An e-bulletin created for healthcare systems working with patients to control their high blood pressure and/or manage theirprediabetes, diabetes, and/or high cholesterol.

March, 2019

Nutrition Monthwww.eatrightpro.orgDiabetes Association Alert DayMarch 26, 2019www.diabetes.orgDoctors’ DayMarch 30, 2019www.smaalliance.org

Cholesterol can be one of the most confusing health topics It’s really no wonder. A blood lipid profile yields a lot of daunting numbers tied to unwieldy technical terms like “low-densitylipoprotein” and “triglycerides.” It can be a challenge to understand how food, physical activity and family history influence those numbers. This confusion—and lots of misinformation from the internet and other sources—surely contributes to the fact that half of adults who could benefit from cholesterol-lowering medicines (statins) don’t take them. Recently, the American Heart Association and American College of Cardiology—along with a host of partners—released an update to the 2013 cholesterol management guideline. The new recommendations provide greater specificity about medicines and high-risk populations and continue to emphasize the importance of a lifelong, heart-healthy lifestyle and shared decision making. This collaborative approach can help each of us better understand our personal risk of a heart attack or stroke, the benefitsand risks that we may expect from medication, and how to tackle obstacles to healthy habits. And just in time to help you chart an active 2019 are the newly updated Physical Activity Guidelines for Americans. The bottom line is that all active minutes matter when it comes to health. Whether getting active to help manage cholesterol or blood pressure, to quit smoking or just to have fun, start taking those small steps today toward a healthier tomorrow.—Janet Wright, MD, FACC Executive Director, Million Hearts®

Quick FactAbout 3 in 10 American adults, or 71 million people, get less than 10 minutes of exercise a week, a major risk factor for cardiovascular disease (CVD). Learn more, including strategies to create change while earning a continuing medical education credit from Medscape.

The Center for American Progress has published an issue brief, Public Policies Promoting Healthy Eating and Exercise: Evaluating the Relationship Among Income, Obesity, and Life Expectancy. The brief examines the relationship between income, obesity, exercise and life expectancy, and looks at federal, state and local policies that may be effective in promoting healthy eating and exercise, including case studies from Baltimore, MD and Boulder, CO. "From increasing access to whole, fresh foods to encouraging increased physical activity, public health officials across the nation are employing creative approaches to boost the health of their communities."

Neighborhoods with more green space may mean less heart diseasePeople who live in neighborhoods with more green spaces may have better blood vessel health and lower levels of stress, and a lower risk of cardiovascular diseases such as heart attacks, strokes and others.

Public Health WeekApril 1-2, 2019www.nphw.orgWorld Health Daywww.who.int/world-health-day/enPatient Experience Daywww.theberyinstitute.org

ABCS are continued on the next page…

Priority: Keeping People Healthy

Priority: Optimizing Care

Do This!Get a sense of the national scope of the Million Hearts® Hypertension Control Challenge. Check out this map of winners: Is there a champion near you? The next application cycle opened in February, so take action for your chance to get on the

map! See a Map of the Champions

New Physical Activity Guidelines encourage people to “Move Your Way”The Department of Health and Human Services’ Office of Disease Prevention and Health Promotion recently updated the Physical Activity Guidelines for Americans. To learn about the recommendations, read and share these engaging campaign materials, including fact sheets, videos and tools. Share “Move Your Way” Materials

Sodium and ChildrenNearly 9 in 10 U.S. children eat more sodium than recommended1 and about 1 in 9 children has raised blood pressure, a major risk factor for heart disease and stroke. Lowering sodium in children’s diets can help lower blood pressure and may prevent heart disease later in life. Learn how to lower sodium in children’s diets to help lower blood pressure and prevent heart disease later in life.

Bloomberg: E-Cigarettes May Lead To Cancer And Heart Disease, New Study Finds

E-cigarette users are possibly putting themselves at risk for developing heart disease, lung and bladder cancers, according to a new report. The findings, though preliminary, indicate that the devices—which aerosolize nicotine and contain no tobacco—may not be as safe as previously assumed. The study, conducted by researchers from the New York University School of Medicine, exposed mice to e-cigarette smoke (ECS) for 12 weeks at a dose and duration equivalent to light e-cigarette smoking for 10 years in humans. By the end of the trial, the smoke had caused DNA damage in the animal’s lungs, bladders and hearts, as well as limiting lung proteins and important DNA repair. (Wolf, 1/29)

Training Opportunity: Aspirin and Cardio-prevention in 2018: A New Solution to an Old Problem CME/ABIM MOC

American Heart Association and The Joint Commission Merge Cardiac Certification Programs

The new certification program for hospitals began on January 1, 2019

Tips to remind patients with high blood pressure this cold and flu season.

