State Program: Missouri
Basic Implementation

The Missouri Department of Health and Senior Services began receiving funds from CDC in 1998 to support a state heart disease and stroke prevention program. The program received increased funding for basic implementation beginning in 2000.

Burden of Heart Disease and Stroke

• Heart disease is the leading cause of death in Missouri, accounting for 16,708 deaths or approximately 30% of the state's deaths in 2002. (National Vital Statistics Report 2004;53(5)). 

• Stroke is the third leading cause of death, accounting for 3,885 deaths or approximately 7% of the state's deaths in 2002. (National Vital Statistics Report 2004;53(5)). 

• According to Behavioral Risk Factor Surveillance System (BRFSS) survey results, adults in Missouri reported having the following risk factors for heart disease and stroke:
  
  In 2005,
   
  • 27.3% had high blood pressure 
  • 38.7% of those screened reported having high blood cholesterol

  In 2006,
   

  • 7.4% had diabetes 
  • 23.2% were current smokers 
  • 62.9% were overweight or obese (Body Mass Index greater than or equal to 25.0)
  • 23.2% reported no exercise in the prior 30 days

State Highlights

• The Missouri Heart Disease and Stroke Prevention (MHDSP) program is collaborating with Federally Qualified Health Centers (FQHC) to impact the priority areas of controlling high blood pressure, controlling high cholesterol, improving quality of care, and eliminating health disparities. Currently 17 of Missouri’s 19 FQHCs are participating in a National Health Disparity Collaborative on diabetes and/or cardiovascular disease to strengthen the process of primary care to improve health outcomes for chronic conditions among the medically under and uninsured.
   
• As of December 2006, 21,853 Missouri patients were enrolled in the diabetes and cardiovascular collaboratives and entered into electronic registries for cardiovascular disease and diabetes. This represents a dramatic increase from the number of patients enrolled in Missouri’s collaboratives since September of 2003, when only 6,120 patients were enrolled. The FQHCs have not only increased the number of patients enrolled in the collaboratives but they have also been successful in making policy and protocol changes that improved clinical outcomes with many health centers, meeting or exceeding the measures and goals set forth by the National Health Disparities Collaborative (HDC).
   
• The state medical director for the Emergency Medical System (EMS) at the Department of Health and Human Services (DHHS) has collaborated with MHDSP to incorporate stroke and heart attack into a comprehensive approach to EMS, called the “Time Critical Diagnosis System.” This system seeks to develop a statewide coordinated approach to medical transport for ST-Segment Elevation Myocardial Infarction (STEMI), stroke, and trauma. An EMS pre-hospital stroke tool has been drafted and approved for distribution based on recommendations from the Statewide Stroke Committee, and collaborations with the American Heart Association, the DHSS EMS unit, the EMS State Advisory Council, and the Missouri Hospital Association (MHA). This is an easy and concise tool that helps EMS quickly assist suspected stroke clients.
   
• The Hospital Survey Summary Report was published by MHDSP in 2006 and provides the first statewide assessment of strengths and gaps in the current stroke system. A subsequent hospital assessment is planned for 2009. The Missouri Acute Stroke System Development Discussion is the companion piece and offers basic education about concepts of acute stroke system development and the potential that exists in Missouri due to the strong collaboration of MHDSP program and the Statewide Stroke Committee with the EMS medical director. Both reports were distributed as the Hospital Survey Summary Report to all Missouri hospitals, the Statewide Stroke Committee members, and to targeted stakeholders.
   
• The MHDSP and the Kansas Heart Disease and Stroke Prevention program (KHDSP) are collaborating with the Mid-America Coalition on Health Care (MACHC) in a unique public-private partnership to design a Community Initiative on Cardiovascular Health (CICV). Initial efforts are focused on a 14 county, bi-state Kansas City metropolitan area to develop a comprehensive model that can be replicated across both states in urban and rural areas and impact cardiovascular health and risk factors, especially hypertension and high cholesterol. This initiative builds upon the concepts contained in the CDC’s Successful Business Strategies to Prevent Heart Disease and Stroke toolkit and the MACHC’s nationally recognized Community Initiative on Depression, which has been cited by the Institute of Medicine (IOM) as the leading community approach to depression. The Initiative will address cardiovascular disease from a clinical, community, and local/state perspective. The collaboration has produced the following results:
  
  • The Community Initiative on Cardiovascular Health steering committee conducted a series of workshops with regional employer decision makers to present the business case for cardiovascular health and disease issues and to determine what extent employers were willing to participate in the CICV Initiative.
     
  • Fourteen employers are participating in the CICV initiative.
     
  • Follow-up meetings were held with each of the individual employers to design employer specific interventions that address high blood pressure, high cholesterol, physical activity, nutrition, and smoking cessation.
  
  
• Lead Public Health Agencies (LPHA) within local public health agencies are selected based on criteria including capacity to address chronic disease risk factors. The LPHAs are addressing both work sites using a Work Site Inventory program and communities using the Community Policy and Environmental Change program. Through these programs the LPHAs provide training and technical assistance to promote heart disease and stroke prevention priority policy and systems interventions.
   
• The Bootheel Heart Health Coalition and the Bootheel Tri-County Task Force have partnered with the MHDSP program to implement secondary prevention activities for heart disease and stroke in high-risk minority communities in Southeast Missouri. The Bootheel Tri-County Diabetes, Heart Disease and Stroke Prevention Task Force has partnered with three home health care agencies to educate employees and agency clients about the signs and symptoms of heart attack and stroke, recognizing stroke as an emergency, and the importance of immediately calling 9–1–1.
   
• The task force is also using local television, radio, and newspapers (with a potential to reach 160,000 residents) to promote heart attack signs and symptoms, and the importance of calling 9–1–1. These messages also emphasize that heart disease is the number one killer in Missouri and the individuals can take charge of their heart health.
   

For more information on heart disease and stroke prevention in the state, visit the Missouri Heart Disease and Stroke Program Web site at http://www.dhss.mo.gov/HeartDisease/.

To view county–level data, visit our interactive map site at http://www.cdc.gov/dhdsp/library/maps/statemaps.htm.

Page last reviewed: October 11, 2007
Page last modified: October 11, 2007
Content source: Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion