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Strengthening Preventive Strategies: Evidenced Based Recommendations Addressing Cardiovascular Disease Leading to a Healthy Heart Priscilla O. Okunji,

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Presentation on theme: "Strengthening Preventive Strategies: Evidenced Based Recommendations Addressing Cardiovascular Disease Leading to a Healthy Heart Priscilla O. Okunji,"— Presentation transcript:

1 Strengthening Preventive Strategies: Evidenced Based Recommendations Addressing Cardiovascular Disease Leading to a Healthy Heart Priscilla O. Okunji, Ph.D., RN-BC Howard University, Division of Nursing and Allied Health Sciences, Washington DC Okunji

2 Address the different preventable and leading causes of death to include heart disease and stroke while highlighting evidenced-based recommendations reducing cardiovascular disease leading to a healthy heart Purpose

3 At the completion of this presentation, participants will be able to: Categorize and apply priorities to improve the health and wellness of our nation. Implement effective strategies aimed at improving health. Incorporate evidenced-based recommendations for reducing cardiovascular disease – diabetic myocardial infarction. Apply culturally sensitive intervention strategies to help eliminate heart disease and stroke health disparities in minority communities. Objectives

4 Goal #1: Strengthen Health Care Objectives (2010 – 2015) After decades of asking, “When are we going to fix our broken health insurance system?” we finally have an answer: “Starting now.” —HHS Secretary Kathleen Sebelius Make coverage more secure for those who have insurance, and extend affordable coverage to the uninsured. Improve healthcare quality and patient safety. Emphasize primary and preventive care linked with community prevention services. Reduce the growth of healthcare costs while promoting high-value, effective care. Ensure access to quality, culturally competent care for vulnerable populations. Promote the adoption and meaningful use of health information technology. Source: National Priorities

5 Prioritized List of 20 High-Impact Medicare Conditions Major Depression Congestive Heart Failure Ischemic Heart Disease Diabetes Stroke/Transient Ischemic Attack Alzheimer’s Disease Breast Cancer Chronic Obstructive Pulmonary Disease Acute Myocardial Infarction Colorectal Cancer Hip/Pelvic Fracture Chronic Renal Disease Prostate Cancer Rheumatoid Arthritis/Osteoarthritis Atrial Fibrillation Lung Cancer Cataract Osteoporosis Glaucoma Endometrial Cancer Disease Prioritization

6 DID YOU KNOW? Cardiovascular Diseases Every 26 seconds, a person in the United States has a major coronary event and every minute, someone dies of one (AHA, 2008) Length of stay (LOS) among cardiac surgery patients with diabetes was 0.76 days longer for every 50-mg/dL increase in glucose (Estrada et al., 2003) Prior to 2010 and to the best of our knowledge, no research reported on the outcomes of hospital inpatient with both MI and T2D (Okunji et al., 2010)

7 MI mortality ranked first with 652,091 while diabetes ranked sixth with mortality rate of 75,119 and total cost of $174 billion with $116 billion in direct medical cost (NHDR, 2009) Diabetes mellitus may be an important factor for long-term survival in patients with Myocardial Infarction (Chyun et al., 2000) Approximately $86 billion, or 12 percent, of all U.S. health care expenditures can be attributed to diabetes. Half of that 12 percent can be attributed to complications of diabetes alone (Keawe'aimoku, et al. 2003) National Costs

8 Coronary heart disease is the most common type of heart disease. In 2008, 405,309 people died from coronary heart disease. Every year about 785,000 Americans have a first heart attack. Another 470,000 who have already had one or more heart attacks have another attack. In 2010, coronary heart disease alone was projected to cost the United States $108.9 billion. This total includes the cost of health care services, medications, and lost productivity. Source: CAD Prevalence

9 CAD Risk Factors Non-Modifiable: Increasing age Hereditary Prior stroke or heart diseases Modifiable: Smoking High blood pressure High blood cholesterol Overweight/Obesity

