Preventing Bad and Expensive Things From Happening by Taking the Healthy Living Polypill: Everyone Needs This Medicine
2017; Elsevier BV; Volume: 92; Issue: 4 Linguagem: Inglês
10.1016/j.mayocp.2017.02.005
ISSN1942-5546
Autores Tópico(s)Health, Environment, Cognitive Aging
ResumoIn the current issue of Mayo Clinic Proceedings, 4 separate articles address the impact of functional capacity and lifestyle characteristics on health outcomes and associated costs.1Manemann S.M. Chamberlain A.M. Boyd C.M. et al.Skilled nursing facility use and hospitalization in heart failure: a community linkage study.Mayo Clin Proc. 2017; 92: 490-499Scopus (6) Google Scholar, 2Supervia M. Medina-Inojosa J.R. Yeung C. et al.Cardiac rehabilitation for women: a systemic review of barriers and solutions.Mayo Clin Proc. 2017; 92: 565-577Scopus (93) Google Scholar, 3Osondu C.U. Aneni E.C. Valero-Elizondo J. et al.Favorable cardiovascular health is associated with lower health care expenditure and resource utilization in a large U employee population: the Baptist Health South Florida (BHSF) employee study.Mayo Clin Proc. 2017; 92: 512-524Abstract Full Text Full Text PDF Scopus (14) Google Scholar, 4Alter D.A. Bing Y. Bajaj R.R. Oh P.I. Relationship between cardiac rehabilitation participation and health service expenditures within a universal health care system.Mayo Clin Proc. 2017; 92: 500-511Abstract Full Text Full Text PDF Scopus (18) Google Scholar These articles highlight the importance of promoting healthy living (HL) behaviors across the life span. People who lead an unhealthy lifestyle are at high risk for the occurrence of bad and expensive health-related phenomena, particularly those related to cardiovascular diseases (CVDs). The bad is related to multimorbidity, frequent physician visits, pharmacologic dependency (eg, drugs to treat hypertension, hyperlipidemia, and diabetes mellitus), surgical procedures, and premature mortality.5Mozaffarian D. Benjamin E.J. Go A.S. et al.Writing Group MembersAmerican Heart Association Statistics CommitteeStroke Statistics SubcommitteeHeart Disease and Stroke Statistics—2016 Update: a report From the American Heart Association.Circulation. 2016; 133 (Erratum in Correction. [Circulation. 2016]): e38-e360Crossref PubMed Scopus (4918) Google Scholar The expensive piece of this equation is related to the dramatically high (and steadily increasing) health care costs associated with treating these morbid complications. Suffice it to say, it is imperative to promote HL characteristics irrespective of age, sex, race/ethnicity, and baseline health status. Moreover, migration from unhealthy behaviors to 1 or more HL characteristics has the potential for significant health and economic benefits (ie, fewer bad, expensive health-related phenomena). Compared with those individuals with the most unhealthy lifestyles, those with an ideal lifestyle—that is, primarily related to being physically active, consuming a nutritious and healthy diet, not smoking, and maintaining a healthy body weight—have up to an approximately 80% lower risk of bad and expensive things happening to their health (ie, diagnosis of a chronic disease and associated adverse health consequences).6Akesson A. Larsson S.C. Discacciati A. Wolk A. Low-risk diet and lifestyle habits in the primary prevention of myocardial infarction in men: a population-based prospective cohort study.J Am Coll Cardiol. 2014; 64: 1299-1306Abstract Full Text Full Text PDF PubMed Scopus (158) Google Scholar, 7Younus A. Aneni E.C. Spatz E.S. et al.A systematic review of the prevalence and outcomes of ideal cardiovascular health in US and non-US populations.Mayo Clin Proc. 2016; 91: 649-670Abstract Full Text Full Text PDF PubMed Scopus (145) Google Scholar, 8Folsom A.R. Yatsuya H. Nettleton J.A. Lutsey P.L. Cushman M. Rosamond W.D. ARIC Study InvestigatorsCommunity prevalence of ideal cardiovascular health, by the American Heart Association definition, and relationship with cardiovascular disease incidence.J Am Coll Cardiol. 