1. Healthy people 2020: Decreasing Heart disease
Morgan Dietrick
Melanie Garrett
Alexandra Fields
Bethany Krus
Emmy Woolard
Courtney Bonner

2. Heart disease deaths, 1999-2011 in U.S.
“The coronary heart disease death rate declined 43.9% between 1999 and 2011, from to deaths per 100,000 population, and varied by race and ethnicity” (Healthy People 2020)
Retrieved from:
Cardiovascular diseases include:
Coronary Heart Disease
Cerebrovascular Disease
Valve Disease
Dysrhythmias
Heart Failure
Peripheral Artery Disease
Reference: Cardiovascular Disease Burden Report. (2013). Retrieved from:

3. Heart disease deaths In the U.S. 2020 Baseline: 129.2 (2007)
2020 Target: 103.4
Desired direction: Decrease
Populations:
2010
2011
2012
2013
Total:
113.6
109.2
105.4
102.6
Per 100,000 population
Even though the death rate from heart disease has fallen, it still remains the No. 1 cause of death in the United States-killing over 375,000 people a year.
The city of Norfolk (rate of 215.8) currently holds the highest averages for Hampton Roads as well as Virginia statewide (rate of 155.9)-double the target rate issued by Healthy People 2020 of
Retrieved from:

4. Heart disease mortality across Virginia
The bottom map of Virginia-section shaded red-represents the Hampton Roads area.
Reference: Cardiovascular Disease Burden Report. (2013). Retrieved from:

5. Heart disease deaths in the Hampton roads vs the U.s.
Reference: Chang, D., Gateley, T., Mullen, J., & Winz, M. (2015). CHA/CHIP report: City of Portsmouth. Portsmouth, Virginia: Healthy Portsmouth, Inc. Retrieved from: %20Report.pdf
(Chang, Gateley, Mullen, & Winz, 2015).

6. Healthy people 2020 risk factors for cardiovascular disease
Reference: Cardiovascular Disease Burden Report. (2013). Retrieved from:

7. Healthy people 2020 objectives
Increase cardiovascular health in the U.S. population.
Reduce coronary heart disease deaths: Target is deaths per 100,000 people.
Reduce adults with hypertension: 10 percent improvement or target of %.
Reduce children with hypertension: Target is 3.2%.
Reduce the proportion of adults with high total blood cholesterol levels to a target of 13.5%, with a mean target of mg/dL.
Baseline for cholesterol:15% of adults, age 20 years or older, had a total blood cholesterol level of 240mg/dL or greater in
Retrieved from:

8. HP2020 Objective: Increase proportion of adults with prehypertension who meet recommended guidelines
Meet guidelines for body mass index (BMI)-33% of population.
Meet guidelines for saturated fat consumption-35.5%.
Meet guidelines for sodium intake-less than 2,300mg per day.
Meet guidelines for physical activity-42.1%
Meet guidelines for moderate alcohol consumption-1 drink per day for women & 2 drinks per day for men.
Baseline BMI: 28.7% met the recommended guidelines for BMI in
By maintaining a normal BMI of kg/m2 systolic blood pressure will be reduced by 5-20 mmHg.
Baseline fat consumption: 31.4%
By consuming less than 10% of calories from saturated fat, and low fat diary-with an increase in fruits and vegetables-systolic blood pressure will be reduced by 8-14 mmHg.
Baseline physical activity: 37.4%
Moderate exercise for at least 150 minutes per week (walking/bicycle) or vigorous physical activity for at least 75 minutes per week (or combination of both).
Retrieved from:

