Research Aims to Continue Reducing Toll of Heart Disease

The focus on hearts this month reaches beyond Valentine’s Day. February is American Heart Month, when national health organizations raise awareness about prevention and treatment of heart and related vascular diseases and the research under way to improve patient outcomes.

The news about heart disease is promising: In the United States, the rate of the disease has declined steadily since the 1960s. However, heart disease is still the leading cause of death in the United States, it accounts for one in four deaths, and almost one-third of Americans aged 65 and older have the disease.

In older people, heart disease often coexists with other medical conditions, and managing multiple chronic conditions poses special challenges to patients and clinicians alike. Patients struggle to follow a regimen of multiple medications, and clinicians often find themselves in a system of care that is not well-coordinated among various specialists.

A Push toward Better Outcomes

PCORI is funding research studies to increase the quantity and quality of information about prevention and treatment of heart and vascular disease. Our portfolio is particularly focused on providing evidence useful to elderly patients and those who have multiple chronic conditions, two of PCORI’s priority populations. Despite the high prevalence of multiple conditions in individuals with heart disease, many past research studies have excluded such patients.

We here provide some example of PCORI-funded studies that focus on cardiovascular disease.

• A research team at the University of Kentucky is comparing two strategies for lowering cardiovascular risk for patients living in Appalachian Kentucky, where there is a high rate of cardiovascular disease and limited access to health care.
• A randomized study in New York State is comparing telehealth self-management to usual care in adults with a type of heart disease known as heart failure. The study will determine whether patient self-monitoring in communities with limited health resources will improve patients’ quality of life and keep them out of the hospital.

Two other studies funded by PCORI assess home-based rehabilitation programs for patients with cardiovascular disease. Older patients especially are more amenable to rehabilitation at home rather than in a clinic.

• A study in San Francisco compares the clinical effectiveness of home-based and clinical center–based rehabilitation using exercise after hospitalization for any of three conditions: heart attack, a procedure to open up clogged coronary arteries, or coronary artery bypass surgery.
• Another study, at Northwestern University, assesses a home-based exercise program versus clinic-based rehabilitation for patients who have peripheral arterial disease.  Although previous research shows that for such patients, supervised exercise improves their walking, many have difficulty getting to a rehabilitation clinic.

PCORI has also funded a study with patients who have heart disease and another chronic illness.

• A study in Colorado involves Native Americans who have diabetes and heart disease, two illnesses that commonly occur together. Investigators are looking at patient education, case management, and use of pharmacists specially trained to help patients manage their medications.

A Network for Clinical Research

PCORI’s investment in its national data research network, PCORnet, is designed to support studies that will address important health challenges, including cardiovascular disease. The Health eHeart Alliance, one of the Patient-Powered Research Networks funded by PCORnet, supports studies that leverage big data and are aimed at heart disease prevention and management.

The alliance has enrolled nearly 5,000 people and is poised to recruit 75,000 patients with a wide variety of characteristics. It aims to take advantage of emerging technologies by collecting self-reported data from patients online and via smartphone and link it with data from wearable personal sensors and electronic health records. The alliance is led by patients in collaboration with researchers from the University of California, San Francisco, and patient advocacy leaders at the American Heart Association.

By funding these and other research studies, PCORI is contributing to the evidence about healthcare options for patients, including those who have multiple chronic conditions. PCORI seeks to ensure that findings from these studies improve the health of elderly patients and others with heart disease.