CVD Risk Reduction

CVD Risk Reduction: A Population-Wide InterventionJames LeathersAugust 24th, 2016

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Case66 yo White MalePMHDMHypercholesteremiaSH: 1-2 glasses of whiskey per weekFH: Father: deceased, MI, 62yoMother: deceased, breast CA, 70

PE: BP 122/78, HR 88, RR 14, BMI 35CV: RRR no MRGLungs: CTABAbdomen: NTND, NBSLabs:Total cholesterol 220; HDL 33MedicationsStatin

ASCVD CalculationAge 66HDL: 33Total cholesterol 220SBP 122DiabetesNon-smokerHTN10 year ASCVD Risk: 29.8%; Lifetime: N/A

AHA Diabetes Statistics2010: 6.4% of world population have DM9% of US population have DM35% of US population has pre-DM2030 projection: 7.7% of world population

The reason I selected the patient for my case example, was because he was a heavier man, with diabetes, and overall a fairly good representation of many of the patients we treat here at Vanderbilt. Diabetes, in particular, is a main risk factor for ASCVD, and as we will see later, will be the target of the population-level intervention that I propose to employ. But before we get there, I wanted to talk a little bit about some diabetes statistics provided by the American Heart Association. 5

Community Resources

Before we talk about my proposal, I wanted to cue you in to some of the community resources available for finding other public health projects that have already been implemented. www.healthynashville.org, is a website that allows you to find projects in Nashville and across the nation. From the homepage, click on the resources and tools tab, and the click on the find promising practices link. 6

From here, you can search projects by keywords. Since my intervention will focus on diabetes, I will start by typing diabetes in the text box in the bottom right corner of the screen. 7

The first project to pop up, is a diabetes self management program in Conneticut. Here, I can read more about the goals and mission of the project, read about any results and accomplishments published as part of the project, and even contact the project coordinator. 8

Aggregate Data20 patients (11M, 9F)Race: 15 W, 5 AAMean HDL: 42.75Mean total cholesterol: 186Mean TRG: 123Mean BMI: 32DM: 60%; HTN tx: 45%, Smoker?: 50%Systolic BP: 136

Project: Target PopulationPatients with DM at risk for ASCVD

So now that I have some ideas from other projects proposed that are related to my intervention, we can finally talk about my proposal. For my project, my target population will be patients with DM, at highest risk for ASCVD. Since we are here at Vanderbilt, my intervention will focus on patients of VUMC. 10

Target of Risk Reduction:DM A1C ImprovementWhy:Elevated A1C has been shown to be directly associated with increased risk of ASCVDI believe that reducing A1C will reduce the risk of ASCVD

The target of of ASCVD risk reduction, will be diabetes control. Specifically, using the objective marker of hemoglobin A1C levels over time. Why might you ask? Well, elevated A1C levels have been shown to be directly associated with an increased risk of ASCVD complications. Furthermore, I believe the data that suggests that reducing A1C will also reduce the risk of ASCVD. 11

Planned Intervention:Community Resource OrganizationPay a public health worker $5000 to create a weekly meeting targeted at providing diabetes education, exercise resources, dietary assistance and blood glucose monitoring training to diabetic patients with highest ASCVD risk

Metric to Determine Improvement1) Attendance of referred patients2) Change in A1C after enrollment at set time intervals

The first metric to determine improvement, is whether or not patients are attending the diabetes training meetings because an intervention can only be successful if its participants comply with the intervention. The second metric to determine improvement, is the change in A1C after enrollment at set time intervals of 3 months, 6months and 1 year. 13

Time Course Needed3 months, 6 months Assess changes in A1C12 monthsAssess sustained changes in A1C

DefenseControlling my patients A1C will decrease the risk for ASCVD eventsManagement of diabetes can be overwhelming for patientsPatients need supportThis project, if successful, can be potentially applied to patients across the country

I support this intervention because controlling my patients A1C will decrease the risk for ASCVD events. I specifically chose this project because the management of diabetes can often be overwhelming to patients, and they will need a lot of support. The weekly structure of this intervention, will allow patients to receive the appropriate education that will train them to manage this chronic disease on their own. If successful, this project could be potentially applied to patients across the country and help reduce diabetes morbidity and mortality. 15