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Agenda
Introductions the New York State Health Foundation the Harlem Health Promotion Center the Colin Powell Center for Social Justice the National Black Leadership Council on
AIDS (NBLCA) Racial Disparities in CVD Focus on the Harlem Community Synopsis of the Million Hearts
Campaign Discussion
Heart Disease and Strokes are Leading Killers in the U.S.
Cause 1 of every 3 deaths Over 2 million heart attacks and strokes each year
800,000 deaths Leading cause of preventable death in people < 65 $444 B in health care costs, lost productivity
Greatest expression of racial disparities in life expectancy
Age-adjusted death rates for stroke by sex and race/ethnicity, 2007.
Source: NCHS and NHLBI.
©2010 American Heart Association, Inc. All rights reserved. Roger VL et al. Published online in Circulation Dec. 15, 2010
CVD Leading Cause of Shorter Life Expectancy Among African Americans
Life expectancy loss for blacks, in months
Source: CDC/NCHS, National Vital Statistics System, Mortality, 2007
Every 24 hours… 131 men of color, and 148
women of color will die from cardiovascular disease (heart attacks, strokes, etc.)
American Heart Association, 2008
High Blood Pressure
Plays a significant role in contributing to:
Heart attacks Strokes
CDC. Health, United States, 2008. Hyattsville, MD: National Center for Health Statistics; 2008.
High Blood PressureOne in three adults…Or, about 75 million people, above the age of 20, in the United States have high blood pressure
High Blood Pressure and People of Color
31% of all Americans affected29% of Hispanics
40% of African-AmericansAmong African Americans,
hypertension (HTN) develops earlier in life and tends to be more severe, therefore increasing the risk for HTN-related complications
Age-Adjusted Prevalence Trends for HBP in Adults, ≥20 years of age by race/ethnicity, sex and survey (NHANES:1988-1994, 1999-2004 and 2005-2008).
Source: NCHS and NHLBI. NH indicates non-Hispanic.
©2010 American Heart Association, Inc. All rights reserved. Roger VL et al. Published online in Circulation Dec. 15, 2010
High Blood Pressure and People of Color In 2004, the mortality
rates from HTN related conditions were disproportionate: 14.9% for white males, compared to 49.7% for black males
14.5% for white females, compared to 40.8% for black females.
(Heart Disease and Stroke Statistics -- 2006 Update).
High BP in Harlem
Compared to national prevalence rates, Harlem residents had higher rates of elevated BP (41%)
(Rubin M, Chukwu E, Pultre F, Manheimer E, College G. Screening and referral for cardiovascular risk factors in Harlem, New York. Paper presented at the American Public Health Association; 2004.
Start with the end in mind…
Vickie Powell Harlem resident Worships at
Abyssinian Baptist Church
Told by physician that she had high blood pressure…
What we eat
What we drink
What, how much we smoke
How we exercise
How we deal with stress
Play significant roles in the development of disease.
Management
Lifestyle modification Pre-hypertension, Stage 1 and Stage 2
hypertension Weight loss (5-20 mmHg SBP reduction for every 20
lbs lost) Reduce Sodium (8-14mmHG SBP reduction) Increase Physical activity (4-9 mmHG SBP reduction) Reduce Alcohol consumption (2-4 mmHG SBP
reduction) Reduce Smoking (10-20 mmHG SBP reduction)
Medications Stage 1 and Stage 2 hypertension
An “activated” Vickie…
Changed her diet Began exercising
regularly Embraced yoga
and meditation Lost 20 lbs Normalized her
blood pressure…without medication
So, how are we doing?
Of those people with high blood pressure, 77.6 percent were aware of their condition.
AHA.org
But… More than one in five (22.4%) people with
high blood pressure don't know that they have it.2
• Lloyd-Jones D, Adams RJ, Brown TM, et al. Heart Disease and Stroke Statistics—2010 Update. A Report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Circulation. 2010;121:e1-e170.
