation to non-commercial content; notification of independent and certified CME/CE expectations; referral to National Author Initiative training; restriction of topic area or content; restriction to discussion of science only; amendment of content to eliminate discussion of device or technique; use of other author for discussion of recommendations; independent review against criteria ensuring evidence support recommendation; moderator review; and peer review.
Disclosure of Unlabeled Use & Investigational Product(click to view)
This educational activity may include discussion of uses of agents that are investigational and/or unapproved by the FDA. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.
Disclaimer(click to view)
This course is designed solely to provide the healthcare professional with information to assist in his/her practice and professional development and is not to be considered a diagnostic tool to replace professional advice or treatment. The course serves as a general guide to the healthcare professional, and therefore, cannot be considered as giving legal, nursing, medical, or other professional advice in specific cases. AKH Inc. specifically disclaim responsibility for any adverse consequences resulting directly or indirectly from information in the course, for undetected error, or through participant’s misunderstanding of the content.
Faculty & Credentials(click to view)
Discloses no financial relationships with pharmaceutical or medical product manufacturers.
Dorothy Caputo, MA, BSN, RN- CE Director of Accreditation
Discloses no financial relationships with pharmaceutical or medical product manufacturers.
AKH planners and reviewers have no relevant financial relationships to disclose.
Complete the Post Test(click to view)
Although mortality from cardiovascular disease (CVD) in the United States has been declining since the 1970s, the burden of the disease remains high, accounting for nearly 32% of all deaths in the U.S., according to recent data. “It was assumed that the steady downward trend in mortality would continue into the future as further breakthroughs in science led to advances in prevention and treatment,” explains Edward P. Havranek, MD. “However, advances in the field have stalled substantially in recent years.”
Research suggests that the prevalence of CVD in the U.S. will rise 10% between 2010 and 2030. “This change in the trajectory of cardiovascular burden is the result of an aging population as well as a dramatic rise in obesity and the hypertension, diabetes, and physical inactivity that accompanies weight gain,” Dr. Havranek says. “Considering this altered trajectory, it’s important to think about the role of social issues in the management of CVD.”
The American Heart Association has released a scientific statement on social determinants of risk and outcomes for CVD with the purpose of increasing awareness of these important factors. Social determinants include circumstances in which people are born, grow, live, work, and age (Table). Published in Circulation and available for free at http://circ.ahajournals.org, the statement summarizes current knowledge about these factors and offers recommendations for future directions in research. The latter includes efforts to develop effective interventions to reduce or eliminate these adverse social influences.
According to the statement, advances in prevention and treatment have driven the decline in cardiovascular deaths, but the benefits have not been shared equally across economic, racial, and ethnic groups in the U.S. “The statement notes several areas in which clear associations between societal factors and cardiovascular health have been shown,” says Dr. Havranek, who was chair of the writing group. “These issues go beyond simple healthcare disparities and include factors that affect everyone, including education, income, and sociodemographic considerations.”
Education has been identified as a top indicator of socioeconomic status because it affects the type of job people have, their access to healthcare, income, stress, and other factors. Studies suggest that people with lower educational levels tend to die at younger ages from CVD. In addition, people with lower incomes are more likely to develop CVD. “A patient’s socioeconomic standing drives health in ways that we don’t often think about,” says Dr. Havranek.
Some differences in cardiovascular risk among races might be explained by genetics and biology, but Dr. Havranek says there are other factors to consider. Several areas are actively being studied with regard to racial disparities in CVD, including the effects of bias, prejudice, and other chronic stressors. Investigators are also exploring the effect of access to healthy foods and opportunities for physical activity among racial and ethnic groups.
Prenatal Care & Early Childhood
According to the scientific statement, there is emerging evidence suggesting that the tendency for adults to develop hypertension and diabetes may be determined by factors that happen before birth and throughout early life. “Children with low birth weight are at risk for structural changes to the heart and kidneys that may predispose them to hypertension and diabetes when they reach adulthood,” says Dr. Havranek. “We now have evidence suggesting that educating preschool children, referring them to pediatricians, and providing them with healthy meals can lower risks for CVD later in life. This is an important opportunity to consider, but more research is needed on effective interventions for preschoolers.”
Access to Healthcare Issues
The scientific statement notes that health insurance access may improve significantly with the Affordable Care Act, but greater efforts are needed to deal with disadvantaged patient groups. There are many barriers to accessing care, including issues involving patient beliefs, literacy, culture, and language. There is also a poor geographic distribution of cardiac services throughout the country.
Dr. Havranek says that although access to health insurance is necessary, it is not a sufficient intervention for improving cardiovascular health. “To improve access, we need multifaceted efforts that require the provision of insurance coverage and a better distribution of services,” he says. “Ultimately, we need to address social, biological, and genetic influences on cardiovascular health in order to achieve a ‘culture of health.’”
Physicians and consumers are recommended to pay attention to how social factors might impact cardiovascular health. “We need greater awareness of the role of social factors in CVD and should take specific steps to ask patients about these factors during our encounters with them,” says Dr. Havranek. “We also need to develop advocacy efforts that go outside the box and implement innovate, cost-effective public health programs that aim to reduce the burden of CVD.”
Edward P. Havranek, MD is a Professor at the University of Colorado School of Medicine; a Staff Cardiologist at Denver Health Medical Center; and Director of Health Services Research at Denver Health.
Edward P. Havranek, MD, has indicated to Physician’s Weekly that he has in the past received research grants from the AHRQ and the NIH.
Readings & Resources (click to view)
Havranek EP, Mujahid MS, Barr DA, et al; on behalf of the American Heart Association Council on Quality of Care and Outcomes Research, Council on Epidemiology and Prevention, Council on Cardiovascular and Stroke Nursing, Council on Lifestyle and Cardiometabolic Health, and Stroke Council. Social determinants of risk and outcomes for cardiovascular disease: a scientific statement from the American Heart Association. Circulation. 2015;132:873-898. Available at: http://circ.ahajournals.org/content/132/9/873.full.
Lloyd-Jones DM, Hong Y, Labarthe D, et al; American Heart Association Strategic Planning Task Force and Statistics Committee. Defining and setting national goals for cardiovascular health promotion and disease reduction: the American Heart Association’s strategic Impact Goal through 2020 and beyond. Circulation. 2010;121:586-613.
Marmot M, Friel S, Bell R, Houweling TA, Taylor S; Commission on Social Determinants of Health. Closing the gap in a generation: health equity through action on the social determinants of health. Lancet. 2008;372:1661-1669.