The Science Is the Heart Association's. The Surface Belongs to Someone Else.

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From the Editor II

We read the American Heart Association the way a newcomer would, from the outside, and one thing came clear before any number did. The institution still owns the science of the heart. It has lost the surfaces where women now read about it.

The shift is permanent

Personal control over one's own health is now a fixed feature of how people live. It has outlasted every campaign built around it. A woman tracks her sleep, her cycle, her blood pressure, and her blood sugar on devices she chose and pays for. The Heart Association's public posture was built in an era when being the trusted source meant broadcasting findings outward. That era set the institution's habits. The audience has moved on from it.

What we looked at, and what we left out

We looked at the Heart Association from the outside, across its public face: the websites, the flagship campaigns, the annual reports, and the companies now competing for the same morning moment of a woman's attention. We used no private data. We asked one question. What does the public picture say about the next ten years.

We looked at the shape, not the scoreboard

This brief does not grade campaigns or count impressions. It looks at what the Heart Association talks about, what its competitors talk about, and the places where two important things are never discussed together. The reframe is on the page that follows. The rest of the report shows why it holds.

A starting point

This is the opening of a conversation the Heart Association's leadership owns, because the decisions belong to the institution. What follows is a reading, offered plainly, of where the next decade is already pulling.

The 2050 forecast that six in ten women will have heart disease is driven by rising blood pressure and metabolic risk, the upstream territory that consumer-health companies have already claimed with language the Heart Association has not adopted.
Younger women's awareness fell twenty-one points in the decade to 2019, even as the Go Red for Women campaign (the Heart Association's flagship women's-heart effort) entered its second decade. The women already reached stayed loyal. The next generation never arrived, and they are the group the forecast says will be hit hardest.
The Heart Association's $6.1 billion of research is the largest credibility asset in its entire field, and it is close to invisible on the surfaces where the next generation of women now reads about her own heart.

— Shur Creative Partners

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Where It Breaks VIII

Five findings, in plain language

Critical

The science stops at the doctor's door

The institution's authority · the woman managing her own risk

The Heart Association's deepest asset is its authority over the science: the guidelines, the research, the standards that doctors follow. That authority reaches the cardiologist and stops there. The 38-year-old woman managing her blood pressure through an app and a primary-care visit rarely meets it. The institution's knowledge lives in clinical guidance and press releases. The woman lives in her phone. Between the two sits very little shared language, and the distance is widest for exactly the younger women the 2050 forecast names.

Critical

Women read their hearts on screens the Heart Association is not on

The woman's daily devices · the institution that proved the science

A woman now checks a ring, a watch, or a lab-test app to understand her own heart. Those surfaces belong to companies like Oura (a health-tracking ring), Apple, Function Health (a lab-testing subscription), and Whoop (a fitness band). The Heart Association funded the science that explains what those devices measure, and its name appears on none of them. Every morning the relationship deepens between a woman and a product the institution does not stand behind. The companies reach her daily. The Heart Association's signature moment with women comes once a year, in February.

Critical

Heart disease is explained as a diagnosis, never as a household cost

Prevention · the language of money

Cardiovascular care costs the country more than $239 billion a year, most of it moving through employer health plans and household budgets. The Heart Association speaks fluently about clinical risk and almost never about cost. It has no language for the employer choosing which wellness benefits to fund, or for the woman weighing her health against her budget. The decisions that determine which prevention tools reach women first are increasingly economic, and the institution does not yet speak in those terms.

Notable

Respect has not turned into daily trust

The institution people admire · the trust they give an everyday product

The Heart Association is among the most trusted names in health. That trust is the broadcast kind: people believe its findings when they hear them. It has not become the everyday kind of trust a woman extends to a product she opens every morning and lets read her body. Admiration and daily reliance are different currencies. The institution holds the first in abundance and has yet to convert it into the second.

Priority

The youngest women, most at risk, have drifted the furthest

The forecast's target group · the campaign meant to reach them

The awareness that heart disease is women's leading killer fell hardest among the youngest women and women of color, the same groups the 2050 forecast says will carry the heaviest burden. Two decades of the Go Red campaign coincided with that drop. The women already inside the Heart Association's world stayed loyal. The successor generation never arrived. The drop is steepest in the very group the forecast says will be hit hardest.