2011; 57: 1690-1696Abstract Full Text Full Text PDF PubMed Scopus (530) Google Scholar, 9Artero E.G. España-Romero V. Lee D.C. et al.Ideal cardiovascular health and mortality: Aerobics Center Longitudinal Study.Mayo Clin Proc. 2012; 87: 944-952Abstract Full Text Full Text PDF PubMed Scopus (68) Google Scholar In fact, there is no other pharmacologic cocktail or surgical procedure that can tout such risk reductions. The American Heart Association has proposed a metric to define poor, intermediate, and ideal cardiovascular health (iCVH) named Life's Simple 7 (LS7),10Lopez-Jimenez F. The pursuit of ideal cardiovascular health: an individual and societal challenge.Mayo Clin Proc. 2012; 87: 929-931Abstract Full Text Full Text PDF PubMed Scopus (3) Google Scholar, 11Lloyd-Jones D.M. Hong Y. Labarthe D. et al.American Heart Association Strategic Planning Task Force and Statistics CommitteeDefining and setting national goals for cardiovascular health promotion and disease reduction: the American Heart Association's strategic Impact Goal through 2020 and beyond.Circulation. 2010; 121: 586-613Crossref PubMed Scopus (2811) Google Scholar and its framework consists of 4 health behaviors (physical activity [PA], diet, avoiding tobacco use, and body weight) and 3 health factors (managing cholesterol, blood pressure, and blood sugar). There is clear evidence that continual improvement in LS7 characteristics (moving from poor to intermediate to iCVH) results in progressive improvement in health trajectory, such as fewer bad health-related consequences and lower cost to the health care system. In this way, LS7 can be viewed as both a vital sign and an HL polypill (which, for the purposes of this discussion, we will describe as a single therapeutic intervention—ie, a metaphorical pill—that contains multiple physiologic and pharmacologic benefits).12Arena R. Lavie C.J. Guazzi M. Prescribing a healthy lifestyle polypill with high therapeutic efficacy in many shapes and sizes.Am J Lifestyle Med. 2015; Google Scholar This polypill is unique in the sense that variable dosages and formulations will all lead to a unifying singularity: improved health outcomes with substantial cost savings. Moreover, this polypill has virtually no adverse effects and is of benefit to the entire human race. An HL health care system is globally applicable, and all individuals should have it prescribed and adhere to their personalized dosage of the HL polypill. As stated at the outset, this issue of Mayo Clinic Proceedings contains several articles that highlight the importance of HL characteristics in preventing bad and costly health outcomes. In a cohort of patients with heart failure (HF) admitted to a skilled nursing facility, Manemann et al1Manemann S.M. Chamberlain A.M. Boyd C.M. et al.Skilled nursing facility use and hospitalization in heart failure: a community linkage study.Mayo Clin Proc. 2017; 92: 490-499Scopus (6) Google Scholar found that decreased physical function was a significant predictor of future hospitalization. In a large cohort of patients referred to cardiac rehabilitation (CR) in Canada, all of whom were diagnosed with CVD, Alter et al4Alter D.A. Bing Y. Bajaj R.R. Oh P.I. Relationship between cardiac rehabilitation participation and health service expenditures within a universal health care system.Mayo Clin Proc. 2017; 92: 500-511Abstract Full Text Full Text PDF Scopus (18) Google Scholar reported that those who participated in CR had significantly lower health care utilization and expenditure over the long-term. Supervia et al2Supervia M. Medina-Inojosa J.R. Yeung C. et al.Cardiac rehabilitation for women: a systemic review of barriers and solutions.Mayo Clin Proc. 2017; 92: 565-577Scopus (93) Google Scholar performed a separate meta-analysis assessing barriers to CR and solutions in women, who are historically underreferred and have significantly lower participation rates in CR than do men. Lower education level, multimorbidity, English as a second language, poor social support, and greater family responsibilities were all identified as barriers to CR. Conversely, facilitating CR enrollment, strong endorsement for participation by a patient's health care provider, and alternate delivery models (ie, tele-health and home-based CR) were all found to be potential solutions to overcome identified barriers. In a large employee-based analysis in Florida, Osondu et al3Osondu C.U. Aneni E.C. Valero-Elizondo J. et al.Favorable cardiovascular health is associated with lower health care expenditure and resource utilization in a large U employee population: the Baptist Health South Florida (BHSF) employee study.Mayo Clin Proc. 2017; 92: 512-524Abstract Full Text Full Text PDF Scopus (14) Google Scholar reported that more favorable profiles (stratified as poor, intermediate, or iCVH, as measured by LS7) equated to progressively lower health care utilization and expenditure in a young, ethnically diverse cohort, most of whom were not diagnosed with chronic disease. In the United States and most of the Westernized globe, HF is a problematic diagnosis on a number of fronts, including frequent repeat hospitalizations.5Mozaffarian D. Benjamin E.J. Go A.S. et al.Writing Group MembersAmerican Heart Association Statistics CommitteeStroke Statistics SubcommitteeHeart Disease and Stroke Statistics—2016 Update: a report From the American Heart Association.Circulation. 