Heart on the Hill - February 2017

AHA Releases New CVD Projections Through 2035

On February 14, the American Heart Association released projections on what lies ahead in cardiovascular disease prevalence and cost from the present through 2035.

According to the new report, by 2035 131.2 million Americans – about 45 percent of the U.S. population – will have some sort of CVD. Between now and 2035, 27.1 million more Americans will be diagnosed with high blood pressure, 7.2 million Americans will develop coronary heart disease and almost 4 million Americans will have suffered a stroke.

In addition, the projections note that the prospect of developing CVD increases significantly the older you get. For instance, at age 24, a person’s risk for CVD is just 20 percent. However, by age 45, the chances more than double to 50 percent and by age 80, about 90 percent individuals will have some sort of CVD.

CVD is predicted to continue to exact a disproportionate toll on various racial and ethnic minority populations and low-income individuals. The report notes CVD-associated risk factors will account for 40 percent of the disparity in life expectancy between blacks and whites.

The increasing pervasiveness of CVD, if left unchecked, will take a significant toll on the U.S. economy. Already the country’s most costly disease, by 2035 total CVD costs will skyrocket to $1.1 trillion. Direct medical costs are expected to more than double to nearly $750 billion, while indirect costs such as lost productivity in the workplace or at home will rise to $368 billion.

The association offered policy recommendations as to how to best improve the cardiovascular health of Americans. To address the CVD burden, the association recommends increasing NIH research funding for heart disease and stroke, enhancing the focus on prevention to improve and preserve population health from birth to old age, and maintaining and expanding access to high quality, affordable health care.

Learn more here.

Contact: Sue Nelson

NIH Gets Funding Boost From 21st Century Cures

A year after receiving its biggest boost in federal funding in more than a decade, the National Institutes of Health (NIH) once again came out ahead in late 2016, receiving an increase of $4.8 billion in funding over the next decade.

The new 10-year funding increase came as part of the 21st Century Cures Act, signed into law by President Obama in December 2016. It includes $1.8 billion for cancer research, $1.5 billion for the Brain Research Through Advancing Innovative Neurotechnologies (BRAIN) Initiative, nearly $1.5 billion for the Precision Medicine Initiative and $30 million for regenerative medicine using adult stem cells.

The association was successful in promoting the burden of cardiovascular disease in several places in the report accompanying the legislation.

Though we were heartened by this funding boost, AHA CEO Nancy Brown in a statement expressed disappointment with two items.

First, none of this new funding will go directly towards cardiovascular disease research, leaving the nation’s no.1 killer chronically underfunded. Currently, just four percent of the NIH budget is dedicated to heart research and a mere one percent goes to stroke research.

Further, Brown noted the decision to use the Prevention & Public Health Fund (PPHF) as an offset to partially pay for the funding included in the law was upsetting. She called the fund an “important investment in our public health infrastructure” and said it “deserves support along with increased funding for the NIH.”

Contact: Claudia Louis

Celebrating Heart Month 2017

On Feb. 2, President Donald Trump declared February "American Heart Month." Throughout the month, the association and its partner organizations and advocates hosted and participated in events encouraging Americans to take control of their heart health.

Rep. Joyce Beatty (D-OH), the new co-chair of the Congressional Heart and Stroke Coalition, spoke on the House floor that same day to express support for the Go Red for Women campaign and applaud the success of the campaign’s efforts.

During her speech, Beatty discussed her personal experience with stroke and noted that more than 627,000 women’s lives have been saved since Go Red for Women began in 2004.

Later that day, the association hosted its fifth annual Congressional Women Go Red photo. More than fifty Congressional representatives from both sides of the aisle attended.

Participating lawmakers also helped the American Heart Association and Go Red For Women promote National Wear Red Day (February 3) by promoting the photo via their own social media networks throughout the week.

On February 6, the AHA and WomenHeart: The National Coalition for Women with Heart Disease hosted a briefing at the U.S. Capitol to discuss heart disease in women. It included presentations on how to know your risk factors and how to modify your lifestyle to live a long and heart-healthy life.

