Rehab Cell

Physical Medicine and Rehabilitation

Nancy Brown at the 2017 Stanford Medicine Big Data in Biomedicine Conference

Nancy Brown at the 2017 Stanford Medicine Big Data in Biomedicine Conference

(soothing, futuristic music playing) – [Bob] Well thanks for, uh… (audience applauds) It’s great to see the room still full here at the last afternoon of the meeting. It’s been a terrific meeting and I think you’ll be pleased at this
next plenary session. It’s my real privilege to
introduce my friend and colleague, Nancy Brown, who’s the
chief executive officer of the American Heart Association, a position she’s held since 2008. For those of you who don’t know much about the American Heart Association, it is the largest voluntary
science organization globally devoted to the understanding, the prevention, and the
treatment of heart disease. After NIH it’s the largest funder of heart and stroke research in this country. So, an important
organization for all of us involved in cardiovascular health. In addition to leading
the Heart Association, Nancy’s also a member of the board of directors of Research America, the Alliance for a Healthier Generation, the Campaign for Tobacco Free Kids, and the Truth Initiative. She serves as a member of the
Health Governors Community of the World Economic Forum
and is a past chairman of the board of the
National Health Council. Please join me in welcoming
the AHA executive Nancy Brown. (audience applauds) – Thanks. – Thank you. – Thank you and good afternoon,
and thanks especially, Bob, to you and to you and Ashley for inviting me to be here with you today. It’s such an honor to be
on this fabulous campus, the home of so much
innovation to talk about a topic that’s really
important to all of us at the American Heart Association, and I want to start by
giving you a sense why. You know, for those of you who don’t work in cardiovascular diseases specifically, you may or may not be
aware of these statistics, but when we think about the leading causes of death in the world, 17
and a half million people a year lose their life to
cardiovascular diseases, and the cost and the burden and the toll of prevention and
treatment of cardiovascular diseases continues to skyrocket. And here in the United
States we actually have just had an alarm bell
rung for our own work in the domestic area, and that is that for the first time in decades death rates from cardiovascular
diseases, including stroke, have actually increased
instead of decreased. So, for almost 40 consecutive years there was this continued
decline down of death rates, and a lot of that was due
to fabulous discoveries in new medications and new treatments for patients who were suffering from heart disease or stroke or
other vascular diseases, and now with all of the
onset of type II diabetes and obesity and the
things that are causing the level of unhealthfulness
in this country, death rates are continuing to rise. Especially for those in
various ethnic populations, and so this is a real concern to the AHA. The other reason this is a real concern to the AHA is that cardiovascular diseases affect real people, and
the promise of big data must help people like my
very new friend, Finn. This young boy is two
years old, and he has already endured nine heart surgeries. In July he will be going
back into the hospital for two more surgeries, and his mother Brittany asks really good questions. She wants to know why and
how the medical system is gonna provide tools
and resources for Finn to manage his health for
the rest of his life. Who is thinking about creating
personal health records for children so that data can be monitored by parents and then ultimately by kids themselves as they grow older. Who’s helping to bring together data so that we can learn from
these types of stories, so that kids like Finn
that maybe haven’t had as good of an outcome might have it later, and so we keep people
like Finn at the front of our minds every single day when we do our work at the American
Heart Association. And we also think about people in general and patients in general,
because so many people have their life and
that’s what they focus on, instead of what people have to do, which is to think about
managing their health. And when we think about interactions between healthcare providers and patients, when is the last time a doctor
or a healthcare provider asked any of you, or for those of you who work directly in that
field seeing patients, when’s the last time
you asked your patient, “What is your greatest aspiration “and how can I help you meet it?” And how can data be more helpful to people in managing their life, and when we think about this era of all of the new technologies that are going to change the way that we do science and think about new outcomes for patients to help, again, reverse those trends of cardiovascular diseases
hopefully in the future, we really think about how these industrial revolutions
have impacted our lives, and what has to be done to be able to manage this new way of
working for all of us. So, when we think about
the industrial revolutions and how they’ve impacted
the world, you know, back in 1784 when mechanical production and steam power energy
were first introduced, that was of course the
1st Industrial Revolution, and it took all the way until 1870 for the 2nd Industrial
Revolution to emerge, and that’s when mass production and electrical energy appeared. You know, imagine living
