The American Heart Association (AHA) has set a 2020 goal of improving the heart health of all Americans by 20% while reducing deaths from cardiovascular disease (CVD) and stroke by 20%. The AHA’s 2020 goals were designed strategically to help all individuals prevent declines in their current health behaviors and take a step toward better heart health by progressing toward ideal healthy lifestyle behaviors. “To achieve these goals, prevention is the top priority,” says Bonnie Spring, PhD. “Major strides have been made toward reducing risks for CVD and stroke, but the significant economic toll linked to these health challenges necessitates a new approach.” According to recent estimates, direct annual CVD-related costs are projected to triple, rising from $272 billion in 2010 to $818 billion in 2030.

A Call to Action

In 2013, the AHA released a science advisory, published in Circulation, emphasizing the importance of greater efforts to preserve cardiovascular health from childhood and to treat health risk behaviors into older ages. The call-to-action statement addresses three novel approaches to attain the AHA’s 2020 goals:

1. Preserving positive cardiovascular health by promoting healthy lifestyle behaviors.

2. Treating unhealthful behaviors in addition to risk biomarkers.

3. Combining individual-level and population-based health promotion strategies that steer the public toward the next level of improved cardiovascular health.

“Clinicians need to treat unhealthy behaviors as aggressively as they treat high blood pressure (BP), cholesterol, and other CVD risk factors,” says Dr. Spring, who was lead author of the AHA statement. “It’s a paradigm shift from only treating biomarkers to also helping people change unhealthy behaviors.” Clinicians already treat physical risk factors, but people also put their health at risk via their behaviors.


Seven metrics have been used to define cardiovascular health, including smoking, diet quality, physical activity, BMI, BP, blood cholesterol, and fasting blood glucose. Individuals with all seven metrics at ideal levels are considered to have ideal cardiovascular health, but few achieve these metrics. The AHA notes that cardiovascular health is being lost from childhood through young adulthood. The major reason is the onset of adverse health behaviors relating to diet, physical inactivity, weight maintenance, and smoking. Eliminating these health risk behaviors would make it possible to prevent many cases of CVD, stroke, and type 2 diabetes, as well as many cancers.

Fostering Collaboration

A chief recommendation from AHA is that healthcare providers create inter-professional practices to connect patients with behavior change specialists, such as dietitians or psychologists (Table 1). Assessing patients’ risk behaviors, advising change, agreeing on goals, assisting patients to establish a treatment plan, and arranging for follow-up are important steps in providing high-quality healthcare. “Physicians are adept at assessing patient behaviors and advising change, but allied health professionals are valuable assets who can assist patients to actually implement behavior change plans,” Dr. Spring says. “At the same time, reimbursement policies must be revised to support inter-professional practices in order for them to work.”

“Fostering heart health isn’t a challenge that can be solved
by a single physician or approach.”

Under an effective healthcare system, professionals can work with patients and draw on community and technology resources to provide the level of treatment intensity that is needed to change health risk behaviors. The AHA recommends several healthcare systems approaches to help support behavior change (Table 2). Both individual clinical and population-level strategies are needed to reduce the high prevalence of heart health risk behaviors. “Fostering heart health isn’t a challenge that can be solved by a single physician or approach,” Dr. Spring says. “Providers need to stop operating in silos and collaborate on effective prevention strategies to get ahead of the curve.”

Working as Advocates

The AHA encourages the community of healthcare providers to intervene directly to help patients adopt healthier lifestyles. Providers need to ramp up their efforts to be champions of healthy lifestyles, Dr. Spring says. “We should be advocates for healthcare system and policy improvements to address behavior changes more effectively for all patients.” Such efforts will likely require assessing and tracking health behaviors over time electronically. They will also require the engagement of community resources and technologies and enhanced reimbursement for intensive behavioral counseling.

Studies show that intervening to achieve sustained improvements in tobacco use, obesity, poor-quality diet, and physical inactivity is feasible and can improve patients’ health. To accomplish AHA’s 2020 goals, low-intensity interventions must be available to all patients at low and moderate levels of cardio-vascular risk. After that, collaboration with inter-
professional healthcare teams is necessary to provide intensive behavioral interventions for those at moderate and high levels of risk. “Support from all
healthcare professionals for these endeavors is worthwhile in order to truly promote healthier lifestyles,” says Dr. Spring.


Spring B, Ockene JK, Gidding SS, et al. Better population health through behavior change in adults: a call to action. Circulation. 2013 Oct 7 [Epub ahead of print]. Available at:

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