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Prevention Works:
CDC Strategies for a Heart–Healthy and Stroke–Free America
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"Prevention Works: CDC Strategies for a Heart–Healthy and Stroke Free
America" provides a snapshot of heart diseases and stroke
prevention at the Centers for Disease Control and Prevention. It also provides information on the health and economic
costs of chronic diseases to our nation and outlines CDC's prevention
strategies.
CDC's Heart Disease and Stroke Prevention Program, with annual appropriations
of approximately $45 million, is CDC's focal point for heart disease and stroke
prevention. This booklet describes the central strategies of that program which
include a focus on controlling high blood pressure and cholesterol, recognizing signs and
symptoms of heart attack and stroke, improving emergency response, improving
quality of care, and eliminating health disparities between population groups.
Heart disease and stroke outcomes are also related to healthy eating, physical
activity and tobacco use, as well as diabetes and obesity. Therefore, the Heart
Disease and Stroke Prevention Program collaborates across CDC to coordinate
units and programs that specifically address these issues, to improve overall
cardiovascular health in the United States.
Please visit the CDC website on heart disease and stroke prevention at
http://www.cdc.gov/dhdsp/. Among the many
topics covered are:
- Summary of the states' heart disease and stroke prevention programs
- Data by county
- Other publications on cardiovascular health
- Fact sheets
- A Public Health Action Plan to Prevent Heart Disease and Stroke
Health and Economic Costs of Heart Disease and Stroke:
Cardiovascular Disease (CVD)
A National Tragedy
- In the United States, heart disease and stroke are the 1st and 3rd leading killers.
More than 100 people die of these diseases every hour.
- Over 71 million Americans have some form of cardiovascular disease (CVD).
- CVD is the leading cause of health–related disparities.
Disabling
- Heart Disease and stroke are among the leading causes of disability.
- Heart Attack: 66% of victims never fully recover.
- Stroke: Many survivors cannot perform daily tasks; 20% will
require institutional care.
Costly
- $403 billion will be spent in 2006 ($258 billion in health care
costs; $146 billion in lost productivity).
- Medicare: CVD hospitalizations cost $30 billion in 2002.
Heart disease is the leading hospital diagnosis.
Growing
- 90% of middle–aged Americans will develop high blood
pressure in their lifetime; 70% who have it now do not have it
controlled.
- Unless prevention and control initiatives are escalated,
there will be an increase in Americans who die of heart disease
and stroke or a sharp rise in the number of survivors with dependency.
Prevention Works:
Priorities of CDC's Heart Disease and
Stroke Prevention Program
- Control high blood pressure
- Control high cholesterol
- Know signs and symptoms, call 9–1–1
- Improve Emergency Response
- Improve quality of care (prevent first and second events; control
risk factors and the diseases)
- Eliminate disparities
Prevention and disease control can reduce heart attacks and strokes,
deaths from these diseases, and the disability suffered by heart disease and
stroke survivors.
Prevention Opportunities
Control High Blood Pressure
- A 12 to 13 point reduction in systolic blood pressure can
reduce heart attacks 21%, strokes 37%, and total cardiovascular
deaths 25%.
- 65 million people have high blood pressure; an additional 59 million are
pre–hypertensive.
- 70% of people with high blood pressure do not have it under
control.
Control High Cholesterol
-
A 10% decrease in total cholesterol levels may reduce the
incidence of coronary heart disease by approximately 30%.
-
In 2003, nearly 100 million people were told they had total
blood cholesterol levels of 200 mg/dl or higher.
-
Over 80% of people with high blood cholesterol do not have
it under control.
Know Signs and Symptoms, Call 9–1–1
-
More than half of Americans don't know the symptoms!
-
Stroke: 17% of the public recognizes the major warning
signs of a stroke and know to call 9–1–1.
-
Heart Attack: only 11% of the public recognize the signs and
symptoms of a heart attack and know to call 9–1–1.
Improve Emergency Response
-
Only 3%–8% of eligible stroke victims get the emergency
thrombolytic therapy that can lead to recovery.
-
47% of heart attack deaths occur before an ambulance arrives.
-
48% of stroke deaths occur before hospitalization.
Improve Quality of Care
-
Prevent first and second events; control risk factors and
diseases.
-
Expand the use of guidelines, reminder systems, preventive care,
the chronic care model, patient databases, and behavioral
counseling.
Eliminate Disparities
-
27% of the black–white life expectancy gap is due to
heart disease, and 8% due to stroke.
-
Only 18% of Hispanics have their high blood pressure under
control, compared with 30% of whites.
-
In 2002, age–adjusted death rates for heart disease were 30%
higher for African Americans than for whites, and stroke death
rates were 41% higher.
CDC's National Reach
Fiscal Year 2005 Funding for State Heart Disease and
Stroke Prevention Programs
[A
text version of
this graphic is also available.]