AHA volunteer Dr. Pamela Ouyang, director of the Johns Hopkins Women’s Cardiovascular Health Center, spoke alongside AHA Vice President of Federal Advocacy Sue Nelson, WomenHeart Champion Starr Mirza, and Marisa Duca, co-director of women’s cardiology at Virtua Health System.

Rep. Chris Smith (R-NJ), co-chair of the Congressional Heart and Stroke Coalition, also spoke at the event. Smith discussed challenges facing women heart disease patients and the importance of congressional funding for lifesaving NIH research initiatives.

The association also hosted an event on Capitol Hill on Feb. 15 to commemorate the release of the burden report. AHA President Steven Houser, M.D., FAHA and burden campaign spokesperson Shane Mandel (pictured to the right) gave remarks to a packed room of nearly 200 attendees, including policymakers and health advocates. NHLBI Director and AHA volunteer Dr. Gary Gibbons also spoke at the event, which was cosponsored by WomenHeart, the American College of Cardiology, the Heart Failure Society of America and the American Society of Nuclear Cardiology.

Rep. Ileana Ros-Lehtinen (R-FL) spoke on the House floor on February 16 about American Heart Month and recognized the work of organizations that promote heart health in South Florida. She highlighted first the work of the American Heart Association Miami-Fort Lauderdale office and mentioned their upcoming heart and stroke ball.

Child Nutrition Stalls; School Meal Standards Remain in Place

The chances of passing child nutrition reauthorization ended when the 114th Congress came to a close. The American Heart Association supported the Senate bipartisan bill, which protected the progress we have made in improving the school nutrition environment and carved out a commonsense compromise on the sodium and whole grains nutrition standards.

We opposed the House version of the bill, which would have decimated the nutrition standards and cut vulnerable children from these programs.

At the end of the day, negotiations stalled because of policies beyond the nutrition standards.

It is unlikely that there will be serious consideration of a reauthorization bill in the 115th Congress because the committees have other priorities. However, unlike other programs, child nutrition program can continue indefinitely without a reauthorization.

Though congressional attempts to reauthorize the law were moot, kids' health received a win earlier this year when the USDA announced that it would still move forward with the Target Two sodium levels for the 2017-2018 school year, clearing up any confusion about whether schools had to comply with the next level of targets. In the memo, the agency also indicated that it would give programs that might be facing some challenges an extra year to comply without incurring a financial penalty from the agency, and would also continue providing technical assistance as needed.

While school meals are healthier than ever, with more than 99 percent of schools now meeting the updated standards – a vast jump from the 14 percent just seven years ago – we can anticipate that there will still be efforts in the appropriations process to roll back various parts of the law, including the nutrition standards.

The association will continue to push back on these efforts, as we stand dedicated to children’s health and protecting these critical programs that have reached more than 50 million kids.

Contact: Kristy Anderson

HUD Rule Requires Public Housing Developments To Implement Smokefree Policies

On November 30, the U.S. Department of Housing and Urban Development (HUD) released a final rule that requires public housing developments to provide a smokefree environment for their residents. The new policy prohibits the use of cigarettes, cigars, pipes and hookah in all living units, indoor common areas and administrative offices. The rule also prohibits the use of tobacco products in outdoor areas within 25 feet of buildings.

The rule will protect two million public housing residents, including 760,000 children, from the dangers of secondhand smoke. The policy is also expected to save $153 million annually, including $94 million in health care costs, $43 million in renovation of housing units where smoking was allowed and $16 million in smoking-related fire losses.

AHA CEO Nancy Brown praised the new rule, calling it a “lifesaver” for millions of Americans; however, she did note it was unfortunate that e-cigarettes are not included in the ban. HUD chose to exclude e-cigarettes because research on these products is still developing, and there is little evidence that e-cigarettes significantly increase fire risks, or that the vapors cause damage to the housing units themselves. Public housing authorities have the option of including e-cigarettes in their individual smokefree policies, but are not required to do so. HUD will reconsider adding e-cigarettes in the future as additional evidence becomes available.