--Before using an over-the-counter cold and flu medication check to see if it contains a decongestant, as they may raise

blood pressure.

--Use the American Heart Association’s medication chart and the CCC Tracker to enter and track your blood pressure

readings overtime.

Mediterranean Diet Linked to Drop in CVD RiskAdherence to the Mediterranean diet (MED) is associated with a 25% reduction in the risk for cardiovascular disease (CVD),

compared with those who do not follow this diet, new research suggests.

Priority: Improving Outcomes for Priority Populations:

American College of Cardiology offers free webinars for clinicians on cardiac rehabilitation.Five webinars—each about one hour long—provide training and resources, including information about regulations and unique considerations for certain conditions, for clinicians who currently lead or want to launch cardiac rehabilitation (CR)

programs. Watch the CR Webinar Series

Get the skinny on cholesterol management from Million Hearts®

Million Hearts® has a new web page on cholesterol, treatments, and the risk of heart disease and stroke. You will also find many resources for clinicians and patients, including a new plain language explanation of statins, “The Scoop on Statins.”

Explore the Cholesterol Page

Task force releases clinical consensus on strategies to help patients quit tobacco(J Am Coll Cardiol) The American College of Cardiology (ACC) develops a wide range of policy documents to provide members with guidance on clinical topics. Although clinical practiceguidelines remain the primary mechanism for offering evidence-based recommendations, such guidelines may contain gaps in their guidance regarding clinical decision making, particularly when equipoise is present in a topic. Expert Consensus Documents are intended to provide guidance for clinicians in areas where evidence may be limited, new and evolving, or lack sufficient data to fully inform clinical decision making.

GirlTrek encourages black women to improve health by walkingBlack women are disproportionately affected by preventable heart disease, and two-thirds of black women do not engage in leisure time exercise. GirlTrek is working to raise awareness and encourage more women to walk while wearing "superhero blue" to show their support for the cause. The Chronicle of Philanthropy (7/13)

Heart Attacks Can Strike Young Adults, So Know the Signs

Take marathoner Angela Parker who, at just 22, experienced a heart attack while on a trip through Africa. So young at the time, doctors brushed off her symptoms as the flu. Or Joseph Collins, a teenage baseball player who collapsed 10 years ago while running wind sprints with his high school teammates. His coaches stood silently as they watched the then 14-year old fall to the ground failing to act because they thought his tumble was a result of his workout.Psychological distress may increase odds of heart troubleUK and Australian researchers found that women ages 45 and older with high or very high levels of psychological distress were 44% more likely to have a stroke and 18% more likely to have a heart attack, compared with those with low levels of psychological distress. The findings in Circulation: Cardiovascular Quality and Outcomes also showed a 30% increased likelihood of heart attack among men ages 45 to 79 with high or very high psychological distress, but the association was weaker among those ages 80 and older. CTV (Canada)/Relaxnews (8/28), Medical News Today (8/28)

Survey: Many adults with stroke symptoms do not seek helpData showed about 35% of people have experienced symptoms of a transient ischemic attack, or ministroke, but just 3% called 911 for immediate medical help, according to a study from the American Heart Association and the American Stroke Association. The survey of more than 2,000 adults found 77% were not familiar with a TIA. HealthDay News (5/1)

Type 2 Diabetes Could Be a Cause of Erectile DysfunctionType 2 diabetes may be a causal factor in the development of erectile dysfunction (ED), with insulin resistance a likely mediating pathway, results of a large-scale genomic analysis suggest. The data also uncovered a genetic locus linked to ED.

Intensive weight-loss program helps prediabetes patients lose weightSeventy-nine percent of adults with prediabetes had a weight loss of at least 8% after an initial two-month intensive weight loss program using low-calorie meal substitutes, while 96% of those who remained in the study over three years did not develop type 2 diabetes and 22% no longer had prediabetes. The findings were based on a cohort of 2,326 adults, ages 25 to 70, and presented at the European Association for the Study of Diabetes annual meeting. Medscape (free registration) (10/17)

2019 Standards of Medical Care in Diabetes

Every year, the American Diabetes Association releases the "Standards of Medical Care in Diabetes" to provide clinicians, patients, researchers, payers and other interested individuals with the components of diabetes care, general treatment goals and tools to evaluate the quality of care. The American Diabetes Association 2019 Standards of Medical Care in Diabetes "emphasize a patient-centered approach that considers the multiple health and life factors of each person living with diabetes," said Dr. William Cefalu, the ADA's chief scientific, medical and mission officer. Published in Diabetes Care, the updated standards include new lifestyle management recommendations, management guidance for new-onset diabetes among youths with overweight or obesity, new goals for shared decision-making between provider and patient, and a new treatment algorithm for insulin therapy. Healio (free registration)/Endocrine Today (12/17)

Are Vegetarian and Vegan Diets Best for Diabetes?This resource is an edited, translated transcript of a video commentary by endocrinologist-nutritionist Boris Hansel, MD, an obesity management specialist who practices in Paris, France.

