Lafayette CountyStephanie Thompson, BSN

Heart to HeartA Heart Disease Screening Program for Women

• In 2013, Lafayette County had a higher mortality rate for diseases of the heart than the state of Arkansas and the nation. (Centers for Disease Control and Prevention, National Center for Health Statistics, 2015).

• According to the CDC Wonder database (2015), 11 women (ages 35-85+) died in Lafayette County related to heart disease in 2013.

• The CDC reports “Heart disease is the leading cause of death for women in the United States” (2015).

Why Heart to Heart ?

Lafayette County Demographics

 Population (2013)◦ 7,252 (6.98% decrease from 2010)

• Southernmost part of Arkansas bordering Louisiana • Four towns: Bradley, Buckner, Lewisville, and Stamps

Characteristics (2103)◦ High school graduate or higher (77.5%)◦ Caucasian (61.1%)◦ African American (37.1%)◦ Persons 65 year and over (21.5%)◦ Median age 65◦ Women (51.7%)◦ Median household income:$29,732 (State, $40,768) ◦ Persons below poverty level (24%)

Lafayette County Demographics

• Occupations/Industry• Administrative (12.2%)• Sales (9.19 %)• Production (9.11%)• Repair (7.14%)• Management (6.22%)

Lafayette County Resources

• Schools• County School District; • Elementary School in Lewisville, and High School in Stamps

• Churches• First Methodist Church in Lewisville• First Presbyterian Church in Stamps

• Parks/Recreational Facilities• Conway Cemetery State Park• Maya Angelou City Park

• Community Resources/Centers• Cooperative Extension Service 4-H

Lafayette County Medical Resources

• Health Resources• CABUN Rural Health Services (8 counties in rural southern Arkansas)• Southwest Arkansas Counseling and Mental Health Center• AR State Dept. of Health

• Health Resources lacking in Lafayette County but nearby• Magnolia Regional Medical Center (Columbia County) • Dentists available in Hope (Hempstead Co), Magnolia (Columbia

Co), and Texarkana (Miller Co)

Lafayette County Health Disparities

• Health Disparities (2013)

higher mortality rate for diseases of the heart than Arkansas and the US

lower mortality rate from malignant neoplasms than Arkansas and the US

lower mortality rate from ischemic heart disease than Arkansas and the US

US Arkansas Lafayette CountyTotal population 316,128,839 2,959,373 7,252

MORTALITY RATES PER 100,000 POPULATIONS, 2013

US Arkansas Lafayette County

TYPES OF DEATHS RATE (NUMBER) RATE (NUMBER) RATE (NUMBER)

Diseases of the Heart 193.31 (611,105) 249.28 (7377) 330.94 (24)

Malignant Neoplasms 185.01 (584,881) 225.99 (6688) 179.26 (13)

Ischemic Heart Disease 117.11 (370,213) 147.19 (4356) 17.19 (15)

SELECTED POPULATION DATA FOR U.S., ARKANSAS, and LAFAYETTE COUNTY, 2013

Community Assessment of Lafayette County

• Community Diagnosis• Increased risk of heart disease among adult women in

Lafayette County related to uncontrolled hypertension, hyperlipidemia, and current smokers as evidenced by a high mortality rate from diseases of the heart.

Healthy People 2020 Goal

Heart Disease

• Goal: Improve cardiovascular health and quality of life through prevention, detection, and treatment of risk factors for heart attack and stroke; early identification and treatment of heart attacks and strokes; and prevention of repeat cardiovascular events (USDHHS, 2015).

Healthy People 2020 Objectives

SHORT TERM Objectives – Heart Disease1. “HDS-4 Increase the proportion of adults who have had their blood pressure measured within the preceding 2 years and can state whether their blood pressure was normal or high” (USDHHS, 2015).

2. “HDS-8 Reduce the mean total blood cholesterol levels among adults” (USDHHS, 2015).

3. “HDS-17 Increase the proportion of adults aged 20 years and older who are aware of the symptoms of and how to respond to a stroke” (USDHHS, 2015).

