Opportunities and Challenges

A Public Health Action Plan to Prevent Heart Disease and Stroke³⁷ highlights the urgent need for action regarding heart disease and stroke prevention and provides targeted recommendations and specific steps toward achievement of this goal. The plan incorporates Healthy People 2010 objectives and addresses seven action areas: establishing effective communication; providing strategic leadership, partnership, and organization; taking action; strengthening capacity; evaluating impact; advancing knowledge through prevention research; and engaging in regional and global partnerships.

One of the emerging areas of opportunity for the stroke care community is the implementation of guidelines for both primary and comprehensive stroke centers developed by the Brain Attack Coalition.^{38, 39, 40} Many institutions are beginning to adopt these recommendations, but data on their success in improving the delivery of thrombolytic agents and patient outcomes are still limited. In particular, additional studies are needed to demonstrate the impact of implementing these recommendations on long-term disability from 3 months after onset to death.

Get With The Guidelines (GWTG) is a hospital-based quality improvement program for the American Heart Association and the American Stroke Association.⁴¹ The GWTG program provides tools to help health care provider teams to consistently treat patients by following the most updated treatment guidelines. Currently, GWTG targets coronary artery disease, stroke, and heart failure. The program seeks to leverage the teachable moment—when patients are most likely to listen to and follow their health care provider's guidance: immediately after a patient has had an acute event. GWTG incorporates a multidisciplinary approach to risk-factor management and encourages collaboration among cardiologists, neurologists, primary care physicians, nurses, pharmacists, and patients. It provides resources to build consensus and optimize treatment protocols.

Successful Business Strategies to Prevent Heart Disease and Stroke is a toolkit for the State Heart Disease and Stroke Prevention Programs to build partnerships and collaborations with employer groups.⁴² The package helps to educate employers about how evidence-based health benefits, health care systems, and workplace interventions can affect heart disease and stroke prevention among employees.

"Act in Time to Heart Attack Signs" is an educational campaign that raises awareness about the importance of early recognition and response to heart attack symptoms, with the goal of limiting heart damage and promoting survival through timely evaluation and treatment.⁴³ Key campaign messages emphasize knowing the common heart attack symptoms, calling 9-1-1 within 5 minutes of when symptoms begin, and working with a physician to create a heart attack survival plan.⁴³

To date, States have lacked data based on actual measurements to monitor high BP or cholesterol objectives. In 2005, a few States launched demonstration models of a State cardiovascular health examination survey.⁴⁴ The purpose is to develop the capacity of a State program to collect BP, blood cholesterol, and other relevant information; compare data between priority populations and the public; and provide guidance to other States to develop, implement, and evaluate health promotion and risk-factor control strategies. In addition, States are establishing statewide Paul Coverdell National Acute Stroke Registries to monitor and improve stroke care quality in acute care hospitals.⁴⁵

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