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HEART DISEASE AND STROKE PREVENTION
Addressing the Nation's Leading Killers

At A Glance 2009

Heart Disease and Stroke: The Nation’s Leading Killers

Heart disease and stroke are among the most widespread and costly health problems facing our nation today, yet they are also among the most preventable. Cardiovascular diseases, including heart disease and stroke, are the first and third leading causes of death for both men and women in the United States. They account for more than one-third (35.3%) of all U.S. deaths. More than 151,000 Americans who died of cardiovascular diseases in 2005 were younger than age 65. Heart disease and stroke are also among the leading causes of disability in the U.S. workforce, with nearly 1 million people being disabled from strokes alone. If all major types of cardiovascular disease were eliminated, U.S. life expectancy would increase by nearly 7 years.

The Costs of Disease Are Staggering

The burden of heart disease and stroke cannot be measured by death statistics alone. The cost of heart disease and stroke in the United States, including health care expenditures and lost productivity from deaths and disability, is projected to be more than $475 billion in 2009. As the U.S. population ages, the economic impact of cardiovascular diseases on our nation’s health care system will become even greater.

Overall, death rates for heart disease and stroke have decreased in the United States in recent decades. However, rates for incidence and death continue to be disproportionally high among some populations, including members of certain racial and ethnic groups, people with low socioeconomic status, and those living in the southeastern United States.

For example, age-adjusted death rates for heart disease are 32% higher among African Americans than among whites. The incidence of coronary heart disease among American Indians and Alaska Natives is nearly double the incidence among the general U.S. population. The risk for first-ever stroke is nearly twice as high for African Americans than it is for whites. In addition, about 55,000 more women than men have a stroke each year.

[A text description of this chart is also available.]

Prevention Saves Lives and Money

Leading a healthy lifestyle—not using tobacco, being physically active, and making healthy food choices—greatly reduces a person’s risk of developing heart disease or stroke. Preventing and controlling high blood pressure and high blood cholesterol also play a significant role in cardiovascular health. For example, a 12–13 point reduction in systolic blood pressure can reduce heart disease risk by 21%, stroke risk by 37%, and risk for death from heart disease or stroke by 25%. Public health strategies and policies that promote healthy living, encourage healthy environments, and promote control of blood pressure and cholesterol levels are key to improving the public’s health and saving lives. Ensuring that all Americans have access to early, affordable, and appropriate treatment is also essential to reducing disability and costs.

CDC’s Response

Several CDC divisions, including the Office on Smoking and Health, the Division of Nutrition, Physical Activity and Obesity, and the Division of Diabetes Translation, are working to prevent risk factors for chronic disease. Through the Division for Heart Disease and Stroke Prevention, CDC translates prevention research into public health practice and provides national and state leadership to help reduce the burden of heart disease and stroke. CDC has funded heart disease and stroke prevention programs in the United States since 1998.

With $50.1 million appropriated in Fiscal Year 2008, CDC funded health departments in 41 states and the District of Columbia to conduct heart disease and stroke prevention programs; six states were funded to implement Paul Coverdell National Acute Stroke Registry programs. CDC also funds national data collection, applied research, and evaluation initiatives. CDC’s work is grounded in goals and strategies set forth in Healthy People 2010, the Division for Heart Disease and Stroke Prevention’s strategic plan, and the landmark publication A Public Health Action Plan to Prevent Heart Disease and Stroke.

National Heart Disease and Stroke Prevention Program

CDC-funded state programs promote policy and systems changes in health care, work site, and community settings. These programs also work to

• Increase awareness of the warning signs and symptoms of heart attack and stroke and the importance of calling 911 immediately.
   
• Improve emergency response and quality of care.
   
• Eliminate health disparities among racial and ethnic minority populations.

Paul Coverdell National Acute Stroke Registry

CDC’s Paul Coverdell National Acute Stroke Registry program helps to improve the delivery and quality of care for acute stroke patients by identifying gaps between recommended treatment guidelines and actual hospital practices. CDC currently funds programs in Georgia, Massachusetts, Michigan, Minnesota, North Carolina, and Ohio.

