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Cardiovascular Disease Cardiovascular Disease DisparitiesDisparities
Oklahoma Task Force to Eliminate Health Disparities
Data Presentation – February 4, 2004
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This Presentation• What is Cardiovascular Disease (CVD)?
• Oklahoma Cardiovascular Disease Facts
• Risk Factors
• Mortality
• Current Quality Indicators
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What is Cardiovascular Disease?
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What is Cardiovascular Disease
• Cardiovascular Disease is a group of diseases that affect the heart and the circulatory system.– This includes the muscles and nerves that support
the heart, arteries and veins.
• There are more than 60 different types of cardiovascular disease.
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Diseases of the Heart
• Congenital Heart Defects – structural problems with the development of the heart.
• Acute Myocardial Infarction – heart attack.• Infections of the Heart such as endocarditis.• Congestive Heart Failure – chambers of the heart
fail to function.• Coronary Heart Disease – plaque in the vessels
that feed the heart muscle.• Arrhythmia – irregularities of the heart beat such as
Atrial Fibrillation
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Diseases of the Circulatory System
• High Blood Pressure or Hypertension – restriction of blood flow through the arteries of the body.
• High Blood Cholesterol – the build up of plaque on the arteries of the body.
• Peripheral Vascular Disease – blockage of the arteries in the legs.
• Stroke – blockage of the blood vessels that supply oxygen and food to the brain.
• Phlebitis – blockages in the veins.
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Oklahoma CVD Facts
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Cardiovascular Disease Facts• Heart disease and stroke still remain the 1st and
3rd leading causes of death in Oklahoma.
• In 2003, heart disease and stroke accounted for over one-third of the total deaths in Oklahoma.
• In 2003, heart disease caused 10,980 deaths in Oklahoma.– 5,365 men– 5,615 women
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Cardiovascular Disease Facts• Oklahoma ranks 50th in Age-Adjusted
Mortality Rate from Cardiovascular Disease Deaths (1999-2001).
• Oklahoma’s Age-Adjusted CVD rate is 411.6/100,000 compared to 336.6/100,000 for the US overall.
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Risk Factors
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Risk Factors• Major risk factors that can’t be
changed.• Life-habit risk factors (modifiable).• Disease risk factors.• Emergency response factors.• Emerging risk factors.
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Non-Modifiable Risk Factors
• Increasing Age– men ≥45 years– women ≥55 years
• Gender (male)• Heredity
– Race– Family History
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Life Habit Risk Factors
• Cigarette Smoking • Obesity (BMI ≥30) and Overweight (BMI ≥25)
• Other factors that Contribute– Physical Inactivity– Nutrition– Stress– Excessive Alcohol
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Prevalence of CVD Risk Factors BRFSS 2003
4.2
85.7
30.6
24.4
36.1
25.1
5.7
76.7
24.4
22.8
36.6
22.0
0 20 40 60 80 100
Heavy Alcohol Consumption
<5 Fruits/Vegetables Per Day
No Leisure Time PhysicalActivity
Obesity (BMI >=30)
Overweight (BMI 25.0-29.9)
Cigarette Smoking
Percent
USOklahoma
BRFSS-Behavioral Risk Factor Surveillance System (Adults 18+)*2002 data only available; data not available.
