An e-bulletin created for healthcare systems working with patients to control their diabetes and high blood pressure.

August, 2018

National Health Center WeekAugust 12 – 18, 2018www.healthcenterweek.org

Neurosurgery Awareness Monthwww.aans.org

Cholesterol Education Monthwww.cdc.gov/dhdsp/data_statistics/fact_sheets/fs_cholesterol.htm

Healthy Aging Monthwww.healthyaging.net

Chronic Disease Self-Management Programs Work!Your clinical practice benefits from the use of an evidence-based program built upon more than 20 years of international experience. Well-designed clinical trials have shown that Chronic Disease Self-Management Programs such as Better Choices, Better Health produce statistically significant, sustained improvements in health behaviors, aerobic exercise, psychological health and communication with physicians. Learn more at http://idph.iowa.gov/betterchoicesbetterhealth

Few adults receive all recommended preventive health servicesA study in Health Affairs showed only 8% of almost 2,800 surveyed US adults older than 35 were receiving all of the 15 highly recommended preventive services with the greatest potential for enhancing their health, including osteoporosis screening, blood pressure checks, vaccinations and tobacco use counseling. "For the most people to benefit from preventive care, the health care system needs to work together to encourage innovation on how care is delivered, how we can use new technology and how we can tailor improvements to meet the needs of local communities," said study lead author Amanda Borsky. Reuters (6/11)

Study links yogurt consumption to lower cardiovascular riskA study in the American Journal of Hypertension linked eating two or more servings of yogurt per week to a lower risk of cardiovascular disease among adults with hypertension. Researchers found a 17% reduced risk of myocardial infarction and stroke among women and a 21% lower risk among men, compared with people who consumed less than one serving of yogurt per month. Tech Times (2/18)

Save the Date: 2022 Iowa Million Hearts Planning Meeting-August 15, 2018 9:00 AM to 12:00 NoonIf you (or your organization) are interested in being part of the Iowa Million Hearts Action Plan through 2022, and you have not already received an invitation, please contact terry.meek@idph.iowa.gov. We are seeking as many partners as possible and would welcome your participation. Even if you cannot attend the meeting, we would like to gain your input into the planning and implementation of our plan. Contact us NOW!

Survey: Older adults eat with heart, muscle health in mindA survey by the International Food Information Council found that heart health, muscle health, energy and brain function are important considerations in the dietary choices of adults older than 50, and most respondents said they try to make healthy food choices. However, a recent study showed that more than 30% of people over 50 do not consume the recommended amount of protein each day, said registered dietitian Abby Sauer. Food Business News (free registration) (6/18)

ABCS are continued on the next page…

23% of US adults meet minimum recommended physical activity levelsJust 23% of US adults meet minimum recommended physical activity levels, according to findings published in the National Health Statistics Reports. Researchers studied more than 155,000 Americans, ages 18 to 64, and found that while 14 states and Washington, D.C., had significantly greater percentages of adults who met the guidelines than the national average, 13 states had significantly lower percentages than the national average. HealthDay News (6/28)

Priority: Keeping People Healthy

Priority: Optimizing Care

Summertime is here and the sunshine and blue skies make it the perfect time to get outside and exercise. Exercising regularly is important for staying healthy, especially if you have heart disease. You can check out new walking trails or bikingpaths, go on a hike with a family member or friend, or check out an outdoor yoga or tai chi class.

But before you go, anyone with a history of heart disease should first check the air quality in their area. Medical studies show that polluted air, such as smog or wildfire smoke, can trigger heart attacks, stroke or irregular heart rhythms, especially in people who have already had a heart attack or stroke. Did you know? An estimated 130,000 premature deaths and 180,000 non-fatal heart attacks occur in the U.S. each year due to particle pollution.

Doctors and other health care providers can help their patients understand the risks of air pollution and how to reduce them:• Check the daily air quality forecast on AirNow.gov or on weather reports to find out what the air quality is like in your

area. The air quality report is color coded. Code orange or above can be harmful to your heart.• When the air outside is unsafe, delay your activity until the air is cleaner, or move your activity indoors.• Avoid exercising near busy roads or industrial areas. Particle pollution can be high near busy roads in urban areas,

especially during rush hour.• When the air is polluted, take it a little easier. This will reduce how much pollution you breathe. For example, go for a

walk instead of a jog, or reduce your mileage.• Know the warning signs of heart attack and stroke. If you feel symptoms, even if they go away, stop your activity and

seek medical help immediately.

