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Background

Heart disease is very complex and there are many ways in which the heart can become

diseased or damaged. A heart attack occurs when the blood flow that brings oxygen to the heart

muscle is severely reduced or completely cut off. (“About Heart Attacks,” 2017) This occurs

because coronary arteries that supply the heart muscles with blood flow can become narrow due

to a buildup of fat, cholesterol and other substances that all together constitute a substance called

plaque. (“About Heart Attacks,” 2017) This gradual process is also known as atherosclerosis.

When an area of plaque in the artery breaks, a blood clot can form around the plaque which in

turn can block the blood flow though the heart muscle. (“About Heart Attacks,” 2017) When the

heart muscle is starved for oxygen ischemia occurs. When damage or death of the heart muscle

occurs because of this process it called a heart attack. Is also called a myocardial infraction (MI).

(“About Heart Attacks,” 2017)

A heart attack also is addressed by a multitude of different terms (which further confuse the

general population). Acute Coronary Syndrome (ACS) is an umbrella term for many situations

where blood supplied to the heart muscle is suddenly blocked. (“About Heart Attacks,” 2017)

Other terms include: STEMI, a common name of a ST-elevation myocardial infraction which is

caused by a complete blockage in a coronary artery, (“About Heart Attacks,” 2017) a NSTEMI, a

non-ST elevated myocardial infraction in which an artery is blocked partially and severely

restricting blood flow (“About Heart Attacks,” n.d), and Coronary thrombosis, the formation of a

clot in one of the arteries that conduct blood to the heart muscle. This can also be called a

coronary occlusion. (“About Heart Attacks,” 2017) Other more rare causes of a heart attack can

be caused by a coronary artery spasm which can trigger a heart attack. It is still unknown what

causes a spasm. (“About Heart Attacks,” 2017) Another even more rare occurrence is a
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spontaneous coronary artery dissection which is a spontaneous tearing in the coronary artery

wall.

All of the above would also be classified as cardiovascular disease. All the above can also

trigger cardiac arrest, not to be confused or used interchangeably with the more common term of

heart attack. Cardiac arrest is when the heart stops beating and can quickly lead to death. (“About

Heart Attacks,” 2017)

In addition to the confusion of the many types of heart disease, technical names, and multi-

uses of terminology for heart attacks, many Americans do not fully understand what risk factors

such as high cholesterol or hypertension are and how they can lead to a heart attack. (Lubischer,

A. 2013) If a general confusion to the basics of what constitutes a heart attack permeates the

general population, how then can the average American proceed to make informed lifestyle

decisions to try to avoid or mitigate future heart disease?

Social and Economic Impact

Heart Disease causes an enormous economic strain upon the country. 1 in every 6 health care

dollars are spent on cardiovascular disease. (“Million Hearts,” n.d.) Individuals experiencing

heart disease along with their families have to cope with not only exorbitant medical bills but

also lost wages and the potential of decreased standard of living. (“Million Hearts,” n.d.) Heart

disease (including stroke) cost the U.S an estimate $13.6 billion in health care costs and lost

productivity in 2011. (“Million Hearts,” n.d.)

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Heart disease is the leading cause of death in Illinois. In 2009, nearly 25000 deaths in adults

age 35 and older in Illinois were due to heart disease. (“Healthy Hearts Project,” 2017) In 2013

there were 24,843 deaths due to heart disease. The total number of deaths for all causes during

the year was 103,409. (“Healthy Hearts Project,” 2017) This is 24% of all yearly deaths!

When compared to the rest of the United States, Illinois has a higher prevalence for the risk

factors of high cholesterol, obesity, physical inactivity, poor nutrition, and excessive alcohol use.

(“Healthy Hearts Project,” 2017)

With the overall nationwide trends of increasing obesity in America and rapidly increasing

aging population (which by default increases the risk of further developing cardiovascular

disease) heart disease will only rise unless drastic measures are taken amongst the general

populous.