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Disease Risk Factors
•High Blood Cholesterol-Low HDL cholesterol (<40 mg/dL)
•Hypertension or High Blood Pressure (HBP) -Pre-hypertension (≥120-139/ ≥80-89 mmHg)-Hypertension (≥140/90 mmHg) -On anti-hypertensive medication
•Diabetes
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Cholesterol ScreeningBRFSS 2003
71.0
72.9
0 20 40 60 80 100
CholesterolChecked
Past 5 years
Percent
USOklahoma
BRFSS-Behavioral Risk Factor Surveillance System (Adults 18+)
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Cholesterol Check in Past 5 Years by Insurance Oklahoma
0
20
40
60
80
100
1997 1998 1999 2000 2001 2002 2003
Uninsured
Total
Insured
2002 BRFSS data unavailable
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Cholesterol Check in Past 5 Years by Education Oklahoma
0
20
40
60
80
100
1997 1998 1999 2000 2001 2002 2003
< High School
< HS/GEDTotal
< Some College
< College Graduate
2002 BRFSS data unavailable
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Cholesterol Check in Past 5 Years by Household Income Oklahoma
0
20
40
60
80
100
1997 1998 1999 2000 2001 2002 2003
< $15,000
< $15,000-$24,999
Total< $25,000-$34,999
< $50,000+
< $35,000-$49,999
2002 BRFSS data unavailable
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Risk FactorsBRFSS 2003
7.2
28.0
7.2
24.8
0 20 40 60 80 100
Diabetes
High BloodPressure
Percent
US
OklahmaUS
BRFSS-Behavioral Risk Factor Surveillance System (Adults 18+)
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Percent of Adults Told HBPby Insurance Status/Income Oklahoma 2003
32.0
18.3
39.8
31.2
22.626.5
22.3
Insu
redUnins
ured
<$15,0
00$1
5-24,9
99$2
5-34,9
99$3
5-$49
,999
$50,0
00 +
BRFSS-Behavioral Risk Factor Surveillance System (Adults 18+)
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CimarronTexas Beaver Harper Woods
Woodward
Ellis
Dewey
Kay
Blaine
Kingfisher
Roger Mills
Beckham
Greer
Har
mon
Jackson
Kiowa
Washita
Custer
Osage
Tulsa
Creek
Was
hing
ton
Now
ata
Craig
Ottawa
Del
awar
e
MayesRog
ers
Pawnee
Potta
wat
omie
Lincoln
Payne
Okfuskee
Hughes
Canadian
Logan
Oklahoma
Cleveland
Cotton
CaddoGrady
Stephens
Jefferson
McClain
ChoctawMcCurtain
Pushmataha
Pittsburg LatimerLe Flore
Haskell
Garvin
Murray
Carter
LoveMarshall
Bryan
AtokaJohnston
Coal
Pontotoc
Sequoyah
Muskogee
McIntosh
Che
roke
e
Adair
Wagoner
Okmulgee
Comanche
Tillman
Sem
inol
e
Noble
Alfalfa Grant
GarfieldMajor
State 79.5%
78.7%-78.5%76.1%-76.6%
74.4%
Percent of Adult Respondents With Any Kind of Health Plan by Sub-State Planning Districts: Oklahoma 2001-2003
Source: Oklahoma Behavioral Risk Factor Surveillance System
CimarronTexas Beaver Harper Woods
Woodward
Ellis
Dewey
Kay
Blaine
Kingfisher
Roger Mills
Beckham
Greer
Har
mon
Jackson
Kiowa
Washita
Custer
Osage
Tulsa
Creek
Was
hing
ton
Now
ata
Craig
Ottawa
Del
awar
e
MayesRog
ers
Pawnee
Pot
taw
atom
ie
Lincoln
Payne
Okfuskee
Hughes
Canadian
Logan
Oklahoma
Cleveland
Cotton
CaddoGrady
Stephens
Jefferson
McClain
ChoctawMcCurtain
Pushmataha
Pittsburg LatimerLe Flore
Haskell
Garvin
Murray
Carter
LoveMarshall
Bryan
AtokaJohnston
Coal
Pontotoc
Sequoyah
Muskogee
McIntosh
Che
roke
e
Adair
Wagoner
Okmulgee
Comanche
Tillman
Sem
inol
e
Noble
Alfalfa Grant
GarfieldMajor
Age-Adjusted Mortality Rate Cardiovascular Disease (ICD10 I00-I09,I11,I13,I20-I51) by Sub-State Planning Districts: Oklahoma 2002
Rate per 100,000Age-Adjusted to US 2000 Standard
State Rate 296.2
298.7304-306.2312.3-314.2
339.3
Source: Oklahoma Vital Records
CimarronTexas Beaver Harper Woods
Woodward
Ellis
Dewey
Kay
Blaine
Kingfisher
Roger Mills
Beckham
Greer
Har
mon
Jackson
Kiowa
Washita
Custer
Osage
Tulsa
Creek
Was
hing
ton
Now
ata
Craig
OttawaD
elaw
are
MayesRog
ers
Pawnee
Pot
taw
atom
ie
Lincoln
Payne
Okfuskee
Hughes
Canadian
Logan
Oklahoma
Cleveland
Cotton
CaddoGrady
Stephens
Jefferson
McClain
ChoctawMcCurtain
Pushmataha
Pittsburg LatimerLe Flore
Haskell
Garvin
Murray
Carter
LoveMarshall
Bryan
AtokaJohnston
Coal
Pontotoc
Sequoyah
Muskogee
McIntosh
Che
roke
e
Adair
Wagoner
Okmulgee
Comanche
Tillman
Sem
inol
e
Noble
Alfalfa Grant
GarfieldMajor
State Rate 11,890
13,00913,767-13,998
14,967
Rates per 100,000 eligible recipients.Rates obtained were from administrative data which included paid claims/encounters only and for recipients eligible at any time during the defined year. Numerator = eligible Medicaid recipients with defined diagnosis code Denominator = total number of people that were Medicaid eligible at any point during the given yearSource: Oklahoma Health Care Authority
Rate of Paid Claim Data with a Diagnosis of Cardiovascular Disease among Medicaid Patients by Sub-State Planning Districts: Oklahoma 2003
Percent of Adult Reporting Having had their Cholesterol Checked in the Past 5 Years by Sub-State Planning Districts: Oklahoma 2003
CimarronTexas Beaver Harper Woods
Woodward
Ellis
Dewey
Kay
Blaine
Kingfisher
Roger Mills
Beckham
Greer
Har
mon
Jackson
Kiowa
Washita
Custer
Osage
Tulsa
Creek
Was
hing
ton
Now
ata
Craig
Ottawa
Del
awar
e
MayesRog
ers
Pawnee
Pot
taw
atom
ie
Lincoln
Payne
Okfuskee
Hughes
Canadian
Logan
Oklahoma
Cleveland
Cotton
CaddoGrady
Stephens
Jefferson
McClain
ChoctawMcCurtain
Pushmataha
Pittsburg LatimerLe Flore
Haskell
Garvin
Murray
Carter
LoveMarshall
Bryan
AtokaJohnston
Coal
Pontotoc
Sequoyah
Muskogee
McIntosh
Che
roke
e
Adair
Wagoner
Okmulgee
Comanche
Tillman
Sem
inol
e
Noble
Alfalfa Grant
GarfieldMajor
State 71.2%
69.0%-69.1%66.7%-67.1%63.9%
Source: Oklahoma Behavioral Risk Factor Surveillance System
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Emergency Response Factors
•Time is critical to increase survival and decrease disability
- Heart Attack – Treatment <5 minutes of onset
- Stroke - Treatment <3 hours of onset
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Recognizing Heart Attack Sign and SymptomsOklahoma BRFSS 2003
Yes NoDon’t know/ Not sure
Pain in the jaw, neck, or back 53.0% 22.0% 25.0%Feeling weak, lightheaded, or faint 70.0% 12.9% 17.0%Chest pain or discomfort 93.9% 2.3% 3.9%Trouble seeing out of one or both eyes 34.7% 29.5% 35.8%Pain or discomfort in the arms or shoulders 85.6% 5.9% 8.4%Shortness of breath 87.4% 4.5% 8.0%
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Recognizing Stroke Sign and SymptomsOklahoma BRFSS 2003
Don’t Know/Not Sure
Sudden confusion or trouble speak ing 87.2% 2.6% 10.2%Sudden numbness or weakness of face, arm, or leg, especially on one side
90.4% 2.7% 6.9%
Sudden trouble seeing in one or both eyes 64.6% 7.5% 28.0%Chest Pain or Discomfort 39.6% 30.8% 29.5%Sudden trouble walk ing, dizziness, or loss of balance
85.8% 3.3% 11.0%
Severe headache with no known cause 59.7% 10.8% 29.5%
Yes No
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Mortality
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Death Rate Due to Heart Diseaseby Age Oklahoma 2002
0500
100015002000250030003500400045005000
<10 10-19 20-29 30-39 40-49 50-59 60-69 70-79 80+
Rate per 100,000
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Age-Adjusted Death RateAcute MI, Heart Failure, and Heart Disease
Oklahoma 2002
US
278.5
33.1
360.2
171.1
30.7
244.8
0
50
100
150
200
250
300
350
400
450
500
Acute MI Heart Failure Heart Disease
MaleFemale
Rate per 100,000Age-adjusted to 2000 US Population
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Deaths due to Heart Diseaseby Race and Ethnicity Oklahoma 1997-2002
050
100150200250300350400450
1997 1998 1999 2000 2001 2002
White NHAfrican-American NHAm Indian (IHS Linked)Hispanic
Rate per 100,000Age-adjusted to 2000 US Population AI IHS Linked data unavailable for 2002.