our lives without things being mass produced and without energy. What would that be like, but people who were brilliant, fabulous innovators created these technologies for all of us. The 3rd Industrial Revolution
came along in 1969, and that’s when we all began to enjoy things like electronics and the old fashioned information
technology tools. And so here we are in the
4th Industrial Revolution where artificial intelligence and big data come together in a new
way to solve new problems. And what we know about this is that the speed of the current breakthroughs has no historical precedence,
and it’s wonderful that all of this technology is available, and the promise that it can bring for science and medicine,
but the question is how will it be managed in a way that ultimately benefits patients like Finn. The other thing that’s happening, as many of you know who see patients and work in the healthcare system is how much the roles are changing, and you know, we talk about the role of patients in the public,
consumers and patients, you know, pick your words
that you might like to use, and people want to be active participants in their health, and
that’s a really good thing because it provides an opportunity for there to be so much more
information and knowledge that can help us create new solutions. And so, today I want to talk about four things that the
American Heart Association is focused on in this
4th Industrial Revolution to try to do our part in
helping to stimulate the system. First, I want to talk about the rise of the empowered consumer. Secondly, redefining
traditional doctor visits. Thirdly, the promise of
patient-powered research, and the fourth in the
importance of data sharing. So, when we think about the rise of the empowered consumer, the wearables, which all of us have and use, really we call that, “Health is the new black.” For those who can afford it, it is. You know that, so for those of us who can afford expensive wearable devices we have an opportunity to interact with our health all the time. But the question we have at
the American Heart Association really is where is the evidence base to show that these tools are actually valuable to individuals
in improving their health, and that this information can actually be reliable enough to be used in studies. You know, we talk a lot
about real world data and we are very supportive of creating an environment of data
coming from many sources at the AHA, and I’ll talk
about that in a little bit. But what we’re concerned
about at the same time is that there needs to be an evidence base to be able to understand
and know what works for what people at what
time, and so through the American Heart Association’s Center for Health Technology,
that Bob is a co-chair of, we’re very much focused on trying to create these studies
and put this knowledge and information into the marketplace. The second thing is in terms of redefining traditional doctor visits. So, when we think about how big data is improving patient
care today we think about improving care
coordination, we think about the opportunity to identify and treat high risk patients, and
certainly remote monitoring, and all of these are important aspects of health and wellbeing that we hope will continue to be integrated into care in all systems in this
country and worldwide. But at the same time, we know that there’s an opportunity to use this data to really recreate what we know
today as the physical exam. You know, with sensing
devices, capturing data for people in terms of
how they live their lives, instead of the moment or
encounter when they’re in the office, can be
very, very important. And I assume that Dr. McCray, who was here yesterday talking about our One Brave Idea research enterprise,
also shared the vision that that team has, and
I see Ewan right there, Ewan is part of that team,
to really think about how we can completely recreate
a digital physical exam. Not just measuring the things that we know how to measure today,
but figuring out what are the things that need
to be measured to better understand this transition
from wellness to disease. Could we find a way to
create, with all of this technology and data, earlier indicators of when people might be
making that transition, so that instead of managing people after they have health problems that we’re helping them
before those exist. In terms of patient-powered research, we’re very excited
about the important role that patients in the public can play in contributing their data
and information to research, and I understand that yesterday you heard and learned about All of Us,
the NIH’s very important, critically exciting new
research enterprise, enrolling a million people
in the US population, and we think that’s really
terrific and look forward to collaborating with
that group extensively. At the American Heart Association we’ve created My Research Legacy, which is with a goal of
really capitalizing upon the amazing connections the
American Heart Association has with people in communities
throughout the country. In case you didn’t know, in addition to the 33,000 science volunteers of the American Heart Association, we have 33 and a half million
volunteers and supporters in communities throughout America, as well as people who are
very loyal and passionate to the AHA in 70 countries
where we do business. And so we think it’s our opportunity and our obligation to help individuals who are willing to contribute data to have an opportunity to