Targeted Health IssueHeart Disease

• In 2013, Lafayette County had a higher mortality rate for diseases of the heart (330.94) than Arkansas (249.28) and the US (193.31) (Centers for Disease Control and Prevention, National Center for Health Statistics, 2015).

• The U. S. Preventive Services Task Force (USPSTF) recommends that all adults aged 18 and older be screened for hypertension. (Blood Pressure in Adults, 2015).

Target Population

• The target population will be women ages 35-65 living in Lafayette County who agree to participate in the program.

• According to the CDC Wonder database (2015), 11 women (ages 35-85+) died in Lafayette County related to heart disease in 2013.

• To prevent premature adult deaths, heart disease preventative measures need to be taught to young adults.

Behavioral Objective # 1

• “HDS-4 Increase the proportion of adults who have had their blood pressure measured within the preceding 2 years and can state whether their blood pressure was normal or high” (USDHHS, 2015).

• Objective 1: Within 6 months of implementing Lafayette County’s “Heart to Heart” Heart Disease Screening Program for Women, 90% of participants will be able to state what their last blood pressure readings were and if the blood pressure was normal or high.

Behavioral Objective # 2

• “HDS-12 Increase the proportion of adults with hypertension whose blood pressure is under control” (USDHHS, 2015).

• Objective 2: Within 12 months of implementing Lafayette County’s “Heart to Heart” Heart Disease Screening Program for Women, 80% of participants ages 35-65 with hypertension will have normalized blood pressure readings in provider medical records.

Behavioral Objective # 3

• “HDS-8 Reduce the mean total blood cholesterol levels among adults” (USDHHS, 2015).

Objective 3: After the completion of the program, Lafayette County’s “Heart to Heart” Heart Disease Screening Program for Women participants ages 35-65 will see a 25% decrease in their total cholesterol level." 

Behavioral Objective # 4

• “TU-1 Reduce tobacco use by adults” (USDHHS, 2015).

Objective 4: After the completion of the program, Lafayette County’s “Heart to Heart” Heart Disease Screening Program for Women, participants ages 35-65 will see a 35% reduction in tobacco use.

Program Interventions

• Baseline Blood Pressure Screen - refer to PCP if indicated

• Baseline Cholesterol Level - refer to PCP if indicated

• Smoking Assessment – refer to Quit line if indicated

• Provide Educational Materials to the target population about ways to

decrease the risk of heart disease, such as exercise, dietary

modifications, and smoking cessation

• Sign up target population for email groups to be provide periodical heart

healthy educational materials from the American Heart Association

• Recheck Blood Pressure and Cholesterol at 6 and 12 months

Resources

• Finances: • Community Sponsors• Business Owners to invest • Write Grants

• Facilities:• The Cooperative Extension Service• CABUN Rural Health Clinic• AR Health Department in Lewisville

• Team members:• APRN• RN’s and LPN’s• Administrative Personnel• Community members

Recruitment

• The target population will be women ages 35-65 living in Lafayette County who agree to participate in the program to reach them advertisement is key!

• Ads in local newspaper, on TV, and radio• Social media (Facebook, Twitter, Instagram)• Fliers at all medical clinics and health department• Post information on Lafayette County website• Fliers at local banks, post office and library• Word of mouth via nurses and providers

Evaluation Plan — 6 Steps

• Step 1 Engage the Stakeholders: stakeholders include the target population, program facilitators/board members, and myself.

• Step 2 Describe the program: to improve cardiovascular health and quality of life through prevention, detection, and treatment of risk factors for heart attack and stroke;

• Step 3 Evaluation design: quantitative study design to measure the number of participants who will be able to state blood pressure readings, have normalized BPs, reduced cholesterol levels and reduction in tobacco use.

Evaluation Plan cont.

• Step 4 Gathering Evidence: Nurses complete screenings with strict documentation LPN’s: BPs, lab draws, smoking assessment. RN’s: education to participants APRN’s: interpret data, make recommendations, full health history. Administrative: email databases to send educational materials.

• Step 5 Justifying Conclusion: analysis and interpretation of data discussed before data collection begins.

• Step 6 Ensuring Use and Lessons Learned: Formal report along with meeting of stakeholders.