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What Breaks If Nothing Changes IX

The cost of leaving these open

Each of the five findings has a future attached to it. None of those futures is dramatic. They are quiet, and that is what makes them dangerous. A relationship forms somewhere else. A story gets told by another voice. A decision happens at a table the institution never sits at. Walk each one forward and the same shape appears: the Heart Association keeps the credit and loses the contact.

The relationship forms without the institution in it

Follow one woman across the next ten years. She is thirty-four now, and she has worn a ring or a watch for most of her adult life. It tells her when she slept badly, when her resting heart rate climbed, when her cycle shifted something she could feel but could not name. The device is the first thing she consults and the last word she trusts, because it is the one that has been with her every day. The Heart Association's big moment with her comes once a year, in February, in red. By the time she has a genuine scare, perhaps a flutter that will not settle, perhaps a pregnancy that turns her blood pressure dangerous, the reference she reaches for is already chosen. It is the product on her finger and the app it feeds. The institution that funded the underlying science is nowhere in that moment, because it was nowhere in the thousand ordinary mornings that built the habit. What it costs to wait here is precise. It is the daily loyalty of the exact generation the forecast names, the women 25 to 34 whose awareness has already fallen the hardest. That loyalty does not switch off. It attaches, quietly, to whoever showed up every day. Right now that is not the Heart Association.

The upstream story gets told by someone else

The forecast that six in ten women will have heart disease by 2050 is driven by blood pressure climbing from roughly half of women to nearly six in ten, and by the slow metabolic drift (the gradual rise in weight, blood sugar, and related measures) that pushes it there. Those slow upstream years, long before anything goes wrong, are exactly the ground that consumer-health companies have already claimed. Function Health sells the annual blood-test panel that catches the trend early. Levels, a blood-sugar-tracking app, built its message on the idea that blood sugar sits at the root of heart trouble. The companies prescribing the new weight and metabolic medicines speak fluently about staying ahead of the curve. They all share one verb the Heart Association rarely uses: prevent, in the active daily sense a woman lives it, the way those products use the word. If the institution keeps describing heart disease as an emergency to be survived, the prevention conversation finishes without it. The science that should anchor that conversation will have been funded by the Heart Association and narrated by everyone else. The women most at risk will learn the language of their own upstream years from a subscription, and they will associate the wisdom with the brand that delivered it daily.

The economic conversation happens at tables the institution never sits at

Cardiovascular care costs the country more than $239 billion a year, and most of that money moves through employer health plans and household budgets long before it reaches a clinic. That means the people who decide which prevention tools actually reach women are often not doctors. They are benefits managers choosing what to fund at open enrollment, and women weighing a device or a screening against the rest of the family budget. These are decisions made in dollars and coverage tiers, and the Heart Association does not yet speak that language. It can describe clinical risk with unmatched authority and say almost nothing about cost. So when an employer decides which wellness benefit to underwrite next year, the institution with the deepest evidence base in the field is not in the room, and the science it funded gets deployed through whichever product won on price and convenience. The cost of staying silent here compounds. Every benefits cycle that passes without the Heart Association's voice is another year in which the economics of prevention are settled by vendors, and the institution's evidence arrives, if it arrives at all, as a footnote to someone else's pitch.

Admiration without presence becomes irrelevance in slow motion

This is the quietest failure of the five, and the hardest to notice from inside. The Heart Association remains one of the most trusted names in American health. Nothing in this brief disputes that. The danger is that trust which is never used in daily life does not stay valuable. It thins. A woman can admire the institution sincerely and still never once open it, never consult it, never let it near the readings that actually govern her day. The 2009 to 2019 awareness drop is the early reading on this: the women already reached stayed loyal, while the next cohort simply never formed the habit of turning to the Heart Association at all. Continue that line and the institution arrives, a decade from now, beloved and unconsulted. The logo will still command a nod of recognition. It will no longer command a place in the moment a woman decides what to believe about her own heart. That is irrelevance, and it does not announce itself. It accumulates one skipped morning at a time.