Addressing Healthcare Disparities in Heart DiseaseThis interactive course examines the work on disparities from the trailblazing research that gave birth to the Office of Minority Health in 1986 to recent contributions. It evaluates the role that cultural humility and cultural curiosity can play inimproving patient outcomes, and analyzes health outcomes of cardiovascular patients affected by stroke, atrial-fibrillation (AFib) and venous thromboembolism (VTE), who frequently access the safety net. Visit bit.ly/ahadisparities to learn more.This activity offers continuing education credit for physicians, nurses and pharmacists, as well as ABIM MOC points and ethics credit. The development of this activity is supported by an independent grant from the Bristol-Myers Squibb Foundation.

Know Diabetes by Heart - Patient EducationMore than 30 million American adults have diagnosed or undiagnosed diabetes, putting them at risk for having cardiovascular disease (CVD). The American Heart Association and the American Diabetes Association launched Know Diabetes by Heart™ to reduce cardiovascular deaths, heart attacks and strokes in people living with type 2 diabetes (T2D):Listen to the podcast series with up-to-date standards of care, guidelines and their implications for T2D and CVD, and approaches to shared decision making — among other topics. Improve your patient’s outcomes starting today!Download the health care provider discussion guide and other resources at KnowDiabetesbyHeart.org.

Emerging CVOT Data from AHA 2018 CMEAre Higher Omega-3 Levels Linked to Healthier Aging? CME / ABIM MOC / CEUpdates in Diabetes-Related Hypoglycemia CME / ABIM MOC

Automation in EHR SystemsAutomation can help improve the ordering process within EHR systems for physicians and enrich EHRs, leading to enhanced patient care and reduced physician frustration, writes Josh Gluck, a vice president at Pure Storage. Gluck notes that automation is also used to adjust staffing in health systems and generate bills more quickly.HealthTech (6/11)

8-oxo-2'-dG tied to all-cause, CV mortality in diabetes, study findsResearchers used a cohort of 3,766 type 2 diabetes patients from the ADVANCE trial and found those with higher levels of 8-Oxo-2'-deoxyguanosine were at an increased risk of dying from cardiovascular disease and all causes. The findings in the Journal of the American Heart Association found no association between 8-oxo-2'-dG levels and nonfatal myocardial infarction, nonfatal stroke or non-CVD death. Endocrinology Advisor (7/26)

Evaluate your practice from the perspective of a patientMedical practices that want to better meet the needs of patients should examine their procedures, writes consultant Owen Dahl, including redundant questions on paperwork, overscheduling, lunchtime availability and proper screening for genuine emergencies. Dahl suggests clinicians evaluate their own visits to medical offices to see what works and what doesn't from the patient perspective. Physicians Practice magazine online (1/10)

Researchers use EHR data, machine learning to predict mortality riskA machine learning algorithm that uses EHR data was developed by researchers from the University of Minnesota to help predict one-year mortality risk of seriously ill patients, according to a study in the Journal of General Internal Medicine. "The hope is when a patient is leaving the hospital, the physician will get a notification that the patient is high risk and needs those specific conversations and care, which would empower patients to make more informed decisions regarding their medical care," said Dr. Nishant Sahni, an adjunct assistant professor at the University of Minnesota Medical School. Health Data Management (free registration) (7/10)

New AMA policy aims to institute EHR training for medical studentsThe American Medical Association adopted a policy that would require medical schools and residency programs to provide training for EHR systems to future physicians. "There is a clear need for medical students to have access to -- and learn how to properly use -- EHRs well before they enter practice," said AMA board member Karthik Sarma. Healio (free registration) (6/13)

EHR adoption tied to lower mortality over time, study findsResearchers found an association between baseline EHR adoption and 0.11% higher 30-day mortality rate per function, but as baseline functions matured over time, EHR adoption correlated with a 0.09% lower rate of mortality per function per year. The findings, published in Health Affairs and based on data collected between 2008 and 2013 from 3,249 hospitals, showed a 0.21% reduction in mortality rate per year per function over the study period for every new EHR function adopted. Becker's Health IT & CIO Report (7/10)

Potential Policy Approaches to Address Diet-Related DiseasesThe plan, published as a Viewpoint in the Journal of the American Medical Association, calls for reducing sodium in packaged foods, taxing sugar drinks, instituting front-of-package nutrition labeling, providing subsidies for low-income people to buy healthy food and other health-promoting measures. Dietary factors were associated with more than 529,000 deaths in 2016 in the United States, making them the leading risk factor for mortality, according to the authors, citing the U.S. Burden of Disease Collaborators.