Getting outside to exercise is important. By adjusting when and where you exercise, patients have had a heart attack or stroke can lead a healthier lifestyle and also help reduce their risk of repeat heart problems or stroke triggered by air pollution. Find more information on air quality resources under New Resources Column on page 6.

Report shows fewer US adults are smokingStudy data released Tuesday showed the smoking rate in the US has reached an all-time low, with the number of adults smoking decreasing from about 16% in 2016 to about 14% in 2017. Experts credited anti-smoking campaigns, smoking bans and cigarette taxes in helping to reduce the smoking rate. The Associated Press (6/19)

Taking Aspirin at Bedtime Decreases Heart Attack RiskSo why are these findings important? We know that heart attack and stroke tend to happen more in the morning because of the body’s morning surge of clotting activity after we wake up. Researchers figured that taking aspirin at night might further reduce risk for heart attack by preventing clotting activity in the morning—and they were right.

Priority: Improving Outcomes for Priority Populations:

Cardiac Rehab Change PackageThe Million Hearts Cardiac Rehabilitation Change Package (CRCP) was completed by the Centers for Disease Control and Prevention (CDC) in collaboration with the American Association of Cardiovascular and Pulmonary Rehabilitation (AACVPR) with the purpose of helping cardiac rehabilitation programs, hospital quality improvement teams, and public health professionals who partner with these groups to implement systems and strategies that improve care for patients who are eligible for cardiac rehabilitation. The CRCP has evidence- and practice-based strategies and complementary tools and resources to help improve rates of cardiac rehabilitation referral, enrollment/participation and adherence. The HTML version is now available and a PDF version will be available in September. If you have questions about this resource you may contact Hilary Wall, Million Hearts Science Lead, at ifx0@cdc.gov <mailto:ifx0@cdc.gov>.

CDC’s Tips campaign teams up with past smokers to help others quitThe Tips From Former Smokers® campaign offers health care professionals—including pharmacists, dentists and optometrists—attention-grabbing resources like videos, ads and fact sheets to help people quit smoking. Try these ready-to-use tools in your waiting room. Get Tips® Videos and Resources

Help patients in your practice measure blood pressure at homeThe Target: BP™ initiative, a collaboration between the American Heart Association and the American Medical Association, offers clear, step-by-step instructions for starting a self-measured blood pressure (SMBP) program in your practice.Implement SMBP in Your Practice with These Resources

Quick FactDuring 2000 to 2015, stroke death rates fell across all U.S. racial and ethnic groups, but improvements have slowed, stalled or reversed in recent years. Blacks experienced the highest death rate across the time frame compared with other racial/ethnic groups.

Researchers develop app to help fight obesityThe SlipBuddy is a smartphone app that integrates behavioral techniques and technologies, such as mobile devices, machine learning and text mining, to help users achieve weight loss. "The use of machine learning algorithms to uncover accurate predictive patterns of behavior allows our app to deliver user-centric, evidence-based, personalized approaches to prevent overeating, which will have a positive impact on combating obesity," said study author Carolina Ruiz. Medical News Today (12/26)

The Washington Post: Statins Can Lower Cholesterol But Not Everyone May Need ThemHigh cholesterol, a risk factor for heart disease, affects nearly 1 in 5 American women who are at least 40 years old. Although heart disease is the No. 1 cause of death in women, there is little agreement on what to do about managing cholesterol. A recent Centers for Disease Control and Prevention report found that 17.7 percent of women ages 40 to 59 had high cholesterol, as did 17. 2 percent of those 60 and older. That’s a higher percentage than men in the middle-age cohort (16.5 percent) and dramatically higher than men in the older cohort (6.9 percent). (Adams, 2/26)

Increase in Stroke Risk Factors: Is It Real? CME / ABIM MOC / CECan Gestational Diabetes Raise Cardiovascular Risk? CME / ABIM MOC / CECan Walking Reduce the Risk for Death? CME / ABIM MOC / CECommon Genes Link Diabetes and Coronary Heart Disease CME / ABIM MOC / CEAlcohol and Cardiovascular/Cancer-Related Death: The J Effect CME / ABIM MOC / CEGaps in Transitional Care in Diabetes: From Peds to Adult CME / ABIM MOC / CEDiabetes Risk Significantly Increased Among Women With PCOS CME / ABIM MOC / CE

