Primordial and Primary Prevention Work Group
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Chair:
Dr. Robert Tota
Preventive Cardiologist
Bridgeport, CT
AHA Representatives:
Megan Tucker
Robin Vitale
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Lia Baroody
Program Coordinator
Heart Disease and Stroke Prevention
New Hampshire Department of Health
Concord, NH
Susan Coburn, MPH, RD
Nutrition and Physical Activity Chief
Vermont Department of Health
Burlington, VT
Barbara A. Dennison, MD
Director, Policy and Research Translation Unit
Division of Chronic Disease and Injury Prevention
New York State Department of Health
Albany, NY
Robin Edelman, MS, RD, CDE
Diabetes Program Administrator
Vermont Department of Health
Burlington, VT
| Stephen Marshalko, MD, PhD
Cardiologist
Bridgeport, CT
Angela Cole Westhoff
Executive Director
Maine Osteopathic Association
Manchester, ME
Monica K. Wheeler, MS, RN
Director of Community Health
Westport Weston Health District
Westport, CT
Intern
Madeline Alyse Chaffee
Trumbull, CT
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The SSCM states that a stroke system should develop support mechanisms and tools to assist communities, patients and providers in initiating and adhering to prevention regimens applicable to the population as a whole, with a focus on educational programs to target high risk populations. Community based organizations, healthcare providers and non-profit and public agencies share responsibility for implementing strategies to prevent stroke. While knowledge alone does not drive behavior change, a properly educated patient and caregiver population is a critical first step in successful stroke prevention programs. Primary care providers can play a critical role in providing individualized education to their patients about risk of stroke and therapeutic lifestyle changes that can be made to reduce the risk.
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1. Continuing medical education of providers, through traditional and e-learning venues should be delivered to increase primary care physician awareness of, and adherence to, stroke prevention guidelines. NECC should partner with like-minded organizations / experts to develop a standardized, simple communication tool to assist healthcare providers in illustrating for patients their current modifiable risk factor profile and their individualized targets for adherence. This patient “report card” should include specific goals for BMI, physical activity, blood pressure, cholesterol, blood glucose and other relevant lab studies, as well as the medications prescribed for stroke prevention.
2. NECC public health partners including state governments, non-profit advocacy, and other like-minded organizations should enhance cooperative outreach and dedicate resources to better educate at-risk patients about stroke and modifiable risk factors, join together to provide primary care physicians with the tools and resources that are necessary to fully educate their at risk patients, and continue to pursue public policies that encourage smoking cessation, promote physical activity and proper nutrition, and provide better access to health screening and disease prevention programs.
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The Primordial and Primary Prevention writing group maintains an intention to assess available physician tool kits to properly determine the best utilization of this type of primary intervention. Outreach is planned to like-minded organizations as a mechanism to broaden NECC’s focus to include potential community partners. In addition, the writing group is interested in recruiting these new partners to becoming members of NECC with an ultimate intention of implementing the physician toolkit. These strengthened partnerships will also be beneficial in pursuit of systemic change through the appropriate preventive measures in public policy.
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Outcomes are anticipated to focus on a detailed inventory of existing tool kit protoypes as well as greater outreach to like-minded potential partners.
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Methodology for measurement of outcomes:
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American Stroke Association, Stroke Risk Assessment Form
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ASA Advocacy / State Health Alliance network of partnering organizations / agencies
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Life's Simple 7
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Patient Activation Measures (PAM survey tool)
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2009 State & Local Public Policy Priorities (updated annually)
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General:
PowerPoint: Heart Disease and Stroke: What You Need to Know - Talking Points
Vermont Department of Health
Defining and setting national goals for cardiovascular health promotion and disease reduction: the American Heart Association's strategic Impact Goal through 2020 and beyond. Circulation. 2010 Feb 2;121(4):586-613. Epub 2010 Jan 20. Review.
Distribution of 10-year and lifetime predicted risks for cardiovascular disease in US adults: findings from the National Health and Nutrition Examination Survey 2003 to 2006. Circ Cardiovasc Qual Outcomes. 2010 Jan 1;3(1):8-14. Epub 2009 Nov 16.
Risk estimation in 2009. Circ Cardiovasc Qual Outcomes. 2010 Jan 1;3(1):4-5
Primary prevention of ischemic stroke: a guideline from the American Heart Association/American Stroke Association Stroke Council: cosponsored by the Atherosclerotic Peripheral Vascular Disease Interdisciplinary Working Group; Cardiovascular Nursing Council; Clinical Cardiology Council; Nutrition, Physical Activity, and Metabolism Council; and the Quality of Care and Outcomes Research Interdisciplinary Working Group: the American Academy of Neurology affirms the value of this guideline. Stroke. 2006 Jun;37(6):1583-633. Epub 2006 May 4. Erratum in: Stroke. 2007 Jan;38(1):207.