do so to an organization that they know and that they trust. And we’re starting, actually instead of just creating an open forum where anyone can contribute data that they want, we’re starting with a pilot study, a proof of concept study,
looking at recruiting 2,500 individuals under the age of 50 who have had a heart attack, a stroke, atrial fibrillation, who
have congestive heart failure or other diseases related to
connected tissue disorders, and with these individuals we are attempting to understand two things. First, what does it mean to someone to know and deliver and
contribute their data, what are their expectations from an engagement standpoint on one side, and secondly, how can this data be most valuable to the scientific community broadly and looking and
understanding patterns between and among those folks. And so we’ll be connecting genetics, lifestyle, and health data
all in a secure portal that will allow individuals,
as I mentioned earlier, to interact with their
health and their health data. We also hope that My Research Legacy in its ultimate format, where we hope to recruit in the next several years 250,000 people who will be
willing to contribute data, can also fill a gap of needed information that helps organizations like the AHA set really important goals. For example, imagine if we could get lots of people to contribute information on their dietary patterns, information on their physical activity patterns through wearable devices if we can be sure we know which ones are reliable and can submit information
in the right way. This data now, when
organizations like ours want to measure impact, or even when this country wants to be able to declare the status of tobacco
use or physical activity, the sample sizes for
databases like NHANES, which are meticulously
developed and managed, are actually very small
when you’re concerned about looking at subpopulations, and we at the AHA are very concerned about looking at subpopulations. And so we hope that My Research Legacy can be a way that we can
contribute most broadly. We also have been very
focused, at the AHA, on trying to propel the
topic of data sharing, and I was really intrigued
by our colleagues that were in the session immediately prior to lunch talking
about data sharing and what the obstacles are and what
the possibilities are. You know, we’ve seen these for
a number of years at the AHA. As Bob mentioned, we’re the second largest funder of cardiovascular research in this country after the NIH, and we’ve had an open data policy for a number of years,
but we see the things that get in the way,
and so we, as we created our Institute for Precision
Cardiovascular Medicine at the American Heart Association, one of the premier
strategies of the institute was to create a data sharing platform where we hoped that we
could use the good name and good will of the
American Heart Association to encourage people to share data in a secure cloud environment. Think about it as a cloud of clouds, so the data sources keep their information in the cloud and the AHA has created this cloud of clouds, and we’ve
been able to do that. We’ve created with Amazon a
Precision Medicine Platform. This Precision Medicine
Platform is now up and running. We’re gathering consumer
generated data through My Research Legacy, omics data, social and environmental data, genomic data, clinical trial data, EHR data, registry data, and population study data. And again, in this cloud of cloud formats people will be able to
contribute data sets that will be searchable
across and among a wide number of data sets, and we
have secure sandboxes. As you can imagine, Amazon has been just spectacular in helping us to create a set of analytics and tools that will be very useful for scientists
and researchers, while the original data sources are protected, of course, at all costs. When we think about our
early data partners, I’m very pleased to be standing here at Stanford today because Joe Wu was one of the first to offer up data from the Stanford
Cardiovascular Institute, some of the stem cell
data will be available on the Data Discovery
Platform, as well as data from this sampling of
studies and organizations. There are many more that
have made commitments and we’re onboarding them right now. We really think that this
Data Discovery Platform will be a game changer in terms
of the way research is done. If we can cut down the time it takes to access critical data and provide people with new tools and
analytics, we think it will make a major difference
in science and research. And to fuel this, the AHA
is putting its own money with Amazon behind inspiring
use of the platform and inspiring the field of data science. The AHA and Amazon have pooled together about six million dollars
in resources that we are giving out in a competitive
grant environment. If you’ve not been on the
American Heart Association’s website lately for research
grants, please take a look. I’m glad to announce that Mintu actually was the recipient of one of these data awards most recently. So, we’ll be launching
awards in data mining, methods validation,
innovative development awards. We’ll be giving data fellowship awards, awards for new patterns in data, and then some awards that are funded by Bayer in the area of discovery. These are on top of
other grants and awards that our Institute for Precision
