Principles of access to health care. Access to Health Care Task Force, American Heart Association

Nonprofit Advocacy at the American Heart Association: Creating a Visionary Way Forward at Our 40th Anniversary: An American Heart Association Policy Statement

In 2021, the American Heart Association celebrates its 40th anniversary in advocacy. This policy statement details the arc of the organization's nonpartisan, evidence-based, equity-focused approach to advocating for public policy change, highlighting key milestones and describing the core components of the association's capacity and activity at all levels of government. This policy statement presents a vision and strategic imperative for future American Heart Association advocacy efforts to inform and influence policy changes that advance equitable, impactful societal solutions that transform and improve cardiovascular health for everyone. The American Heart Association maintains accountability by measuring and evaluating the totality of this work and its impact on equitable health outcomes. The American Heart Association will apply these lessons to constantly refine its own strategic policy focus and advocacy efforts. The association will also serve as a resource and catalyst to other organizations working to engage and educate policy makers, partners, the media, and funders about the important role and contribution of public policy change to achieve shared goals.

Women and cardiac rehabilitation: accessibility issues and policy recommendations

The purpose of this study was to identify whether certain factors related to accessibility can predict women's participation in cardiac rehabilitation (CR). This cross-sectional comparative study used a convenience sample of 370 women cardiac patients who were treated and discharged between April 1, 1995, and September 30, 1995. A self-report instrument and medical record reviews were used to collect data at five hospitals and four CR centers in three midsized cities in northeastern Ohio. Differences between participants and nonparticipants were examined on the groups of variables. Logistic regression showed women's participation in CR to be overwhelmingly determined by physician referral (odds ratio [OR] = 0.000), which was more likely to occur if the patient had CR insurance (OR = 0.73). The probability of compliance with a referral in women with CR insurance and no history of coronary heart disease (CHD) was .89; with no insurance and a history of CHD, the probability of participation was .37. Participation was associated with level of education, coronary artery bypass surgery, and available transportation. We recommend the promotion and encouragement of the use of Clinical Practice Guidelines by physicians, and lower cost and more accessible approaches to CR, such as contracting with managed care, home rehabilitation, and community-based programs.

The role of the pediatrician in the promotion of cardiovascular health

The subspecialist has been historically on the forefront of diagnosis and management of cardiovascular disease in our society. Recently, however, we have seen the focus shifting from high technology to include primary care and prevention. Cardiovascular risk evaluation has been identified as the thrust of the 1990s, and there is a reemergence of the generalist as a potential leader in cardiovascular care. It is now recognized that efforts early in life to promote cardiovascular health may have dramatic impact beyond the pediatric age. Five major areas are identified as targets for cardiovascular health promotion in childhood: obesity, cardiovascular fitness, hypertension, hypercholesterolemia, and smoking prevention. Pediatricians, as well as family physicians, must recognize their critical role in the promotion of cardiovascular health. The focus should not be limited to traditional childhood diseases but also to adult diseases that have their origins in childhood. Appreciation of the scientific findings generated by studies such as the Bogalusa Heart Study should influence the pediatrician in assuming a major role in prevention of adult heart and other chronic diseases.

Task Force 1: The underserved

The ACC has affirmed its commitment to universal access to health care. Underserved populations exist in urban and rural centers. Common to each is a paucity of personnel trained in cardiovascular care and a lack of access to preventive and highly technologic services. These factors contribute to a poor health outcome (75). Part of the rural problem can be corrected by the transfer of information to local providers by the use of new information systems. Included would be real-time electronic consultation, on-site subspecialty visits and the appropriate use of nonphysician providers (15). The urban problem requires changes in priorities and responsibilities of the academic health centers toward the communities they serve. Curricula changes of cardiovascular specialists, internists, generalists and nonphysician health care personnel must include diversity in training, physician training of ethnically matched providers in addition to technical excellence and research into methods of patient education and motivation for a healthier life-style (51). Reimbursement must appropriately reward those caring for underserved patients and those providing evaluation and management services (43,52).