CDC Funds Heart Disease and Stroke Prevention Programs in
State Health Departments...
- ...and provides guidance for these programs. States are funded at two levels:
capacity building (approximately $350,000 per state) and basic
implementation (approximately $1.25 million per state). In
fiscal year 2005, CDC funded 32 states and the District of Columbia
(14 for basic implementation and 19 for capacity building).
CDC Funds Regional Stroke Networks...
-
...to increase stroke awareness and prevention activities across state
boundaries, and enhance prevention efforts of state heart disease and
stroke prevention programs. These networks include Tri–State (North
Carolina lead; includes Georgia and South Carolina), Great Lakes
(Illinois lead; includes Indiana, Michigan, Minnesota, Ohio, and
Wisconsin), and Delta States (Alabama lead; includes Arkansas,
Louisiana, Mississippi, and Tennessee).
CDC Also Funds the Paul Coverdell National Acute Stroke
Registries...
-
...in Georgia, Illinois, North Carolina and Massachusetts.
Taking Action:
Examples from State Heart Disease and Stroke Prevention
Programs
Wisconsin: 21% Increase in Blood Pressure Control
-
Wisconsin worked with 20 health plans to collect Health Plan
Employer Data and Information Set (HEDIS) measures related to
cardiovascular health. Based on these data, health plans made
quality improvements for blood pressure control. Among
participating health plans, the percentage of patients who had
their high blood pressure controlled increased from 48% to 58%, a
21% relative increase.
South Carolina: Taking Local Action in African American
Communities
-
South Carolina worked in collaboration with local community partners
to promote heart health in African American communities. Several faith
organizations implemented specific policy and environmental strategies
appropriate to their needs that address high blood pressure, high
cholesterol, and tobacco use prevention.
Montana: Improving Emergency Response to Strokes
- When a stroke happens, calling 9–1–1 in time to prevent disability
or death depends on people knowing the signs of stroke. Montana has
launched a stroke signs public education campaign in the Great Falls
area. Montana is also working with local hospital and health systems,
a stroke task force, and local fire and ambulance services to improve
Emergency Medical Services and hospital response to stroke.
Improvements that get an ischemic stroke sufferer to appropriate
thrombolytic therapy within 3 hours can mean the difference between recovery
and long–term disability from stroke.
New York: Businesses Provide Employees With Heart Healthy Options
- New York assesses work sites using the "Heart Check" tool and
helps them make changes to promote their employees' heart health.
Between 1995 and 2004, approximately 639 participating work sites increased policy and environmental supports
for heart health. On average, work sites experienced a 62%
increase in these supports. Many
of these work sites are now making blood pressure screening available,
offering low–fat food choices, and instituting policies for smoke–free
workplaces.
Cardiovascular Disease Collaborative: State Heart Disease and
Stroke Prevention Programs Bring State of the Art Techniques in
Disease Management to Those Most in Need
- Approximately one–half of the 33 CDC–funded state heart disease
and stroke prevention programs participate in the CVD Collaborative
through which they support federally qualified health
centers (FQHCs) in their state to bringing state of the art techniques in
disease management and other public health expertise to those most in
need. Techniques such as patient data management systems and training
to improve blood pressure measurement have produced impressive
results. For example, among participating health centers during an
initial 9 month period, the percentage of people with hypertension who
have their blood
pressure controlled increased by 5 percentage points, and the number of
patients with coronary artery disease on aspirin or other antithrombotic
agents increased by 39 percentage points. The CVD
Collaborative, which builds on a similar diabetes model, is a
collaboration of Health Resources and Services Administration,
CDC, the Agency for Health Care Research and Quality, state CVD
programs, and FQHCs.
Prevention Strategies:
An Outline for States
Health Care Setting
- Promote policy, environmental, and system strategies to improve
quality of care. For example, promote the chronic care model and the
adoption of evidence–based guidelines in hospitals (e.g., Get with the
Guidelines [American Heart Association], Guidelines Applied to
Practice [American College of Cardiology]).
- Establish policies to treat stroke as an emergency in hospitals,
to provide immediate diagnostic evaluation and treatment within 3
hours, and to have a neurologist on call at all times.
- Provide education and public awareness on use of 9–1–1, emergency
medical services, signs and symptoms of heart attack and
stroke.
Work Site
- Provide health care coverage for employees and their families that
includes primary and secondary heart disease and stroke prevention
services as well as rehabilitation services.
- Promote adequate cost coverage/reimbursement for prescription
drugs required for primary and secondary prevention of heart disease
and stroke.
- Provide work site detection and follow–up services with employees
for control of blood pressure and cholesterol.
- Ensure employee training and education on signs and symptoms of
heart attack and stroke, Cardiopulmonary Resuscitation (CPR), and automated
emergency defibrillators.