9. Hp2020 objectives cont.
Increase proportion of adults with hypertension who are taking the prescribed medications to lower blood pressure-69.5% target.
Increase proportion of adults who have hypertension under control-61.2% target.
Increase proportion of adults with elevated LDL cholesterol who have been advised by a health care provider regarding lowering management-lifestyle changes & medications.
Increase aspirin/anti-platelet use for ages years old with a history of cardiovascular disease-52.1% target
Increase proportion of adults who are aware of heart attack symptoms-43.6% target.
Increase proportion of out of hospital cardiac arrests in which appropriate bystander and EMS were administered.
Increase proportion of patients with heart attacks to receive timely artery-opening therapy.
Increase proportion of patients who had a heart attack be referred to a cardiac rehabilitation program at discharge.
Reduce hospitalizations of older adults (greater than 65 years old) with heart failure.
Baseline for people with LDL levels below 100mg/dL: 52.3% (high LDL levels: mg/dL).
Target LDL levels: 66.5% of population
Baseline for heart attack awareness: 39.6%
Symptoms include: pain/discomfort in jaw, neck, back, or shoulder; syncope-weak or lightheaded; chest pains; shortness of breath.
Artery-opening therapy includes:
Fibrinolytic therapy within 30 minutes of hospital arrival-70% baseline with a 77% target.
Percutaneous intervention within 90 minutes of hospital arrival-90.4% baseline with a 99.4% target.
Reperfusion therapy within 3 hours of hospital arrival-74.1% baseline with a 81.5% target (IV tPA-risk for stroke patients too).
Retrieved from:

10. National and state related cardiovascular deaths
Heart disease is the leading cause of death in the United States, approximately 610, 000 Americans die from heart disease each year (Centers for Disease Control and Prevention, 2016).
High blood pressure puts individuals at a much higher risk of developing cardiovascular disease. In 2014 the Centers for Disease Control and Prevention reported high blood pressure contributed to approximately 410, 000 Americans deaths in America.
Virginia has the 28th highest death rate from cardiovascular disease in the country (American Heart Association, 2010).
The rate of cardiovascular related deaths in Virginia had steadily been declining since 2004; in 2013 there were 211 deaths per 100,000 people in Virginia and in the nation.
Centers for Disease Control and Prevention. (2016). Heart disease facts. Retrieved from
Council on Virginia's Future. (2015). Cardiovascular disease. Retrieved from
American Heart Association. (2010). Virginia state fact sheet. Retrieved from

11. National and state cardiovascular disease trends
The areas in Virginia with the highest death rates from hypertension include the cities of Richmond, Hampton Roads, Portsmouth and Norfolk.
In 2010, the age-adjusted death rate due to hypertension in the Hampton Roads area was per 1000 people.
In 2013, the age-adjusted death rate for heart disease in Norfolk was per 1000 people, which is almost double the Healthy People 2020 target of per 1000 people.
National Trends
In the United States an estimated 68 million adults have high blood pressure, over 36 million of which do not have their blood pressure in control.
The national death rate due to hypertension increased 14% from 1999 to 2010.
State Trends
In Virginia an estimated 1.9 million individuals have hypertension.
The total heart disease death rates for Virginia in 2013 was per people.
Kissner, E., & Redden, C. (2016). Norfolk community health status assessment report. Retrieved from:
Virginia Department of Health. (2011). Hypertension in Virginia.
Retrieved from

12. Mortality rates due to cardiovascular disease 2004-2013
Council on Virginia’s Future. (2016). Cardiovascular disease. Retrieved from:
(Council of Virginia’s Future, 2016)

13. Mortality rates due to cardiovascular disease 2004-2013
Council on Virginia’s Future. (2016). Cardiovascular disease. Retrieved from:
(Council of Virginia’s Future, 2016)

14. What does this mean?
Mortality rates from Cardiovascular disease have declined from 2004 – 2013 in both Virginia, as well as Hampton Roads.
When compared to other States, Virginia is actually faring pretty well, however the rates can be decreased further.
Virginia is actually just below the national average (211 vs. 233 deaths per year).
When comparing Hampton Roads to other communities within Virginia, the rates have decreased, however they could still decrease significantly further as evidenced by the lower rates seen in Northern Virginia.

15. Area programs that target the problem
Health and Preventive Services:
4417 Corporation Lane Virginia Beach, VA
Free Community Classes for residents of Hampton Roads are provided at various locations throughout the year.
Health Education Seminars: Organizations may request educational programs on a variety of health related topics.

