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The Human Heart, a series of eight 15-minute transcribed stories of people who learned to live with heart disease were prepared under the joint auspices of the American Heart Association and the National Heart Institute.

With each year, the affiliated heart associations have increased the scope and intensity of their own publicity activities. In order to give them practical assistance in the development of publicity in all media, and to promote coordination between national and local policies and objectives, the national office has prepared and distributed a publicity manual for heart associations, a guide to the planning of year-round publicity programs.

As a matter of basic policy, the heart-fund campaign publicity was projected in relation to an educational message, emphasizing the hopeful aspects of the heart-disease problem. This year the core of this message was formulated in a leaflet, Five Facts You Should Know About Heart Disease. The five facts were also widely publicized in radio and television shows, and in magazine and newspaper editorial comment.

There is no question that the national publicity directly supporting the 1953 heart-fund campaign has far exceeded that of any previous year.

This was particularly true of television which has now emerged as perhaps the single most important communication medium for bringing the heart fund to the attention of the public. In recognition of this development, the association's radio and television advisory committee has been considerably expanded; as it is now constituted, it brings together top leadership from all the radio and television networks and virtually all the important advertising agencies.

The heart-fund campaign was given very extensive radio and television coverage both locally and nationally. All four radio networks broadcast special half-hour shows, devoted to the heart fund and originating in key cities. In these again, as last year, musical talent was contributed by the music performance trust fund of the American Federation of Musicians.

The association prepared and distributed radio and television spot announcements, transcription

including appeals by prominent figures in public life and the entertainment field, television films, and slides. Special kits for local radio and television outlets contained prepared talks, interviews, and round table discussions.

It can be conservatively estimated-on the basis of logs submitted by local stations—that the total number of spot announcements broadcast or telecast during the campaign was well in excess of 250,000.

Press participation was also very extensive. Each of the major syndicates cooperated in the preparation and distribution of not one but many feature stories. The association supplied, for local use, editorials, photographs, specialfeature articles, mat sheets, and campaign logotypes.

The remarkable volume of publicity during the past year indicates an immense and still rapidly growing public interest in the heart story.

Dr. WRIGHT. May we also request that the History, Policies, and Program of the American Heart Association, which is a statement of the American Heart Association, may be made a part of this record ?

The CHAIRMAN. Certainly. That likewise contains information that very properly should be made a part of this hearing.

(The matter referred to is as follows:)

THE HISTORY, POLICIES, AND PROGRAM OF THE AMERICAN HEART ASSOCIATION

Diseases of the heart and blood vessels, known technically as cardiovascular diseases, unquestionably constitute the most serious of all existing threats to the health of the American people. It has been conservatively estimated that some 10 million men, women, and children suffer from some form of heart or circulatory disorder. According to the latest available figures from the National Office of Vital Statistics, these diseases caused 771,000 deaths in 1952 in the United States. It should be noted that 35 percent of all deaths under the age of 65, the most productive years of life, are caused by the cardiovascular diseases. Over the age of 45, approximately 1 out of every 2 deaths is caused by heart and circulatory disease.

The American Heart Association, with its nationwide network of affiliated and cooperating heart associations, is the only voluntary health organization devoting all its efforts to the reduction of death and disability caused by the cardiovascular diseases. The purpose of this statement is to outline briefly the history of the association, its formation and development, its organizational structure and its program.

FORMATIVE YEARS

The American Heart Association was formed in 1924 by a group of America's leading cardiologists. At a meeting held 2 years earlier to initiate the formation of the new organization, its objectives were defined in these words:

"The function of such an association would be to coordinate all activities bearing on the heart problem, to develop new lines of research, to collect and distribute information, to further public health and industrial education, and to develop a sound public opinion as to the true meaning and seriousness of the problem.”

Today, some 30 years later, that statement is still a fair, if incomplete summary of the objectives of the American Heart Association. But it was not until 1948 that these aims began to be implemented on a scale approaching the magnitude of the problem. In that year the American Heart Association was reorganized as a national voluntary health agency. Laymen were admitted to membership and to positions on the governing bodies. The attack on heart disease became vested in an active partnership between the physicians and the public.

Up to 1940 the association had carried on a modest program. It established standards, held scientific meetings, distributed educational materials, encouraged the establishment of new heart associations and cardiac clinics, and published a scientific journal.

By 1940 many of the directors were dissatisfied with the limited scope of these purely professional activities. It was the conviction of the medical members that the association should finance urgently needed research in the cardiovascular field. Furthermore, they believed that the time had come for a broad community approach to the cardiovascular diseases. Only by opening the door to lay participation and the development of a vigorous research and community service program would it be possible to deal effectively with heart and blood vessel disorders on the vast scale dictated by their prevalence.