The science becomes a public good that others monetize

Here is the structural trap underneath the other four. The Heart Association's $6.1 billion research base does not stop working when the institution loses the surface. It keeps producing the evidence that makes a wearable's alert credible, that lets a lab test claim it means something, that gives a prevention app its scientific footing. The research continues to underwrite the entire consumer-health category. What changes is who captures the relationship that the evidence makes possible. The institution funds the science as a public good, and the products convert that public good into paid daily contact with the woman. They take the membership, the loyalty, the morning ritual, the trust that compounds with use. The Heart Association is left holding the most expensive credibility asset in its field while the daily value of that asset accrues to companies that did not pay to build it. This is the deepest cost of inaction, because it is self-reinforcing. The longer the institution stays off the surface, the more its own research strengthens the very products standing between it and the woman.

What it costs to leave these open is the daily trust of the generation that will carry the heaviest share of the disease, handed to companies that talk to her every morning while the institution that proved the science waits for February.

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The Ranking XI

Nineteen organizations, one field of attention

This ranks health nonprofits and consumer-health companies side by side, by how strongly each holds women's heart-health attention today. It is not a ranking of charitable impact. SBPI is the Structural Brand Power Index, the five-measure score explained just above and in the appendix.

Rank	Organization	What they own	SBPI	Band
1	Function Health	The annual lab-testing subscription, fronted by Dr. Mark Hyman	73.70	Strong
2	Apple Health	The health dashboard on a billion wrists	72.80	Strong
3	Oura	The ring that tracks a woman's body through every life stage	71.75	Strong
4	ALS Association	The clearest single-disease cause in the field	71.20	Strong
5	British Heart Foundation	UK heart research plus a high-street charity-shop network	70.50	Strong
6	Susan G. Komen Foundation	The pink-ribbon awareness movement	69.50	Emerging
7	American Cancer Society	The trusted cancer-screening guidelines	68.40	Emerging
8	Levels	The message that blood sugar is the root of heart disease	68.10	Emerging
9	Alzheimer's Association	The caregiver community and the biggest charity walk in the US	67.30	Emerging
10	Stand Up To Cancer	The celebrity telethon that funds research teams	66.90	Emerging
11	Whoop	The recovery band that added blood-test panels	66.05	Emerging
12	American Diabetes Association	The diabetes standard-of-care reference	64.60	Emerging
13	Hims & Hers Health	The telehealth service that writes the prescription too	62.90	Emerging
14	American Heart Association	The science and trust behind cardiovascular health	62.30	Emerging
15	World Heart Federation	World Heart Day and global heart-health policy	61.50	Emerging
16	March of Dimes	Maternal and infant health advocacy	61.00	Emerging
17	Garmin (Health Features)	Endurance-athlete body and heart tracking	59.80	Emerging
18	Smart Heart Sports	Clinical-grade heart screening for young athletes	59.00	Emerging
19	F.A.S.T. Coalition	The four-letter stroke-warning checklist	55.80	Emerging

How to read the bands: 85–100 Category Dominant, 70–84 Strong, 55–69 Emerging, 40–54 Niche, below 40 Limited. The top five organizations sit in the Strong band. The American Heart Association sits at the lower edge of the Emerging band, at rank 14 of 19.

Function Health owns the lab subscription. Apple owns the wrist. Oura owns the woman's life stages. The American Heart Association ranks fourteenth, holding the science without yet holding the surface where people read it.

See the full ranking in the interactive view →

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The Brand Scorecard XII

The whole deficit sits in one measure

62.30 / 100

Composite SBPI · Rank #14 of 19

Band: Emerging

The foundation is intact. Four of the five scores sit in the low-to-mid sixties. The fifth, differentiation, is the lone outlier at 53. It measures one thing: whether the institution owns a distinctive place in a woman's daily life. The field's leaders score 65 to 70 here. That single measure is the one dragging the rank down, and it carries only 10% of the total, so it is also the most fixable.

Awareness 63

Trust 63

Mission clarity 65

Differentiation 53

Loyalty 60

Trust is real, and it is not yet attached to a distinctive daily presence. That is the gap to watch: a strong score sitting right next to the weak one, with nothing yet connecting them.