The association has been a strong advocate for smokefree housing. In early 2016, soon after HUD first proposed the new smokefree requirement, AHA joined 36 other health organizations in sending a letter of support to the agency.

The new rule was scheduled to go into effect on February 3, however the effective date may be delayed by two months due to the change in administration. Public housing agencies will have 18 months from the effective date to implement the new requirements.

Contact: Susan K. Bishop

FDA Proposes First Tobacco Product Standard

The Food and Drug Administration (FDA) earlier this month issued a proposed rule that would limit the amount of N-nitrosonornicotine (NNN) allowed in smokeless tobacco products to no more than 1.0 microgram per gram of tobacco.

The announcement is significant because it marks the first time the FDA has proposed a product standard for any tobacco product.

The agency has the authority to set product standards governing the design and content of tobacco products, such as requiring tobacco manufacturers to reduce or eliminate harmful ingredients in their products.

According to the announcement, the FDA proposed the limit because “NNN is a potent carcinogenic agent found in smokeless tobacco products and is a major contributor to the elevated cancer risks associated with smokeless tobacco use…. [and] products with higher NNN levels pose higher risks of cancer.”

The FDA estimates that the NNN standard would prevent approximately 12,700 new cases of oral cancer and 2,200 oral cancer deaths in the first 20 years. In addition, approximately 15,200 life years would be gained during the 20-year period.

The agency is accepting comments on the proposed standard until April 10.

Contact: Susan K. Bishop

President Issues Executive Orders To Freeze, Eliminate Regulations

Last month, President Trump signed two executive orders to alter the process used to develop and release regulations.

The first executive order, signed Jan. 20, temporarily “freezes” the release of any new federal regulation or guidance document. Per the order, new regulations or guidances cannot be released until they have been reviewed by the appropriate individuals in the new administration. The executive order also directs agencies to postpone the effective date for any regulation previously released, but not yet in effect, for 60 days. During the 60-day delay, agencies are to review the regulations and determine if they raise any “questions of fact, law, and policy” that may warrant change.

Several regulations issued near the end of President Obama’s term could be subject to the 60-day delay, including the just mentioned final rule on smokefree public housing, a CMS rule creating a cardiac rehabilitation incentive payment program, and a multi-agency rule updating federal policy to protect research subjects (the common rule).

The second executive order, which was issued Jan. 30, is intended to reduce the total number of regulations. For each new significant regulation a federal agency proposes, the agency must identify at least two existing regulations for repeal or elimination. In addition, the executive order requires that the cost of any new regulation be offset by the cost savings of the regulations to be repealed. For the remainder of fiscal year 2017, the total cost of all new regulations – when the cost savings of the regulations to be repealed are assessed – shall be no greater than $0. In future years, federal agencies will be given “a total amount of incremental costs that will be allowed for each agency in issuing new regulations and repealing regulations for the next fiscal year.”

To help federal agencies implement the second executive order, the White House provided guidance on what qualifies as a “significant regulation,” how the cost offsets will be determined and what type of emergencies or other circumstances will qualify for a waiver from these requirements. However, it is unclear yet how the executive order will be applied.

The new requirements could significantly slow down the regulatory process as agencies weigh the benefits of issuing a new regulation against the potential ramifications of eliminating two existing ones. In addition, the repeal process is complex and time-consuming, and requires an opportunity for public comment.

Contact: Susan K. Bishop

CMS Releases Cardiac Rehab Incentives

On December 20, 2016, the Centers for Medicare and Medicaid Services (CMS) released the Medicare Program; Advancing Care Coordination Through Episode Payment Models (EPMs); Cardiac Rehabilitation Incentive Payment Model; and Changes to the Comprehensive Care for Joint Replacement Model (CJR) final rule.

The association was particularly pleased about the inclusion of the Cardiac Rehabilitation Incentive Payment Model.

The model provides extra payments to hospitals to encourage the use of CR and intensive CR services following hospital discharge for patients hospitalized for a heart attack or bypass surgery. Hospitals may use these incentive payments to better coordinate CR and to support beneficiary adherence to the CR treatment plans by removing barriers to participation. The association provided comments on the proposed model and recommendations to broaden the array of patient incentives was included in the final rule.