Active steps toward broadening the association were taken in 1946; they culminated 2 years later in the reorganization of the American Heart Association as a national voluntary health agency. This marked a significant step forward by providing leadership and a national program for the fight against heart disease.

Physicians themselves are thus responsible for the initial realization that the heart diseases cannot be attacked successfully by medical means alone. Organized voluntary action in cooperation with laymen is required to provide and coordinate the many different resources needed for a threefold assault on the problem-through research, education, and community heart programs.

This concept of partnership between physician and layman is the bedrock on which the association stands. Experience has shown that concerted public participation is required to give the medical profession the means to attack the problem at its source—through research. At the same time it creates the channels through which the benefits of expanding medical knowledge can be brought to those who suffer from some form of cardiovascular disease, by means of professional education, public information, and through the development of community services for the patient.

ORGANIZATIONAL STRUCTURE

The American Heart Association and its affiliated associations and chapters constitute a democratic and voluntarily established structure to help the physician, the heart patient, and the public combat the heart diseases. National assembly

The overall governing body of the American Heart Association is the national assembly, composed of approximately 400 delegates representing affiliated heart associations selected, according to population, and the various councils and sections of the national organization. At the association's annual meeting, the assembly holds panel discussions on problems in all principal areas of the association's interest and operation. Its recommendations, presented to and debated by the entire assembly, establish directives to the board of directors and executive committee for the following year. The assembly elects the officers and directors of the association. Scientific council

The scientif and medical program of the American Heart Association is under the immediate direction of the scientific council, open to all medical members of the association and its affiliates. It includes the section for high blood pressure research, the council on rheumatic fever and congenital heart disease and the section on circulation. During the past year steps were taken toward the organization of three new sections, a section of clinical cardiology, and a section on cardiovascular surgery and a section on basic science. National office

The association's national office directs the national phases of the heart program and guides affiliated associations in the development of its community aspects, providing a clearing house and a source of information, ideas and materials. Its staff is organized into the following divisions : administrative, medical, community service and education, fund raising. Affiliates

The network of heart association affiliates and chapters has rapidly extended its geographical coverage. In 1948, there were a national office and 18 affiliated associations. Today, in 1953, there are 56 affiliates covering almost all 48 States as well as Puerto Rico, Hawaii and the District of Columbia. They provide leadership to more than 350 local chapters with approximately 15,000 members, divided about evenly between physicians and laymen.

Consultation and guidance are provided by the national office to help affiliates improve their operations through field visits of national staff members, national training institutes, regional conferences and interassociation publications. The annual meeting of the staff conference of heart assoc

rganization composed of executive directors and staff members of affiliates, exercises an important function in interpreting the policies of the national office to State and local groups and in making better known the needs and desires of heart associations to the national organization.

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PROGRAM

Research

Lack of knowledge is the greatest present obstacle to the fight against heart disease.

Although there are more than a score of different forms of cardiovascular disease, three of them are responsible for the bulk of heart and vascular damage. These are hypertensive heart disease, coronary heart disease and rheumatic heart disease. The basic causes of none of these disorders is as yet fully understood. It is clear, then, that decisive progress in controlling heart disease depends on the acquisition of new knowledge. For this reason the program of the American Heart Association has rested, from the beginning, on a foundation of research.

The national research support program of the American Heart Association is a joint undertaking of the national office and affiliated State and local heart associations. The national office allocates to research at least half of its 25-percent share of the total funds raised in the annual heart fund campaigns. A substantial portion of the balance retained by affiliated heart associations and their chapters is devoted to the financing of additional scientific investigations in their respective areas as part of their own separate research programs.

The 5-year record of research awards in both the joint national program and the separate local research programs of the affiliates is shown below. These figures represent the formative years of the American Heart Association as a voluntary health agency during which only limited funds have been available. Since the association began its national research support program in 1949, progressively higher sums have been allotted, making a total of almost $61/2 million. Between 1949 and 1953 the number of fellowships awarded grew from 26 to 53 and the number of grants-in-aid increased from 19 to 70.

Research awards by the American Heart Association and its affiliates, 1949–53

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The aim of the association's research policy is to help develop a climate in which research can move forward freely and continuously toward its goals. It strives to attract into the cardiovascular field the first-rate minds of skilled, imaginative scientists of proven talent and creative ability, and it tries to make it possible for them to carry on their work without restricting pressures and without becoming too heavily burdened with teaching and administrative responsibilities.

Research support is made available by the association under the following categories.

1. Established investigatorships are awarded annually for a 5-year period to scientists of proven ability and superiority who are interested in a research career. They are assured of support during long-range development of their work.

