HPCD Connection Table of Contents

Statewide Acute Stroke System Legislation Update
Minnesota Heart Health Program – Partners in Prevention
Minnesota Heart Disease and Stroke Prevention Plan Progress
May is Stroke Month
New Heart Disease and Stroke Videos
Hennepin County Hypertension Pilot Project
Heart Safe Communities
Lakeville Program Success
What Makes a Good Cardiac Rehabilitation Program?
Cardiac Health Network – Improving Health for Populations and Communities
Join the Cardiac Health Network

Minnesota Heart Disease & Stroke Prevention

Statewide Acute Stroke System Legislation Update

by Justin Bell, JD, American Heart Association

Added 05/02/13

As the first step to launching a statewide acute stroke system of care, a bill was introduced this session authorizing the Minnesota Department of Health to designate hospitals as: Comprehensive Stroke Centers, Primary Stroke Centers & Acute Stroke Ready Hospitals. The proposed legislation has broad bipartisan support and an impressive list of authors, including the chairs of the HHS Policy Committees (Representative Tina Liebling and Senator Kathy Sheran) as chief authors. The bill had four very positive committee hearings, passing unanimously out of both the HHS Policy & Finance committees in the House and Senate. The bill language is expected to be included in the House and Senate HHS Omnibus bills.

In a statewide stroke system, paramedics and EMTs will use protocols to screen stroke patients and direct them to hospitals prepared to treat them; they pre-notify the hospital so the hospital can be ready to receive the patient; and all hospitals are ready to diagnose and treat stroke patients as soon as they arrive in the emergency department. The primary focus for the system, therefore, is getting all stroke patients to a stroke-ready hospital as quickly as possible for initial diagnosis and treatment.

This bill is important because the first step in this whole process is to formally set care standards for hospitals to reach, and officially recognize hospitals for providing high quality stroke care. Once this is in place, we can implement other parts of this system. EMS protocols, that are locally developed, can include guidance for taking suspected stroke patients to hospitals recognized by the state. Hospitals and EMS can engage in performance improvement work, to ensure they are providing high quality care. And, we will be better able to identify hospitals that need assistance in building capacity to provide better care.

For updates, go to http://yourethecure.org
Or search House File 672 or Senate File 598 on http://www.leg.state.mn.us/

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Minnesota Heart Health Program – Partners in Prevention

By Karen H. Miller, MSW, MPA, and Alan T. Hirsch, MD, University of Minnesota, Minnesota Heart Health Program – Partners in Prevention

Added 05/02/13

“Partners in Prevention” is a new and unique population-based initiative that promotes the primary prevention of cardiovascular disease to improve the health of the citizens of the State of Minnesota through the use of low-dose aspirin. The Minnesota Heart Health Program’s mission is to help all Minnesotans achieve a high level of cardiovascular disease prevention.
“Partners in Prevention” provides comprehensive support for the Million Hearts™ goal of preventing 1 million heart attacks and strokes in the United States over five years by achieving measurable cardiovascular event reduction within Minnesota. Noting the comprehensive role of each of the ABCS (Aspirin use, Blood pressure control, Cholesterol management, and Smoking cessation), “Partners in Prevention” currently promotes the “A” of the ABCS via use of low-dose aspirin to prevent heart attack and stroke in targeted age groups (men age 45-79 and women age 55-79).

The program is designed to help Minnesotans understand their cardiovascular risk and take action, and therefore improve use of primary prevention risk reduction interventions. The program encompasses all health professionals and health systems in a sustainable, cost-effective manner.
The program is designed to promote two interventions: one aimed at increasing public awareness of effective heart attack and stroke prevention, and a second that facilitates delivery of these interventions by health professionals and health systems. The program, which began in early 2012, will encompass metropolitan, suburban, and rural populations across Minnesota over 3-5 years.
The program uses mass media, a program website, social media, and health professional educational tools to disseminate cardiovascular disease prevention messages within a frame that supports the recommendations of the Centers for Disease Control, the U.S. Preventive Services Task Force, the American Heart Association, and the Minnesota Department of Health.

Heart attack and stroke events will be measured using Minnesota Hospital Association discharge data. Aspirin usage in the target population will be measured through population-based -pre and -post surveys.

For more information, contact Karen Miller at (612) 624-5461 or khmiller@umn.edu.