Health Fairs: Public Health Nurses and other professionals participate in community health fairs.  Blood pressure screening, health education displays and a variety of other services are available.
 
The seven cities of the Hampton Roads individually provide preventive services and screenings. They also have the health fairs which focus on different prevention strategies so diseases including cardiovascular disease, diabetes, and obesity.

16. There are many options for smoking cessation to help target and reduce cardiovascular disease
Smokeless Program
Riverside Wellness & Fitness Center Jefferson Avenue Newport News, VA Contact: Holly Hicks
(757)
Quit Smart Program
Naomi Goldblum Ph.D. Clinical Associates of Tidewater McManus Boulevard, Bldg. #8 Newport News, VA (757) Website:
Nicotine Anonymous
Great Bridge United Methodist Church 201 Stadium Dr. Chesapeake, VA 23322
(757)
(Tobacco Cessation, 2015)
These programs are available some may require insurance others are free to the public. Each person can get help deciding which option is the best for their treatment.

17. Area programs
The health and wellness information centers at the public libraries (Virginia, 2015)
Low income resources
The Healthy Start Program for the childbearing population (Community, )
Bon Secours Hampton Roads Health System
Free screenings, mobile health screenings with low cost testing, and in house testing
The health and wellness center is great for people in the area that have varying health concerns. The library resource center helps connect people with the appropriate resources in order to attain or maintain health care (Virginia, 2015).
The Healthy start program is great for expectant families, it allows for the families to come in and get education about getting a healthy start. This is especially important because it prepares families to start making healthy choices and it primarily preventing cardiovascular disease (Community, 2011).
Bon Secours Health System is Hampton Roads wide health care that offers free health screenings and preventative care. They also have the heart health screenings periodically throughout the year as well (Screenings, 2016). The screenings may include, drawing cholesterol, blood glucose, and recording blood pressure. They also provide free counseling for preventative health, and making heart healthy choices.

18. Successful programs in other communities
Pawtucket Heart Health Program in Pawtucket, Rhode Island helped to reduce risks for cardiovascular disease and coronary heart disease by 16 percent. This was achieved through community wide programs involving: smoking cessation, regular aerobic physical activity, and maintenance of desirable body weight using strategies consistent with the tenets of social learning theory (Carleton et al. 1995).
“Shape Up Somerville,” in Somerville, Massachusetts “included improved nutrition in schools, a school health curriculum, an after-school curriculum, parent and community outreach, collaboration with community restaurants, school nurse education, and a safe routes to school program”. A year after this program began, an average of one pound of weight gain was reduced for an 8 year old child. (Economos et al. 2007)

19. Successful programs cont.
A program targeted for low-income adults in Oslo, Norway provided, “individual counseling, walking groups, increased accessible areas for safe recreation, and information through leaflets and mass media.” Three years after the program initiation, “the intervention group had an 8-9 percent increase in physical activity, 14 percent fewer individuals gained weight, 3 percent more quit smoking, and significant decrease in blood pressure rates were reported”. (Jenum et al. 2006).
Ohio State University researchers initiated a 12-week walking program and recruited sixty local women in their forties. “At 3 months, the intervention group saw a 1 percent decrease in body mass index (BMI), a 3.4 percent decrease in hypertension, a 3 percent decrease in cholesterol, and a 5.5 percent decrease in glucose” (Haines et al. 2007)

20. New Development WHO Global NCD Action Plan
They focus is on noncommunicable diseases not only cardiovascular disease but caner, diabetes, and chronic respiratory disease.
Their Objectives our to:
To make prevention of noncommunicable diseases a priority.
To reduce modifiable risk factors
To strengthen and orient health systems and governments
To support research on the noncommunicable diseases
Monitor trends.
Reference: World Health Organization. (2016). Global Action Plan: For prevention and control of noncommunicable diseases. Retrieved from