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Quality Improvement in Medicare:
Acute Myocardial Infarction and Heart Failure
Oklahoma Foundation for Medical Quality
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Death from: Total Cardiovascular Disease Coronary Heart Disease
http://www.americanheart.org/downloadable/heart/1105390918119HDSStats2005Update.pdf
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National Priorities for Hospital Quality Improvement
• Acute myocardial infarction– 1.1 million Americans each year– 400,000 Medicare admissions annually– Most common cause of death
• Heart Failure– Affects 1-2 million Americans– 713,000 Medicare admissions annually– Most common reason for hospitalization
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National Performance MeasuresAcute Myocardial Infarction
• Acute Myocardial Infarction– Quality In
• Early administration of aspirin• Early administration of beta blockers• Time to reperfusion therapy
– Quality Out• Aspirin at discharge• ACE-I / ARB for patients with systolic dysfunction• Beta blocker at discharge• Smoking cessation counseling
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Acute Myocardial InfarctionCurrent Surveillance, 1st Quarter 2004
80.4
65.7
0 0
87.781.1
25 27.8
98.7 98.3 10096.8
0
20
40
60
80
100
ASA Admit β-block Admit Thrombolytic w/n30 minutes*
PTCA w/n 90minutes*
Per
cent
Oklahoma National National Benchmark*
Admission Measures
*For these two measures, the state-specific denominators are very small.
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Acute Myocardial InfarctionCurrent Surveillance, 1st Quarter 2004
0
10
20
30
40
50
60
70
80
90
1st Qtr 2nd Qtr 3rd Qtr 4th Qtr
East
West
North
83
68
20
50
63
93
85
0
20
40
60
80
100
ASA Admit β-block Admit Thrombolytic w/n30 minutes*
PTCA w/n 90minutes*
Per
cent
Caucasian American Indian African American
Admission Measures
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Acute Myocardial InfarctionCurrent Surveillance, 1st Quarter 2004
75.470
56
77.2
90.4
65.761.8
87.7
98.493.8 93.7
98.1
0
20
40
60
80
100
ASA DC ACE-i LVSD SmokingCounseling
β-block DC
Per
cent
Oklahoma National National Benchmark*
Discharge Measures
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Acute Myocardial InfarctionCurrent Surveillance, 1st Quarter 2004
83
6661
76
86
63
79
40
6760
0
20
40
60
80
100
ASA DC ACE-i LVSD SmokingCounseling
β-block DC
Perc
ent
Caucasian American Indian African American
Discharge Measures
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National Performance MeasuresHeart Failure
• Heart Failure– Quality In
• Evaluation of left ventricular function before or during hospitalization
– Quality Out• ACE-I at discharge for patients with systolic dysfunction• Discharge instructions• Smoking cessation counseling
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Heart FailureCurrent Surveillance, 1st Quarter 2004
10.6
68.1 66.7
50
12.7
80.2
64.3
45.8
97.3 95.4 95.4
0
20
40
60
80
100
DischargeInstructions
LVEF Assess ACE-i LVSD SmokingCounseling
Per
cent
Oklahoma National National Benchmark*
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Heart FailureCurrent Surveillance, 1st Quarter 2004
9
65 64
50
8
46
5
7973
00
20
40
60
80
100
DischargeInstructions
LVEF Assess ACE-i LVSD SmokingCounseling
Per
cent
Caucasian American Indian African American
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Hospital Public Reporting Measures
• Acute myocardial infarction• Aspirin at arrival• Beta blocker on arrival• Aspirin prescribed at discharge• ACE-inhibitor for LV systolic dysfunction• Beta blocker at discharge
• Heart Failure• Left ventricular function assessment• ACE-inhibitor for LV systolic dysfunction
• Pneumonia• Antibiotic dose within 4 hours of hospital arrival• Oxygenation assessment at arrival• Inpatient pneumococcal vaccination rate
Required reporting to Oklahoma State Department of Health for hospital quality report card expected to start in 2005.
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