Heart and Stroke Healthy Community

Improving heart and stroke health

a community at a time

May 14, 2009

Heart and Stroke Healthy Community Steering Committee

Lucinda Bryant, PhD – Co-chairMori Krantz, MD – Co-chair

Cassie Bair (AHA/ASA)Erin Bertoli (AHA/ASA)* Thea Carruth (CCGC)* Jennifer Dunn, (CRHC)* Sally Foland (Kaiser Permanente)Michelle Hubbard-Pitts (AHA/ASA)* Laurie Konsella, (HHS – Region VIII)* Susan Moyer (Jeffco Health)

Koral O’Brien (CDPHE)*Merrilee Phillips (HealthOne)Andrea Ponies (CDPHE)* Robin Rice (AHA/ASA)Mario Rivera (CDPHE)Laurie Scott (CDPHE)Sara Tobin (AHA/ASA)* Kris Wenzel (AHEC)

* Meeting planning group

Thank you to…..Indira Gujral DataMario Rivera DataRuth Ayala Copy, stuff, notebookSusan Gantt Fiscal stuffLaurie Scott Patience & hard work

Thank you to….. Barbara Boner & Novartis

Pharmaceuticals

Lunch

KeynoteMori Krantz,

MD

Overview Marsha Wilde, MPH

Goals for the Day

Introduce the Heart and Stroke Healthy Community Initiative How it came to be… What it is based on… What it is intended to do…

Provide description of the Goals and Measures along with examples of “how it can be done.”

Elicit feedback on the initiative.

Background: How it came to be…

Multiple activities in…Multiple communities addressing…Multiple aspects of Heart Disease and Stroke…In many cases not knowing for sure if what we are doing is making a difference…Or not knowing what others are doing…So, over a cup of coffee and an idea…

Heart and Stroke Healthy Communities

Socio-Ecological Model-Looking Beyond the Individual-

Background: What it is based on…

DataAKA:

The Metrics

Data : Mortality DataA g e-adjus ted death rates * from C ardiov as c ular Dis eas e

(C V D), C olorado Males and F em ales , 2003 - 2007 (n = 43,618)

0

50

100

150

200

250

300

350

2003 2004 2005 2006 2007

Y ear

*Rat

e pe

r po

pula

tion

(100

,000

)

Males F emales

MI Death ratesA g e-adjus ted death rates * from My oc ardial Infarc tion

(MI), C olorado Males and F em ales , 2003 - 2007 (n = 6,557)

0

10

20

30

40

50

60

70

2003 2004 2005 2006 2007

Y ear

*Rat

e pe

r po

pula

tion

(100

,000

)

Males F emales

Death rates for StrokeA g e-adjus ted death rates * from S troke, C olorado Males

and F em ales , 2003 - 2007 (n = 8,148)

0

10

20

30

40

50

60

2003 2004 2005 2006 2007

Y ear

*Rat

e pe

r po

pula

tion

(100

,000

)

Males F emales

Hospital Discharge: MIA g e-adjus ted hos pital dis c harg e rates *

from My oc ardial Infarc tion (MI), C olorado Males and F em ales

050

100150200250300350400

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

2005

2006

2007

Y ear

*Rat

e p

er p

op

ula

tio

n (

100,

000)

T otal Males F emales

Hospital Discharge: StrokeA g e-adjus ted hos pital dis c harg e rates *

from S troke, C olorado Males and F em ales

0

50

100

150

200

250

300

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

2005

2006

2007

Y ear

*Rat

e pe

r po

pula

tion

(100

,000

)

T otal Males F emales

Risk Factors for Heart Disease

Conditions Blood Cholesterol Levels High Blood Pressure (Hypertension) Diabetes

Behavioral Factors Tobacco Diet Physical Inactivity Obesity Alcohol

Conditions: Blood cholesterolP revalence of High C holes terol among C olorado Adult Males

and F emales by Age G roup, B R F S S 2003, 2005, & 2007

0

10

20

30

40

50

60

18-44 45-64 65-84 ≥85

A g e G roup

Pre

vale

nce

(%)

Males F emales

Conditions: High Blood Pressure

P rev alenc e of Hig h B lood P res s ure am ong C olorado A dult Males and F em ales by A g e G roup, B R F S S 2003,

2005, & 2007

0

10

20

30

40

50

60

18-44 45-64 65-84 ≥85A g e G roup

Pre

vale

nce

(%

)

MalesF emales

*

* Statistically Significant Difference (95% confidence level)

Conditions: Diabetes

P rev alenc e of Diabetes am ong C olorado A dult Males and F em ales by A g e G roup, B R F S S 2003, 2005, & 2007

02468

1012141618

18-44 45-64 65-84

A g e G roup

Pre

vale

nce

(%)

Males F em ales

Behavioral Factors: Tobacco

P rev alenc e of C urrent S m oking am ong C olorado A dult Males and F em ales by A g e G roup, B R F S S 2003, 2005,

& 2007

0

5

10

15

20

25

30

18-44 45-64 65-84

A g e G roup

Pre

vale

nce

(%)