Cardiovascular Medicine is giving to help identify
and deepen information in the phenotypic area, as well
as the exposome interaction with the phenotype and
genotype information. And so, the AHA is so
committed to the field of precision medicine we’ve committed our own 30 million dollars to launch the institute and have been busy at work creating things like
the My Research Legacy and this Data Discovery Platform, and the One Brave Idea research enterprise that the AHA, Verily, and AstraZeneca have funded for 75 million dollars. We know that for big data to be able to be used in a way that is truly meaningful we have to get at the core of the issues that will hold us back. You know, if you were a
healthcare provider today, these are the kinds of
questions that we’re hearing. You know, “Are EHRs helping or hurting? “Are patient-facing digital tools useful “for my patients, and if so, which ones? “What will provide better care “and more efficient care
and allow for more time “for a physician-patient interaction?” And if you’re a patient
you’re asking questions like, “What does all of this data mean? “Am I healthier because
I’m tracking my steps “and monitoring my food intake? “What digital health solutions work? “What’s meaningful, what should I use? “How do I share this
information with my provider? “Does he or she even care, does it help?” You know, these are real questions that are being asked today, and so when we think about the speed
of new technologies coming into the marketplace
we have to pause or at least concurrently make sure that we’re working on
answers to these questions so that we can get the
biggest uplift possible. The other thing when we
think about the convergence of data and all of the
opportunities and challenges, I’ve mentioned to you
previously that we’re working with all of this data at the AHA. Physical data, consumer
generated data, clinical trial, EHR, environmental
data, and registry data. We’re doing it in our Institute
for Precision Medicine, we’re doing it in One Brave Idea, and we know that there’s
so many opportunities that come with these data
sets coming together. The 360 degree view of the patients, new discoveries, new therapies, new models for prevention, and
improved care coordination, all critically important things. At the same time, there’s
challenges that come about. Data sharing, data integration, privacy, computational infrastructure,
and analytics capabilities. So, we have to devote time to answer these questions and to make sure that we’re investing in the challenges as much as we’re investing
in the opportunities. So, I want to come back to
the 4th Industrial Revolution for a moment to tell you that there is an organization that’s very focused on the infrastructure for
all of the new technologies, and at the American Heart Association we’re really honored to be a part of the World Economic
Forum, and it’s founder, professor Klaus Schwab,
has said the following about the 4th Industrial Revolution. “The 4th Industrial Revolution “can compromise humanity’s traditional “sources of meaning, work, community, “family, and identity,
or it can lift humanity “into new collective
and moral consciousness “based on a sense of shared destiny… The choice is ours.” And because the World Economic Forum believes so strongly in this
they’ve actually created, and it was opened just two months ago, the Center for the 4th
Industrial Revolution, right here in the Silicon Valley. This Center for the 4th
Industrial Revolution, is going to be launching nine projects focused on AI and machine learning, precision medicine,
the internet of things, digital trade and cross border data flows, innovation and production,
autonomous vehicles, civilian use of drones, blockchain, and environment and oceans. And as an international organization that convenes governments, companies, NGO’s or not for profit organizations, and the public in general,
the World Economic Forum is well positioned to help
create an infrastructure to answer the very important questions of how can all of these new technologies and how can all of these new possibilities that are at our fingertips because of the 4th Industrial Revolution really help humanity and not create
more health disparities or disparities in the way people live their lives, but really lift everyone up. And I think this is a real concern. Down in the bottom you’ll
see the white building, which for those of you who have lived here for a while and know the history of all the technology will recognize that as a very historic landmark, and that’s really the center. That will be the Center for
the 4th Industrial Revolution. This center is being sponsored by great organizations in addition to the World Economic
Forum, like Sales Force, Kaiser Permanente,
Microsoft, and I’m really proud to announce today
for the first time publicly that the American Heart
Association will also be a sponsor of the Center for
the 4th Industrial Revolution, and the AHA will be
bringing its resources, its volunteers, its scientists, its business resources
to bear to help focus on the issues around precision medicine in the Center for the 4th
Industrial Revolution. We’re very excited about that opportunity and look forward hopefully to engaging some of you in that work as well. The last thing I want to talk about is the importance of giving people trust and hope, and