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Minnesota Heart Disease and Stroke Prevention Plan Progress

Added 05/02/13

A new report is available for download, evaluating the progress of the Minnesota Heart Disease and Stroke Prevention Plan 2011-2020. The report shows current activity and indicator levels to evaluate progress. We look at activity levels by strategies and consider the reach, scope, quantity, and quality of the activities as well as the impact on decreasing cardiovascular risk, morbidity and mortality. We look at indicators that focus on our overall objectives to reduce the burden of cardiovascular disease and stroke as well as specific indicators linked to Prevention, Acute Treatment, and Disease Management.

Minnesota Heart Disease and Stroke Prevention Plan: Implementation Report 2013 (PDF: 1.22MB/20 pages)

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May is Stroke Month

Raise Awareness of Stroke Signs and Symptoms and Prevention with These New Materials

Added 05/02/13

In partnership with the Minnesota Stroke Association and Minnesota Department of Health, the Minnesota Stroke Partnership has developed two tip cards and a poster. One tip card features the Act FAST graphic and additional information about stroke signs & symptoms. The second tip card provides tips on how to prevent a stroke. Both of these messages are combined in the poster.

You can either choose the Standard versions with the Minnesota Department of Health, Minnesota Stroke Association, and Minnesota Stroke Partnership logos, or choose to the Open Logo versions which can be co-branded with a hospital or organization name as long as the Minnesota Stroke Association and Minnesota Stroke Partnership logos are unaltered.

Standard Versions

Released April 2013.

Act FAST Tip Card (PDF: 528 KB/1 page)
Prevent Stroke Tip Card (PDF: 342 KB/1 page)
Act FAST & Prevent Stroke Poster (PDF:368 KB/1 page)
Print at 11x17 minimum

Open-Logo Versions

Released April 2013.

Act FAST Tip Card (PDF: 517 KB/1 page)
Prevent Stroke Tip Card (PDF: 342 KB/1 page)
Act FAST & Prevent Stroke Poster (PDF: 364 KB/1 page)
Print at 11x17 minimum

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New Heart Disease and Stroke Videos

Added 05/02/13

The Minnesota Department of Health has created a series of four videos describing the signs and symptoms of a heart attack or stroke, and the importance of knowing your blood pressure and cholesterol level in clever, easy-to-understand terms. View them now on our home page. The short clips deliver messages about calling 911 when you have chest pain, rather than assuming it will go away; recognizing that the signs of stroke appear on one side of the body; and checking your cholesterol and blood pressure every birthday (and following up with your doctor if the numbers are high).

These clips were designed to reach a large audience and can be shown in clinics or community setting. Html code is provided at the YouTube hosting page if you would like to place them on your website.

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Hennepin County Hypertension Pilot Project

- Renee Gust, MA, RN,
Hennepin County Public Health and Human Services

Added 01/14/13

The Hennepin County Hypertension Pilot Project was a one year project funded by the MDH Heart Disease and Stroke Prevention Unit. The purpose of the project was to design and implement a new clinic delivery system to better manage patients diagnosed with hypertension and hyperlipidemia. Three medicine clinics were involved in the pilot project.

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A multidisciplinary team of clinic staff was convened to study best practices for the management of patients diagnosed with hypertension and hyperlipidemia. Current practices were assessed including patient flow, clinic protocols, and staff needs. A chart audit was completed to assess compliance with the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7) guidelines. Chart audit results revealed that patients were not receiving therapeutic lifestyle change counseling and recommended follow-up visits were not taking place. Based on the practice assessment and chart audit, a new clinic protocol was developed. The Plan–Do–Study–Act process was used to implement and evaluate the protocol.

The D5 Diabetes Scorecard results for one of the providers were reviewed before and after implementation of the protocol. They showed that patient blood pressure rates improved from 59.8 percent to 67.1 percent. Patient LDL scores improved from 25.6 percent to 52.4 percent. Based on these results, clinic management began reorganizing the firms into care coordination teams. These care coordination teams included the physician, nurse, CHW, medical assistant, and pharmacist. Training was provided for clinic staff to help them effectively counsel patients. It included use of the “health coaching” technique that involves setting goals toward a healthy lifestyle. Staff members working as health coaches were given protected clinic time to follow up with patients in need of support and guidance. More clinic staff will be trained as health coaches in 2013.

PharmD staff assigned to the clinics became key players. They reviewed cases where patients were taking many medications, but still struggling with high blood pressure and lipid levels. Using the JNC 7 guidelines, physicians and pharmacists developed protocols for medication management that allowed pharmacists to work with the patient and change medications for better treatment. Physicians liked the support and began referring their patients to see PharmD staff.

