Kentucky Heart Disease and Stroke Prevention Task Force
Transcript of Kentucky Heart Disease and Stroke Prevention Task Force
Dr. Jeffrey D. Howard, Commissioner
Kentucky Heart Disease and Stroke Prevention Task ForceJune 26, 2019
Allie Merritt, MPH – KHDSP Epidemiologist
Heart disease and stroke rates in KY
and the US
Risk factor data related to heart
disease and stroke
Overview of the Task Force
CARE Collaborative update
SEQIP at 10 years
Overview
Leading Causes of Death in KY
3
KY Leading Causes of Death 2017 DeathsAge-Adjusted
KY RateAge-Adjusted
US Rate
1. Diseases of the Heart 10,343 195.9 266.5
2. Cancer 10,145 185.7 200.8
3. Chronic Lower Respiratory Disease 3,480 64.5 45.4
4. Accidents 3,264 72.9 35.3
5. Cerebrovascular Disease 2,050 39.4 61.6
6. Alzheimer’s Disease 1,765 35.0 16.5
7. Diabetes 1,474 27.7 25.0
8. Kidney Disease 1,024 19.4 13.0
9. Septicemia 979 18.5 11.3
10. Influenza/Pneumonia 932 18.1 23.5
Source: Centers for Disease Control and Prevention, National Center for Health Statistics. Underlying Cause of Death 1999-2017 on CDC WONDER Online Database, released December, 2018. Data are from the Multiple Cause of Death Files, 1999-2017, 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 Jun 11, 2019 3:53:29 PM
Cardiovascular Death Rate
4
0
50
100
150
200
250
300
350
400
1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017
Age
-Ad
just
ed D
eath
Rat
e p
er 1
00
,00
0
Year
Cardiovascular Age-Adjusted Death Rate 1999-2017
KY - Black or African American KY - White US - Black or African American US - White
Source: Centers for Disease Control and Prevention, National Center for Health Statistics. Underlying Cause of Death 1999-2017 on CDC WONDER Online Database, released December, 2018. Data are from the Multiple Cause of Death Files, 1999-2017, 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 Jun 11, 2019 3:13:37 PM
CDC Heart Disease Mortality 2014-2016
5Source: Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Division for Heart Disease and Stroke Prevention. Accessed at https://www.cdc.gov/dhdsp/maps/atlas/index.htm on Jun 18, 2019 11:36:06 AM
Cerebrovascular Death Rate
6
0
10
20
30
40
50
60
70
80
90
100
1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017
Age
-Ad
just
ed D
eath
Rat
e p
er 1
00
,00
0
Year
Cerebrovascular Age-Adjusted Death Rate 1999-2017
KY - Black or African American KY - White US - Black or African American US - White
Source: Centers for Disease Control and Prevention, National Center for Health Statistics. Underlying Cause of Death 1999-2017 on CDC WONDER Online Database, released December, 2018. Data are from the Multiple Cause of Death Files, 1999-2017, 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 Jun 11, 2019 1:36:06 PM
CDC Stroke Mortality 2014-2016
7Source: Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Division for Heart Disease and Stroke Prevention. Accessed at https://www.cdc.gov/dhdsp/maps/atlas/index.htm on Jun 18, 2019 11:26:18 AM
Prevalence of Risk Factors
Risk Factors Related to CVD
9Source: Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Division of Population Health. BRFSS Prevalence & Trends Data [online]. 2015. [accessed May 20, 2019]. URL: https://www.cdc.gov/brfss/brfssprevalence/.
38.1%
24.6%
12.9%
34.3%
92.5%
83.0%
57.3%
33.0%
17.1%
10.5%
31.6%
89.5%
81.9%
63.2%
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
High Cholesterol
Tobacco Use (Current Smoker)
Diabetes
Obesity
Health Care Access/Coverage
Eat Vegetables one or more times aday
Eat Fruit one or more times a day
2017 Risk Factors: KY and the US
US
KY
Prevalence of Cardiovascular Diseases
10
0%
5%
10%
15%
20%
25%
30%
35%
40%
Have Angina or Coronary HeartDisease?
