November 11, 2010

Volunteer Brigades in the Fight Against CVD

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Cardiovascular disease is the leading cause of death globally, and accounted for 34 percent of the deaths in the United States in 2006. Not surprisingly, one in three Americans has one or more types of CVD, and the lost productivity and healthcare spending associated with CVD cost the U.S. $475 billion in 2009. Alarmed? We are, and we’re baffled, because you probably already know how to prevent it. Did we mention that the most common CVD risk factors fueling this global epidemic are largely preventable?  So are you at risk? The answer to that question might surprise you. Just like your phone number, here are five numbers that you simply must know: blood pressure, body mass index, cholesterol (the good, HDL, and the bad, LDL), blood sugar (or hemoglobin A1C, a better measure of long term blood glucose control) and waist circumference.

For many of us, there is little excuse for not knowing our personal risk, or for being indolent in the fight against CVD: don’t smoke, exercise regularly and eat healthy. But for many Americans, knowing their personal risk, and what their numbers mean is itself a challenge.

So that is exactly what Weill Cornell’s Heart-to-Heart Outreach Campaign seeks to do. Once a month, the program takes volunteer medical, nursing and physician’s assistant students into an underserved community to perform basic health screening. Volunteers use point-of-care testing machines to provide patrons with their lab values within minutes. Think of it as the Jiffy Lube of CVD — results while you wait. After a short survey, patrons meet with a physician to discuss their lab tests and lifestyle habits, and are provided with a list of local clinics, including the WCCC, Weill Cornell’s student-run free clinic, where they can follow up if necessary.

At about $18 per person, the program is cheap. Very cheap. Yet the potential for results is astounding. If a single person of the approximately 100 screened each month learns something new — say a discovery of borderline diabetes or moderate hypertension, or perhaps how to eat healthier — the long-term savings of an early intervention are tremendous. What’s more is that of the 100 individuals screened on any given day, at least 20 percent are uninsured and the program constitutes their only access to a physician, aside from the local emergency room. Moreover, a staggering 50 percent have an annual household income of less than $20,000. By utilizing community centers and state senators to reach out to its local constituents, the Heart-to-Heart program effectively targets underserved, at-risk populations most in need.

Still, at 100 patrons each month, this is a drop in the bucket of health care inequality, given New York City’s 1.2 million uninsured residents. Hence, the next step is to effectively outsource the program to other medical schools. This month, the program will start a partnership with New York Medical College to expand its reach. If the collaboration is a success, it will serve as a template upon which to build similar programs in medical schools in New York City and around the country.

After all, medical education should encompass not just the theory of preventative medicine, but the practice as well.

Education, prevention, early screening and treatment. These are the tenets of primary care medicine that must be fostered in the nation’s next generation of physicians. By educating medical students and allied health professionals “in the field” early in their careers students can learn first hand the challenges and competing social priorities that pose barriers to better health. Though the Heart-to-Heart Outreach Campaign’s inception was student-led, the necessity for a supportive institutional architecture within which such ideas are fostered and implemented cannot be underscored enough. Only through a systematic and concerted effort will tomorrow’s healthcare workforce be able to make a dent in the burden of CVD.

In the meantime, though, it starts with you. We challenge you to take an active part in your health — by knowing your numbers; by making interventions in your lifestyle; and by being contagious to make sure others around you know, too. Because the simple fact is one in three Americans is currently dying of CVD. That time-honored young American notion of “this won’t happen to me” simply does not hold muster.

Jonathan D. Moreno and Suchit H. Patel are fifth-year graduate students in Weill Cornell Medical College. They can be reached at jom2036@med.cornell.edu and sup2011@med.cornell.edu respectively. What’s Up, Doc? appears alternate Fridays this semester.

Original Author: Suchit H. Patel