Males F em ales

Behavioral Factors: DietP rev alenc e of C olorado Males and F em ales E ating

F ruits and V eg g ies 5 + per day by A g e G roup, B R F S S 2003, 2005, & 2007

0

10

20

30

40

18-44 45-64 65-84A g e G roup

Pre

vale

nce

(%)

Males F em ales

***

* Statistically Significant Difference (95% confidence level)

Behavioral Factors:Physical Inactivity

P revalenc e of C olorado Males and F emales reporting no phys ic al ac tivity in 30 days by Ag e

G roup, B R F S S 2003, 2005, & 2007

0

10

20

30

18-44 45-64 65-84Ag e G roup

Pre

vale

nce

(%)

Males F emales

*

* Statistically Significant Difference (95% confidence level)

Behavioral Factors: ObesityP rev alenc e of Obes e (B MI 30+) am ong C olorado A dult Males and F em ales by A g e G roup, B R F S S 2003, 2005,

& 2007

0

5

10

15

20

25

18-44 45-64 65-84

A g e G roup

Pre

vale

nce

(%)

Males F em ales

Behavioral Factors: AlcoholP rev alenc e of B ing e Drinkers am ong C olorado A dult

Males and F em ales by A g e G roup, B R F S S 2003, 2005, & 2007

0

2

4

6

8

18-44 45-64 65-84A g e G roup

Pre

vale

nce

(%

)

Males F em ales

*

* Statistically Significant Difference (95% confidence level)

Effect Modification: Interactions Between Conditions and Risk Factors

Social Determinants as Risk Factors

EducationIncomeGeographyEnvironmental ExposuresBuilt EnvironmentAccess to Care

Social Determinant: Access to Care

P rev alenc e of Hig h B lood P res s ure am ong C olorado A dult Males and F em ales by A c c es s to Health C are ,

B R F S S 2003, 2005, & 2007

0

5

10

15

20

25

H ealth Ins uranc e No H ealth Ins uranc e

Pre

vale

nce

(%)

Males F emales

* Statistically Significant Difference (95% confidence level)

**

Cost of Chronic Disease

Chronic Disease Costs Colorado Medicaid Beneficiaries 2007

$-

$20,000,000

$40,000,000

$60,000,000

$80,000,000

$100,000,000

$120,000,000

$140,000,000

Chronic Diseases

Heart Disease

Congestive Heart Failure

Hypertension

Stroke

Diabetes

Cancer

* Calculations for cost are based on the CDC cost calculator and uses estimates based on medicaid expenditures for Colorado

Cost of Hypertension

2007 Colorado Medicaid Estimated Cost for Hypertension

by AgeTotal Cost $132,192,000

7%$9.541 M

12%$15.273 M

81%$107.378 M

Age 18 - 44

Age 45 - 64

Age 65+

Cost of Heart Disease

2007 Colorado Medicaid EstimatedCost of Heart Disease

by Age Total Cost $40,927,000

52%$21.277M

28%$11.383 M

20%$8.267 M

Age 18 - 44

Age 45 - 64

Age 65+

Cost of Stroke

2007 Estimated Medicaid Expendituresfor Colorado

Cost of Stroke Care by SexTotal Cost: $87,120,000

Male36%

$31.375 M

Female64%

$55.745 M

Chronic Disease Integration

What we do about the risk factors for heart disease and stroke has an impact on other

chronic diseases.DiabetesKidney DiseasePeripheral Artery DiseaseRetinopathyAortic Aneurysm

Heart and Stroke HealthCDC Priorities

Control high blood pressure

Control high blood cholesterol

Increase awareness of signs and call 9-1-1

Improve emergency response

Improve quality of care

Eliminate disparities

Heart and Stroke HealthHealthy People 2010 Objectives

Goal: Improve cardiovascular health and quality of life through the prevention, detection, and treatment of risk factors; early identification and treatment of heart attacks and strokes; and prevention of recurrent cardiovascular events.

Objectives 1 – 12 are in the binder.

Related objectives from other focus areas.

Background:What it is intended to do…

Bring us closer to realizing a vision for the

future…

Action Framework For A Comprehensive Public Health Strategy To Prevent Heart Disease and Stroke

Social andEnvironmentalConditions FavorableTo Health

BehavioralPatterns ThatPromoteHealth

LowPopulationRisk

FewEvents/Only rare Deaths

Full functionalCapacity/Low Risk ofRecurrence

Good QualityOf Life UntilDeath

Heart and Stroke Healthy Community overarching goal:Increase quality and years of healthy life and

Eliminate disparities

Goal 1

Prevent the development ofrisk factors for heartdisease and stroke.

Goal 2

Detect and treat riskfactors for heart disease

and stroke.

Goal 3

Early identification andtreatment of heart disease

and stroke.

Goal 4

Prevent recurrence andcomplications of heart

disease and stroke.

A Vision of the Future

Unfavorable social and environmental conditions

Adverse Behavioral Patterns

Major risk factors

First event/ sudden death

Disability/risk of recurrence

Fatal CVD complications/ decompensation

Present Reality

Structure

Each of the 4 Goal areas is divided into: Community Organizations Schools Worksite Health Care Delivery Systems

How to become a Heart and Stroke Healthy Community:

Define your community.

Assess your current activities.

Identify your disparities and plan how to eliminate them.

Meet the criteria listed.

Apply for recognition