Elizabeth Ofili, M.D., M.P.H., F.A.C.C. Professor of Medicine and Chief of Cardiology Director, Clinical Research Center Associate Dean of Clinical Research Morehouse School of Medicine Atlanta, Georgia Elizabeth Ofili, M.D., M.P.H., F.A.C.C. Professor of Medicine and Chief of Cardiology Director, Clinical Research Center Associate Dean of Clinical Research Morehouse School of Medicine Atlanta, Georgia Advances in Heart Attack Prevention and Treatment: Are Women and African Americans Reaping the Benefits? Gnat Lines News Briefing, Lake Blackshear Resort, Cordele GA. Feb 20, 2006 Gnat Lines News Briefing, Lake Blackshear Resort, Cordele GA. Feb 20, 2006

CVD Mortality Trends for Males and Females: US 1979–2002 American Heart Association. Heart Disease and Stroke Statistics — 2005 Update. Dallas, Tex: American Heart Association; ©2005, American Heart Association. Years Males Females Deaths (thousands) NCEP I NCEP IINCEP III NCEP = National Cholesterol Education Program.

African Americans make up 29% of the population in Georgia, but account for 68% of CVD deaths before age % AA Pop 68 % CVDDeath Georgia Heart Report, 1998

Leading Causes of Death Among US Women (2000) * Number of deaths are rounded to the nearest thousand. COPD = chronic obstructive pulmonary disease. National Heart, Lung, and Blood Institute. The Healthy Heart Handbook for Women Cause of Death Number of Deaths * 0 50, , , , , , , ,000 Heart Disease 366,000 Breast Cancer 42,000 COPD 62,000 Lung Cancer 65,000 Stroke 103,000

National American Heart Association Survey Women’s Awareness 2003: Perceived Leading Cause of Death by Ethnic Group Mosca L et al. Circulation 2004; 109: Percent (%) Breast Cancer Cancer (general) Heart Disease Unsure White Black Hispanic

The Facts Heart disease has been the top killer of women for nearly 100 years It kills 65,000 more women than men each year It kills more women under 45 than any other disease –From 1989 to 1996 sudden cardiac death climbed 31% among women age 15 to 34

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NITRO0010 — AHeFT Slides — v1111 Days Since Baseline Visit Date Fixed-dose I/H Placebo A-HeFT: 4 3% Decrease in Mortality Survival (%) P=.01 Fixed-dose I/H Placebo Hazard ratio=0.57

A-HeFT: Components of Composite Score n= % 6.2% Death P=.02 Placebo BiDil First HF Hospitalization n=85 n= % 16.4% P= P= Change in QOL n=54 5

Translational Blocks Career disincentives Regulatory burdenPractice limitation Fragmented infrastructureLack of funding Incompatible databases Lack of qualified investigators “Lost” in Translation Basic Biomedical Research ImprovedHealth Clinical Science +Knowledge Translation of New Knowledge Into Clinical Practice + Health Decision Making Translation of Basic Sciences Into Human Sciences 12 JAMA 2003;289:

CPN Academic Leadership Innovative Research Clinical & Research Training Guideline based CME Community Physicians Program M S M Hlth Disp African American Patient base Busy Practitioners Morehouse Community Physicians Network©

Best Practice Information - Measurement Tools and Outcomes Patient Educated (Empowered) Provider: 1. Physician 2. Mid-Level Providers 3. Pharm.D. 4. Educators A. Nurses B. Dieticians C. Wellness Team CPN

Cohen JD. Lancet. 2001;357: B Beta-blockade Blood pressure control A Aspirin ACE inhibition C Cholesterol management D Diet Don’t smoke E Exercise ABCs of coronary prevention

CPN has 130 practices in Metro ATL

Healthy Georgia Diabetes and Obesity Initiative

21st Century Intelligent Diabetes Care Model Patient-Centered Information Rich Electronically-Based Outcomes Focused Quality Based Improved control of diabetes Decreased health disparities Development of new knowledge through: – –Evaluation of Protocols – –Forecasting the health & economic effects of the project on the geographic area Creating a system that is: Resulting in:

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