21. PRIMARY PREVENTION MEASURES
Individual &
Community based
Prevention
Risk Reduction
for High Risk
Individuals
Early Disease
Management
Treatment of
Disease
Prevention of
Recurrence
Tobacco control polices-smoke free environments.
Building sidewalks or cycling paths to promote safe physical activity.
Healthy school meals for children/teenagers.
Hospitals/medical staff support and encourage breast feeding the first six months of life (promoting healthy children).
Increase availability and affordability of fruits and vegetables.
Reference: World Health Organization. (2016). Cardiovascular disease fact sheet. Retrieved from:
Tobacco control examples: “Legislative for 100% smoke free environments in all indoor workplaces, public transport, and indoor public place” & “warn people about dangers of tobacco use with evidence based media campaigns.”
Retrieved from:

22. Secondary/tertiary prevention of cardiovascular disease
Smoking cessation
Aspirin
Beta blockers
ACE inhibitors
Statins
Coronary artery bypass
Balloon angioplasty
Valve repair or replacement
Heart transplantation
Artificial heart replacement
Reference: World Health Organization. (2016). Cardiovascular disease fact sheet. Retrieved from:

23. Conclusion
Cardiovascular disease is the number one cause of mortality nation wide.
The programs that our available to the Hampton community have been helping decrease cardiovascular disease because the number has decreased and his lower then the national average.
We need to continue to make programs to help lower the number of cardiovascular related deaths.
Educating our patients is key and letting them know about the programs.
Programs need be targeted to lower blood pressure, lower obesity, lower cholesterol, increase physical activity, lower sodium intake, lower saturated fat in diet, and smoking caseation.

24. References
Carleton, R.A., Lasater , T. M., Assaf, A.R., Feldman, H.A., & McKinlay, S. (1995). The Pawtucket heart health program: Community changes in cardiovascular risk factors and projected disease risk. American Journal of Public Health, 85(6),
Centers for Disease Control and Prevention. (2016). Heart disease facts. Retrieved from
Community and Health Services. (2011). Retrieved from:
Council on Virginia's Future. (2015). Cardiovascular disease. Retrieved from
Economos, C.D., Hyatt, R.R, Goldberg , J.P., Must A,., Naumova, E.N., Collins, J.J., & Nelson , M.E. (2007). A community intervention reduces BMI z-score in children: Shape up Somerville first year results. Obesity, 15(5), .

25. References
Haines, D.J., Davis, L., , Rancour P., Robinson M., Neel-Wilson, T., & Wagner, S..(2007). A pilot intervention to promote walking and wellness and to improve the health of college faculty and staff. Journal of American College Health, 55(4),
Heart & Vascular. (n.d.). Retrieved from: vascular/screening-and-prevention.aspx
Jenum, A.K., Anderssen, S.A., Birkeland, K.I., Holme, I., Graff-Iversen, S., Lorentzen, C., Ommundsen, Y., Raastad, T., & Odegaard, K., & Bahr, R. (2006). Promoting physical activity in a low-income multiethnic district: effects of a community intervention study to reduce risk factors for type 2 diabetes and cardiovascular disease: a community intervention reducing inactivity. Diabetes Care, 29(7):
Kissner, E., & Redden, C. (2016). Norfolk community health status assessment report. Retrieved from:

26. References
Screenings and prevention. (2016. Retrieved, from:
Tobacco Cessation Resource Guide. (2015). Retrieved, from: guide.pdf
Virginia. (2005). Community services. Retrieved from:
Virginia Department of Health. (2011). Hypertension in Virginia. Retrieved from
World Health Organization. (2016). Cardiovascular disease fact sheet.
Retrieved from:
World Health Organization. (2016). Global Action Plan: For prevention and control of noncommunicable diseases. Retrieved from

27. Honor Code
“I pledge to support the honor system of Old Dominion University. I will refrain from any form of academic dishonesty or deception, such as cheating or plagiarism. I am aware that as a member of the academic community, it is my responsibility to turn in all suspected violators of the honor system. I will report to Honor Council hearings if I am summoned.”
SIGNED: Morgan E. Dietrick, Alexandra Fields, Melanie Garrett, Courtney Bonner, Bethany Krus and Emmy Woolard, 7/24/16