Laurence Sperling, MD, on Barriers to Preventing Cardiovascular Events

In this video, Million Hearts® Executive Director Laurence Sperling, MD, highlights the barriers to optimal care of which you should be aware or may be facing in the prevention of cardiovascular events among your patients.

Additional Resources:

  1. Sperling L. About the Million Hearts® Initiative. Cardiology Consultant. 2020. Accessed September 22, 2020.
  2. Million Hearts®. Centers for Disease Control and Prevention. Accessed September 22, 2020.


Laurence Sperling, MD, is the executive director of the Million Hearts® for the Centers for Disease Control and Prevention/Centers for Medicare and Medicaid Services. He is also a Katz professor in preventive cardiology and a professor of global health at the Rollins School of Public Health at Emory University in Atlanta, Georgia. 

For more videos, visit the Resource Center.



My name is Dr Laurence Sperling. I’m the executive director of the Million Hearts® initiative. Also, I serve as the Katz professor in preventive cardiology and a professor in global health at Emory University School of Medicine in Atlanta, Georgia.

I would say we have many barriers to optimizing care. Those barriers are at the level of clinicians. The barriers are at levels of our healthcare and our health system. The barriers are at the level of the patient and the community.

What we underappreciate is that the determinants of health and disease are not solely determined by the clinical realm. Actually, a very modest portion of that is determined by what we do in clinical medicine to understand the ability to impact health and prevent disease at the community level and the population level.

Some specific barriers, though, include clinical inertia. Clinical inertia is really not moving the bar of care. This clinical inertia is really a great roadblock for hypertension control, for instance. We also know that there is significant nonadherence with medications. Establishing a true clinician‑patient relationship and partnership and ongoing discussion is very important.

Other important barriers would include lack of support, sociodemographic factors. In our country, clinical medicine has become challenging for many. I frequently describe clinical medicine in our country as fragmented, episodic, and catastrophic.

By thinking differently and acting differently, we’ll have the ability to address prevention for populations and really think not only at an individual level but embracing a population health approach.