I’ll come back to Finn. Now, the day I met Finn he had this awesome shirt on that says, “Future CEO,” and so I was a little nervous. I said, “You know, Finn, I’ll keep “the seat warm for you, don’t worry.” But you know, this young child, Finn, and his mother
Brittany most especially, have aspirations for his life. You know, they want to see Finn rise and become a productive member of society, but there are so many questions about how new advances in science, new advances in healthcare treatment, and how new ways of using and collecting
data for precision medicine can help young people just like Flynn. And so I invite all of us as we do our work every single day to lift up our minds and remember that there are people who are counting
on us to find solutions and to bring new solutions to bear. So, with that I will
say thank you very much and I think Bob Harrington and I are gonna have a little conversation, thank you. (audiences applauds) – Sit here. – Mm-hmm. – Thank you, Nancy,
terrific, and we’ll let people start to get to the microphones. As they’re doing that let me just open up with a few comments and questions. The first is that, for
people that aren’t familiar with the AHA from a research perspective, they might think, “Well,
this is an organization “that’s traditionally worked with “pharma and bio-pharmaceutical companies “and device companies,” and
now it’s much different. I mean, your partners now
are all the tech companies. – Absolutely. – How has that transition taken place and what do you see for the future of AHA in terms of grant funding,
donations, et cetera, that really fit with a changing paradigm? – Yeah, it’s such an important question and just to give you a
sense of the magnitude of the AHA’s existing research program, right now we have about
2,200 active grants that we’re managing, several hundreds of millions of dollars of research funds at the AHA, and largely in a historical perspective money has come into us through fundraising, for those of you who help us raise money,
thank you very much, and through a very aggressive peer review system we’ve granted it out. But now we’re into this business of strategic business relationships where we are working much more closely with pharmaceutical
companies and technology companies to bring the best of what each of us have to offer
to create new opportunities and new solutions, and
so we’re doing that in… I’ll use quotes, in almost a “joint venture” way in a number of ways. Our work with Amazon is
a great example of that. We’ve jointly created the
Precision Medicine Platform, we’re jointly giving out research grants, we’re jointly bringing to bear a number of assets that we have now and will continue to explore in the future. We’re doing the same with
Verily and AstraZeneca, and I think that’s gonna
be an important model for the AHA’s future, both with businesses will invest indirectly,
as well as opportunities for people to access funding from the AHA. – So, there’s a lot of
young investigators in the audience and have been for
the last couple of days. One of the things they want to know is, “Well, how can I gain access
to some of this data?” – Yeah. – Now, some of it you specifically noted is designated through
research funding, et cetera… What if people have their
own research funding, can they come to the AHA because they want to collaborate over an interesting question and gain access to some data? – Absolutely, that’s
the reason we’ve built the Data Discovery Platform, is that we want any accredited
investigator to be able to use this data to
push forward questions. So, the reason we’re
giving money initially is to build momentum for the system, but over time we hope that the system will be the momentum
itself, and people should come forward now if they
have interesting questions and are interested in accessing data. – To continue on the
research funding theme, one of the interesting things… Kellen McCray was here yesterday, as you alluded to, and talked
about One Brave Idea. – Yeah. – You talked about the
Amazon relationship with AWS. There’s also been the network grants. This is a really different
type of research grant. – Yes. – Suggestions, recommendations, thoughts for the audience,
particularly again, the focus on the young investigators, how they should be thinking about in this new era, how do they get prepared to work with groups like the AHA? – Yeah, you know, we’re thinking a lot about this question because we have built the legacy of the AHA’s research program on providing funding
to young investigators, and we’re so proud of the people who are established today that started their research career because of the American Heart Association’s funding. So, we intend to try to figure how we can create fellowships to work with some of these programs, but I think this issue of mentoring is very important. I know that the senior people who are leading a number of these enterprises are very interested in serving as mentors for young folks who are
interested in knowing and understanding this
convergence of specialties that are working in
some of these new areas. – Talk a little bit about specifically the network grants, which
are different than some of the other things you’ve talked about. – Sure. – Because they do fit with the theme of big data because they’re really everything from discovery to pop health, they’re one institution but are required to partner
with other institutions. Give the group some sense
of the kind of things the Heart Association’s
