We could have better cardiovascular care for women now! There is an important clue on the map. Can you see it? It is right in front of you. Look at Minnesota. The rate of death caused by heart disease is in the lowest category in almost every county. Now look at Oklahoma! Four times as many women die of heart disease in Oklahoma compared with Minnesota. Almost every county is in the highest category. The map points to a glaring quality problem. High variation means low quality, and there is huge variation in the number of women dying annually from heart disease depending on where you live in the United States.
Here is part of the reason. You cannot improve what you don’t measure. Optimal medical therapy (OMT) for cardiovascular disease has four goals that should be achieved at the same time. Those are:
Blood pressure control to 140/90 or less (130/80 is the new target)
LDL cholesterol under 70 and on a statin
Not smoking
On aspirin
The percentage of individuals who achieve those four goals concurrently is your percentage OMT attainment. Nationally the number is terrible and it is pretty easy to understand why. Only 44% of Americans achieve a blood pressure of 140/90 or less so just on that basis only 44% are achieving OMT. Only half take a statin, now we are down to 22%. Minnesota gathers information on how often medical organizations achieve OMT and they report it publicly.
Here are the best performing OMT clinics in Minnesota for OMT in vascular disease:
Here are the worst performing:
Even in Minnesota there is huge variation. That means pockets of poor quality care exist. Many diabetics have heart artery disease and for them there is a fifth component of glucose control. The hemoglobin A1c target on this measure is less than 8. The range of OMT achievement in Minnesota for diabetes is from 72% to bottom numbers of 6, 10, and 13%. Even within Minnesota there is huge variation, but there is a focus on OMT. They are measuring it and reporting it to the public. That is a big reason that death from heart disease in Minnesota is one fourth of the rate in Oklahoma.
In 2014, Americans with heart artery disease achieving goals for blood pressure, LDL cholesterol, and aspirin treatment was just 16%. In most other states OMT achievement is not a quality measure or a focal point. That is why women are safer in Minnesota. Heart disease is the number on killer of women. We need to change our system to protect them.
Tomorrow marks the one year anniversary of Slow Aging and Delay Chronic Disease Development. This site is all about staying healthier longer by adopting OMT. For the first time in 25 years, the message seems to be gaining more traction. I am not OK with more women dying of heart disease because we are not providing them with patient-centered care. If you would like to bring OMT to your community, contact me at whbester@gmail.com. Let’s make some progress in 2022. Happy new year!
This displays clearly how the good guys beat the socks off the bad guys to the benefit of patients who survive and thrive. C'mon people- we can do so much better. Let the primary care providers run the show and reward those who accomplish the best results. We all win.
Let’s systemically upgrade the unscalable inefficient legacy medicine in America:
https://www.linkedin.com/posts/joseph-thomas-shen-md-b01760106_we-are-building-our-multifunction-cardiogram-activity-6882655151602110464-prBg