Heart Disease and Stroke

General

1. It is important to get a flavor for comprehensiveness of each chapter. It was recommended that the Related Objectives be placed in the front of each chapter. Since there are so many objectives that may be relevant and are not included in the chapters, it is good to see them up front as "related objectives."
2. Better than the best discussion—these may not be achievable. It is not always straightforward. May need to reconsider some of them.

Specific:

1. Change term from "doctor" to "heath care providers" as there are many other disciplines that are involved with this issue. In many areas, access to physician is not possible, nurse practitioners and other health care providers are those who are interfacing with patients.
2. Since African American males are included as a select population breakout, what isn't African American females included as well in objective #8. In addition, consider adding gender select population breakouts for each race/ethnic group.
3. Information needs to be included on the proportion of people who arrive at medical care facility alive. In addition, information on brain attack awareness and time to treatment— administration of TPA—Refer to objective #15.

• Proportion of people who arrive on time "early enough to use it"

• 911 availability -brain attack

• TPA administration--wait beyond the three hours -closed window of opportunity

4. The text needs to discuss lack of utilization of known therapeutics that work for heart attacks such aspirin and beta blockers. Why are these not discussed?