2. Research fellowships are granted for renewable 1-year periods to persons interested in research who plan to follow an academic career. They conduct their studies under seasoned leadership.

3. Grants-in-aid are made on a project basis to experienced investigators working in nonprofit institutions, medical schools, hospitals, and laboratories who have demonstrated their productiveness or who otherwise give promise

of accumulating useful new information. The American Heart Association has also established a form of research support unique among voluntary health organizations. This is the career investigatorship which offers lifetime support to recipients selected for exceptional creative ability in experimental work. The awards include both personal stipends and funds to cover laboratory expenses and overhead.

The career investigator is free to follow his ideas in whatever direction they may develop. He may work in an institution of his own choosing; the only limitation imposed on him is that he can spend no more than 15 percent

his time in teaching. To date, the association has appointed three career investigators. Professional education

In order to put medical research to the use for which it is intended-helping human beings—it is necessary to narrow the gap that often exists between a scientific discovery and its actual application to save a life, to avert or lessen disability.

Communications between the research scientist and the clinical physician who deals with patients are being speeded up by the American Heart Association through the development of broad professional education programs. These programs provide practical information and tools to physicians and closely allied professional groups such as nurses to help them deal more effectively with patients.

The annual scientific sessions and special activities of the various sections and councils of the scientific council are increasingly useful in bringing practical information to the medical profession.

The national office produces and makes available a wide range of technical pamphlets, scientific journals and bulletins, manuals and guides, exhibits, teaching aids, films, pamphlets, and cardiac record forms. Its technical publications include Circulation, Circulation-Research, and Modern Concepts. The association cooperates in the distribution of the Heart Bulletin which began publication in 1952 as a new medium for reporting the latest advances in diagnosis and treatment to the physician in general practice.

Among affiliated heart associations, the national office encourages the development of teaching aids as well as conferences, seminars, institutes, postgraduate medical courses, nurses' institutes, and teaching courses in cardiovascular clinics, often arranged with the cooperation of local medical societies. Public information and education

So much attention is devoted to heart disease these days in the press, on radio and television, and in the magazines that it is difficult to realize how little information was available to the public through these media only a few years ago. The reason for this was undoubtedly a general apathy, fear, and misunderstanding about the heart diseases and to a large extent the lack of an enterprising national organization and an active nationwide program in the cardiovascular field.

The changed situation and the altered attitudes of press as well as public have been greatly influenced by the public relations policies laid down by the American Heart Association. This approach has exerted a strong effect in arousing public interest and winning the cooperation of the various media of communication in reporting on the increasing progress made in the fight against heart and bloodvessel diseases.

The educational messages of the association reflected in the wide variety of pamphlets, exhibits, films and other materials prepared for general distribution, are designed to stress accurate information without exaggeration or distortion; to correct misconceptions; to substitute encouragement and realistic hope for the fear and fatalism too frequently found in the past; to emphasize the scope of the cardiovascular problem and the belief that heart disease can be ultimately controlled through research; and to urge prompt and proper treatment of heart and circulatory disorders.

The core of the association's educational message is the hopeful concept that something can be done about heart disease. It may be summarized in these five simple facts:

(1) Some forms of heart disease can be prevented * * * a few can be cured.

(2) All heart cases can be cared for best if diagnosed early.
(3) Almost every heart condition can be helped by proper treatment.
(4) Most heart patients can keep on working-often at the same job.

(5) Your symptoms may or may not mean heart disease. Don't guess or worry. See your doctor and be sure.

Broadly speaking, the health education program is a dynamic effort to change people's behavior in relation to the cardiovascular diseases, encouraging them to accept the responsibility of acting upon the knowledge they receive. This action takes the form of self-help through consultation with a physician to obtain needed medical aid and of participation in community heart association programs to develop the needed facilities and services for patients with heart disease. Community service

The effectiveness and success of the national heart program is measured in terms of what is accomplished in local communities for individuals suffering from heart disease.

Affiliated heart associations are engaged in furthering community programs for the prevention, care, and treatment of heart disease; in educating physicians and other professional groups and the lay public; and in establishing and maintaining high standards of medical and other services.

The fact that diseases of the heart and circulation are chronic in nature and require long-term care necessitates a high degree of coordination of many medical and nonmedical community agencies and facilities. Among the facilities to be integrated into an effective community cardiac program are medical, nursing and social services; health and welfare agencies; cardiac clinics and hospitals; convalescent homes; educational departments; rehabilitation, vocational training and employment programs.

The American Heart Association assists its affiliates in determining the needs of their communities, in creating or fostering required facilities and in coordinating their programs with those of other voluntary and official agencies in their areas.

It is not possible in this brief account to list in detail the many different community services now being fostered by State and local heart associations.

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