Improving heart health in harlem


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  • Hypertension in New York City – 100 people, 29% will get hypertension
  • 22% of white people get hypertension…
  • 36.8% of african americans get hypertension.
  • Hey guys I changed this one – my recommendation is to teach community leaders about hypertension so they can host programs at their organizations
  • Improving heart health in harlem

    1. 1. Discussion with the New York State Health Foundation4/17/12
    2. 2. Agenda Introductions  the New York State Health Foundation  the Harlem Health Promotion Center  the Colin Powell Center for Social Justice  the National Black Leadership Council on AIDS (NBLCA) Racial Disparities in CVD Focus on the Harlem Community Synopsis of the Million Hearts Campaign Discussion
    3. 3. Magnitude of the problem -nationally
    4. 4. Heart Disease and Strokes are Leading Killers in the U.S. Cause 1 of every 3 deaths Over 2 million heart attacks and strokes each year  800,000 deaths  Leading cause of preventable death in people < 65  $444 B in health care costs, lost productivity Greatest expression of racial disparities in life expectancy
    5. 5. Age-adjusted death rates for stroke by sex and race/ethnicity, 2007. Source: NCHS and NHLBI.©2010 American Heart Association, Inc. All rights reserved. Roger VL et al. Published online in Circulation Dec. 15, 2010
    6. 6. CVD Leading Cause of Shorter Life Expectancy Among African Americans Life expectancy loss for blacks, in monthsSource: CDC/NCHS, National Vital Statistics System, Mortality, 2007
    7. 7. Every 24 hours… 131 men of color, and 148 women of color will die from cardiovascular disease (heart attacks, strokes, etc.)American Heart Association, 2008
    8. 8. High Blood PressurePlays a significant role in contributing to: Heart attacks Strokes  CDC. Health, United States, 2008. Hyattsville, MD: National Center for Health Statistics; 2008.
    9. 9. High Blood PressureOne in three adults…Or, about 75 million people, above the age of 20, in the United States have high bloodpressure
    10. 10. High Blood Pressure andPeople of Color 31% of all Americans affected 29% of Hispanics40% of African-Americans  Among African Americans, hypertension (HTN) develops earlier in life and tends to be more severe, therefore increasing the risk for HTN- related complications
    11. 11. Age-Adjusted Prevalence Trends for HBP in Adults, ≥20 years of age by race/ethnicity, sex and survey (NHANES:1988-1994, 1999-2004 and 2005-2008). Source: NCHS and NHLBI. NH indicates non-Hispanic.©2010 American Heart Association, Inc. All rights reserved. Roger VL et al. Published online in Circulation Dec. 15, 2010
    12. 12. High Blood Pressure and Peopleof Color  In 2004, the mortality rates from HTN related conditions were disproportionate: 14.9% for white males, compared to 49.7% for black males  14.5% for white females, compared to 40.8% for black females.  (Heart Disease and Stroke Statistics -- 2006 Update).
    13. 13. Community level perspective
    14. 14. High BP in Harlem Compared to national prevalence rates, Harlem residents had higher rates of elevated BP (41%)  (Rubin M, Chukwu E, Pultre F, Manheimer E, College G. Screening and referral for cardiovascular risk factors in Harlem, New York. Paper presented at the American Public Health Association; 2004.
    15. 15. Hospitalizationsdue to HARLEMHypertensiverelateddiseases UPPER EAST SIDE
    16. 16. Emotional Costs???
    17. 17. So, what do we do?
    18. 18. Start with the end in mind…  Vickie Powell  Harlem resident  Worships at Abyssinian Baptist Church  Told by physician that she had high blood pressure…
    19. 19.  What we eat  What we drink  What, how much we smoke  How we exercise  How we deal with stressPlay significant roles in the development of disease.
    20. 20. Management Lifestyle modification  Pre-hypertension, Stage 1 and Stage 2 hypertension  Weight loss (5-20 mmHg SBP reduction for every 20 lbs lost)  Reduce Sodium (8-14mmHG SBP reduction)  Increase Physical activity (4-9 mmHG SBP reduction)  Reduce Alcohol consumption (2-4 mmHG SBP reduction)  Reduce Smoking (10-20 mmHG SBP reduction) Medications  Stage 1 and Stage 2 hypertension
    21. 21. An “activated” Vickie…  Changed her diet  Began exercising regularly  Embraced yoga and meditation  Lost 20 lbs  Normalized her blood pressure…without medication
    22. 22. Unfortunately…  Vickie is unique
    23. 23. So, how are we doing? Of those people with high blood pressure, 77.6 percent were aware of their condition.  But…  More than one in five (22.4%) people with high blood pressure dont know that they have it.2 • Lloyd-Jones D, Adams RJ, Brown TM, et al. Heart Disease and Stroke Statistics—2010 Update. A Report from the American Heart Association Statistics Committee and Stroke S . Circulation. 2010;121:e1-e170.