Had a Heart Attack (MI)? Had a Stroke? Have High Blood Pressure
Perc
ent
of
Ken
tuck
ian
s
Cardiovascular Diseases
2011 2012
2013 2014
2015 2016
2017
Source: Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Division of Population Health. BRFSS Prevalence & Trends Data [online]. 2015. [accessed June 12, 2019]. URL: https://www.cdc.gov/brfss/brfssprevalence/.
Overview of the Task Force
12
Prevention (KASH)
Systems of Care
Advocacy
Heart Systems of Care
Kentucky Heart Disease and Stroke Prevention TASK FORCE
Stroke Systems of
Care
(SEQIP)
CARE Collaborative Update
2018 CARE Data
14
Participation Totals
Month
Total Education
Encounters New Participants
Returning
Participants
Percent Returning
Participants
January 8664 3297 5367 61.95%
February 11723 5089 6634 56.59%
March 20082 12588 7494 37.32%
April 6706 3883 2823 42.10%
May 8186 2803 5383 65.76%
June 8919 3421 5498 61.64%
July 7074 2387 4687 66.26%
August 7717 2572 5145 66.67%
September 7678 2362 5316 69.24%
October 8787 3043 5744 65.37%
November 6246 1788 4458 71.37%
December 6045 1684 4361 72.14%
TOTAL 2018 107,826 44,926 62,900 58.33%
2018 CARE Data
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44.04%
34.59%
21.38%
BP Color Zones
Green Color Zone
Yellow Color Zone
Red Color Zone
18.2% 10.0%
32.4%
Improved to Green or Yellow
Improved After Starting
Medication
Made Lifestyle Change
Identify BP Color Zone
81.3%
SEQIP at 10 Years
Mission of SEQIP
17
The mission of Stroke Encounter Quality
Improvement Project (SEQIP) is to advance
acute stroke care management and
reduce stroke disparities in Kentucky.
SEQIP Registry Volume
18
43585058
57796278
7819 7907
8941 88199408 9563
10015
2726
0
2000
4000
6000
8000
10000
12000
2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019
Nu
mb
er
of
Re
gist
ry C
ase
s
SEQIP Registry Case Volume
SEQIP Action Plan - Dysphagia
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Dysphagia Screening Results
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37.8%
69.5%
77.3%81.7%
87.7% 86.7%89.9% 89.8% 91.7% 92.3%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Baseline 2009 2010 2011 2012 2013 2014 2015 2016 2017
Perc
ent
of
Pati
ents
Screened for Dysphagia
VTE Prophylaxis
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14.1%7.3%
41.6%
57.6%
91.2%95.5% 96.5% 97.4% 97.7% 97.7%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Baseline 2009 2010 2011 2012 2013 2014 2015 2016 2017
Perc
ent
of
Pati
ents
Received VTE Prophylaxis by End of Hospital Day Two
IV tPA Action Plan
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SEQIP DECREASING DOOR TO NEEDLE TIME STATEWIDE QUALITY PLAN
Start Date: February 2011
IV tPA Within 60 Minutes
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27.3% 24.4%
41.7%
33.3%30.2%
23.2% 25.2% 24.5%
49.3%
68.3%73.4% 75.6%
79.4%83.5% 84.0%
87.0%
0%
20%
40%
60%
80%
100%
2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019
Perc
ent
Trea
ted
wit
hin
Be
nch
mar
k
SEQIP: IV tPA Door to Needle within 60 Minutes
IV tPA Within 45 Minutes
24
18.2%
8.9%
20.4%
8.1% 7.4% 7.5% 10.1% 8.2%13.2%
20.6%
27.4%
34.8%38.7% 41.1%
49.6%53.9%
0%
20%
40%
60%
80%
100%
2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019
Perc
ent
Trea
ted
wit
hin
Ben
chm
ark
SEQIP: IV tPA Door to Needle within 45 Minutes
EMS Pre-Notification
25
0%
10%
20%
30%
40%
50%
60%
Bas
elin
e
20
08
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Perc
ent
of
Pati
ents
In Hospital Mortality
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0.0%
1.0%
2.0%
3.0%
4.0%
5.0%
6.0%
7.0%
8.0%
9.0%
10.0%
All Patients Ischemic Stroke Subarachnoid Hemorrhage Intracerebral Hemorrhage
2009 2010 2011 2012 2013
2014 2015 2016 2017 2018