When issues of blood pressure accuracy arose, the team decided to use home blood pressure monitoring machines. Some patients found coming to the clinic stressful, which caused abnormally high blood pressure readings. Having the ability to review blood pressure readings taken while the patient was at home gave physicians a clearer understanding of what to treat and more importantly, what not to treat. This resulted in improved patient care and ultimately, improved patient health.

For more information about this project, please contact Renee Gust at renee.gust@co.hennepin.mn.us.

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Lakeville Program Success

Added 01/14/13

Kathryn Lewis, RN, knows what it takes to train a community to respond to Sudden Cardiac Arrest. She organized a successful program in Lakeville that trained 7,000 people in two years, earning designation as a Heart Safe Community.

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Her advice: “Take time to plan your program. Bring it to the people, wherever they are. Make it accessible. Keep the training simple.”

As an intensive care nurse at Fairview Ridges Hospital, Lewis is familiar with SCA. Her epiphany on the need to educate the general public came during a presentation by Keith Lurie, MD, professor of emergency medicine at the University of Minnesota and founder of the SCA prevention program Heart Safe America.

“I thought, ‘Why aren’t we doing more?’ SCA strikes people in the prime of life. They’re gone, with no warning. We were missing the community education piece about the importance of starting early CPR and calling 911,” Lewis said.

First, she secured agreement on a public education campaign from her colleagues at Fairview Ridges. Then she met “with everyone I could think of: the superintendent, city manager, mayor and fire chief.” Lewis organized a planning group with Co-chair Tom Vonhof, Lakeville police chief, to design and implement a program with a goal of training 14,000 people.

Among the techniques used in Lakeville:

A “train the trainer” approach, using volunteers to teach groups ranging from churches and businesses to Rotary, Chamber of Commerce, and parent meetings
Training kits for 30-minute classes, with mannequins, a DVD, and AED simulator
Extensive partnership with the schools, including teaching all coaches and activities teachers and purchasing mannequins and equipment for high school classrooms
Connection with the Minnesota Sudden Cardiac Arrest Survivors Association to locate Lakeville survivors to tell their stories to groups
Fundraising to purchase training equipment and 78 AEDs that have been placed around Lakeville
A Town Hall Forum on SCA that was recorded and aired on the city TV cable channel

Lakeville’s training efforts are saving lives, according to data from Allina Health Emergency Medical Services, the provider that serves the city. In Lakeville during 2009, Allina Health EMS saw no survivors of SCA, said Katie Tewalt, Heart Safe Communities supervisor.

Lakeville’s educational program trained 7,000 people from 2010 to 2012, and survival rates for SCA patients increased to 27 percent for 2012. “We credit this to bystander CPR and better recognition of SCA,” Tewalt said.

Heart Safe Communities

- Sally Thompson,
United Hospital Marketing Department

Added 01/14/13

The partnership of 10 Minnesota organizations that joined forces in 2012 to combat Sudden Cardiac Arrest (SCA) is bearing fruit, with new cities and groups set to become Heart Safe Communities in 2013.

From Willmar to Apple Valley, thousands of Minnesotans are learning how to respond when someone has SCA. Members of the general public are a vital first link in the “Chain of Survival.” Through Heart Safe Communities, people learn to respond quickly by calling 911, starting CPR, and using an AED, which promote survival before first responders, paramedics, and hospital staffs take over.

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Improving the responses of bystanders is crucial to increasing survival from SCA, which kills most of its victims. Nationally, one-third of SCA victims receive CPR from a bystander; Minnesota’s rate is only 23 percent.

“Communities are delivering the message that it’s easy to learn CPR and use an AED,” said Katie Tewalt, Heart Safe Communities supervisor for Allina Health Emergency Medical Services. “Community volunteers are very creative in helping people learn CPR in short classes.”

For example, Woodbury volunteers taught CPR to people while they waited in line for stores to open on Black Friday. During 10 months in 2012, Woodbury’s program trained 6,500 people, Tewalt noted.