doing in that arena. – Yeah, we recognized
a number of years ago that if we were going
to meet our own goals at the AHA we needed to be very precise about areas of research
where we saw big gaps, and where we felt that if we were to fund centers of excellence and provide a lot of money to a center of excellence that we could get quicker outcomes to areas that were important. So, over the past four or five years we’ve launched centers of excellence in women in heart disease, prevention, health disparities,
heart failure, and soon we will be announcing centers in atrial fibrillation, children’s health. Actually, those just
went through peer review, so the winners will be coming out soon in children’s health, and
peripheral vascular disease. These centers, we invest
between 15 and 20 million in each network, and within the network three to four to five
centers are selected to do the work in that particular topic area. So, for example in health
disparities we have four centers of excellence
in health disparities. Each center has a center director and four or five senior and several junior people that are working, and then across each of the centers that make up a network we
require collaboration. This has been an amazing movement in the AHA’s research program. We have seen so many
people learn and grow. We have also seen sharing in institutions that wasn’t happening before, let alone across institutions, of data, of samples, of ideas, of training of young people. It’s been really remarkable. – I think there’s a question up here. – [William] Thanks, Nancy, I’m
William Gunn from Elsevier. – Hi. It was a really impressive
visionary presentation. – Thank you. – [William] I liked it very much. I was thinking, though, given that generally just earlier this morning talked about the leaky pipeline of drug discovery and
a lot of the problems they’ve had with that coming from irreproducibility of
the preclinical results. Could you talk a little bit more about what you’re doing
with your grant program to ensure not only that
the research gets done but it really is rigorous
and reliable as it can be? – Thank you for that question. We have the highest standards at the American Heart Association
for our research programs, both when we’re deciding
who to give money to and after we’ve decided
who to give money to, and so in many of these programs, whether it’s our Institute
for Precision Medicine or our traditional granting mechanisms, we have oversight groups
that are charged with managing the activity that’s going on. So, for an example, the
networks that I just mentioned. Let’s take the heart failure network. Those four centers of
excellence are managed, if you will, by an
oversight advisory group of AHA volunteers, 10
or so science leaders who stay very focused on
the research production, the data, the publications, the sharing, and where appropriate reproducibility and other kinds of things,
and so we take our role in pushing that pristine
quality very seriously. – [William] Thank you. – Thank you. – I thought you were gonna ask a question from Elsevier about– – I was gonna say about the journals. – About the future of medical journals. – Yes, right. – Dissemination of information. – Exactly. – [William] That will
be another discussion. – Okay, there you go. We’re happy to talk about that, too. – Over on this side. – [John] Yeah, Nancy, great talk. My name is John Birch and I’m with the Mid America Angels Capital
network in Kansas City. I have a question for you about Finn. – Yes. – Number one, if you wouldn’t mind, how many Finns are there approximately, and what can be done to provide them with lifelong access to their data? – Yeah, you know, I would
hate to misquote the number. Do you know the number of how many kids are living with congenital heart disease? – I do know the fact that there are now more adults living with congenital heart disease than there are children. Ewan, do you know the number of children with congenital heart disease? Would you mind looking– – Go on the American Heart
Association’s statistical update, that number will be very handy. We publish all the statistics every year in our journal circulation, but as Bob has said, more kids… Because of advances in medical treatment and surgical procedures, more kids with congenital heart disease are growing up to become adults, which by the way and off to the side, not your question, has created a real challenge
for adult cardiologists who are managing kids who’ve grown up with congenital heart disease, and that’s been an important area for training and for new medical practice. But in terms of the data, you know, I can tell you we have a council on children and cardiovascular disease and we work very actively
with our own families of kids that have
congenital heart disease. You know, for example, Finn himself has 43,000 followers on Facebook. If you went on Finn’s
Facebook page right now, today, you would see that he’s doing a Dance with Finn
competition to raise money for the AHA, kind of like
the Ice Bucket Challenge, and all these people are doing it. But what they want is they want to know what should they be tracking. Brittany, Finn’s mother,
“What should I be tracking? “What should I be using? “Does the doctor want to see it or not?” You know, and is there a way to create, and we talked about this earlier, a children’s personal medical record that can follow a kid like Quinn through his lifetime, not just with basic information but really
