Author + information
- Christopher M. O’Connor, MD∗ ()
- ↵∗Address for correspondence:
Dr. Christopher M. O’Connor, Editor-in-Chief, JACC: Heart Failure, American College of Cardiology, Heart House, 2400 N Street NW, Washington, DC 20037.
Apple pie is the cornerstone of American food and dessert on holidays, especially during the summer months. We cherish the tradition of family, friends, fireworks, food, and apple pie, but I have been recently reminded that apple pie highlights the need for APPLying PrEventions and Implementation Evidence in our health care system. As a leader of cardiovascular health care systems at Duke University and Inova Health System, I have had the unique opportunity to have seen the pie of the U.S. health care system, which is fractured, broken, and unfinished. As we look forward to the epidemic of cardiovascular risk factors and chronic health illnesses, including hypertension, diabetes, obesity, metabolic syndrome, and coronary artery disease, it is only certain that our health system is not in a position to provide adequate care and coverage of our aging population and the increasing burden of illness. The debate in Washington that we have all keenly observed is based on the fact that the current model of health care is not sustainable from a financial standpoint to cover the lives promised today and tends to focus on short-term fixes.
Therefore, we have to look at different models in preventing the diagnosis and progression of chronic illnesses that contribute to the burden of disease and cost to our health system. The ultimate approach is through prevention, early detection, and a healthy lifestyle. During my recent summer vacation, I asked my children to take a random scientific poll of the kids under 18 who were walking on the beach and assess their body mass index. Seven of 10 met the criteria for obesity. Today, it is expected that of our friends, colleagues, and family members who reach the age of 65, over 75% will be burdened with hypertension and obesity and 50% with diabetes. All these risk factors are contributing to significant coronary artery disease and heart failure. These illnesses are causing significant burden on our health care system, and are the number one reason for hospitalization at the Inova Heart Center, as well as across the 5,000 hospitals in America today.
What can we do to take a different approach? We have to stand for aggressive education, information, and primary preventive measures to improve the health status of the citizens of the United States today. Although the United States spends more money on health care than other developed countries do, its health outcomes are generally no better. So what can we do? First and foremost, we have to start early. We have to begin with the young citizens of the United States under the age of 18 by encouraging highly beneficial and healthy lifestyle, diet, exercise, nutritional education, and prevention of smoking. In this capacity, we can begin to control the early and aggressive increase in obesity, diabetes, hypertension, metabolic syndrome, and other abnormalities that are afflicting our young adults.
What specifically can we do? We need to encourage all citizens to move toward dietary approaches to controlling chronic illness that include consumption of higher amounts of vegetables, fruits, and foods that are anti-inflammatory, support good glycemic control, and are associated with lower cholesterol levels (1). We need to advocate for routine habitual exercise just like brushing your teeth, around 200 min a week as demonstrated in the HF-ACTION (Heart Failure: A Controlled Trial Investigating Outcomes of Exercise Training) Study (2). We need to continue education regarding lifestyle interventions that are beneficial and market it to our citizens. We cannot let the marketing of foods that are low in nutritional value continue to bombard our citizens in a manner that convinces them to believe that it is okay to consume these products in large quantities. We need to continue to integrate nutritional education and prevention information into the curriculum of the health care providers as this has been neglected for many decades. How much training on nutrition is in formal medical education today?
Finally, there continues to be the burden of smoking, e-cigarettes, and other alternatives to smoking that have known adverse health effects on the youngest citizens in this country. We need to put a stop to this. We need to support education about tobacco products and continue to provide information so that all our colleagues and friends make the healthiest choices going forward. How can we curb the overwhelming cost of health care going forward? It has to be with early interventions that promote the healthiest lifestyle, that promote the most positive nutritional decisions, exercise, and educational interventions so that we can stop this epidemic of cardiovascular risk factors that result in significant coronary artery disease and the ultimate deterioration of health—heart failure. Let us pull together and support apple pie—the application of prevention and implementation evidence into clinical care.
- 2017 American College of Cardiology Foundation