Eleven Minnesota communities received designation as Heart Safe Communities. To earn this recognition, they conducted educational activities to build local links in the Chain of Survival:

Early access: Teach the signs and symptoms of SCA (including how it differs from heart attack) and the need to call 911
Early CPR: Conduct CPR classes, including practicing hands-only chest compressions on a mannequin
Early defibrillation: Learn to find and use an AED; make arrangements for ongoing AED maintenance

Allina Health started Heart Safe Communities in 2001, when its EMS service adapted a SCA program from the American Heart Association. Starting in communities with Allina Health hospitals, the program has helped to educate 35,000 people and to place or maintain 2,000 AEDs in the hands of first responders and in businesses, schools, and public places. (http://www.allinahealth.org/ahs/aboutallina.nsf/page/Comm_Heartsafe)

“We offer quick, easy, simple training,” Tewalt explained. “We developed a 1.5 hour ‘Train the Trainer’ class and self-instructional DVDs for classes of 10, 30, or 60 minutes.” Allina Health also loans mannequins and AED trainers. Its employees have been generous, donating $200,000 since 2005 to help communities purchase AEDs.

In 2009, New Brighton became Minnesota’s first community to receive Heart Safe designation. In 2012, the statewide partners united to coordinate Heart Safe Communities activities and designations. http://www.health.state.mn.us/divs/hpcd/chp/cvh/heartsafecommunities.html

“Heart Safe Communities just keeps growing,” Tewalt said. “Our overall system works when members of the public can recognize and respond when someone develops SCA.”

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What Makes a Good
Cardiac Rehabilitation Program?

- Jacquelyn Huebsch PhD, RN,
HealthPartners Institute for Education and Research

Added 01/14/13

As the number one cause of death for both men and women1, cardiovascular disease (CVD) has significant effects on health, the economy, society and public health policy. In the best of worlds, CVD would be prevented. However, given the prevalence of the disease and the number of people at risk for it, which feasible, effective, evidence-based therapies can lessen the magnitude of its appalling consequences? One proven treatment approach is a Cardiac Rehabilitation/Secondary Prevention Program (CR/SPP).

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CR/SPPs are medically supervised, multidisciplinary programs that provide multifactorial services to persons with CVD to help them recover faster and reduce the risk of subsequent cardiac events. These programs offer eligible CVD patients nutritional and physical activity counseling, exercise training, psychosocial counseling, and aggressive risk factor education and management.

Qualifying conditions include acute myocardial infarction, acute coronary syndrome, chronic stable angina and heart failure. CVD patients are also eligible after percutaneous coronary intervention, coronary artery bypass surgery, heart valve surgery or cardiac transplantation.2

Importantly, participation in outpatient cardiac rehabilitation (OCR) is associated with a 25% reduction in mortality and morbidity.3-6 OCR might provide more than one-third of the benefit of delivering all evidence-based therapies to patients with CVD, according to estimates.7

Referrals are required for program enrollment. However, not all patients referred participate in OCR. Unfortunately, both referral and participation rates for CR/SPPs are low—especially for women and those who are elderly, of a minority race or ethnicity or lower education or socioeconomic status, and who live in rural areas.3, 8 OCR participation rates of eligible patients are 14% to 35%, depending on the population studied.3, 8 Barriers to attendance can be formidable, often are multiple, and must be identified to be overcome.

Recent statements and advisories from the American Heart Association, the American College of Cardiology and the American Association of Cardiovascular and Pulmonary Rehabilitation2-3, 8 gave recommendations to improve referral and enrollment rates in CR/SPP and reduce barriers to participation.

Central to many of the proposed strategies and methods are coordinated systems:

Standing order systems for eligible inpatients that produce automatic, efficient referral to OCR at discharge
Case management, home health and social work systems that problem-solve patients’ unique barriers to attending OCR—particularly financial and transportation issues
Immediate post-event systems to educate patients and families about the benefits of CR/SPP and motivate participation
Systems to shorten the time gap between the qualifying cardiac event and OCR participation (long gaps can diminish the urgency for initiating OCR)
Systems that remind health care providers that a CR/SPP is part of optimal outpatient follow-up care after a cardiac event

Systems for better referral and patient participation in CR/SPP programs rely on team-based efforts. Cardiac rehabilitation teams of diverse clinicians providing multidisciplinary expertise and skills can respond effectively to the wide array of individual patient needs. However, team members are inter-dependent and must communicate with each other regularly to ensure integrated messages and efficiency in the components of the cardiac rehab care that achieve optimal recovery and outcomes.