detailed information. Finn, as an example today I understand because he was intubated so many times, you know, when he gets a
little cough or something he has to be hospitalized
and is either on his way to the ER or has been
hospitalized for that. You know, is that important and what kind of data should be captured. We need a scientific
approach to figuring that out to help people like Finn and his mother. – [John] Would you be interested in creating a registry, a proactive, prospective I guess I mean,
observational registry going forward for these children? – Yeah, there are some registries in the marketplace already, and we at the AHA care a lot about registries. We have our own hospital based registry with 10 million patient encounters around all kinds of areas and I think we’d be happy to talk about that offline. We are in the registry
business, that’s for sure. Thank you. – Yeah, it’s a great example of something that both Adrian and Mintu
talked about this morning, that here you have a
disease or a condition that’s relatively infrequent and yet trying to do clinical trials in that group has proven to be very, very difficult in part because of that infrequency, so bringing them together in a unified way certainly was one of the goals behind the Children’s Heart Network. – Yes. – Ewan, you’ve got to tell us. – Yeah, Ewan. – [Ewan] From the AHA website– – Thank you. – [Ewan] So, 40,000 new cases every year. – Right. – [Ewan] Almost a million
adults and almost a million children living with
congenital heart disease. – Thank you. – Thanks, Ewan. – Yeah. – That was good, I’m glad
you’re sitting there. – Yeah. – Nancy, let me extend the conversation, because you brought up and
we know you have a role, a leadership role in the
World Economic Forum. The noncommunicable diseases are really, the WHO and others have
acknowledged that this is really now the next
scourge of the earth. – [Nancy] Yeah. – And if ischemic heart
disease, for example, is now the leading cause
of death and disability everywhere except for sub Sahara Africa. What relationships does the AHA have or what work is the AHA doing with other disease organizations, cancer, kidney disease, diabetes,
obesity, et cetera, because they’re all the same risk factors. – Yes. – That tie them all together, smoking, physical inactivity, poor diet, et cetera. – Yeah, these are real problems that need to be solved and
collaboration and integration of strategies will allow it to happen. I actually just came back from Geneva where I was at the World Health Assembly where the health ministers
of every developed and developing country,
110 health ministers including our own
Secretary Price were there, thinking about this issue
of noncommunicable diseases and what are the strategies that can be focused on together,
and in much of the world there are issues around
building infrastructure. You know, when we think about primary care delivery in countries outside of the large developed country, you know, it doesn’t exist, and in
a way it’s so horrific, but in a way it’s an opportunity because do we need to
build these big buildings and have all of this infrastructure to be able to deliver
primary care in the world so that we can monitor and track things as simple as people’s blood pressures. So, how can new technologies and companies that are actively working in this space, you know, think about creating technology solutions and dropping them into countries so that people can manage
their health better. These are the kinds of
things we’re involved in in terms of thinking about
the global health picture. We also recognize that the American Heart Association’s own vast network. As I mentioned earlier, we have a presence in 70 countries largely through our CPR and first aid business where we not only write the guidelines for CPR and first aid but we deliver solutions
in the US certainly, but in 70 countries where training centers who are certified or other organizations are able to help spread the importance of CPR and first aid and deliver science based care in those countries. So, how do we take those
relationships and extend programs that we have like
Get with the Guidelines or extend other things important to countries like managing blood pressure. You know, I would say from an
international point of view this concept of blood pressure management is really key and very important
and there’s a high level of interest as well as
in diabetes management. – And let’s talk about blood pressure for a bit because the AHA
has been very involved in large data exercises,
Check It, Change It. – Yeah. – In terms of trying to maintain blood pressure control
at the individual level but also at the community
level, and our friends Alan Go at Kaiser have
been superb at this. – [Nancy] Yes. – Lessons learned from those
exercise, because in part that exercise has been a data exercise. – Totally, you know, we did a study with Kaiser probably
seven or eight years ago that showed that patients who manage blood pressure remotely and uploaded that information in a way
that exception reporting could be done by nurse practitioners in doctor’s offices, those practices had much lower aggregate
blood pressures of patients than practices who didn’t do that. So, that’s old information,
yet the practices in this country haven’t
changed, and so we at the AHA have created many
technology tools, Heart360. We’ve created programs like