10 Faces of Statistics

11 MI Pathophysiology & Treatment Source: Aaronson, P. I., & Ward, J. P. (2007). 41. The Cardiovascular System at a Glance (At a Glance) (3 ed., pp. 86). Malden, MA: Wiley- Blackwell

12 Evidenced Based Few studies on the hospital characteristics and their treatment outcomes have been focused on: Chronic heart failure and pneumonia (Ayanian, et al. 1998) Preventable adverse effects (Thomas, et al. 2000) Surgical outcomes (Sloan, et al. 2000) Cardiovascular diseases (Polanczyk, et al. 2002) Patient safety indicators (Romano, et al. 2003) Effects of hospital characteristics and economy on T2D (Dowell, et al. 2004) Acute myocardial infarction alone (Allison, et al. 2007) No study has focused on patients with both MI and T2D treatments and outcomes prior to 2010 (Okunji, et al. 2010)

13 Diabetic Myocardial Infarction Inpatient: Prevalence, Disparities and Outcomes Reducing disparities in health care requires measurement and reporting (NHDR, 2009). The ability to monitor and track changes in disparities is critical. Growing interest in public reporting for quality improvement activities continues to be an impetus to improve not only the quality of data but also the quality of care provided. The Department of Health and Human Services strongly advocates for patient-centered outcomes research (PCOR). Our Study -- Background

14 Method Data from the National Inpatient Stay (NIS) Healthcare Cost and Utilization Project under the Agency for Healthcare Research and Quality (HCUP_AHRQ) was retrospectively analyzed and compared for 2006 hospital discharges. Statistical analyses using descriptive, bivariate, regression and dummy coded methods to answer the study hypotheses.

15 Result & Conclusions Troubling disparity between gender and patient insurance, X 2 (1, N = 1480) = 1.598, p <.001. More males 1,862 (67%) than females 912 (33%) admitted. Male had more major procedures than their female counterparts, X 2 (1, N = 2127) = 1.343E2, p <.001). More females died than expected, X 2 (1, N = 2771) = 23.12, p <.001. Older patients with the age groups (59 – 71) and (72 – 84) had longer LOS, more transferred and died more after adjustment. Transfer to Short Term Hospital (B = -.091, p <.001) and Another Nursing facility (B = -.095, p <.001) were major predictors of patient mortality when compared to Routine discharge. Patient mortality not affected based on if the hospital was a teaching or non teaching hospital X 2 (1, N = 1034) =.023, p = 1.00.

16 Ensure healthcare to all patients regardless of age, race, ethnicity, or insurance possession. MI inpatient with T2D mortality rates to be reduced with timely diabetes screening. Emergent treatment procedure in a timely fashion (Time is muscle). Healthcare providers to adopt effective communication, listen to their patients, show respect, and answer their questions. Our Recommendations

17 Preventive Strategies

18 Preventive Measures Monitor your blood pressure regularly Maintain a healthy weight Heart healthy nutrition Get 30 to 60 minutes of moderate physical activity most days of the week Eat less saturated fat and sodium Eat more fruits and vegetables Limit beverages and foods with sugar Have regular checkups with your health care provider Take medications as prescribed by your health care provider No smoking Find healthy ways to manage stress Get a good night sleep

19 Preventive Measures Lipid disorders screen and treat men ≥35 years and women ≥45 years of age for lipid disorders. Screen and treat men years and women years with increased risk for coronary heart disease Hypertension, screen men and women ≥18 years *** Screen all overweight children and teenagers for T2D Source: U.S. Preventive Services Task Force. Recommendations. Available at: Accessed 6/12,

20 Solve The Portion Puzzle © 2010 California Walnut Board.

21 What is my risk for heart disease? What is my blood pressure? What does it mean for me and what do I need to do about it? What are my cholesterol numbers? (these include total cholesterol, LDL, HDL and triglycerides. What do they mean for me and what do I need to do about them? What are my body mass index (BMI) and waist measurement? Do they mean that I need to lose weight for my health? What is my blood sugar levels, and does it mean that I’m at risk for diabetes? If so, what do I need to do about it? What other screening tests do I need to help protect my heart? What can you do to help me quit smoking? How much physical activity do I need to help protect my heart? What’s a heart healthy eating plan for me? How can I tell if I’m having a heart attack? If I think I’m having one, what should I do? (http://www.cdc.gov/women/heart/)http://www.cdc.gov/women/heart/ Ask Questions!!! Questions to ask your Healthcare Provider