2016; 133 (Erratum in Correction. [Circulation. 2016]): e38-e360Crossref PubMed Scopus (4918) Google Scholar Functional capacity and PA, an integral component of LS7 and the HL polypill, is linked to the clinical trajectory of patients diagnosed with HF.13Ades P.A. Keteyian S.J. Balady G.J. et al.Cardiac rehabilitation exercise and self-care for chronic heart failure.JACC Heart Fail. 2013; 1: 540-547Abstract Full Text Full Text PDF PubMed Scopus (127) Google Scholar, 14Anderson L. Taylor R.S. Cardiac rehabilitation for people with heart disease: an overview of Cochrane systematic reviews.Cochrane Database Syst Rev. 2014; : CD011273PubMed Google Scholar, 15Downing J. Balady G.J. The role of exercise training in heart failure.J Am Coll Cardiol. 2011; 58: 561-569Abstract Full Text Full Text PDF PubMed Scopus (169) Google Scholar, 16Lavie C.J. Arena R. Swift D.L. et al.Exercise and the cardiovascular system: clinical science and outcome.Circ Res. 2015; 117: 207-219Crossref PubMed Scopus (431) Google Scholar, 17Arena R. Harrington R.A. Despres J.P. A message from modern-day healthcare to physical activity and fitness: welcome home!.Prog Cardiovasc Dis. 2015; 57: 293-295Abstract Full Text Full Text PDF PubMed Scopus (40) Google Scholar, 18DeFina L.F. Haskell W.L. Willis B.L. et al.Physical activity versus cardiorespiratory fitness: two (partly) distinct components of cardiovascular health?.Prog Cardiovasc Dis. 2015; 57: 324-329Abstract Full Text Full Text PDF PubMed Scopus (182) Google Scholar, 19Myers J. McAuley P. Lavie C.J. Despres J.P. Arena R. Kokkinos P. Physical activity and cardiorespiratory fitness as major markers of cardiovascular risk: their independent and interwoven importance to health status.Prog Cardiovasc Dis. 2015; 57: 306-314Abstract Full Text Full Text PDF PubMed Scopus (425) Google Scholar, 20Lavie C.J. Arena R. Blair S.N. A call to increase physical activity across the globe in the 21st century.Future Cardiol. 2016; 12: 605-607Crossref PubMed Scopus (21) Google Scholar This premise is again confirmed by Manneman et al1Manemann S.M. Chamberlain A.M. Boyd C.M. et al.Skilled nursing facility use and hospitalization in heart failure: a community linkage study.Mayo Clin Proc. 2017; 92: 490-499Scopus (6) Google Scholar in an HF cohort at particularly high risk: that is, those admitted to a skilled nursing facility. This analysis highlights the importance of optimizing functional capacity in the skilled nursing facility environment. This can be achieved through various professional services, including physical therapy and exercise physiology.21Arena R. Williams M. Forman D.E. et al.American Heart Association Exercise, Cardiac Rehabilitation and Prevention Committee of the Council on Clinical Cardiology, Council on Epidemiology and Prevention, and Council on Nutrition, Physical Activity, and MetabolismIncreasing referral and participation rates to outpatient cardiac rehabilitation: the valuable role of healthcare professionals in the inpatient and home health settings: a science advisory from the American Heart Association.Circulation. 2012; 125: 1321-1329Crossref PubMed Scopus (142) Google Scholar Upon discharge from a skilled nursing facility, referral to an outpatient CR program for all qualified patients should be considered a priority, including those diagnosed with chronic systolic HF.21Arena R. Williams M. Forman D.E. et al.American Heart Association Exercise, Cardiac Rehabilitation and Prevention Committee of the Council on Clinical Cardiology, Council on Epidemiology and Prevention, and Council on Nutrition, Physical Activity, and MetabolismIncreasing referral and participation rates to outpatient cardiac rehabilitation: the valuable role of healthcare professionals in the inpatient and home health settings: a science advisory from the American Heart Association.Circulation. 