Emerging Trends in Management

Treatments, interventions and medications to treat and manage cardiovascular disease are far

ranging and varied. The types of treatments are as varied as there are types of cardiovascular

disease and differ from person to person and delving into each could easily constitute a research

paper in themselves. Medications range from ACE inhibitors, antiarrythmics, antiplatelets,

aspirin therapy, to clot busters, beta-blockers, nitrates and blood thinners. (“Treatment & Care,”

2017) Generally, treatments range from early prevention and CPR to some of the most high-tech

and dramatic surgical procedures in medicine such as various implanted devices (depending on

the condition), angioplasty, bypass surgery to full out heart transplantation. (“Treatment &

Care,” 2017)
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By the time one has had a heart attack, gone into cardiac arrest or has suffered cardiovascular

disease damage to the heart muscle has already occurred. What is agreed upon by everyone (as

evidenced by the federal and state initiatives discussed later in this paper) is that the best policy

is to avoid any of the dramatic, risky and incredibly expensive procedures and surgeries and take

steps to avoid developing cardiovascular disease in the first place as it is a preventable (barring

certain genetic predispositions) disease. (“Take Heart!,” 2017)

From both the federal and state level the best trend currently is to spread and promote

awareness, education and prevention. Now in regards to cardiovascular health, Dr. Robert D.

Simari, a cardiologist at the Mayo Clinic, stakes the future of cardiovascular disease prevention

on providing exercise, activity and weight management strategies at the community level.

(Lubischer, A. 2013) “Although relatively mundane and not very sexy, these are the kinds of our

things that will change the face of our cardiovascular risk long term. It’s a lot more exciting to

talk about space-age therapies, but, in the broadest sense, for communities, those are the kind of

things [self-reliance] we really need.” (Lubischer, A. 2013)

In addition to awareness, Americans also have to take action and actually implement lifestyle

changes. This ultimately could be the hardest aspect to implement despite the best efforts of

federal or state health officials, regulators, initiatives and campaigns. "Because historic

presumptions prevail that such risks are not amenable to clinical interventions, personal

behaviors have been largely considered as either outside the scope of the medical care system or

immutable to change. Health insurance companies rarely have reimbursed providers for

preventive services, thus reinforcing these presumptions and de-valuing non-medical

interventions." (Young, Kroth & Sultz, 2018)

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Federal or State Programs

Nationally the overall strategy in addressing cardiovascular disease seems to be rooted in

education, awareness and education with an emphasis on healthy lifestyle choices. As many

Americans turn immediately to the internet to learn about health and diseases the websites of

many of the top health posts, organizations and associations contain a wealth of information as

well as outlining initiatives.

The Department of Heath and Human Services launched “A Million Hearts” national

campaign initiative with the stated goal to prevent one million heart attacks by 2017. (“Million

Hearts,” n.d.) This will be accomplished with a special Million Hearts website filled with useful

information and statistics with a focus on education and prevention. Many of the features are

geared toward living a health lifestyle including staying active, lowering sodium intake, quitting

tobacco as well as featuring a host of delicious heart healthy recipes. (“Million Hearts,” n.d.) In

addition a full social media campaign including Facebook, Twitter, and Youtube is featured to

accompany the website. A series of events throughout the year are also scheduled such as

February being designated as American Heart Month and November 16th as the “Great American

Smokeout” to inspire people to quit tobacco. (“Million Hearts,” n.d.)

The Office of the Surgeon General, the leading spokesperson for all matters of public health

in the U.S, has a “Healthy Eating” initiative which addresses heart disease as a priority as part of

its National Prevention Strategy. (“Healthy Eating,” n.d.) However, no “Call to Action”, “a

science-based document to stimulate action nationwide to solve a major public health problem”

(“Surgeon General’s Calls to Action,” n.d.) dating back to 1999 address cardiovascular disease.
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The Center for Disease Control, another federally prominent organization in the minds of

most people in regards to all matters of health and disease, has a page on their website addressing

its “Division for Heart Disease and Stroke Prevention” with a few funded programs the

organization is involved with. One of these programs that address cardiovascular disease

prevention is the State Public Health Actions to Prevent and Control Diabetes, Heart Disease,

Obesity and Associated Risk Factors and Promote School Health. (“Division of Heart Disease,”

2015) It uses “State Public Health Actions grant funds statewide initiatives to prevent, manage,

and reduce the risk factors associated with chronic diseases—including childhood and adult

obesity, diabetes, heart disease, and stroke.” (“Division of Heart Disease,” 2015) Though many

may think of the CDC in terms of epidemics and outbreaks (especially due to Hollywood films)

the CDC is also deeply involved in heart disease which kills far more Americans yearly than

perhaps more fearful sounding ebola or SARS.

