Two Yale alumnae pioneer a new program to address premature death from heart disease

A new program led by two Yale School of Medicine alumnae aims to improve cardiovascular health and reduce health disparities at the community level. The new initiative — the Preventive Cardiovascular Health Program at the Yale New Haven Hospital Heart and Vascular Center — is founded by Erica Spatz, MD, MHS, an associate professor in the Section of Cardiovascular Medicine and Oyere Onuma, MD, MSc, an assistant professor in the Section of Cardiovascular Medicine, who joins the Preventive Cardiovascular Health Program as the associate director.

The new program aims to integrate each patient’s biology (e.g., blood pressure, cholesterol) and biography (lifestyle, stressors, social and emotional well-being) into an individualized health care plan to improve cardiovascular health outcomes.

New Haven County has one of Connecticut’s highest hospitalization rates for hypertension according to Spatz. As a clinical investigator, Spatz has focused her research on increasing patient engagement in shared decision making and precision-based approaches to diagnosis, risk prediction, and treatment.

Dr Onuma brings crucial skillsets from her prior experience at the World Health Organization, where she helped launch the Global Hearts Initiative to support community leaders, politicians, and policymakers in strengthening cardiovascular disease prevention and control.

A patient’s genetics and environment have a strong influence on health outcomes. Spatz and a team of cardiologists, pharmacists, nutritionists, exercise physiologists, and health psychologists offer accessible approaches to cardiovascular care. There is a strong focus on hypertension and cholesterol management as well as lifestyle behaviors like physical activity, healthy diet, stress management, and sleep quality. The goal is to prevent incident or recurrent heart disease, stroke, atrial fibrillation and heart failure, and help people live their healthiest lives.

A redefining moment for cardiovascular disease prevention

With the heightened risks brought by the coronavirus, health care delivery needs to adapt. A timely report released by the nonprofit group DataHaven, "Towards Health Equity in Connecticut The Role of Social Inequality and the Impact of COVID-19," linked the widespread health disparities in Connecticut to discrimination, poverty, and access to community resources. Low-income and minority communities are disproportionately affected by the COVID-19 pandemic. Growing evidence has also demonstrated that COVID-19 hospitalization may increase the risk of major adverse cardiac events.

With COVID, mitigating cardiovascular risk factors is ever more important. Yet there are important challenges. During her lecture “Preventive Cardiovascular Medicine through a 20/20 Lens,” Spatz summarized a statement from John S. Rumsfeld, MD, PhD, the chief innovative innovation officer at the American College of Cardiology. ‘The problem is not that we haven't had the advances in science, medicine, and technology, it's that we haven't allowed the system to also evolve in the same period.’

For example, hypertension is a major risk factor for COVID complications and controlling blood pressure is a key priority. Guidelines recommend monitoring blood pressure at home and titrating medication to achieve goal blood pressure. Spatz commented that, “There are opportunities to make care easier and safer for patients and at the same time improve quality.” The Heart and Vascular Center Digital Hypertension Program seeks to do just that. In partnership with pharmacy, patients are given blood pressure cuffs, taught how to sync them with their electronic medical records, and scheduled for brief but frequent check-ins with a pharmacist to address barriers to blood pressure control and titrate medications.

Through a grant from the CDC called REACH (Racial and Ethnic Approaches to Community Health) and in partnership with Project Access New Haven and the Community Alliance for Research and Engagement (CARE), patients who screen positive for social determinants of health are assigned a community health worker, including housing, transportation and digital connectivity/literacy, that impact cardiovascular outcomes. A study published in the journal Circulation: Cardiovascular Quality and Outcomes demonstrated how community health workers can facilitate the uptake of digital health technologies to help patients monitor their health and reduce health disparities.

“Our aim is to reduce cardiovascular risk, improve well-being, and significantly impact the rates of cardiovascular disease in New Haven and beyond,” said Onuma.

For more information on the Preventive Cardiovascular Health Program at Yale, please visit yale.edu/ pchpy.