Dr. Jeffrey D. Howard, Commissioner

Kentucky Heart Disease and Stroke Prevention Task ForceJune 26, 2019

Allie Merritt, MPH – KHDSP Epidemiologist

Heart disease and stroke rates in KY

and the US

Risk factor data related to heart

disease and stroke

Overview of the Task Force

CARE Collaborative update

SEQIP at 10 years

Overview

Leading Causes of Death in KY

3

KY Leading Causes of Death 2017 DeathsAge-Adjusted

KY RateAge-Adjusted

US Rate

1. Diseases of the Heart 10,343 195.9 266.5

2. Cancer 10,145 185.7 200.8

3. Chronic Lower Respiratory Disease 3,480 64.5 45.4

4. Accidents 3,264 72.9 35.3

5. Cerebrovascular Disease 2,050 39.4 61.6

6. Alzheimer’s Disease 1,765 35.0 16.5

7. Diabetes 1,474 27.7 25.0

8. Kidney Disease 1,024 19.4 13.0

9. Septicemia 979 18.5 11.3

10. Influenza/Pneumonia 932 18.1 23.5

Source: Centers for Disease Control and Prevention, National Center for Health Statistics. Underlying Cause of Death 1999-2017 on CDC WONDER Online Database, released December, 2018. Data are from the Multiple Cause of Death Files, 1999-2017, as compiled from data provided by the 57 vital statistics jurisdictions through the Vital Statistics Cooperative Program. Accessed at http://wonder.cdc.gov/ucd-icd10.html on Jun 11, 2019 3:53:29 PM

Cardiovascular Death Rate

4

0

50

100

150

200

250

300

350

400

1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017

Age

-Ad

just

ed D

eath

Rat

e p

er 1

00

,00

0

Year

Cardiovascular Age-Adjusted Death Rate 1999-2017

KY - Black or African American KY - White US - Black or African American US - White

Source: Centers for Disease Control and Prevention, National Center for Health Statistics. Underlying Cause of Death 1999-2017 on CDC WONDER Online Database, released December, 2018. Data are from the Multiple Cause of Death Files, 1999-2017, as compiled from data provided by the 57 vital statistics jurisdictions through the Vital Statistics Cooperative Program. Accessed at http://wonder.cdc.gov/ucd-icd10.html on Jun 11, 2019 3:13:37 PM

CDC Heart Disease Mortality 2014-2016

5Source: Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Division for Heart Disease and Stroke Prevention. Accessed at https://www.cdc.gov/dhdsp/maps/atlas/index.htm on Jun 18, 2019 11:36:06 AM

Cerebrovascular Death Rate

6

0

10

20

30

40

50

60

70

80

90

100

1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017

Age

-Ad

just

ed D

eath

Rat

e p

er 1

00

,00

0

Year

Cerebrovascular Age-Adjusted Death Rate 1999-2017

KY - Black or African American KY - White US - Black or African American US - White

Source: Centers for Disease Control and Prevention, National Center for Health Statistics. Underlying Cause of Death 1999-2017 on CDC WONDER Online Database, released December, 2018. Data are from the Multiple Cause of Death Files, 1999-2017, as compiled from data provided by the 57 vital statistics jurisdictions through the Vital Statistics Cooperative Program. Accessed at http://wonder.cdc.gov/ucd-icd10.html on Jun 11, 2019 1:36:06 PM

CDC Stroke Mortality 2014-2016

7Source: Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Division for Heart Disease and Stroke Prevention. Accessed at https://www.cdc.gov/dhdsp/maps/atlas/index.htm on Jun 18, 2019 11:26:18 AM

Prevalence of Risk Factors

Risk Factors Related to CVD

9Source: Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Division of Population Health. BRFSS Prevalence & Trends Data [online]. 2015. [accessed May 20, 2019]. URL: https://www.cdc.gov/brfss/brfssprevalence/.

38.1%

24.6%

12.9%

34.3%

92.5%

83.0%

57.3%

33.0%

17.1%

10.5%

31.6%

89.5%

81.9%

63.2%

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

High Cholesterol

Tobacco Use (Current Smoker)

Diabetes

Obesity

Health Care Access/Coverage

Eat Vegetables one or more times aday

Eat Fruit one or more times a day

2017 Risk Factors: KY and the US

US

KY

Prevalence of Cardiovascular Diseases

10

0%

5%

10%

15%

20%

25%

30%

35%

40%

Have Angina or Coronary HeartDisease?