Summary

• Lafayette County has a higher mortality rate for diseases of the heart

than the state of Arkansas and the nation.

• With this low-cost program, we can see a reduction in heart disease risk

factors in just 12 months!

• By reducing risk factors, we will see a decrease in mortality rates for

those living in Lafayette County.

• Teamwork is key for a successful Heart to Heart Program!

References

• Blood Pressure in Adults: Screening. U.S. Preventive Services Task Force. July 2015. http://www.uspreventiveservicestaskforce.org/Page /Document/UpdateSummaryFinal/blood-pressure-in-adults-hypertension-screening

 • CABUN Rural Health Services - Providing Healthcare for All in Arkansas. (2015). Retrieved September 2, 2015, from http://www.cabun.org

• Center for Disease Control and Prevention. (2015). Women and Heart Disease Fact Sheet. Retrieved September 16, 2015, from http://www.cdc.gov/dhdsp/data_statistics/fact_sheets/fs_women_heart.htm

 • Centers for Disease Control and Prevention. (2011). Program Performance and Evaluation Office. Retrieved from Centers for Disease Control

and Prevention: http://www.cdc.gov/eval/steps/index.htm • Centers for Disease Control and Prevention, National Center for Health Statistics. Underlying Cause of Death 2013 on CDC WONDER Online

Database, released 2015. Data are from the Multiple Cause of Death Files, 2013, as compiled from data provided by the 57 vital statistics jurisdictions through the Vital Statistics Cooperative Program. Accessed at http://wonder.cdc.gov/ucd-icd10.html on Sep 7, 2015 10:57:09 PM

• Conway Cemetery State Park. (2015). Retrieved September 2, 2015, from https://en.wikipedia.org/wiki/Conway_Cemetery_State_Park

• Health Unit Details. (2015). Retrieved September 2, 2015, from http://www.healthy.arkansas.gov/programsServices/localPublicHealthOffices/Pages/huDetails.aspx?show=Lafayette County Health Unit - Lewisville

 • James, P. A., Oparil, S., Carter, B. L., Cushman, W. C., Dennison-Himmelfarb, C., Handler, J., ... & Ortiz, E. (2014). 2014 evidence-based

guideline for the management of high blood pressure in adults: report from the panel members appointed to the Eighth Joint National Committee (JNC 8). Jama, 311(5), 507-520.

• Lafayette County, Arkansas. (2015). Retrieved August 30, 2015, from https://en.wikipedia.org/wiki/Lafayette_County,_Arkansas#Demographics

References cont.

 • Lafayette County, Arkansas Extension Office. (2015). Retrieved September 3, 2015, from http://www.uaex.edu/counties/lafayette/

• Lafayette County School District. (2015). Retrieved September 1, 2015, from http://www.lcscougars.org

•  Magnolia Regional Medical Center. (2015). Retrieved September 2, 2015, from http://magnoliarmc.org

• Maya Angelou City Park. (2015). Retrieved September 3, 2015, from http://www.arkansas.com/attractions/detail/maya-angelou-city-park/96650/

• McKenzie, J., Neiger, B., & Thackeray, R. (2013). Planning, implementing, evaluating health promotion programs: A Primer (6th ed.). San Francisco, CA: Pearson Benjamin Cummings.

• Occupations in Lafayette County, Arkansas. (2015). Retrieved September 17, 2015, from http://statisticalatlas.com/county/Arkansas/Lafayette-County/Occupations

• Southwest Arkansas Counseling and Mental Health Center. (2015). Retrieved September 2, 2015, from http://www.swacmhc.com

• U.S. Department of Health and Human Services. (2012). About healthy people. Retrieved from http://www.healthypeople.gov/2020/topics objectives/topic/heart-disease-and-stroke

• U.S. Department of Health and Human Services. (2015). About healthy people. Retrieved from http://www.healthypeople.gov/2020/topics-objectives/topic/heart-disease-and-stroke

• United States Census Bureau. (2015). Retrieved September 2, 2015, from http://quickfacts.census.gov/qfd/states/05/05073.html