Public Policy, for the Heart

There were the usual reports of splashy new science at this year’s convention of the American Heart Assn., but for a change participants also focused on ways to save lives through public policy. They put a spotlight on the problem of getting tried-and-true techniques that researchers understand into wider use by doctors and patients.

Some problems might be solved just through better patient education. For instance, too many heart patients think that corrective surgery allows them to eat all the fatty foods they want. Other problems, however, need a helping hand at the federal level. Conferees recommended that the government take two important steps:

* Direct more research dollars toward understanding social and economic barriers to treating heart disease, the leading cause of death in the United States. As Heart Assn. President Martha N. Hill pointed out, nearly all heart research dollars have focused on the science of cardiovascular disease and that focus needs broadening. For instance, the Department of Health and Human Services (HHS) could research ways to induce insurance plans to pay for all proven therapies and persuade managed care companies to give their time-strapped doctors incentives not only to recommend healthful diets but to schedule follow-up appointments to monitor compliance. Studies show that such incentives pay off by reducing the need for expensive procedures like angioplasty.

* Develop national standards for cardiovascular care. Preventive care and heart attack treatment vary widely among health organizations and from one region to another. One study presented at the convention found that more than 90% of heart attack patients in New England receive highly effective “beta blockers” but less than 20% received such treatment in some plans in the South-Central states, leading to higher mortality rates.

The HHS has developed effective guidelines to measure heart treatment for Medicare patients, known as “best practice guidelines.” UC San Francisco/Mount Zion Medical Center has implemented the guidelines, and a recent study showed dramatically improved treatment success and patient satisfaction there.

This week, the Presidential Commission on Health Care, convened to establish a set of national guidelines for HMOs, is scheduled to recommend a “bill of rights” for HMO care. But the commission’s guidelines will not codify effective medical procedures, as speakers at the American Heart Assn. convention recommended. Ultimately, only enforceable national standards can ensure that hospitals, insurance plans and doctors all embrace the proven practices that keep hearts healthy.