The Centers for Disease Control and Prevention's (CDC) Morbidity and Mortality Weekly Report highlighted new guidelines from the American Academy of Pediatrics that changed the criteria for diagnosing hypertension amongst youth.

Free resource for your patients living with type 2 diabetesOrder copies of "Where Do I Begin?" and use this great resource for your patients newly diagnosed or living with type 2 diabetes. Get started and order copies.

The Iowa Department of Public Health -- Health Promotion and Chronic Disease Control Partnership

Terry Y. MeekHealth Systems Coordinator

terry.meek@idph.iowa.gov

Laurene HendricksLinkage Coordinator

laurene.hendricks@idph.iowa.gov

Editors:

This e-Bulletin is supported by Cooperative Agreement Number 5U58DP006514-01-00 from the Centers for Disease Control and Prevention. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the Centers for Disease Control and Prevention or the Iowa Department of Public Health.

Remote Clinical Pharmacy Services: Gain real-time access to a clinical pharmacist in your practiceWant help improving patient outcomes and performance measures? Centralized Healthcare Solutions (CHS) is a team-based care approach utilizing clinical pharmacists to address chronic conditions and prevention services right here in Iowa. CHS supports primary care providers (PCPs) with comprehensive disease management and achievement of key performance measures. CHS clinical pharmacists communicate with each patient via telephone, email, text message or virtually face-to-face. Unlike other medication therapy management services, CHS clinical pharmacists have access to the patient’s EMR, allowing for individualized and immediate recommendations to the PCPs. This model has been successfully tested in two rigorous randomized controlled trials. Learn more by visiting our website at https://uiowa.edu/chs/

Research: Individualized physician-patient communication key in diabetes careA study in the Annals of Family Medicine showed that communication between primary care physicians and patients plays an important role in providing diabetes care, and researchers suggested that providers offer patients information relevant to their experience. New Zealand researchers analyzed interactions between 32 patients with newly diagnosed diabetes and their healthcare providers via video for six months and found many discussions were out of context or not relevant to the patient's situation or needs. Healio (free registration) (1/9)

Apple unveils new health app feature to transfer medical recordsThe New York Times (1/24/18, Singer, Subscription Publication) reports that Apple unveiled a new feature as part of its Health app that will allow “users to transfer clinical data,” such as physician-prescribed medications or cholesterol levels, “directly from their medical providers to their iPhones.” So far, 12 U.S. medical institutions including Johns Hopkins Medicine and Cedars-Sinai “have agreed to participate in the beta version of the new feature,” which will be opened to users on Thursday. The Times says this is the latest indication of “how focused Apple is on using its iPhone, Apple Watch and apps to give people more control over their health care.” The Washington Post (1/24/18, Johnson) reports that “Apple has worked with three vendors of electronic medical records for the first wave of its apps: Epic, Cerner and AthenaHealth,” and that additional “hospitals and other electronic health vendors will be able to join in coming months.” TIME (1/24/18, Ducharme) reports that as part of the new Health Records feature, “information will be transmitted electronically from participating providers to patients’ phones.” Users will need “to opt in to the service through the Health app.”

Med Ed News » Turning up the heat in the kitchen to lower BP in practiceMost medical schools are not focused on teaching their students about cooking, but that is starting to change. With the growing importance of lifestyle change in the management of hypertension and other chronic diseases, Tulane University School of Medicine is not only teaching their medical students about nutrition, but how to cook. Read more at AMA Wire.

Health News » Don’t get stumped when patients ask for nutrition adviceAs patients stream into your office motivated to eat more healthfully in 2018, a new series of online courses can prepare you to help them make the nutritional changes needed to prevent—and help treat—heart disease, diabetes and high blood pressure. The AMA is partnering with the suburban Chicago-based Gaples Institute for Integrative Cardiology—a nonprofit focused on enhancing the role nutrition and lifestyle changes play in healthcare—to provide physicians with a new, three-hour online nutrition course for clinicians. Read more at AMA Wire.

WellCare CEO calls on industry to tackle social determinants of health WellCare Health Plans CEO Ken Burdick urges

the entire medical community to work together to better integrate social determinants of health into healthcare delivery.

WellCare launched a program in 2011 that connects members in need with local, community-based public assistance

programs that tackle social determinants of health, and the program was associated with lower emergency care, inpatient

and outpatient spending, Burdick writes. U.S. News & World Report (6/14)