Modifications to Objectives and Subobjectives

The following discussion highlights the modifications, including changes, additions, and deletions, to this focus area's objectives and subobjectives as a result of the midcourse review. In addition, to maintain consistency, several objectives and subobjectives were revised based on recommendations from the National Cholesterol Education Program (NCEP) or the latest research findings. All death rates in this focus area are age adjusted. However, for presentation, the phrase "death rate" is used instead of "age adjusted death rate."

Four objectives became measurable at the midcourse review. Objective 12-3, receipt of timely artery-opening therapy, was reworded and divided into two subobjectives: receipt of fibrinolytics within an hour of symptom onset (12-3a) and use of percutaneous coronary intervention within 90 minutes of symptom onset (12-3b). Bystander response to cardiac arrest (12-4) was reworded to reflect the proportion of the population trained in cardiopulmonary resuscitation (CPR) within the previous year, rather than those who call 9-1-1 and administer CPR for an out-of-hospital cardiac arrest. Although out of-hospital emergency care (12-5) was not measurable at the midcourse, a potential data source was identified for the objective.

Knowledge of the early warning signs of stroke (12-8) was reworded to include "calling 9-1-1." The change made the objective more consistent with the latest research that shows the benefits of transporting stroke patients to the hospital quickly for rapid treatment.⁴ Low-density lipoprotein (LDL) cholesterol level in CHD patients (12-16) remained developmental and was reworded based on recommendations from NCEP⁵ to state the target for LDL as "less than 100 mg/dL" instead of "less than or equal to 100 mg/dL."

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