In 2007, CDC partnered with the American Heart Association and The Joint Commission to develop performance measures for acute stroke care. These measures are now being used in all hospitals that participate in the stroke registry and an additional 1,200 hospitals across the country to improve the quality of care for acute stroke patients.

Cardiac Arrest Registry to Enhance Survival (CARES)

The Cardiac Arrest Registry to Enhance Survival (CARES) program is a database that consolidates essential data related to prehospital cardiac arrests in order to improve medical responses and health outcomes. The program began in 2005 in metro Atlanta and has since expanded to 15 cities, with nine added just in the past year. The goal is to create a national registry that helps local Emergency Medical Service (EMS) administrators and medical directors identify when and where cardiac arrests occur, what elements of their EMS system are functioning properly, and what changes can be made to improve outcomes.

In metro Atlanta, Grady EMS, a large-volume, hospital-based program, used CARES to identify weaknesses in its emergency dispatch process. This information led to changes designed to decrease delays in handling 911 calls. These changes, combined with a community-wide CPR training program, led to a significant increase in the cardiac arrest survival rate in Atlanta, from 12.5% in December 2006 to 31.2% in December 2007.

The federal Agency for Health Care Research and Quality (AHRQ) selected the CARES program to be part of its Health Care Innovations Exchange program, which highlights successes in health care quality improvement. The AHRQ program encourages health care professionals to share and adopt innovations
that work.

CDC Activities Support State Programs

In addition to funding state programs, CDC conducts the following activities to help prevent heart disease and stroke at state and local levels:

• Evaluation. CDC conducts evaluation research and helps states evaluate the effectiveness of prevention programs and policy and systems-level changes.
   
• Monitoring and Tracking Disease. CDC tracks data and trends in heart disease and stroke to help states make informed program decisions. For example, we recently helped develop a Chronic Disease Cost Calculator (http://www.cdc.gov/nccdphp/ resources/calculator.htm). This tool can provide estimates of state Medicaid spending for six chronic diseases—congestive heart failure, heart disease, stroke, hypertension, cancer, and diabetes.
   
• Training and Technical Assistance. CDC provides guidance and training to states on how to best apply evidence-based practices and develop effective programs.
   
• Translating Science into Practice. CDC interprets the science of prevention and translates it into practices and programs for states and communities.
   
• Partnerships. CDC builds partnerships with other federal agencies and national groups to promote policies and system improvements to prevent heart disease and stroke across the country. For example, we work with several federal agencies on the Healthy People 2010 Partnership and the Federal Interagency Committee on Emergency Medical Services.

Future Directions

In recent years, risk factors for heart disease and stroke, such as high blood pressure, obesity, and diabetes, have increased at alarming rates. To reverse this trend, CDC must continue to focus on improving the nation’s cardiovascular health. In 2009, CDC will work to help Americans control their blood pressure and reduce their sodium consumption. To achieve this goal, CDC is conducting research on sources of dietary sodium, disparities in dietary intake, and barriers to behavior change. CDC will work to increase public awareness of sodium’s effect on blood pressure and to promote national, state, and local strategies to reduce sodium consumption.

In addition, CDC will promote the need for better surveillance systems to capture the data critical to guide states and partners in policy development, program planning, and evaluation. CDC also will continue to work to eliminate health disparities among population groups at higher risk.

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Success Stories

Utah: Helping Residents Manage High Blood Pressure

Nationally, less than one-third of adults have their high blood pressure under control. The Utah Department of Health has partnered with two managed care organizations to improve blood pressure control among Utah residents. These efforts included development of a care model that served as the basis for continuing medical education for health care professionals throughout the state.

In addition, the Utah Heart Disease and Stroke Prevention Program distributed guidelines on how to manage high blood pressure to residents. It also developed self-management kits in English and Spanish in response to a need identified through focus groups with health care providers and patients with high blood pressure.

The kit includes tracking tools, an information guide, a video that explains what high blood pressure is and why controlling it is important, and a brochure that explains the DASH (Dietary Approaches to Stop Hypertension) diet.