So, how are we doing?
About 80% of those with high blood pressure, were aware, were in treatment
48% had their high blood pressure controlled
But… 52% were not controlled
AHA.org
I have high blood pressure, but no one has every told me what high blood pressure is and how it can affect my life. What are the target numbers?
I already know I have high bloodpressure, it runs in my family. I know it can cause a stroke, but what else? How can I lower it?
There are so many things I don’t knowabout high blood pressure. I don’t knowwhere to turn to. My doctor doesn’t have time to teach me, and none of my friendscan help.
Doctor-Patient Communication
The average visit length was 15 minutes.
The average patient who came with one or more concerns used only 32 seconds to complete their review of concerns.
In 24.6% of visits, the physician did not ask the patient about his/her concerns.
Marvel, MK, Epstein, RM, Flowers, K & Beckman, HB (1999) Soliciting the patient’s agenda: have we improved? JAMA, 281(3):283-287
Lifestyle Modification
Providers have minimal time to provide counseling and education with clients
May not feel comfortable in providing information and support
Lack of resources for other types of clinic-based supports
Need for adjunctive measures
Key Components of Million Hearts
Community Prevention Reduce the number of people who
need treatment
Clinical Prevention Optimize care for those who do
Status of the ABCS
Aspirin People at increased risk of cardiovascular disease who are taking aspirin
47%
Blood pressure
People with hypertension who have adequately controlled blood pressure
46%
Cholesterol
People with high cholesterol who have adequately controlled hyperlipidemia
33%
Smoking People trying to quit smoking who get help
23%
Source: MMWR: Million Hearts: Strategies to Reduce the Prevalence of Leading Cardiovascular Disease Risk Factors --- United States, 2011, Early Release, Vol. 60
Million Hearts: Getting to the Goal
Population metric Baseline2017
1
Clinical target2
Aspirin for those at high risk ~50% 65% ~70% Blood pressure control ~50% 65% ~70% Cholesterol control ~33% 65% ~70% Smoking prevalence ~20% 17% ─
Average sodium intake 3.5g/day20%
↓─
Average artificial trans fat intake
1% of calories/day
50% ↓
─
1 Population-wide indicators2 Clinical systems
Community PreventionReducing the Number who Need Treatment Strengthen tobacco control and reduce smoking
Improve nutrition
Clinical Prevention
Uniform, simplified set of ABCS measures Getting the ABCS into federal and state
programs EHR meaningful use criteria
Point of care clinical decision support Systematic assessment of cardiac risk Use of recall reminders and order sets Monitoring of medication adherence
Insurers Measure and incentivise performance on the ABCS;
collect and share data for quality improvement; empower consumers
Medical System Messages
Individuals Know your numbers—and goals Take aspirin, if advised Get aggressive with BP and Cholesterol Cut sodium and trans-fats If you smoke, quit
Getting the messages out
Mobilize the best change agents Pharmacists, health coaches, lay workers, nurses,
community orgs, others
Community Messages
Retailers and Employers Offer blood pressure monitoring and educational
resources; focus on improving ABCS care in retail and worksite clinics
Government Support community and systems transformation to reduce
tobacco use and improve nutrition, including smoke-free policies and food procurement standards; provide data for action; expand coverage for the uninsured
Foundations Support consumer and provider outreach and activation
Advocacy groups Monitor and demand progress toward goal and promote
actions that prevent heart attacks and strokes
Million Hearts Outcomes
10M more people with HBP controlled 20M more people with high cholesterol controlled
4M fewer people will smoke 20% drop in average sodium intake 50% drop in average trans fat intake
I was scared to have my blood pressure taken… But, my friends convinced me to have it taken. Now I have work to do in order to keep it normal.
Community-based Initiatives Involving the faith community Experiences of NYSHF with Diabetes
Program
Community-based Initiatives Involving health ministries, lay health
workers Involving nursing students Involving College students