- Assess policies and environmental supports for heart–healthy work
sites and provide education on strategies to enhance environments for
heart health.
Community
- Raise awareness of signs and symptoms of heart attack and stroke
through educational initiatives.
- Promote enhanced 9–1–1 services statewide.
- Promote emergency medical service training and protocols
related to heart attack and stroke.
- Promote the use of community guidelines.
- Promote policies, system changes, and educational opportunities
related to blood pressure and cholesterol management and the
importance of heart health.
School
- Raise awareness of signs and symptoms of heart attack and stroke,
and the importance of calling 9–1–1; implement awareness interventions
in the schools, and with related groups such as Parent Teacher
Organizations.
- Work with Coordinated School Health Programs to implement
curricula, consistent with state education standards, to increase
awareness among students regarding signs and symptoms of heart attack
and stroke and the importance of calling 9–1–1.
- Promote school–based CPR training for faculty, staff, and students
through after–school programs and extra credit opportunities.
- Implement policy–and systems–change interventions to address
employees' access to care and management of blood pressure and
cholesterol.
- Approach schools as work sites (see work site).
CDC Provides Tools and Services for the Nation
Standardization of Lipid Measurements
CDC's Lipid Reference Laboratory (LRL) (located in the National Center
for Environmental Health) ensures that all lipid and lipoprotein
measurements are reliable by standardizing measurements in laboratories
across the nation. Standardization is provided to labs participating in
longitudinal studies and clinical trials, clinical and hospital
laboratories, manufacturers of diagnostic products, and state public health
laboratories.
Sourcebook for Community Health Workers
The Community Health Workers' Heart Disease and Stroke Sourcebook
resource for training community health workers (CHWs) who work to increase
public knowledge about heart disease and stroke and help eliminate health
disparities. Topics include high blood pressure and regimens (including
medicines), communicating with doctors, diabetes, atrial fibrillation,
coronary heart disease, heart attack, stroke, heart failure, and the CHW's
role in supporting life–style changes and patient self–care is being
developed by the U.S. Department of Health and Human Services (including
CDC, the Health Service, and the Office of Disease Prevention and Health
Promotion), and the American Heart Association/American Stroke Association.
It will be available in 2006.
Business Tool Kit
CDC has developed the Cardiovascular Health and Business Tool Kit to help
employers assess which health benefits and work site health promotion
services can improve cardiovascular health and reduce disease, disability,
and costs associated with heart disease and stroke.
Communication Tool Kits
CDC currently provides two heart disease and stroke prevention
communication guides. CDCynergy 2001—Cardiovascular Health Edition
is a communication planning tool in CD–ROM format. To request a copy, e–mail
CDC at cdcinfo@cdc.gov. CDC also
provides a Communication Guide
for educating key constituencies about how to make changes in communities,
health care settings, work sites, and schools to promote cardiovascular
health, and how to increase public awareness of signs and symptoms of a
heart attack and stroke.
CDC Provides Data for Decision–Making
CDC's Paul Coverdell National Acute Stroke Registry Addresses the Issue
of Improving and Measuring Quality of Care for Stroke Victims in Hospitals
Four states (Georgia, Illinois, North Carolina and Massachusetts) are funded to implement state–based stroke registries. CDC's Paul
Coverdell National Acute Stroke Registry addresses this problem by improving
and measuring quality of care for stroke victims in hospitals. Stroke
affects an estimated 5.4 million Americans and their families and is a
leading cause of long–term disability in the United States. Although thrombolytic medications applied
within 3 hours of a stroke can
improve outcomes of ischemic stroke and can sometimes mean the difference
between recovery and long–term disability, only about 3–8% of eligible
patients receive this therapy.
CDC Tracks State and National Trends in Cardiovascular Health
CDC identifies and tracks trends in heart disease and stroke principally
using data from the National Health and Nutrition Examination Survey (NHANES)
and Behavioral Risk Factor Surveillance System (BRFSS), a unique data system
that provides state–specific data. For example, the number of people
reporting multiple risk factors for cardiovascular disease is on the rise.
Using BRFSS data, CDC recently identified a 10% or more increase in the
prevalence of multiple risk factors for cardiovascular disease (CVD) in 36
states from 1991 to 1999. This increase is seen in both men and women and in
all groups defined by race or ethnicity, age and education level.
* Risk factors included reported high blood
pressure, high blood cholesterol, current smoking, obesity and diabetes.
Although physical inactivity is an important factor, data were not available
for each year and thus, were not included.
Source: Greenlund et al. Archive Intern Med 2004;164:181–8
[A text version of
this graphic is also available.]