22 Identification of community/opinion leaders as potential stakeholders to reach out to minority population. Initiate and/or expand English, other language tutorial programs for minority population on nutrition, exercise, etc. A dialogue to be focused on minority population. Trust building between minority, providers, and community activists on health issues. Regional and national networking, communications, and dialogue among minority based community and organizations. Cultural Focus

23 Design culturally appropriate prevention (Screening) and care interventions for the community. Involve youths in all of the above aspects. Eliminate stigma in the community towards certain diseases. Clinicians awareness of the current conditions and offer themselves to meet the health needs of this group by practicing in inner communities. Encourage comprehensive health checks for new arrivals, particularly from high-risk areas. Nurse Practitioners to be more involved in preventive measures of chronic diseases prior to complications. Cultural Focus

24 All hospitals to adopt electronic documentation by 2014 Introduce nursing informatics and EHR in our traditional classrooms and online programs for the future paperless work environment Community multipurpose/mobile telehealth screening tool to target areas of high density of minority population Distance/on-line learning and “3D” second life real time virtual healthcare classroom for the cyber (younger) generation Increase grants and training funding for healthcare tech leaders in nursing profession for a cost effective health care Meaningful Use (Safety)

25 Aaronson, P. I., & Ward, J. P. (2007). The Cardiovascular System at a Glance (At a Glance) (3 ed., pp. 86). Malden, MA: Wiley-Blackwell. American Heart Association (AHA). (2008). Heart disease and stroke statistics 2008 update. Dallas, TX: American Heart Association, In Ignatavicious, D. D. and Workman, M. L. (2009). Medical-Surgical nursing. Patient-centered collaborative care (6 th ed). St Loius: Sounders. Chyun D, Obata J, Kling J, Tocchi C (2000). In-hospital mortality after acute myocardial infarction in patients with diabetes mellitus. Am J Crit Care. May;9(3): Estrada CA, Young JA, Nifong LW, Chitwood WR Jr. (2003). Outcomes and perioperative hyperglycemia in patients with or without diabetes mellitus undergoing coronary artery bypass grafting. Ann Thorac Surg.;75: HCUP Nationwide Inpatient Sample (NIS). Healthcare Cost and Utilization Project (HCUP) Agency for Healthcare Research and Quality, Rockville, MD. HCUP Clinical Classifications Software (CCS) for ICD-9-CM. Healthcare Cost and Utilization Project (HCUP) Agency for Healthcare Research and Quality, Rockville, MD. us.ahrq.gov/toolssoftware/ccs/ccs.jsp. Accessed July 10, 2008 Keawe'aimoku, K.J., Haynes, S.N., Grandinette, A., Chang, H.K. (2003). Biological, psychosocial, and sociodemographic vairables associated with depressive symptoms in persons with type 2 diabetes. Journal of Behavioral Medicine, Vol. 26, Issue 5, pp National Healthcare Disparities Report: Summary (2009). Agency for Healthcare Research and Quality, Americanheart.org National Heart, Lung and Blood Institute, National Institute of Health. References

26 Dr. Mary Hill, Professor and Dean, College of Nursing and Allied Health Sciences, Howard University, Washington, DC Dr. Afrooz Afghani, Professor, Trident University College of Health Sciences, Cypress, CA Dr. Angela Hegamin, Associate Professor, Trident University College of Health Sciences, Cypress, CA Dr. Frank Gomez, Professor and Director of PhD program, Trident University College of Health Sciences, Cypress, CA Dr. Tenasescu, Professor and Dean, Trident University College of Health Sciences, Cypress, CA Acknowledgement

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