Had a Heart Attack (MI)? Had a Stroke? Have High Blood Pressure

Perc

ent

of

Ken

tuck

ian

s

Cardiovascular Diseases

2011 2012

2013 2014

2015 2016

2017

Source: Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Division of Population Health. BRFSS Prevalence & Trends Data [online]. 2015. [accessed June 12, 2019]. URL: https://www.cdc.gov/brfss/brfssprevalence/.

Overview of the Task Force

12

Prevention (KASH)

Systems of Care

Advocacy

Heart Systems of Care

Kentucky Heart Disease and Stroke Prevention TASK FORCE

Stroke Systems of

Care

(SEQIP)

CARE Collaborative Update

2018 CARE Data

14

Participation Totals

Month

Total Education

Encounters New Participants

Returning

Participants

Percent Returning

Participants

January 8664 3297 5367 61.95%

February 11723 5089 6634 56.59%

March 20082 12588 7494 37.32%

April 6706 3883 2823 42.10%

May 8186 2803 5383 65.76%

June 8919 3421 5498 61.64%

July 7074 2387 4687 66.26%

August 7717 2572 5145 66.67%

September 7678 2362 5316 69.24%

October 8787 3043 5744 65.37%

November 6246 1788 4458 71.37%

December 6045 1684 4361 72.14%

TOTAL 2018 107,826 44,926 62,900 58.33%

2018 CARE Data

15

44.04%

34.59%

21.38%

BP Color Zones

Green Color Zone

Yellow Color Zone

Red Color Zone

18.2% 10.0%

32.4%

Improved to Green or Yellow

Improved After Starting

Medication

Made Lifestyle Change

Identify BP Color Zone

81.3%

SEQIP at 10 Years

Mission of SEQIP

17

The mission of Stroke Encounter Quality

Improvement Project (SEQIP) is to advance

acute stroke care management and

reduce stroke disparities in Kentucky.

SEQIP Registry Volume

18

43585058

57796278

7819 7907

8941 88199408 9563

10015

2726

0

2000

4000

6000

8000

10000

12000

2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019

Nu

mb

er

of

Re

gist

ry C

ase

s

SEQIP Registry Case Volume

SEQIP Action Plan - Dysphagia

19

Dysphagia Screening Results

20

37.8%

69.5%

77.3%81.7%

87.7% 86.7%89.9% 89.8% 91.7% 92.3%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Baseline 2009 2010 2011 2012 2013 2014 2015 2016 2017

Perc

ent

of

Pati

ents

Screened for Dysphagia

VTE Prophylaxis

21

14.1%7.3%

41.6%

57.6%

91.2%95.5% 96.5% 97.4% 97.7% 97.7%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Baseline 2009 2010 2011 2012 2013 2014 2015 2016 2017

Perc

ent

of

Pati

ents

Received VTE Prophylaxis by End of Hospital Day Two

IV tPA Action Plan

22

SEQIP DECREASING DOOR TO NEEDLE TIME STATEWIDE QUALITY PLAN

Start Date: February 2011

IV tPA Within 60 Minutes

23

27.3% 24.4%

41.7%

33.3%30.2%

23.2% 25.2% 24.5%

49.3%

68.3%73.4% 75.6%

79.4%83.5% 84.0%

87.0%

0%

20%

40%

60%

80%

100%

2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019

Perc

ent

Trea

ted

wit

hin

Be

nch

mar

k

SEQIP: IV tPA Door to Needle within 60 Minutes

IV tPA Within 45 Minutes

24

18.2%

8.9%

20.4%

8.1% 7.4% 7.5% 10.1% 8.2%13.2%

20.6%

27.4%

34.8%38.7% 41.1%

49.6%53.9%

0%

20%

40%

60%

80%

100%

2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019

Perc

ent

Trea

ted

wit

hin

Ben

chm

ark

SEQIP: IV tPA Door to Needle within 45 Minutes

EMS Pre-Notification

25

0%

10%

20%

30%

40%

50%

60%

Bas

elin

e

20

08

20

09

20

10

20

11

20

12

20

13

20

14

20

15

20

16

20

17

20

18

Perc

ent

of

Pati

ents

In Hospital Mortality

26

0.0%

1.0%

2.0%

3.0%

4.0%

5.0%

6.0%

7.0%

8.0%

9.0%

10.0%

All Patients Ischemic Stroke Subarachnoid Hemorrhage Intracerebral Hemorrhage

2009 2010 2011 2012 2013

2014 2015 2016 2017 2018