The CR Incentive Payment Model will be implemented in 98 geographic areas. The model will be tested in both the cardiac bundled payment model and in a medical fee-for-service environment to evaluate the effects of the CR incentive payment within both contexts. The participants would be matched and compared to programs that are not receiving the incentives to observe the effects of the payments on utilization of CR/ICR services and short-term and longer-term outcomes, including mortality, hospitalizations, complications and other clinically relevant events, as well as on Medicare expenditures.

The first performance period for the model was set for July 1, 2017 and would cover the same five-year period as the cardiac care bundled payment model. However, the recent regulatory freeze, set to last for 60 days, has put the CR Incentive Payment Model implementation on hold.

The AHA is hopeful that after the freeze, this program will move forward so more eligible patients can take advantage of the benefits of CR.

Coalitions Meet With NIH Directors

The American Heart Association on January 11 conducted its annual meetings for association-managed coalitions, including the NHLBI Constituency Group, at the National Institutes of Health.

The groups meet each year to discuss funding priorities for the upcoming fiscal year (FY18) and determine potential new initiatives using past accomplishments and cost-savings examples.

Each coalition met separately with National Institute of Neurological Disorders and Stroke (NINDS) Director Walter Koroshetz, M.D., and with NHLBI Director Gary Gibbons, M.D.

The information obtained in meetings is crucial in our efforts to advance NIH heart and stroke research during the FY 2018 congressional appropriations process.

Contact: Claudia Louis

FAST Act Reintroduced in the House and Senate

Congressman Morgan Griffith (R-VA) and Congresswoman Joyce Beatty (D-OH) reintroduced the Furthering Access to Stroke Telemedicine (FAST) Act in the House on February 17. This bill (HR 1148) expands access to stroke telemedicine treatment in Medicare. The American Heart Association issued the following comment:

“Many thanks to Reps. Griffith and Beatty for re-introducing the FAST Act today,” said American Heart Association President Steven Houser, Ph.D., FAHA. “This critical bill would make a world of difference for stroke survivors facing barriers to telestroke services. Evidence indicates that telestroke improves patient outcomes and reduces disability. However, nearly 94 percent of the strokes that occur in America take place in areas where telestroke is not paid for by Medicare. We urge Congress to give more Medicare patients access to this proven form of treatment and support the FAST Act.”

The House bill had several original sponsors. These included: Reps. Carter (R-GA), Ryan (D-OH), Collins (R-NY), Roe (R-TN), Bilirakis (R-FL), Abraham (R-LA), Babin (R-TX), and Turner (R-OH).

In the Senate, the bill (S. 431) was re-introduced by Sens. Thune (R-SD), Schatz (D-HI) and Wicker (R-MS).

The association will work to build cosponsors for the bill over the next several months, working closely with our partners form the American Association of Neurology (AAN). The goal will be to find a bill to attach it to in the House and Senate, since few standalone bills move forward in either house.

Contact: Sue Nelson


Columbus, OH, St. Louis, MO and California Bring Tobacco Policy Wins

California: On November 8, California voters overwhelmingly approved a $2.00 per pack increase in the state’s cigarette tax and an equivalent tax on all other tobacco products. It is estimated that the tax increase alone will cause 265,000 adult smokers to quit, reduce youth smoking by almost 24 percent and save over $9 billion in long-term medical costs. A portion of the revenue generated from the tax will provide approximately $100 million in new funding for the state’s tobacco prevention and cessation program. This will increase funding for the program from 22 percent to 59 percent of the Centers for Disease Control and Prevention (CDC) recommendation.

Columbus, OH and St. Louis, MO: The cities of Columbus and St. Louis have raised the tobacco sales age to 21. In addition to Columbus, five other cities in Ohio – Cleveland, Bexley, Grandview, New Albany and Upper Arlington – have raised the minimum sales age to 21.

