Developing a master plan for heart disease and stroke prevention and treatment: California's experience

Background: Assembly Bill 1220 (2003) established the California Heart Disease and Stroke Prevention and Treatment Task Force (TF), charged with developing a plan to reduce the morbidity, mortality, and economic burden of heart disease (HD) and stroke.

Methods: Public forums were held to gather input from organizations/programs/individuals focused on HD and stroke and yielded recommendations, brought before the TF in advance of its first meeting. Objectives and action steps for four settings (community, workplace, schools, healthcare) were developed, addressing risk factor screening/management, acute/chronic disease management, education, legislation/policy development, priority populations, research, and surveillance/monitoring/evaluation. The Master Plan (MP) was developed with three overarching principles: timely access to high-quality, affordable care; patient empowerment for prevention in partnership with providers; and reimbursement/valuation of prevention in line with that of treatment.

Results: The result is the MP, not just an organizational roadmap but, instead, California's plan -- a statewide effort to defeat HD and stroke, involving private and public sectors. It focuses on diseases of the heart and blood vessels, with emphasis on coronary HD, stroke, and heart failure. Other diseases to be affected include: valvular HD; congenital HD; cardiac arrhythmias; cardiomyopathies; pulmonary hypertension; and peripheral vascular disease.

Conclusions: Success of the MP depends on organizations/programs with a stake in reducing HD and stroke; those addressing smoking, obesity, physical inactivity, diabetes, hypertension, and hypercholesterolemia; those trying to reduce the risk of HD and stroke among populations that are disparately affected; and those in healthcare treating HD and stroke, trying to prevent their recurrence.