Current Challenges and Opportunities in the CVD Treatment Landscape

Jen Norton, vice president and head of US Value & Access, Amgen, breaks down the challenges cardiovascular disease (CVD) presents for patients, payers, and providers, as well as opportunities for stakeholders to improve CVD management.

This interview is part of the series, "Innovation in Cardiovascular Disease Care & Coverage."

Read the full transcript:

My name is Jen Norton. I'm the vice president and head of US Value & Access at Amgen.

Can you comment on the prevalence and burden of disease in the cardiovascular (CVD) space?

Cardiovascular disease, aka CVD, is the leading public health issue in the United States. It includes a number of conditions such as heart attacks, strokes, arrhythmias, hypertension, valvular heart disease, and peripheral artery disease. An American suffers a heart attack every 40 seconds.

Atherosclerotic CVD, known in short as ASCVD, is a specific type of CVD that includes heart attacks and stroke. Clinical ASCVD is associated with an increased risk of secondary CVD events.

CVD creates a greater toll on a patient's health than any other condition and accounts for not only personal disruption but also family disruption, loss of income, and medical care expenditures. It impacts Americans across a wide variety of racial and ethnic backgrounds.

From a system-wide perspective, the total costs of CVD in the United States are expected to reach $1.1 trillion per year by 2035. Medicines can significantly reduce the burden of disease; however, the burden of CVD remains prevalent even though there are treatments available, including newer advanced treatments.

Elevated low-density lipoprotein cholesterol, also known as LDLC or what some call “bad cholesterol,” are a key risk factor for CV events. Lowering the LDLC brings down CV event risk for patients with CVD.

What are some of the key challenges in the CVD space, specific to patients, payers, and prescribers?

Lipid management is at the heart of treating patients with CVD. However, there are several key challenges currently in the CVD treatment paradigm. This is particularly true when it comes to preventing secondary CV events and reducing the risk of CVD.

Lipid management is not top-of-mind oftentimes for clinicians who are treating hospitalized patients, and opportunities for in-patient education on cholesterol, LDLC goals, and comprehensive reduction of CV events often are missed.

There are also gaps in the transition of care and inconsistent follow-up posthospitalization for lipid management for these patients. Patients experiencing CV events while they are on statin therapy often do not get reevaluated for additional treatments that might help to manage their condition. Statins are underused in patients with ASCVD, who are at high risk for recurrent CV events, and nonstatin lipid-lowering therapies remain underutilized in appropriate patients, as defined by the latest guidelines.

For instance, even when a patient is eventually prescribed a medication, utilization management protocols sometimes impede access for those patients. Sometimes they may abandon their prescriptions because of affordability concerns or other factors that interfere with adherence to their treatments.

With the health care industry investing heavily in rare disease and specialty care, why is it beneficial for stakeholder groups to still prioritize investing in the CVD space? What are the opportunities?

It's important for stakeholders to invest in improving the management of CVD to strengthen the continuity of care throughout the patient journey, along with ensuring every patient has uncomplicated access to their medicine.

Improving patient outcomes will help reduce costs throughout the entire health care system. Heart disease in the United States is costing about $363 billion annually and $147 billion in lost productivity. By 2035, it's projected to reach $1.1 trillion a year in the United States.

There are several opportunities for different stakeholders to improve CVD management. For instance, with payers, from a health economics perspective, we know avoiding CVD events saves money. We can use data and guidelines to identify specific populations who are most likely to benefit from these treatments.

We need health care providers to deliver the right treatment to the right patient at the right time based on guidelines that align with updated quality metrics, and then not be burdened by cumbersome utilization management protocols.

Can you briefly share what Amgen is doing to improve care for this patient population?

Amgen is partnering with stakeholders, including payers as well as health systems, to reduce the burden of cardiovascular disease. We’re leveraging real-world data to highlight gaps in clinical guidelines' implementation. Amgen recently collaborated with a large national payer and a health plan network ACO team to implement a teams-based approach to improve care for members managing hyperlipidemia.

One of the goals was to improve the number of patients with ASCVD being treated for their high LDLC by prioritizing guideline-based treatments. The program shows how payers and providers can use data to quickly incorporate guideline-based care recommendations with patients, as well as into daily practice processes.

We also have several public-private partnerships aiming to improve cardiovascular health among communities of color, given prevalence. We support independently led initiatives and forge strategic collaborations with other organizations.

We’re really proud of the work we are doing, and we're really excited for the promise of these partnerships to improve patient care and outcomes. Thank you.