Saving a million lives, one heart at a time

Today, the number of Americans with heart disease is simply staggering—more than 80 million people. Over the next five years, more than 3 million of these Americans will die from heart-related ailments, including heart attack and stroke. This is a tragic number equal to about one percent of the entire US population. Even more tragic for us is the fact that one-third of these deaths—about 1 million persons—will be people who have a mental or substance use condition.

To address this number one killer of Americans, the US Department of Health and Human Services has developed the Million Hearts Campaign. This campaign aims to prevent 1 million heart attacks and strokes over the next five years by implementing ABCS:  A — Appropriate Aspirin Therapy; B — Blood Pressure Control; C — Cholesterol Management; and S — Smoking Cessation; You can learn much more about the Campaign and its activities at http://millionhearts.hhs.gov/index.html.

We have known for some time that persons with behavioral health conditions are at particular risk of heart disease. Specifically, depression increases blood cortisol, which increases the risk of heart attack; smoking, a potent risk factor, is very prevalent among those with behavioral health conditions; use of psychotropic medications frequently leads to the metabolic syndrome and obesity, which increases risk; and excessive use of alcohol can exacerbate high blood pressure and trigger a stroke or heart attack.

We also have known another tragic fact: Persons with severe behavioral health conditions are likely to die 25 years or more prematurely. In addition to the risk factors noted above, most of these persons lack access to any primary care. Realization of this very serious problem has led to major behavioral health initiatives at the national, state, and county levels to develop integrated care that brings together mental health, substance use, and primary care. It also has resulted in many efforts to develop wellness interventions, particularly by consumers and their peers. These wellness efforts have been codified by SAMHSA, first in the 10 by 10 Campaign and more recently in the SAMHSA Wellness Initiative. You can learn much more about this Initiative at http://www.promoteacceptance.samhsa.gov/10by10/default.aspx.

What we have not known before is that fully one third of all deaths due to heart disease or stroke are suffered by persons with behavioral health conditions—1 million deaths over five years. We can and must take further action to address this monumental tragedy!

Several courses of action seem very necessary:

• First, over the next five years, we must reach at least 1 million high risk persons with behavioral health conditions through the SAMHSA Wellness Initiative and the Million Hearts Campaign. In undertaking this outreach, we also must recognize that many of these persons are not currently receiving behavioral health services. Hence, new and innovative outreach strategies will be required.
• Second, we must mobilize the SAMHSA Wellness Initiative so that it can become a potent voice in every community to reach those with behavioral health conditions who are at high risk, to inform them about their risks, and to link them with appropriate peer counselors who can assist with wellness interventions and referrals to integrated care systems. Two key features of this work will be the development and dissemination of effective wellness interventions and the training and mobilization of a large cadre of peer counselors.
• Third, we must work with the Million Hearts Campaign so that persons with behavioral health conditions who contact the Campaign are able to develop an understanding of their own risk factors for heart attack and stroke, and to receive actionable information on the practical steps they can take to address these risks. Ideally, this will include a referral to a peer counselor in their own community who can mobilize them to undertake wellness regimens and participate in needed formal care. 

Implementation of the Affordable Care Act will provide a wonderful opportunity to facilitate this critical work. Early in 2013, outreach will begin to enroll uninsured adults in health insurance programs through the Medicaid Expansion and the State Health Insurance Exchanges, both of which will begin operation early in 2014. Ultimately, this outreach will extend to 32 million uninsured persons, of which an estimated 10.5 million have pre-existing mental or substance use conditions. Clearly, each of these 10.5 million should receive information to determine whether they are at high risk of heart attack or stroke and, if so, be provided a referral to a peer counselor who can assist with appropriate interventions.

Action to prevent these deaths is not only humanitarian, it is also a moral imperative. Each of us needs to make a commitment today to urgent action.