References
1.         Roger VL, Go AS, Lloyd-Jones DM, et al. Heart disease and stroke statistics--2012 update: a report from the American Heart Association. Circulation. Jan 3 2012;125(1):e2-e220.
2.         Thomas RJ, King M, Lui K, Oldridge N, Pina IL, Spertus J. AACVPR/ACCF/AHA 2010 update: performance measures on cardiac rehabilitation for referral to cardiac rehabilitation/secondary prevention services: a report of the American Association of Cardiovascular and Pulmonary Rehabilitation and the American College of Cardiology Foundation/American Heart Association Task Force on Performance Measures (Writing Committee to Develop Clinical Performance Measures for Cardiac Rehabilitation). Circulation. Sep 28 2010;122(13):1342-1350.
3.         Arena R, Williams M, Forman DE, et al. Increasing Referral and Participation Rates to Outpatient Cardiac Rehabilitation: The Valuable Role of Healthcare Professionals in the Inpatient and Home Health Settings: A Science Advisory From the American Heart Association. Circulation. Jan 30 2012.
4.         Hammill BG, Curtis LH, Schulman KA, Whellan DJ. Relationship between cardiac rehabilitation and long-term risks of death and myocardial infarction among elderly Medicare beneficiaries. Circulation. Jan 5 2010;121(1):63-70.
5.         Goel K, Lennon RJ, Tilbury RT, Squires RW, Thomas RJ. Impact of cardiac rehabilitation on mortality and cardiovascular events after percutaneous coronary intervention in the community. Circulation. May 31 2011;123(21):2344-2352.
6.         Taylor RS, Brown A, Ebrahim S, et al. Exercise-based rehabilitation for patients with coronary heart disease: systematic review and meta-analysis of randomized controlled trials. Am J Med. May 15 2004;116(10):682-692.
7.         Kottke TE, Faith DA, Jordan CO, Pronk NP, Thomas RJ, Capewell S. The comparative effectiveness of heart disease prevention and treatment strategies. Am J Prev Med. Jan 2009;36(1):82-88 e85.
8.         Balady GJ, Ades PA, Bittner VA, et al. Referral, enrollment, and delivery of cardiac rehabilitation/secondary prevention programs at clinical centers and beyond: a presidential advisory from the American Heart Association. Circulation. Dec 20 2011;124(25):2951-2960.

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Cardiac Health Network – Improving Health for Populations and Communities

Added 01/14/13

Stratis Health, the Medicare Quality Improvement Organization for Minnesota, is a proud partner of the Million Hearts campaign, a nationwide initiative to prevent 1 million heart attacks and strokes in the next five years. Stratis Health is supporting the initiative at the community level by convening a network of physician office teams and stakeholders to actively address cardiovascular health. The Cardiac Health Network will engage in a 3-year collaborative initiative to standardize, sustain, and spread improvements in coordinating delivery of cardiovascular health services. The goals of the Network are to:

Bring together Minnesota physician offices and local and national stakeholders as a sustainable network aimed at improving health in populations at risk for ischemic vascular disease and other vascular diseases
Connect stakeholders and providers to implement evidence-based interventions aimed at reducing risk factors and addressing disparities that contribute to heart disease and stroke
Support physician offices in implementing and measuring interventions to improve delivery of evidence-based care to at-risk patients

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Become a partner in the Million the Hearts Initiative today by going to http://millionhearts.hhs.gov/index.html and taking the pledge.

You can also join the Cardiac Health Network and play a leading role in improving cardiovascular health for all Minnesotans. Healthcare providers, community stakeholders, and citizens are encouraged to participate.

For more information or to participate contact:
Jerri Hiniker, BSN, RN, CPEHR, Program Manager, 952-853-8540, jhiniker@stratishealth.org

Share this PSA and Register your AED today!
http://vimeo.com/55644188?goback=.gmr_4338591.
gde_4338591_member_201281711

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HPCD Connection Table of Contents

Minnesota Heart Disease & Stroke Prevention

Related Topics

Statewide Acute Stroke System Legislation Update

Added 05/02/13

Minnesota Heart Health Program – Partners in Prevention

Added 05/02/13

Minnesota Heart Disease and Stroke Prevention Plan Progress

Added 05/02/13

May is Stroke Month

Raise Awareness of Stroke Signs and Symptoms and Prevention with These New Materials

Added 05/02/13

Released April 2013.

Released April 2013.

New Heart Disease and Stroke Videos

Added 05/02/13

Hennepin County Hypertension Pilot Project

Added 01/14/13

Lakeville Program Success

Added 01/14/13

Heart Safe Communities

Added 01/14/13

What Makes a Good Cardiac Rehabilitation Program?

Added 01/14/13

Cardiac Health Network – Improving Health for Populations and Communities

Added 01/14/13

HDSP Announcements

Connection Archives

Questions ?

What Makes a Good
Cardiac Rehabilitation Program?