The British Heart Foundation shows this gap can be closed. The United Kingdom's national heart charity ranks fifth at 70.50 on the same five measures, running the same kind of model. It holds higher trust, equal mission clarity, and a differentiation score of 66 against the Heart Association's 53, because it owns a distinctive everyday presence: roughly 700 charity shops on UK high streets and a close working relationship with the National Health Service. People meet the brand in ordinary life, week in and week out, well beyond any annual awareness month. That comparison settles the question a board member most needs answered. A national heart charity can hold strong trust, strong mission, and a distinctive daily presence all at once. The Heart Association's gap is specific and addressable. The surface has simply not been built yet, and a thing that has not been built can be built. Technology is not beating the nonprofit here. This one has not shown up in daily life.

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What the Heart Association Can Do XIII

Five moves, ordered by what moves the score most

01 Daily Presence

Become a daily presence, not an annual campaign

Move Go Red for Women from a February event toward a year-round companion a woman actually uses. The Heart Association needs to earn a place in a woman's ordinary Tuesday, the same way the ring on her finger already has one. Start with the content and tools women already search for between doctor visits, in the language of prevention and personal control, and make the institution present in that daily window.

Lifts: Differentiation, Loyalty

02 Endorsement

Put the Heart Association's seal on the wrist and the lab result

The Heart Association's research authority is the one credibility asset large enough to stand behind what consumer devices already tell a woman. Open partnerships with the wearable, ring, and lab-testing companies so that the institution's evidence is what confirms a reading. When a watch flags high blood pressure or an irregular rhythm, the trusted voice that explains what it means should be the Heart Association's. The science is already theirs. The endorsement is the missing piece.

Lifts: Differentiation, Trust

03 Economics

Speak the language of cost

Give employers and households a way to understand heart health as a financial decision as well as a clinical one. The choices that determine which prevention tools reach women first are made at open enrollment and in benefit meetings. The Heart Association can become the trusted reference in those rooms by translating its evidence into the plain economics of prevention: what it costs to wait, and what it saves to act early.

Lifts: Mission Clarity, Differentiation

04 Women's Guide

Build the Heart Association's own guide for women

Stand up an evidence-grounded companion that follows a woman through pregnancy, postpartum, and menopause, the life stages where her heart risk changes and the clinical system has most often dismissed her. A breast-cancer nonprofit already ships a free tool that lets a woman check her own risk on her phone. The heart field has no equivalent. The Heart Association's research base is exactly the foundation that makes such a guide trustworthy in a way a general app cannot match.

Lifts: Mission Clarity, Differentiation, Awareness

05 Lifelong Bond

Turn the school program into a lifelong relationship

The Kids Heart Challenge reaches more than a million students and their families every year. Today the relationship ends when the event does. Build a lasting connection that carries heart-health habits and guidance from the classroom into the family, so a single fundraising week grows into the start of a lifelong relationship.

Lifts: Loyalty, Mission Clarity

How the moves sequence

1 · Daily presence

Year 1, with Action 2

2 · Endorsement

Year 1, with Action 1

3 · Economics

Once daily presence carries it

4 · Women's guide

Builds on device partnerships

5 · Lifelong bond

Runs continuously throughout

Year 1Year 2Year 3

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Sources & Method XVI

Appendix

A plain glossary

Structural Brand Power Index (SBPI). A single score from 0 to 100 that measures an organization across five things: how widely it is known (awareness), how much it is believed (trust), how clearly it stands for one purpose (mission clarity), whether it owns a distinctive place in daily life (differentiation), and how strongly people stay with it (loyalty). For health causes, trust and mission clarity carry the most weight.

A band. A plain-language tier the score falls into: Category Dominant (85 and up), Strong (70 to 84), Emerging (55 to 69), Niche (40 to 54), and Limited (below 40).

The field. The nineteen organizations a woman might turn to, or pass by, in a moment of attention about her own heart. It deliberately mixes health nonprofits with the consumer devices, lab tests, and apps that now compete for the same moment.

Disclosure

This brief uses only public information. No private Heart Association data was used: no donor records, no operating data, no campaign performance numbers. The competitive scores reflect public evidence gathered from late 2025 through early 2026.

Method note

The findings come from reading the Heart Association's public language alongside its competitors', and from the published Structural Brand Power Index scoring described above. This appendix is the only place in the brief where the working method is named. Everywhere else, the report speaks in plain terms about what the institution says, what its competitors say, and where the two never meet.

