COMMENTARY

What's Needed After AHA 2018? ACTION

Melissa Walton-Shirley, MD

Disclosures

November 15, 2018

Imagine if I were called to the emergency department (ED) to see a patient with chest pain.  I run down the corridor and fling open the doors, and within minutes I’m standing by the patient, who is sweaty, vagal, and nauseated. The ECG tech pushes "print," emergently rips the ECG from the machine, and hands me the 12-lead for interpretation. There is obvious sharp ST elevation in leads II, III, and AVF.  The nurse, ED physician, radiology tech, and phlebotomist turn toward me, anticipating my call for a CODE-STEMI. My silence magnifies the sound of the intravenous pump chugging.  I adjust my glasses and the distance of the ECG from my chest a few times and continue to study it. Another 30 seconds pass, and even the patient takes a break from acknowledging his intense pain to stare up at me. Nope—  I’m still studying. The ED doc visualizes a 90-minute hour glass tracking door-to-balloon time with sand pouring through. "Why are you still studying the ECG?" he yells. It’s obvious to everyone what needs to be done, but I’m still assessing.

Zip Codes vs Genetics

I thought of this analogy when attending a session at the American Heart Association (AHA) 2018 meeting called "Zip Codes Are More Important Than Genetic Codes." We have known for years that social determinants of health are the main drivers of cardiovascular risk, and while we continue to study them, we do little that really makes a significant difference.  

At the meeting, wise presenters spotlighted great advances in medicine to packed rooms. Yet some of the best population scientists in the United States presented their findings in a Saturday evening session in a small room down a hallway. I sensed the frustration in the questions asked and the chatter in the hallway.  The presenters spoke  on how to reduce disparities in healthcare and how to decrease poverty. These individuals have more than enough actionable information.

We heard again that communities need parks to improve walkability that will help reduce cardiovascular disease events and falls and improve quality of life. Neighborhood food deserts are in desperate need of grocery stores to provide ready access to nourishment instead of the ongoing lethal intake of fast food. Communities need improved access to general medical care. Bringing a primary care practice to a neighborhood could decrease morbidity and mortality for generations. My golly. This stuff is just so basic.

This Isn’t News

I found an article on Huffpost with a similar title as the  session on zip codes and genetics. It read,  "Some Americans will die 20 years earlier than others who live just a few miles away because of the differences in education, income, race, ethnicity and where and how they live." The article is dated May 24, 2009. Nine years later, we’re still saying the same things.

With the monies we intend to use to study the same things we’ve been studying for decades, we could impact neighborhoods all across the United States. We could form action committees comprising AHA members to  advocate to local government officials and attend sessions on economic development.  In discussing the impact of neighborhood deprivation on health, Darrell Gaskin, PhD, director of Johns Hopkins Center for Health Disparities Solutions in Baltimore, Maryland, interrupted his well-honed presentation to blurt, "It’s easy to say doctors need to do better. Patients need to do better. Somebody needs to tell the mayor."

It is a shame that his knowledge is gridlocked by lack of organization and our national complacency. He’s just so right. Give this guy a megaphone. Beg him to run for president.  

Physical Activity Guideline Omissions

It’s not just zip codes.

Following the presentation on the AHA’s new physical activities guidelines, the press corp’s questions spotlighted obvious concerns: "What exactly are you going to do to get people moving?" Why not make firm recommendations for schools to increase student physical activity?" "Why didn't you make specific recommendations to limit screen time?" I applaud the hard work that went into the  new guidelines, but at the same time,  I’m concerned about those needless omissions. These commonsense things need to be addressed now. We need to stop being afraid of political correctness or the slightest hint that common sense can’t carry as much weight as “data” when it comes to population science.

I look forward to a national meeting where instead of hearing "further research is needed," we actually hear "Based on what we’ve known for years, we implemented this, we accomplished that, and we are in progress on this now." This type of presentation should be center stage, smack dab in the middle of a slew of late-breakers. We could call it "The Community Translation Series." We need a late-breaking presentation chockfull of these types of accomplishments to spotlight actions that the whole country can learn from.

Just Do It

Americans are dying exponentially because we are studying to death the very things that are killing us. We have smart and readily available resources of retirees, part-timers, and volunteers waiting to be tapped. Some of the very experienced and innovative presenters at the zip codes session know how to make these things happen, if they had the resources. We need a grassroots movement and a plan to educate AHA members on how to approach local leaders, mayors, and city planners. We need guidance about how to get more people involved. We need to engage education systems to  advocate for the teaching of cardiovascular  health and prevention strategies in grades K through 12. There should be a health advocate in every city whose focus is to help their community go smoke-free. The list could go on and on.

Let’s get moving, figuratively and literally. We need our major health organizations to help make this happen. Put us to work and then put the fruits of our works on display for all to see.  Let’s be Nike. Let’s just do it.

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