The kits are distributed to health care providers and systems that serve priority populations, such as community health centers, Medicaid managed care plans, and other primary care networks for low-income residents.

As a result of these efforts, one of the managed care organizations reported that blood pressure control improved 47% among its overall membership in Utah from 2004 to 2007.

Tennessee: Helping Health Care Providers Improve Patient Care

In 2005, the Tennessee Department of Health’s Heart Disease and Stroke Prevention Program promoted the use of evidence-based guidelines for cardiovascular care to health care providers throughout the state. They gave current protocols and clinical decision-support tools to nurses and doctors working in state hospitals to help ensure that the care they provide to patients with coronary artery disease, stroke, and heart failure is in line with the latest scientific guidelines.

In 2008, three hospitals were recognized for achieving 85% adherence to all performance measures for acute care or prevention of coronary artery disease, stroke, or heart failure for 12 consecutive months. Six hospitals were recognized for achieving 85% adherence for 3 consecutive months.

[A text description of this chart is also available.]

Georgia: Atlanta Hospital Wins AHA Award

Georgia’s Paul Coverdell National Acute Stroke Registry implemented a plan and database to help improve the quality of stroke care in hospitals across the state. As a result, in 2008, the American Heart Association (AHA) awarded Atlanta’s Grady Memorial Hospital, which participates in the registry, with a silver award for achieving at least 85% adherence to nine performance measures for stroke care for 12 consecutive months.

Campaigns Increase Awareness

Increasing public awareness of the signs and symptoms of heart attack and stroke and the need to call 911 quickly will decrease death and disability from cardiovascular disease. The following examples show how three states are working to reach this goal.

New York: Campaign Increases Awareness Among State Residents

New York’s Healthy Heart Program launched a pilot campaign in Albany, Rensselaer, Saratoga, and Schenectady counties to increase awareness about the signs and symptoms of stroke. The program matched contributions from six area hospitals to fund the campaign’s television, radio, and public transit advertising components.

This campaign resulted in an 18% increase (from 42.7% in 2006 to 50.3% in 2007) in the number of people who arrived at hospital emergency rooms in less than 2 hours after experiencing the first symptoms of a stroke. It also resulted in a 13% increase (from 51.6% in 2007 to 58.5% in 2007) in the number of people arriving at hospitals by ambulance.

Massachusetts: Campaign Helps People Identify Stroke Symptoms

With state and federal funding, the Massachusetts Heart Disease and Stroke Prevention and Control Program created a public education campaign to increase awareness about the warning signs and symptoms of stroke. The campaign is called Stroke Heroes Act FAST (Face, Arms, Speech, Time). In a pilot test, about 94.4% of participants correctly identified three symptoms of stroke, and 76.4% identified all five symptoms. In a 3-month follow-up survey, 100% of participants correctly identified slurred speech and facial drooping as symptoms, 98.5% recalled arm weakness or numbness, and 97% said they would call 911 if they thought someone was having a stroke.

Arkansas: Radio and Internet Campaigns Raise Awareness

In November 2007 and February 2008, Arkansas launched radio campaigns to increase awareness about the warning signs and symptoms of heart attack and stroke. An Internet-based campaign also promoted the importance of knowing your cholesterol level because high blood cholesterol is a risk factor for heart disease and stroke.

The campaign reached more than 1.5 million radio listeners and another 639,000 people through the Internet. Surveys conducted before and after the 2007 campaign showed a 27.3% increase in knowledge of the signs and symptoms of heart attack and stroke among white residents in Arkansas. Among African Americans in the state, the increase was 37.2%.

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Related Materials

• Heart Disease and Stroke Prevention—At A Glance 2009 (PDF–3.7Mb)
• Heart Disease and Stroke Prevention—Success Stories (PDF–894K)
• CDCs Heart Disease and Stroke Prevention Web Site
• Preventing Heart Disease and Stroke
• State and Program Examples (93K–PDF)

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Page last reviewed: February 19, 2009
Page last modified: February 19, 2009
Content source: National Center for Chronic Disease Prevention and Health Promotion