2012; 125: 1321-1329Crossref PubMed Scopus (142) Google Scholar Traditional CR is perhaps the most well-established dispenser of the HL polypill; although not conceptualized in this way for the past several decades, the key tenets of CR have been to optimize the LS7 phenotype. There is a dearth of literature irrefutably demonstrating the benefits of CR for all qualified individuals, irrespective of age, race/ethnicity, and sex. Well-established CR benefits include significant improvements in quality of life (QOL), improved functional capacity, better adherence to dietary and pharmacologic therapies, as well as significant reductions in future adverse CVD events and health care expenditures.14Anderson L. Taylor R.S. Cardiac rehabilitation for people with heart disease: an overview of Cochrane systematic reviews.Cochrane Database Syst Rev. 2014; : CD011273PubMed Google Scholar, 22Ades P.A. Keteyian S.J. Wright J.S. et al.Increasing cardiac rehabilitation participation from 20% to 70%: a road map from the Million Hearts Cardiac Rehabilitation Collaborative.Mayo Clin Proc. 2017; 92: 234-242Abstract Full Text Full Text PDF PubMed Scopus (206) Google Scholar, 23Arena R. Lavie C.J. Cahalin L.P. et al.Transforming cardiac rehabilitation into broad-based healthy lifestyle programs to combat noncommunicable disease.Expert Rev Cardiovasc Ther. 2016; 14: 23-36Crossref PubMed Scopus (18) Google Scholar, 24Balady G.J. Ades P.A. Bittner V.A. et al.American Heart Association Science Advisory and Coordinating CommitteeReferral, enrollment, and delivery of cardiac rehabilitation/secondary prevention programs at clinical centers and beyond: a presidential advisory from the American Heart Association.Circulation. 2011; 124: 2951-2960Crossref PubMed Scopus (422) Google Scholar The investigation by Alter et al4Alter D.A. Bing Y. Bajaj R.R. Oh P.I. Relationship between cardiac rehabilitation participation and health service expenditures within a universal health care system.Mayo Clin Proc. 2017; 92: 500-511Abstract Full Text Full Text PDF Scopus (18) Google Scholar further reinforces the well-established economic benefit of CR, preventing future bad things from happening and reducing health care expenditures. Supervia et al,2Supervia M. Medina-Inojosa J.R. Yeung C. et al.Cardiac rehabilitation for women: a systemic review of barriers and solutions.Mayo Clin Proc. 2017; 92: 565-577Scopus (93) Google Scholar in the same issue of the Proceedings, highlight an important and concerning issue, which is the significant underutilization of CR in women compared with men. This is part of a larger underreferral and, more importantly, underutilization pattern of CR in all eligible patients.22Ades P.A. Keteyian S.J. Wright J.S. et al.Increasing cardiac rehabilitation participation from 20% to 70%: a road map from the Million Hearts Cardiac Rehabilitation Collaborative.Mayo Clin Proc. 2017; 92: 234-242Abstract Full Text Full Text PDF PubMed Scopus (206) Google Scholar, 24Balady G.J. Ades P.A. Bittner V.A. et al.American Heart Association Science Advisory and Coordinating CommitteeReferral, enrollment, and delivery of cardiac rehabilitation/secondary prevention programs at clinical centers and beyond: a presidential advisory from the American Heart Association.Circulation. 2011; 124: 2951-2960Crossref PubMed Scopus (422) Google Scholar Numerous barriers, many highlighted by Supervia et al,2Supervia M. Medina-Inojosa J.R. Yeung C. et al.Cardiac rehabilitation for women: a systemic review of barriers and solutions.Mayo Clin Proc. 2017; 92: 565-577Scopus (93) Google Scholar have been identified. Strong health care practitioner endorsement and patient education on the benefits of CR are imperative to assist in overcoming these barriers. A shortened time frame from hospital discharge to initiation of CR also appears to be of tremendous benefit to CR referral, initiation, and, most importantly, completion. In a cohort of patients suffering a myocardial infarction, Parker et al25Parker K. Stone J.A. Arena R. et al.An early cardiac access clinic significantly improves cardiac rehabilitation participation and completion rates in low-risk ST-elevation myocardial infarction patients.Can J Cardiol. 2011; 27: 619-627Abstract Full Text Full Text PDF PubMed Scopus (36) Google Scholar demonstrated that engagement in an early-access CR clinic, held between 4 and 14 days after hospital discharge, resulted in a CR completion rate of 71.4%. This was significantly higher than the completion rate of 29.9% in the historical matched comparison group that was commonly evaluated and referred to CR several weeks after hospital discharge. Health care in the United States and many other countries is undergoing a dramatic paradigm shift, moving from a reactionary model, in which individuals are commonly at high risk for or already diagnosed with a chronic disease, toward a proactive prevention model, in which avoiding diagnosis of a chronic disease and ideally associated risk factors, such as those for CVD, is the primary objective. The latter model is far more advantageous from a number of perspectives, including enhanced functional capacity and QOL, as well as decreased health care utilization and expenditure. A proactive prevention health care model is committed to prolonging the healthspan, defined as the number of years an individual is healthy and free from debilitating disease.26Increasing healthspan: prosper and live long.EBioMedicine. 