Choose your path to the LTCP professional credential

The Long-Term Care Professional is the premier designation in the long-term care insurance field. And now, AHIP offers three ways to earn this impressive credential: a four-part program, a single-exam combined course, or customized team training. All lead to the designation that can take your career further. Which path is best for your learning style? Find out here

From NACDD CVH Team and CDC Division for Heart Disease and Stroke Prevention Recording of the June, 2018 fireside chat on Y-USA Blood Pressure Self-Monitoring Program now availableThe Y-USA designed this program to help adults with hypertension lower and manage their blood pressure. The program focuses on regulated home self-monitoring of one’s blood pressure using proper measuring techniques, individualized support and nutrition education for better blood pressure management. Click here for more information on the Y-USA program.

Obesity paradox tied to type 2 diabetes, smoking, study findsA study in Diabetes Care showed that the obesity paradox was seen among type 2 diabetes patients and was heavily influenced by smoking status, with current smokers having a more pronounced obesity paradox that wasn't present in never smokers. UK researchers used a cohort of 596,531 individuals and found the obesity paradox to be more pronounced in men than women. Physician's Briefing/HealthDay News

Study links cost-related insulin underuse to poor glycemic controlPatients with type 1 or type 2 diabetes who said they used less insulin than directed because of worries over cost were three times more likely to have poor glycemic control than those who did not report insulin underuse, according to a study presented at the American Diabetes Association Scientific Sessions. The study, based on a survey of 199 patients, found those who reported cost-related insulin underuse were more likely to have lower income, variable drug coverage and variable employment. Healio (free registration)/Endocrine Today (6/23)

Patients with type 2 diabetes commonly affected by "clinical inertia"A study presented at the annual American Diabetes Association Scientific Sessions showed only 56% of patients with uncontrolled type 2 diabetes achieved glycemic control within two years. The researchers attributed the findings to "clinical inertia," described in the study as not being prescribed any of a new class of medication or having ongoing uncontrolled diabetes, and they recommended clinicians seek best practices from high-performing providers or clinics. Medscape (free registration) (6/24)

Study examines incidence of CVD, mortality in prediabetesPrediabetes as defined using the American Diabetes Association and the World Health Organization/International Expert Committee criteria was associated with a 37% and 54% higher incidence rate of nonfatal/fatal cardiovascular disease or all-cause mortality, compared with normoglycemia, according to a study in Diabetes Care. Danish researchers used a cohort of 5,427 individuals, ages 50 to 79, and found no association between prediabetes defined by fasting plasma glucose or two-hour plasma glucose and excess risk of nonfatal/fatal CVD or all-cause mortality. Physician's Briefing/HealthDay ews (2/22)

What you can do about patient safety’s latest threat—cyberattacksA groundbreaking cybersecurity survey points to policy changes that can help physicians preserve patient safety amid widespread cyberattacks. In the meantime, there are quickly implementable steps that practices can take until the industry catches up with what physicians say they need to protect patients. Read more at AMA Wire®. This story is featured as part of the AMA’s Advocating for Patients and Physicians topic page.

Surveillance for Certain Health Behaviors and Conditions Among States and Selected Local Areas - Behavioral Risk Factor Surveillance System, United States 2015 The Centers for Disease Control and Prevention published the article Surveillance for Certain Health Behaviors and Conditions Among States and Selected Local Areas - Behavioral Risk Factor Surveillance System, United States, 2015 in its Morbidity and Mortality Weekly Report (MMWR). The report underlined "the importance of continuing to monitor chronic diseases, health-risk behaviors, and access to and use of health care in order to assist in the planning and evaluation of public health programs and policies at the state, territory, and metropolitan and micropolitan statistical area levels."

From the American Heart Association and the Million Hearts® CollaborationRelease of the Million Hearts® Community-Clinical Linkages ToolkitThe American Heart Association and the Million Hearts® Collaboration developed the Million Hearts® Community-Clinical Linkages Toolkit to complement the Centers for Disease Control and Prevention's Practitioner’s Guide: Community-Clinical Linkages for the Prevention and Control of Chronic Diseases. The Community Clinical-Linkages Toolkit adds to the collection of Million Hearts® tools and is intended to help public health practitioners further the Million Hearts® goal of preventing heart attacks and strokes through the development and strengthening of effective community-clinical linkages. Click here to view the toolkit.