Contact: Lucy Culp

Bike and Pedestrian Appropriations Passed in Austin, TX, Charlotte, NC and Rhode Island

Austin, TX: Austin voters approved a comprehensive transportation bond with the passage of Proposition 1 on November 8. The bond invests $126 million in improvements to and creation of new walking and biking routes for transportation and recreation purposes across the city. This bond will benefit more than 900,000 residents and millions of visitors to Austin over the years to come.

After the proposition ballot placement was announced in last August, the American Heart Association began discussing the potential engagement with the campaign behind the proposition “Move Austin Forward” during the summer of 2016. The AHA allocated staff resources to attend Move Austin Forward meetings and to create pathways to build partnerships in the ultimately successful campaign around Prop 1.

Charlotte, NC: The more than 800,000 residents of the City of Charlotte will have more opportunities for daily physical activity in safer environments because of a transportation bond that provides $42 million in pedestrian safety efforts, advancement of the Cross Charlotte Trail, a South End Pedestrian/Bicycle Connector (walk or bike from the Rail Trail to the Publix shopping area), upgrades to traffic signals and street improvements.

The improvements to walking and biking infrastructure will provide people of all income levels better access to transportation choices that connect them to jobs, education, health care and other daily needs. More people commuting safely on bike and foot will also lead to less air pollution and stymie health risks associated with poor air quality.

Rhode Island: Rhode Island staff have been working on this this appropriation for more than a year, engaging Gov. Gina Raimondo (D) and her staff on key budget priorities, including funding for walking and biking. The governor identified bike paths, parks and greenspace as key priorities in the following year’s legislative session and the association actively engaged legislators to support these efforts.

After the bond was referred to the voters, the AHA began a more robust public education campaign, utilizing social media, grassroots and media advocacy to inform the electorate of the need for safe walking and biking options. The association also engaged a broader coalition, Yes on 6, and played a leadership role in messaging and outreach. The vote passed on November 8, 2016 with more than two-thirds support.

Contact: Tim Vaske

Michigan Passes CPR in Schools Policy

With the final passage of Senate Bill 647, Michigan becomes the 35th state to enact policy requiring CPR training for high school graduation. This means that more than 100,000 students every year in Michigan will be trained in guideline-based CPR, adding to the over 2 million students already being trained annually because of statewide CPR in school policies.

Contact: Douglas Dunsavage

Four Cities Pass Sugar-Sweetened Beverage Tax

Three cities in California (Albany, Oakland and San Francisco) as well as Cook County, IL, have passed legislation to tax sugary drinks $0.01 per fluid ounce. Media coverage surrounding the campaigns helped lead the charge in de-normalizing sugary drinks.

Albany: The revenue from Albany's tax -- which will benefit the city's19,000 residents and passed with nearly 72 percent approval -- is estimated to raise $220,000 in funds that will be spent to improve the health of its residents.

Oakland: This sugary drink tax, which passed with nearly 61 percent approval, will positively benefit Oakland’s 406,000 residents by increasing the cost of sugary drinks and decreasing consumption. The tax will raise an estimated $6 million to $8 million to support health programs for city residents.

San Francisco: This sugary drink tax will have a positive benefit on San Francisco’s 837,000 residents. Revenue from the tax can be used to fund public health programs to further decrease consumption and improve the health of people in San Francisco. The tax passed with 62 percent of the vote.

Cook County: Illinois staff worked hard to get this $0.01 per ounce tax passed in Cook County. The County Board President had to break a rare tie of the county commissioners to pass the $0.01 per ounce sugar-sweetened beverage tax. The county, which is the second-most populous county in the United States and includes the city of Chicago, is expected to raise $223 million in revenue from the tax, which will go to supporting the community needs of its 5.25 million residents.

Contact: Katie Bishop Kendrick

Austin, TX Funds Obesity Prevention Program

The City of Austin included $800,000 in appropriations in its 2016-2017 budget to create infrastructure and support initiatives focusing on obesity prevention and increasing access to healthy foods for its nearly 1 million residents. For the first time in the city, half of these dollars will be included not just as a one-time appropriation, but in the annual budget, demonstrating the city’s commitment to priorities around food access and overall obesity prevention.