2015; 2: 1559Abstract Full Text Full Text PDF PubMed Scopus (10) Google Scholar, 27Sagner M. McNeil A. Puska P. et al.The P4 health spectrum—a predictive, preventive, personalized and participatory continuum for promoting healthspan.Prog Cardiovasc Dis. 2016; ([published online ahead of print August 18, 2016])https://doi.org/10.1016/j.pcad.2016.08.002Abstract Full Text Full Text PDF Scopus (125) Google Scholar A commitment to prolonging the healthspan is in sharp contrast to prolonging the life span, the latter of which exclusively speaks to the number of years an individual is alive without necessarily considering functional independence and QOL. Moreover, a health system that focuses on promoting the healthspan as opposed to the life span is far more favorable from an economic perspective.28Wakim R. Ritchey M. Hockenberry J. Casper M. Geographic variations in incremental costs of heart disease among Medicare beneficiaries, by type of service, 2012.Prev Chronic Dis. 2016; 13: E180Crossref PubMed Scopus (5) Google Scholar, 29Heidenreich P.A. Trogdon J.G. Khavjou O.A. et al.American Heart Association Advocacy Coordinating CommitteeStroke CouncilCouncil on Cardiovascular Radiology and InterventionCouncil on Clinical CardiologyCouncil on Epidemiology and PreventionCouncil on ArteriosclerosisThrombosis and Vascular BiologyCouncil on CardiopulmonaryCritical CarePerioperative and ResuscitationCouncil on Cardiovascular NursingCouncil on the Kidney in Cardiovascular DiseaseCouncil on Cardiovascular Surgery and Anesthesia, and Interdisciplinary Council on Quality of Care and Outcomes ResearchForecasting the future of cardiovascular disease in the United States: a policy statement from the American Heart Association.Circulation. 2011; 123: 933-944Crossref PubMed Scopus (2339) Google Scholar There is not a more important medicine for a proactive premorbid/primary prevention health care model, committed to prolonging the healthspan, than the HL polypill. Traditional health care systems should consider embedding HL teams (ie, exercise scientists, dieticians, and behavioral and physical therapists) throughout clinical settings, working alongside physicians, nurses, and so forth.30Arena R. Lavie C.J. The healthy lifestyle team is central to the success of accountable care organizations.Mayo Clin Proc. 2015; 90: 572-576Abstract Full Text Full Text PDF PubMed Scopus (23) Google Scholar, 31Sallis R. Franklin B. Joy L. Ross R. Sabgir D. Stone J. Strategies for promoting physical activity in clinical practice.Prog Cardiovasc Dis. 2015; 57: 375-386Abstract Full Text Full Text PDF PubMed Scopus (175) Google Scholar Australia has already moved in this direction, providing a mechanism for accrediting exercise physiologists and making them an integral component of the interdisciplinary health care team.32Soan E.J. Street S.J. Brownie S.M. Hills A.P. Exercise physiologists: essential players in interdisciplinary teams for noncommunicable chronic disease management.J Multidiscip Healthc. 2014; 7: 65-68Crossref PubMed Scopus (27) Google Scholar, 33Cheema B.S. Robergs R.A. Askew C.D. Exercise physiologists emerge as allied healthcare professionals in the era of non-communicable disease pandemics: a report from Australia, 2006-2012.Sports Med. 2014; 44: 869-877Crossref PubMed Scopus (27) Google Scholar Moving outside of the traditional health care model toward a direction of primary prevention in the workplace, Osondu et al3Osondu C.U. Aneni E.C. Valero-Elizondo J. et al.Favorable cardiovascular health is associated with lower health care expenditure and resource utilization in a large U employee population: the Baptist Health South Florida (BHSF) employee study.Mayo Clin Proc. 2017; 92: 512-524Abstract Full Text Full Text PDF Scopus (14) Google Scholar highlight the importance of iCVH in a large cohort of employees, most of whom have yet to be diagnosed with a chronic disease. Those with an iCVH phenotype, as measured by LS7, demonstrated significantly lower health care utilization and expenditure. There are