Cardiometabolic Research in the Center Cardiometabolic Research in the Center for Health Discovery and Well Being at for Health Discovery and Well Being at Emory University Emory University The Imminent Revolution in Healthcare Emir Veledar PhD, Arshed Quyyumi MD, Jennifer Vazquez, MS, Lynn Cunningham, MS, MBA, Kenneth Brigham, MD Emory University *Division of Cardiology;** Predictive Health Institute
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Cardiometabolic Research in the Center for Health Discovery and Well Being at Emory University Cardiometabolic Research in the Center for Health Discovery.
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Cardiometabolic Research in the Cardiometabolic Research in the Center for Health Discovery and Center for Health Discovery and Well Being at Emory UniversityWell Being at Emory University
Emory University *Division of Cardiology;** Predictive Health Institute
Predictive HealthPredictive Healththe concept
in both biomedical research and clinical care is spent on organ and disease focused activities even though end organ failure is often an irreversible process.
A third of the Medicare budget is spent in the last year of life
and a third of that amount is spent in the last month of life.
Research with this focus results in dramatic but increasingly expensive interventions that often have problematic effects on quality of life.
The majority of resourcesThe majority of resources
to maintain health rather than to treat disease.implementing general interventions that
epidemiological evidence indicates will improve health—“preventive medicine”---in health care systems.
New programs of this sort with novel titles are appearing at major academic institutions.
shifting emphasis away from end organ failure and toward health maintenance in the health care continuum.
That shift will gather momentum if improved efficiency and cost/benefit become more apparent.
Goal for Health systemGoal for Health system
for biomedical research has been slower to develop.
There is a need to focus the formidable power of the research enterprise-
basic, translational and clinicalon developing a positive definition of health in
quantitative terms and on developing an evidence base for novel health care paradigms that promise improved cost effectiveness.
The shift in focus of biomedical researchThe shift in focus of biomedical research
This would provide essential tools for health surveillance, risk assessment and premorbid diagnosis as well as the knowledge base for interventions in essentially healthy people
that would preclude progression to end organ failure.
The shift from disease to healthThe shift from disease to health
“Predictive Health anticipates the course of an individual’s health status, based on leading edge science and technology, and prescribes interventions that proactively optimize wellness”
“This revolutionary approach will move from a reactive disease focused system to a pro active health focused system; disease becomes a medical failure”
The Health/Disease ContinuumThe Health/Disease Continuum
NormalLow risk
NormalHigh risk
Predisease
Earlydisease
Latedisease
Predictive Health
Contemporary Medicine
HEALTH
DISEASE
Predictive Health and Public HealthPredictive Health and Public HealthCongruenceCongruence
IMMUNE HEALTH
Determinantsof
Health
Generic Processes
INCREASED CAROTID
IMT
Pre-disease
DIABETES
NEURO-DEGENERATIVE
DISEASE
ATHERO-SCLEROSIS
PSYCHIATRICDISORDERS
CANCER
Disease
Protecting health: The territory
Role of Academic Health Role of Academic Health Centers in the Health Care Centers in the Health Care TransitionTransition
◦Multiple disciplines within one organization◦Creative mindset
Strong research base◦Capacity to foster (and direct) collaborative,
interdisciplinary research on a large scale◦Catalyst for translational research – integrated
basic science, healthcare, public health, and other necessary, supporting disciplines
◦Objectivity about national economic issues◦Organized voice in national debate
Predictive Health Predictive Health ResearchResearch
The Cardiometabolic Study
dyslipidemia, insulin resistance, elevated blood pressure and obesity/overweight commonly referred to as the metabolic syndrome. tend to cluster and clearly confer increased risk for the development of
atherosclerosis and consequent cardiovascular pathology
Cardiometabolic Risk Factors and the Metabolic Syndrome
Coincident with the “epidemic” of overweight/obesity in the United States
portending an increase in cardiovascular morbidity and mortality in the future.
The syndrome is characterized by increased biomarkers of inflammation and oxidative stress even prior to development of cardiovascular morbidity (Kaya 2009, Dawood 2009).
Improved diet and regular exercise have been shown to be effective in reducing various components of the metabolic syndrome (Ma 2009), but
public health approaches to effecting such behavior changes have not prevented its increasing incidence
Predictive HealthPredictive HealthThe Imminent Revolution in Health Care
A random sample of Emory’s 20,000 employees.
Upwards of 300 participants completed an initial evaluation and have been assigned a Health Partner. follow up evaluations at 6 months and one
year following enrollment. Drop out less than 2%
Study Population
characteristics of this cohort are similar to those of the overall Emory employee population:
Minimum of a bachelor’s degree in a health science or related field. A broad range of backgrounds and skills are required to address the integrated complex issues of health definition and maintenance including a basic understanding of human biology. Some background in human behavior is also desirable.
Training by the professional staff of the Center will cover the following areas:
Predictive Health history, rationale and goals
IRB and informed consent process
CPR, AED training Customer relations Use of instruments and
equipment in the Center Use and purpose of survey
instruments Basic physiology, normal
and abnormal test and survey results
Empathetic and active listening
Motivational interviewing Assessing readiness to
change Collaborative goal setting Collaborative decision making Goal directed problem solving Elements of coaching,
mentoring, supportive engagement
The intervention Center processHealth assessment and plan Nutrition Physical activity Stress reduction Personalization of the plan Other Partner activitiesOngoing contact