Screening Tools:
Screening for cardiovascular risk in asymptomatic patients. J Am Coll Cardiol. 2010 Mar 23;55(12):1169-77.
General cardiovascular risk profile for use in primary care: the Framingham Heart Study. Cerebrovasc Dis. 2008;25(4):366-74. Epub 2008 Mar 13.
Stroke risk profile: adjustment for antihypertensive medication. The Framingham Study. Stroke. 1994 Jan;25(1):40-3.
Prediction of ischemic stroke risk in the Atherosclerosis Risk in Communities Study. Am J Epidemiol. 2004 Aug 1;160(3):259-69. Erratum in: Am J Epidemiol. 2004 Nov 1;160(9):927.
Lipoprotein-associated phospholipase A2 and high-sensitivity C-reactive protein improve the stratification of ischemic stroke risk in the Atherosclerosis Risk in Communities (ARIC) study. Stroke. 2009 Feb;40(2):376-81. Epub 2008 Dec 18.
An example a "report card" approach
One-year follow-up of a therapeutic lifestyle intervention targeting cardiovascular disease risk. CMAJ. 2007 Oct 9;177(8):859-65.
Therapeutic lifestyle and disease-management interventions: pushing the scientific envelope. Alter DA.
An example of a community-based approach:
Healthy hearts--a community-based primary prevention programme to reduce coronary heart disease. BMC Cardiovasc Disord. 2008 Jul 26;8:18.
An example of facilitating Patient-Physician communication:
Communicating evidence for participatory decision making. JAMA. 2004 May 19;291(19):2359-66. Review.
IOM workshop and report to Congress:
The first is the 2009 report to Congress.
http://www.ers.usda.gov/Publications/AP/AP036/AP036.pdf The second document is from the Institute of Medicine which provided a technical background for the Congressional report. http://books.nap.edu/openbook.php?record_id=12623&page=64 In this second document I would call your attention to an excerpt from Dr. Frank Hu of the Harvard School of Public Health (see document page 42) Hu said the evidence is “pretty solid” that plant-based foods—including whole grains, fruits and vegetables, nuts, legumes, and healthy vegetable oils—are beneficial for cardiovascular disease (CVD) prevention. These foods are basically an indication of a high-quality diet. Diets high in saturated fat, trans fat, or refined sugars, including some starchy food, are detrimental for both diabetes and CVD. Sugar-sweetened beverages increase the risk of obesity, diabetes, and perhaps CVD. The IOM report is from a workshop that was held in January 2009. Attached is a slide from Dr. Hu's presentation at that workshop (unfortunately the link to the presentation seems to be no longer working at the workshop site http://www.iom.edu/Activities/Nutrition/FoodDeserts/2009-JAN-27.aspx). I think when when you see this slide you will see why cardiovascular providers need to be advocates in public health nutrition.
Chronic Disease Self-Management Program (CDSMP) Research:
The Stanford Patient Education Research Center out of Stanford University developed a self management program for individuals living with chronic diseases. It serves to compliment traditional treatment options and disease specific education and heightens the success of disease management by helping individuals develop a strong social support network and boost overall confidence. It is operated as a workshop that is held for two and a half hours, once a week, for a period of six weeks at various community locations. During this time, several different techniques and skills are taught, including coping methods for pain, fatigue, frustration, and isolation, appropriate use of medications, proper nutrition and fitness, as well as, effective communication among family members and health professionals. Each workshop is facilitated by two trained leaders, each of whom has a chronic disease. A key feature of the program is that participants help each other with brainstorming and problem-solving regarding individual action plans for behavior improvement that are shared weekly. Tools that are utilized during the workshop include: a companion book entitled, “Living a Healthy Life with Chronic Conditions” (3rd Edition), as well as an audio tape for relaxation purposes entitled, “Time for Healing”. This program is offered throughout the United States, as well as internationally. More information can be attained via the Stanford University Medical School website:
http://patienteducation.stanford.edu/programs/cdsmp.html
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- Review of Tool Kit Prototypes
- Recruitment of additional primary / primordial prevention partners
- Development of NECC StrokeTool Kit
- Implementation of Tool Kit Pilot
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Potential Venue for Presenting Results:
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For Members of the Primordial and Primary Prevention Group:
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