a number of other publications demonstrating the same pattern—that is, iCVH, as measured by LS7, equates to an improved health trajectory and decreased health care expenditure.7Younus A. Aneni E.C. Spatz E.S. et al.A systematic review of the prevalence and outcomes of ideal cardiovascular health in US and non-US populations.Mayo Clin Proc. 2016; 91: 649-670Abstract Full Text Full Text PDF PubMed Scopus (145) Google Scholar, 8Folsom A.R. Yatsuya H. Nettleton J.A. Lutsey P.L. Cushman M. Rosamond W.D. ARIC Study InvestigatorsCommunity prevalence of ideal cardiovascular health, by the American Heart Association definition, and relationship with cardiovascular disease incidence.J Am Coll Cardiol. 2011; 57: 1690-1696Abstract Full Text Full Text PDF PubMed Scopus (530) Google Scholar, 34Folsom A.R. Shah A.M. Lutsey P.L. et al.American Heart Association's Life's Simple 7: avoiding heart failure and preserving cardiac structure and function.Am J Med. 2015; 128: 970-976.e2Abstract Full Text Full Text PDF PubMed Scopus (111) Google Scholar In fact, the American Heart Association has made a significant commitment to advocating for a standardized, evidence-based model for worksite health and wellness programming,35Arena R. Arnett D.K. Terry P.E. et al.The role of worksite health screening: a policy statement from the American Heart Association.Circulation. 2014; 130: 719-734Crossref PubMed Scopus (25) Google Scholar, 36Fonarow G.C. Calitz C. Arena R. et al.American Heart AssociationWorkplace wellness recognition for optimizing workplace health: a presidential advisory from the American Heart Association.Circulation. 2015; 131: e480-e497Crossref PubMed Scopus (68) Google Scholar recognizing the tremendous opportunity to improve iCVH metrics in a larger proportion of the population through immersion of a culture of health and wellness in the workplace. Arena et al37Arena R. Guazzi M. Briggs P.D. et al.Promoting health and wellness in the workplace: a unique opportunity to establish primary and extended secondary cardiovascular risk reduction programs.Mayo Clin Proc. 2013; 88: 605-617Abstract Full Text Full Text PDF PubMed Scopus (68) Google Scholar also opined that the core evidence-based principles of CR are well aligned with worksite health and wellness. Arena et al23Arena R. Lavie C.J. Cahalin L.P. et al.Transforming cardiac rehabilitation into broad-based healthy lifestyle programs to combat noncommunicable disease.Expert Rev Cardiovasc Ther. 2016; 14: 23-36Crossref PubMed Scopus (18) Google Scholar recently proposed expanding the traditional CR model to serve as the foundation to expand prescription and daily consumption of the HL polypill. The core tenets of CR—that is, promoting increased PA, intake of a healthy/nutritious diet, not smoking, and maintaining a healthy body weight—should be implemented in premorbid and primary prevention settings at every opportunity. In such a model, community settings, such as parks, grocery stores, school systems, and the workplace, would become part of the new health care system, immersing people in a culture of HL in which they live, work, and go to school. To realize such an expanded vision, stakeholders within such a health care system would have to be reconceptualized. Arena et al38Arena R. Whitsel L.P. Berra K. et al.Healthy lifestyle interventions to combat non-communicable disease: a novel non-hierarchical connectivity model for key stakeholders: a policy statement from the AHA, ESC, EACPR and ACPM.Mayo Clin Proc. 2015; 90: 1082-1103Abstract Full Text Full Text PDF PubMed Scopus (61) Google Scholar recently published a blueprint for such an expansion in Mayo Clinic Proceedings. This document identifies key stakeholders including (1) professional organizations, (2) educational systems, (3) government, (4) health care organizations, (5) the insurance industry, (6) nonprofit and community organizations, (7) media outlets, (8) mobile health and technology companies, (9) employers, (10) the food industry, (11) the health and fitness industry, and (12) individuals and families. All the aforementioned stakeholders have a vested interest and important role in promoting HL. A nonhierarchical connectivity model was proposed, advocating for creative collaborations among 2 or more stakeholders with the goal of conceptualizing and implementing novel HL initiatives that are locally applicable. Such an approach could be an important component of the evolution of what is now known as CR, migrating from a secondary prevention model that reaches a suboptimal proportion