The American Heart Association is the most prominent organization in the minds of most

Americans in regards to all matters pertaining to heart health and their website has a variety of

information and resources about healthy lifestyles including smoking cessation, stress

management, weight management and physical activity (“American Heart Association,” n.d.) in

addition to research and general information about heart disease. The Association also offers

certification in CPR and ECC. (“American Heart Association,” n.d.) Also very recently, the

American Heart Association changed its longstanding blood pressure standards to a lower

threshold of tolerance than previously, so “normal” blood pressure is 120 (or less) over 80 (or

less). (“Understanding Blood Pressure,” 2017) A nationwide effort to promote these new

standards will bing about awareness in the general populous to (hopefully) regularly check and

monitor their blood pressure and to make lifestyle changes accordingly.

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Statewide, in Illinois, the Illinois Heart Disease and Stroke Prevention Program focuses on the

The ABC’s of Cardiovascular Health: (A) Aspirin therapy, (B) Blood Pressure control (including

sodium reduction), (C) Cholesterol management and (s) smoking cessation. (“Diseases of the

Heart,” 2017)

The Illinois Department of Public Health is partnering with agencies and colleagues statewide

in raising awareness about heart disease and helping people in understanding their risk factors.

(“Diseases of the Heart,” 2017) Programs are in place to: reduce tobacco use, promote and

increase daily physical activity, to promote the consumption of fruits, vegetables and low-fat

milk and to change policy and environmental systems that can have an impact on heart disease.

(“Diseases of the Heart,” 2017) In 2011, the Illinois Department of Health and Human Service

also launched its own Million Hearts Campaign on support of a national initiative to prevent one

million heart attacks by 2017. (“Diseases of the Heart,” 2017)

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References

About Heart Attacks. (2017, January 27) Retrieved from

http://www.heart.org/HEARTORG/Conditions/HeartAttack/AboutHeartAttacks/About-Heart-

Attacks_UCM_002038_Article.jsp#.WhZHJLT82u4

American Heart Association. (n.d.). Retrieved from https://www.heart.org/HEARTORG/

Division or Heart Disease and Stroke Prevention. (2015, February 10). Retrieved from

https://www.cdc.gov/dhdsp/

Diseases of the Heart and Stroke: Illinois’ Leading Killers. (2017). Retrieved from

http://www.dph.illinois.gov/topics-services/diseases-and-conditions/heart-stroke

Healthy Eating. (n.d.) Retrieved from https://www.surgeongeneral.gov/priorities/

prevention/strategy/healthy-eating.html

Healthy Hearts Project. (n.d) Retrieved from

http://www.dph.illinois.gov/topics-services/prevention-wellness/patient-safety-

quality/healthy- hearts-project

Lubischer, A. (2013). The Un-sexiest Disease in the Room: Why is the idea of improving our

heart health so unattractive to us? Chicago Health, 43-52.

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Million Hearts. (n.d.). Retrieved from https://millionhearts.hhs.gov/learn-prevent/cost-

consequences.html

Surgeon General’s Calls to Action. (n.d.) Retrieved from https://www.surgeongeneral.gov/

library/calls/index.html

Take Heart! Heart Disease Is Preventable. (2017) Retrieved from http://www.uchospitals.edu/

specialties/heart/services/prevention/prevent-CVD.html

Treatment & Care. (2017). Retrieved from https://www.webmd.com/heart-disease/guide/heart-

Disease-treatment-care

Understanding Blood Pressure Readings. (2017, November 17). Retrieved from

http://www.heart.org/HEARTORG/Conditions/HighBloodPressure/KnowYourNumbers/

understanding-Blood-Pressure-Readings_UCM_301764_Article.jsp#.Whty2rQ-eu4

Young, K., Kroth, P., & Sultz, H. (2018). Sultz & Young's health care USA: Understanding its

organization and delivery. Jones & Bartlett Learning, 9, 332