From CDC Division for Heart Disease and Stroke Prevention, Applied Research and Evaluation BranchScience-in-Brief: Turning Science into ActionTurning Science into Action synthesizes research findings from peer-reviewed journal articles into concise and user-friendly summaries. Each brief contains a short synopsis of the journal article and highlights how findings might be applied to the work in cardiovascular health promotion. This month's SIB: A Cluster-Randomized Trial of Blood-Pressure Reduction in Black Barbershops; A synopsis of the article “A Cluster-Randomized Trial of Blood-Pressure Reduction in Black Barbershops,” published in the March 12, 2018, issue of the New England Journal of Medicine

Multivitamins aren't linked to lower heart disease riskMultivitamins and minerals don’t seem to do much to curb the risk of cardiovascular disease, according to a new analysis of the research to date. The study’s authors combed through 18 studies on the link between vitamin and mineral supplements and cardiovascular disease outcomes in the general population. The conclusion: Taking multivitamins and minerals wasn’t associated with a significantly lower risk of stroke, death due to cardiovascular disease, or death due to coronary heart disease.

Study shows differing EHR error rates across health care systemsResearchers analyzed video, mouse-click and keystroke data from EHR vendors Cerner and Epic across four health care systems and found that error rates varied according to task but reached as much as 50%, with some tasks having an eightfold and ninefold difference in clicks and time, respectively. The findings, published in the Journal of the American Medical Informatics Association, showed that the design, development and implementation of EHR systems contribute to errors in imaging, medication and labs, study author Raj Ratwani said.

Lifestyle influences CVD risk in type 2 diabetes, study findsA study in the Journal of the American College of Cardiology showed that type 2 diabetes patients with a low-risk lifestyle factor score of 3 or more were at reduced risk for cardiovascular disease mortality, coronary heart disease, stroke and totalCVD, compared with those with a score of 0, which signified higher-risk behaviors. Researchers evaluated data from 11,527 patients, mean age of 63, calculating lifestyle scores based on diet, physical activity, smoking status and alcohol consumption, with higher scores signifying healthier choices. Healio (free registration)/Cardiology Today (6/18)

The Iowa Department of Public Health -- Health Promotion and Chronic Disease Control Partnership

Terry Y. MeekHealth Systems Coordinator

terry.meek@idph.iowa.gov

Laurene HendricksLinkage Coordinator

laurene.hendricks@idph.iowa.gov

Editors:

This e-Bulletin is supported by Cooperative Agreement Number 5U58DP004807-05 from the Centers for Disease Control and Prevention. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the Centers for Disease Control and Prevention or the Iowa Department of Public Health.

Million Hearts® Partner Resources on Air QualityAmerican Heart Association (AHA)Air Pollution and Heart Disease, StrokeFact Sheet: Air Pollution and Cardiovascular Disease

Bay Area Air Quality Management District, includes San FranciscoSpare the Air

Cardio Smart: American College of CardiologyAir Pollution Accelerates Damage to the Heart's ArteriesLiving an Active Lifestyle: Move More

Centers for Disease Control and Prevention (CDC)How Air Pollution Harms your Heart and BrainPhysical Activity Prevents Chronic Disease

Environmental Protection Agency (EPA)Lookup local air quality conditions on AirNow.govParticle Pollution and Cardiovascular EffectsHealthy Heart Toolkit and ResearchWhat health care providers should know about particle pollution and cardiovascular riskHeart disease, stroke and outdoor air pollution fact sheet

Million Hearts®Particle Pollution and Heart DiseasePhysical Activity and Cardiovascular Disease

National Association of County & City Health Officials (NACCHO)What Health Professionals Should Know About the Cardiovascular Risk of Air Pollution

The CAHPS Ambulatory Care Improvement Guide: Practical Strategies for Improving Patient ExperienceA comprehensive resource for health plans, medical groups, and other providers seeking to improve their performance in the domains of patient experience measured by CAHPS surveys of ambulatory care. You can use this guide to help the organizations you work with: Cultivate an environment that encourages and sustains improvements in patient-centered care. Analyze the results of CAHPS surveys and other forms of patient feedback to identify strengths and weaknesses.Develop strategies for improving performance. Sections of the Guide (PDF) include:Why Improve Patient Experience?Are You Ready to Improve?Ways to Approach the Quality Improvement ProcessDetermining Where to Focus Efforts to Improve Patient ExperienceStrategies for Improving Patient Experience