OK, Dick Cheney wasn’t president but was a heartbeat away. Both Dick Cheney and another former leader, Bill Clinton, have been in the news recently as a result of their heart conditions. Their previous histories of heart treatments have been widely reported in the media. What lessons do these contrasting stories have for ACOs?
Vice President Cheney displays the external battery pack for his surgically implanted pump
A slimmed-down and symptom-free Bill Clinton now enjoys his plant-based, whole foods diet
| Age | Vice President Cheney | President Clinton |
| 37 | 1st Heart Attack | |
| 43 | 2nd Heart Attack | |
| 47 | 3rd Heart Attack | Hillary Clinton recruits famous lifestyle medicine physician Dean Ornish, MD to improve health of White House food. |
| 58 | Chest Pain, shortness of breath, 90% arterial blockage. Quadruple bypass. | |
| 59 | 4th Heart Attack. Quadruple bypass. | Surgery to address complication from last year’s quadruple bypass. |
| 60 | Chest pain. Angioplasty. Pacemaker. Implantable defibulator. | |
| 64 | Two stents inserted. Two months later, the grafted arteries are re-clogged. After personal research, begins whole foods, plant-based diet espoused by Caldwell Esselstyn, Jr., MD. This diet is similar to Ornish’s heart disease reversal diet. | |
| 66 | Episode of arterial fibrillation | Bill Clinton has maintained his lifestyle change for two years, is free of heart disease symptoms, has returned to his high school weight, reports more energy, and through his foundation advocates for healthier lifestyles among all generations. |
| 67 | Procedure to replace heart monitor | |
| 69 | 5th heart attack; surgery to implant pump to support weakened heart | |
| 71 | Heart transplant |
Lesson 1. Heart disease remains a deadly and costly condition among the Medicare population. Coronary artery disease often involves multiple costly interventions over the life of a patient.
Lesson 2. A significant body of peer-reviewed medical literature exists that demonstrates that lifestyle interventions can reverse coronary artery disease. This research can be found by anyone who looks. The specific interventions are well documented and supported with over 20 years of history.
Lesson 3. Achieving behavior change among patients is difficult. Of course, we all knew that already. It was widely reported that Bill Clinton enjoyed junk food. Clinton was first introduced to Ornish’s diet in 1993; it took him 17 years and multiple heart procedures to embrace this lifestyle change.
Lesson 4. Teachable moments exist. Clinton’s came in the Spring of 2010. Two months after two stents were inserted, Clinton reports that he was discouraged when his new bypasses are re-clogged again. He wanted to live to be a grandparent. He conducts his own research, and begins Esselstyn’s heart disease arrest and reversal diet. These teachable moments exist with many patients. If the ACO can re-engineer its delivery system to detect and intervene appropriately at these teachable moments, the health system can succeed in empowering patients with radical lifestyle changes that improve health, reduce costs and increase profits.
This author thanks both of these men for their many years of public service and wishes both of them good health in the future.