Selected public sources

American Heart Association — Annual Report and financial statements, FY2024–2025 (heart.org).
American Heart Association — "2024 Statistical Update" and Go Red for Women campaign materials (heart.org).
American Heart Association — Nation of Lifesavers and Kids Heart Challenge program pages (heart.org).
American Heart Association — 2050 cardiovascular disease prevalence projection, presidential advisory (2024).
Women's heart-disease awareness study, 2009–2019 trend data (Circulation).
British Heart Foundation — Annual Report and retail network disclosures (bhf.org.uk).
Function Health, Oura, Whoop, Levels, Apple Health, Hims & Hers — public company materials and product announcements (2025–2026).
IDC Worldwide Wearables tracker, 2025 shipments; FDA clearance notices, September 2025.
US healthcare-system trust surveys, 2020 and 2024; institutional-trust study (2025).
Global Wellness Institute — wellness-economy monitor, 2024.

Retrieval dates span late 2025 through 2 June 2026. Full URLs and per-claim citations are maintained in the research record accompanying this brief.

6 in 10	US women projected to have some form of cardiovascular disease by 2050. The rise comes mostly from climbing high blood pressure (from 48.6% of women in 2020 to 59.1% in 2050), well upstream of any heart attack.
65% → 44%	Share of women who know heart disease is their leading cause of death, fallen across 2009 to 2019. The drop was steepest among women 25 to 34 (down 81%), Hispanic women (down 86%), and Black women (down 69%).
50% / 70%	Women are 50% more likely to be given a wrong diagnosis after a heart attack, and the women who are misdiagnosed face 70% higher odds of dying within thirty days.
$6.1B	The Heart Association's total research funding since 1949, the largest of any organization outside the federal government.
$369.5M / $226M	The Heart Association now earns more from CPR training ($369.5M a year) than it spends on research ($226 million, about 18% of expenses). Total revenue is $1.36 billion.
22M / year	People trained in CPR each year by the Heart Association, with a goal to roughly double survival from cardiac arrest outside hospitals, from about 10% to 20% by 2030.
1M+ / 16,000	Students and schools that take part in the Kids Heart Challenge each year. The program has raised $1.8 billion for the Heart Association since 1978.
611.5M	Wearable devices shipped worldwide in 2025. The Apple Watch added high-blood-pressure detection, cleared by the FDA, in September 2025.
~5M / $1.1B	Oura's paid members (2026) and Whoop's yearly revenue (2025, more than double the prior year). Consumer-health companies now operate at the scale of major institutions.
$10.5M	The Heart Association's artificial-intelligence research grants in 2025, a small fraction of what a single consumer-health company raises in one year.

The Science Is the Heart Association's. The Surface Belongs to Someone Else.

The shift is permanent

What we looked at, and what we left out

We looked at the shape, not the scoreboard

A starting point

The mandate, and its boundary

Four shifts that make this analysis matter now

Prevention has overtaken treatment as the thing people buy

People now manage their own health, day to day, on their own devices

Trust in health institutions has fallen sharply, and fast

Health has become a household expense people actively manage

Ten anchors for the decade ahead

What the public conversation is built from, and where it has holes

Five findings, in plain language

The science stops at the doctor's door

Women read their hearts on screens the Heart Association is not on

Heart disease is explained as a diagnosis, never as a household cost

Respect has not turned into daily trust

The youngest women, most at risk, have drifted the furthest

The cost of leaving these open

The relationship forms without the institution in it

The upstream story gets told by someone else

The economic conversation happens at tables the institution never sits at

Admiration without presence becomes irrelevance in slow motion

The science becomes a public good that others monetize

Who the Heart Association competes with now

Nineteen organizations, one field of attention

The whole deficit sits in one measure

Five moves, ordered by what moves the score most

Become a daily presence, not an annual campaign

Put the Heart Association's seal on the wrist and the lab result

Speak the language of cost

Build the Heart Association's own guide for women

Turn the school program into a lifelong relationship

How the moves sequence

A sixty-day working window

A working session with the digital team

An introduction to the device and lab companies

A handful of school sites

When the next 25-year-old woman with chest pain walks into an emergency room, what does the Heart Association want her to walk in carrying?

Appendix

A plain glossary

Disclosure

Method note

Selected public sources