CDC's Heart Disease and Stroke Atlases Provide Local Data
and Identify Disparities
To address the serious racial, ethnic, and geographic
disparities in heart disease and stroke mortality, CDC has published a
series of atlases about heart disease and stroke. The atlases provide, for
the first time, an extensive series of national and state maps that
demonstrate local areas of need and show local differences in heart disease
and stroke death rates. Data are provided for men and women and for the five
largest U.S. racial and ethnic groups (American Indians and Alaska Natives,
Asians and Pacific Islanders, blacks, Hispanics, and whites.)
County–specific data and state maps are available at
http://www.cdc.gov/hdsp/library/maps/index.htm.
Heart Disease Death Rates, 1996–2000
Adults Ages 35 Years and Older, by County
Stroke Death Rates, 1991–1998
Adults Ages 35 Years and Older, by County
Discovering What Works: Prevention Research
CDC supports research to develop and evaluate effective
tools and strategies for use by prevention programs and others interested in
taking action to improve heart disease and stroke outcomes. Current research
areas include disparities between population groups, primary and secondary
prevention, policy and environmental strategies, emerging risk factors,
evaluation, health economics, global issues, and the public health impact of
human genome findings.
Spotlight: CDC is developing a Prevention Research
Center Network in Cardiovascular Health Intervention Research and
Translation to develop and implement prevention research activities that
emphasize cardiovascular health promotion.
Leadership and Collaboration
Cardiovascular Health Across CDC: Because of the
interrelation of heart disease and stroke outcomes with healthy eating,
physical activity, and tobacco use, as well as diabetes and obesity, the
Heart Disease and Stroke Prevention Program reaches out across CDC to coordinate units and
programs at CDC that address these issues and can help contribute to the
nation's overall cardiovascular health.
National Collaboration: As CDC works towards
achieving a heart–healthy and stroke–free America, the agency also collaborates closely
with other federal agencies, states, communities, national voluntary
organizations, and private–sector organizations with an interest in heart
disease and stroke prevention. Turning the tide to improve heart disease and stroke
prevention will require action from many sectors of society. CDC plays a
vital role in providing leadership for the prevention steps that our nation
can take.
Spotlight: The Healthy People 2010 Partnership
for Heart Disease and Stroke Prevention fosters national achievement of the
Healthy People 2010 goal for heart disease and stroke prevention,
which includes the prevention of risk factors, detection and treatment of
risk factors, early identification and treatment of heart attacks and
strokes, and a reduction in the number of recurrent cardiovascular events.
Together, CDC and its partners support and coordinate the partnership.
Participants include the American Heart Association/American Stroke
Association and six agencies and offices of the U.S. Department of Health
and Human Services: CDC, the Centers for Medicare and Medicaid Services, the
Indian Health Service, the National Institutes of Health's National Heart,
Lung, and Blood Institute and National Institute for Neurological Disorders
and Stroke, and the Office of Disease Prevention and Health Promotion.
A Public Health Action Plan to Prevent
Heart Disease and Stroke
A Public Health Action
Plan to Prevent Heart Disease and Stroke is a groundbreaking national
collaboration that will propel national prevention efforts. This plan
supports an integrated, comprehensive public health strategy that
encompasses two fundamental requirements (effective communication and
strategic leadership, partnerships, and organization) and five essential
components (taking action, strengthening capacity, evaluating impact,
advancing knowledge, and engaging in regional and global partnerships). The
National Forum for Heart Disease and Stroke Prevention, representing some 50
national and international organizations, serves as the vehicle for
implementing the Action Plan. The three lead partners are the
American Heart Association/American Stroke Association, the Association of
State and Territorial Health Officials, and CDC, which provides core support
for convening the national forum and implementing the Action Plan.
At the Third National Forum in April 2005, participants
built on the foundation of previous years by reviewing the plans and
accomplishments of the task groups in the seven priority areas. Participants
also laid the groundwork for adopting a long–term organizational structure
for the National Forum.
- Effective Communication: Establish a media task
force.
- Strategic Leadership, Partnerships, and Organization:
Convene public health agencies at national, state, and local levels.
- Taking Action: Commission a group to address priority
policies for heart disease and stroke prevention.
- Strengthening Capacity: Commission a group to define
infrastructure and staff competencies required for the full range of CVH
activities by state and local health agencies.
- Evaluating Impact: Bring key partners and
stakeholders together to address gaps in heart disease and stroke–related
data systems and convene a planning committee for a "watershed" conference
to address the science of evaluating public health programs for policy and
environmental change.
- Advancing Knowledge: Convene a group to address the
prevention research agenda for heart disease and stroke prevention.
- Engaging in Regional and Global Partnerships:
Establish a steering group to oversee assessment of U.S. policies directly
relevant to global heart disease and stroke prevention.
Back to Top Date last reviewed:
08/29/2008
Content source: Division for Heart Disease and Stroke
Prevention,
National Center for Chronic Disease Prevention and
Health Promotion |
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