of the population to a comprehensive prevention model (ie, premorbid, primary, and secondary) that has a much larger reach and impact. There is also a need to ensure that health professionals are appropriately trained to prescribe an individualized HL polypill. Administration of this vital medicine should be the responsibility of all health professionals (eg, physicians, nurses, dentists, pharmacists, physical therapists, and registered dieticians) and, as such, there is a need to create a universal educational model. Arena et al39Arena R. Lavie C.J. Hivert M.F. Williams M.A. Briggs P.D. Guazzi M. Who will deliver comprehensive healthy lifestyle interventions to combat non-communicable disease? Introducing the healthy lifestyle practitioner discipline.Expert Rev Cardiovasc Ther. 2016; 14: 15-22Crossref PubMed Scopus (30) Google Scholar proposed a novel "stackable credential" in the form of a 21-credit certificate program that health professionals can either take (1) in parallel to their professional education or (2) as an elective sequence after the completion of their professional education. This HL practitioner mastery of information and credentialing would allow for all health professionals to dispense the HL polypill in a uniform, hopefully evidence-based fashion. Other education/training models should be considered to train individuals from various walks of life, to champion for and promote a culture of HL. For example, it may be advantageous to consider training the lay public on the basic principles of HL in a similar fashion to the training provided for basic cardiopulmonary resuscitation. In conclusion, when someone leads an unhealthy life, the risk of bad and expensive things happening significantly rises. Several articles in this issue of Mayo Clinic Proceedings highlight the importance of broad distribution of the HL polyill, which should be administered as early as possible and maintained throughout life, ideally preventing CVD risk factors associated with chronic disease from ever developing. In those individuals in whom risk factors or an actual chronic disease diagnosis has manifested, including CVD, initiating the HL polypill still has tremendous benefit, preventing future bad things from happening and reducing health care expenditures. It is time to recognize that the best medicine we have for improving population health consists of physically moving more, eating nutritiously, not smoking, and maintaining an appropriate body weight. Regardless of the future course of health care delivery and reimbursement systems in the United States, these 4 essential characteristics to one's optimal healthspan should be the foundation of any health care system moving forward. Relationship Between Cardiac Rehabilitation Participation and Health Service Expenditures Within a Universal Health Care SystemMayo Clinic ProceedingsVol. 92Issue 4PreviewTo examine the relationship between cardiac rehabilitation participation and health service expenditures in Ontario, Canada. Full-Text PDF Skilled Nursing Facility Use and Hospitalizations in Heart Failure: A Community Linkage StudyMayo Clinic ProceedingsVol. 92Issue 4PreviewTo examine the effect of skilled nursing facility (SNF) use on hospitalizations in patients with heart failure (HF) and to examine predictors of hospitalization in patients with HF admitted to a SNF. Full-Text PDF Favorable Cardiovascular Health Is Associated With Lower Health Care Expenditures and Resource Utilization in a Large US Employee Population: The Baptist Health South Florida Employee StudyMayo Clinic ProceedingsVol. 92Issue 4PreviewTo examine the association of favorable cardiovascular health (CVH) status with 1-year health care expenditures and resource utilization in a large health care employee population. Full-Text PDF Cardiac Rehabilitation for Women: A Systematic Review of Barriers and SolutionsMayo Clinic ProceedingsVol. 92Issue 4PreviewCardiac rehabilitation (CR) services improve various clinical outcomes in patients with cardiovascular disease, but such services are underutilized, particularly in women. The aim of this study was to identify evidence-based barriers and solutions for CR participation in women. A literature search was carried out using PubMed, EMBASE, Cochrane, OVID/Medline, and CINAHL to identify studies that have assessed barriers and/or solutions to CR participation. Titles and abstracts were screened, and then the full-text of articles that met study criteria were reviewed. Full-Text PDF
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