Check, Change, Control, that are community based programs, and most recently we formed a partnership with the AMA to develop
and launch a program called Target BP, Target Blood Pressure, where we’re working with
primary care practices throughout America to help make sure that there are technology solutions for tracking blood pressures of patients, where practitioners are setting goals for blood pressure management and will be incentivized and recognized for having blood pressures controlled
at certain levels, and that data then, of course, comes in a de-identified way into a
data repository so that we can use that for science
and research as well. We’ve seen from other AHA programs like Get with the Guidelines that this benchmarking of data between hospitals has been very valuable in improving the quality of care delivered in America, so if we can do the same with
blood pressure management in an office setting, not only will we help people live healthier lives but we’ll have this
vast repository of data that can help all of us know and study and understand what will it really take to help people have that
shot at good health. – Hypertension, high
blood pressure is an area that really brings out
some of the challenges in underrepresented populations
and vulnerable populations, and one of the new relationships that the AHA has is with the
Jackson Heart Study. – [Nancy] Yeah. – Again, I know that there are people in the audience who are
working on health disparities, who are working on
underserved populations. You want to comment on
what the AHA’s doing with Jackson Heart to try to give some people some insight, and also, it’s a data source that people can access. – Yes, absolutely, we have
a strategic relationship with the Jackson Heart Study, which is the largest cohort study
of African Americans. Jackson, Mississippi, three generations followed meticulously
over time, similar to the Framingham Heart Study,
and the Jackson Heart Study, and in Framingham, the AHA has given competitive grants for people to use those data sources together to try to look at this issue
of health disparities, and some really amazing
findings have come out of some of the early
research that we funded. We continue to work with Jackson and hope that their data
will become available on our data platform, through the Institute for Precision Medicine, and in the meanwhile
folks who are interested in looking at and studying
that data, you know, come to the AHA because we
can help make that happen. The other thing I’ll say
on health disparities that’s so important is
that we recognize study after study after study,
whether it’s economic impact, whether it’s education levels, that these social determinants of health really matter in terms of the promise that people have to live
a long and happy life. And we don’t believe that
zip code should determine a person’s health status
but it really does. In many cases the zip code is a more obvious indicator of a
person’s overall longevity than their genetic code will be, and so we must find ways and we must find new strategic partners to
help people in communities see this promise for a
long and healthy life. This is one of the reasons in the area of blood pressure that
we’ve managed and created a relationship with the YMCA of America. We have determined, as has the YMCA, that if we can use the physical locations of the YMCA and their proven ability to bring people in to focus on health through the Diabetes Prevention Program that has been run through the YMCAs over the past many years, if we can do the same thing in blood pressures we might really be able to get to the heart of communities where real people with real disadvantage live to help them. – Final closing comment, we
have about a minute left. It made me think of it when you brought in the economic issues. One of the things AHA has done well, through your CEO Roundtable
you’ve accumulated a number of relationships
with big employers. – Yes. – Tie that in as we
finish, because certainly the big employers who are bearing a lot of the cost of
healthcare are very interested in what the Heart Association’s doing. – Yes, we created a round table of CEOs led by Henry Kravis,
the co-founder of KKR, and Terry Lundgren of Macy’s, we have now 30 CEOs of large influential companies. You know, Bank of America, Nestle, UPS, AT&T, Kaiser Permanente,
Johnson & Johnson, Merck, et cetera, you get the idea. This round table has
agreed to be an incubator for new ideas for creating solutions for employees and employers to help people be inspired to manage their own health and for employers to have new ways to think about engaging
people in their health so that they see the company
as a great place to work, but also in a way to
control healthcare costs. And we’re very, very pleased
with what’s come out of this. One of this, at the core
of it, is a data question. We’re recognizing companies
both on subjective as well as very specific health data to recognize companies at
gold, silver, and bronze levels in a way to try to move companies up to offer more things for
employees, and the data that we’re seeing from
that is really remarkable. And so over time, again,
in a de-identified way we hope this data can be available. – Great, well join me in thanking Nancy for joining us on our campus. – Thank you, thank you. (audience applause) – Thank you, Nancy. – Thank you.

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