    24. 24. So, how are we doing? About 80% of those with high blood pressure, were aware, were in treatment 48% had their high blood pressure controlled But… 52% were not controlled 
    25. 25. I have high blood pressure, butno one has every told me whathigh blood pressure is and how itcan affect my life. What are thetarget numbers?
    26. 26. I already know I have high bloodpressure, it runs in my family. I knowit can cause a stroke, but what else?How can I lower it?
    27. 27. There are so many things I don’t knowabout high blood pressure. I don’t knowwhere to turn to. My doctor doesn’t havetime to teach me, and none of my friendscan help.
    28. 28. Doctor-Patient Communication  The average visit length was 15 minutes.  The average patient who came with one or more concerns used only 32 seconds to complete their review of concerns.  In 24.6% of visits, the physician did not ask the patient about his/her concerns.Marvel, MK, Epstein, RM, Flowers, K & Beckman, HB (1999) Soliciting the patient’sagenda: have we improved? JAMA, 281(3):283-287
    29. 29. Lifestyle Modification Providers have minimal time to provide counseling and education with clients May not feel comfortable in providing information and support Lack of resources for other types of clinic- based supports Need for adjunctive measures
    30. 30. Response
    31. 31. Preventing 1 million heart attacks and strokes in 5years
    32. 32. Key Components of Million Hearts Community Prevention  Reduce the number of people who need treatment Clinical Prevention  Optimize care for those who do
    33. 33. Status of the ABCS Aspirin People at increased risk of cardiovascular 47% disease who are taking aspirin Blood People with hypertension who have 46% adequately controlled blood pressure pressure Cholestero People with high cholesterol who have 33% adequately controlled hyperlipidemia l Smoking People trying to quit smoking who get 23% helpSource: MMWR: Million Hearts: Strategies to Reduce the Prevalence of LeadingCardiovascular Disease Risk Factors --- United States, 2011, Early Release, Vol. 60
    34. 34. Million Hearts: Getting to the GoalPopulation metric Baseline 20171 Clinical target2Aspirin for those at high risk ~50% 65% ~70%Blood pressure control ~50% 65% ~70%Cholesterol control ~33% 65% ~70%Smoking prevalence ~20% 17% ─Average sodium intake 3.5g/day 20% ↓ ─Average artificial trans fat intake 1% of calories/day 50% ↓ ─ 1 Population-wide indicators 2 Clinical systems
    35. 35. Multi-system Approach
    36. 36. Community PreventionReducing the Number who NeedTreatment Strengthen tobacco control and reduce smoking Improve nutrition
    37. 37. Clinical Prevention Uniform, simplified set of ABCS measures Getting the ABCS into federal and state programs  EHR meaningful use criteria  Point of care clinical decision support  Systematic assessment of cardiac risk  Use of recall reminders and order sets  Monitoring of medication adherence Insurers  Measure and incentivise performance on the ABCS; collect and share data for quality improvement; empower consumers
    38. 38. Medical System Messages Individuals  Know your numbers—and goals  Take aspirin, if advised  Get aggressive with BP and Cholesterol  Cut sodium and trans-fats  If you smoke, quit
    39. 39. Getting the messages out Mobilize the best change agents  Pharmacists, health coaches, lay workers, nurses, community orgs, others
    40. 40. Community Messages Retailers and Employers  Offer blood pressure monitoring and educational resources; focus on improving ABCS care in retail and worksite clinics Government  Support community and systems transformation to reduce tobacco use and improve nutrition, including smoke-free policies and food procurement standards; provide data for action; expand coverage for the uninsured Foundations  Support consumer and provider outreach and activation Advocacy groups  Monitor and demand progress toward goal and promote actions that prevent heart attacks and strokes
    41. 41. Million Hearts Outcomes 10M more people with HBP controlled 20M more people with high cholesterol controlled 4M fewer people will smoke 20% drop in average sodium intake 50% drop in average trans fat intake
    42. 42. Locally How do we start in Harlem?
    43. 43. I was scared to have my blood pressure taken…But, my friends convinced me to have it taken.Now I have work to do in order to keep it normal.
    44. 44. How do we promote awarenessand create opportunitiesfor success?
    45. 45. Community Outreach
    46. 46. Community Outreach
    47. 47. Community Outreach
    48. 48. Community-based Initiatives Involving the faith community Experiences of NYSHF with Diabetes Program
    49. 49. Community-based Initiatives Involving health ministries, lay health workers Involving nursing students Involving College students
    50. 50. Faith-based initiative
    51. 51. Next Steps…