Building a Coalition for Heart Attack and Stroke-Free Greater Princeton Community.

New Jersey is not a heart-healthy state. The most recent New Jersey CDC data showed the heart disease hospitalizations per 1,000 Medicare beneficiaries in New Jersey ranked much higher than the U.S. national average among all races: white, 67.5 vs. 56.3; black, 82.3 vs. 69.6; and Hispanic, 71.4 vs. 54.3.

CDC Director Dr. Tom Freidan said: “How can our healthcare system save the most lives (while also reducing cost)? We can save the most lives by preventing heart disease and stroke.”

Identifying community residents who are at high risk for developing heart attack, stroke, and sudden death, and therefore, most likely to need expensive and recurring hospitalizations in the next 10 years, is widely available. A 10-year cardiovascular risk assessment can be performed by your primary care physician at no cost during an office visit. If your risk assessment revealed that you are at high or very high risk, evidence-based medical therapy that is proven to be safe and highly effective is available and covered by your medical insurance.

The Million Hearts Initiative to prevent 1 million heart attacks and strokes in just five years, which began in 2012, is at its halfway mark. Based on what we have already accomplished at Princeton Preventive Cardiology for more than a decade now, this goal is achievable.

But on this large scale, preventing 1 million heart attacks and strokes, while saving countless lives and hundreds of billions in healthcare expenditures, also means large lost revenues for hospitals, including the five hospitals in Mercer County. Every hospital offers a “stroke center” and emergency stenting for major heart attacks. A recent large study published in the prestigious New England Journal of Medicine showed that rapid heart attack care (shorter door-to-balloon time) did not reduce death rate.

Aggressive heart attack and stroke prevention does not work for hospitals under the current long-standing business model that rewards more hospitalizations and more procedures. There is already a rapid transformation in healthcare that started a few years ago, but some are hoping that the old system will not really go away. Healthcare (mostly disease care) is a huge part of our economy and the transformation that is taking place creates new opportunities for those who can see the future before everybody else does.

No hospital administrator seems to be willing to commit to aggressive cardiovascular disease prevention. Not all the five county hospitals (all financially challenged and have too many beds to fill) are suited to provide this service. Only two hospitals, both university-affiliated, have made significant investments in a large wellness facility for the community they serve. While this alone is not enough, it is a good start.

Having a cardiology practice for more than 30 years made it clear to me a decade ago that the current system is not sustainable. Healthcare (disease care) now consumes close to 20 percent of the GDP, leaving less room for social security, defense, and other federal government roles.

Let us challenge ourselves, residents of the greater Princeton community, to build a coalition for a heart attack and stroke-free community that can serve as a model for other communities. To avoid expensive duplication of services and foster higher quality and better efficiency; choose one hospital that is best suited to provide this outpatient service to our county. An ounce of prevention is worth a pound of cure is especially true when it comes to heart attack and stroke. Most of our community residents will not gain full recovery after a major stroke and those who will suffer a major heart attack will not have a lower death rate even with a shorter door-to-balloon time.

Our community needs to be pro-active and needs its leaders and employers to come together. Please submit your suggestions by visiting

Princeton Preventive Cardiology, 1445 Whitehorse-Mercerville Road, Suite 109, Hamilton. Two Capital Way, Suite 333, Pennington. 416 Bellevue Avenue, Suite 303, Trenton. 609-396-6363.

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