CDC National Heart Disease and Stroke Prevention Program

Arkansas
Basic Implementation

In July 2000, CDC provided capacity funding to the Arkansas Department of Health to support a state heart disease and stroke prevention program. The program received increased funding for basic implementation in 2004, and in July 2007, it received additional CDC funding to lead the Delta States Stroke Consortium.

Burden of Heart Disease and Stroke

• More than 1 out of 4 deaths in Arkansas are due to heart disease. (National Vital Statistics Report, 2009.)
• 7,431 Arkansans died from heart disease in 2006 (26.6% of total deaths in Arkansas). (National Vital Statistics Report, 2009.)
• 1,884 Arkansans died from stroke in 2006 (6.8% of total deaths in Arkansas). (National Vital Statistics Report, 2009.)

See the Arkansas Department of Health report, The Burden of Cardiovascular Disease in Arkansas—Summer 2004 [PDF–4.3M], for more burden statistics.

• According to 2007 Behavioral Risk Factor Surveillance System (BRFSS) survey results, adults in Arkansas reported the following risk factors for heart disease and stroke:
  
  • 31.3% had high blood pressure
  • 40.1% of those screened reported having high blood cholesterol
  • 9.2% had diabetes
  • 22.4% were current smokers
  • 65.6% were overweight or obese (Body Mass Index greater than or equal to 25.0)
  • 54.1% reported no exercise in the prior 30 days
  • 78.2% ate fruit and vegetables less than 5 times a day

Key Responsibilities

• Facilitate collaboration among public and private sector partners, such as managed care organizations, health insurers, federally funded health centers, businesses, priority population organizations, and emergency response agencies.
• Define the burden of heart disease and stroke and assess existing population-based strategies for primary and secondary prevention of heart disease and stroke within the state.
• Develop and update a comprehensive state plan for heart disease and stroke prevention with emphasis on heart-healthy policies development, physical and social environments change, and disparities elimination (e.g., based on geography, gender, race or ethnicity, or socioeconomic status).
• Identify culturally appropriate approaches to promote heart disease and stroke prevention among racial, ethnic, and other priority populations.
• Use population-based public health strategies to increase public awareness of the heart disease and stroke urgency, the signs and symptoms of heart disease and stroke, and the need to call 9–1–1.
• Support health care organizations system changes to assure quality of care and implementation of primary and secondary prevention for heart disease and stroke.
• Monitor, implement, and evaluate prevention strategies and programs in health care sites, work sites, and communities.
• Provide training and technical assistance to public health, health care professionals, and partners to support primary and secondary prevention of heart disease and stroke.
• Monitor quality of care for primary and secondary prevention.

State Highlights

In 2003, the Heart Disease and Stroke Prevention (HDSP) section became partners with the existing Diabetes Prevention and Control Collaborative to address cardiovascular disease (CVD). Together with Arkansas’ Quality Improvement Organization, the Arkansas Chronic Illness Collaborative (ACIC) for People with Diabetes and CVD was formed. Since this time, 74 clinics have participated in the Collaborative.  ACIC is a systems change model that health care professionals can implement in their clinics, hospitals, or private practices to improve patient management techniques using the Health Resources and Services Administration’s Planned Care Model.

• In 2008, qualifying health clinics became eligible for scholarships to participate in the ACIC. Clinic teams attend three learning sessions and an “outcomes congress” during a 13-month period. Sessions include a minimum of 25 hours of continuing medical education (CME) credits on various topics such as using the electronic medical record resources registry to provide patient-centered care, self-management support, delivery systems design, decision support, clinical information systems, and community resources and policies.
• Seven clinics were awarded scholarships to participate in the 9th ACIC which included learning sessions on the Planned Care Model over a 13 month period.  The clinics follow 1,045 cardiovascular (CV) and diabetes registry patients with a potential spread to 61,322 patients. Clinics are asked to meet certain key measure goals. The two CV clinics had 70% and 83% of patients with blood pressure controlled to goal (>50%), 75% and 68% with low-density lipoprotein (LDL) controlled to goal (>60%), and 46% and 96% (>80% is goal) of tobacco users referred for cessation. One clinic received patient medical home certification as a result of participation and two other clinics are currently seeking certification.
• HDSP Section staff has established formal partnerships and serves on committees implementing Arkansas’ heart disease and stroke state plan, Small Steps, Great Strides toward a Healthier Arkansas. These partnerships and collaborations include:
  • Heart Disease and Stroke Task Force
  • Arkansas Acute Stroke Care Task Force
  • Arkansas Chronic Disease Forum Advisory Group
  • Arkansas Wellness Coalition
  • Southeast Targeted Area for Health (STAR-Health) Initiative in three Mississippi Delta counties.

  Additionally, the HDSP Section chief serves as chair of the National Association of Chronic Disease Directors’ Cardiovascular Council and represents the Council on the National Forum for Heart Disease and Stroke Prevention’s board of directors.

• The HDSP Section sponsored the Arkansas Hypertension Summit in November 2010. The Summit featured national experts who addressed the growing problem of high blood pressure, which is the most important risk factor for stroke and a major risk factor for heart disease. Between 1999 and 2008, the percentage of Arkansas adults who said a health professional told them that they had high blood pressure increased from 28.4% to 34.4%, an upward trend experienced nationally. Both Arkansas and the United States exceed the Healthy People 2010 goal of reducing the population diagnosed with high blood pressure to 16% or lower.
• In June, 2010, the University of Arkansas for Medical Sciences’ Department of Family and Preventive Medicine CME Division and the HDSP Section partnered to implement a hypertension symposium in Desha and Chicot counties as a way to improve health outcomes for the Southeast Targeted Area Resources for Health (STAR-Health) counties of Arkansas. The 55 attending health professionals were eligible for four hours of CME credit. Participants received a toolkit that included stickers, buttons, office posters with hypertension guidelines, and a CD of reproducible materials. The symposium’s key objectives included defining the state of hypertension and CVD in the Delta region, reviewing the proper technique for taking a patient’s blood pressure, and promoting use of the most current hypertension treatment guidelines.
• In collaboration with the Arkansas Acute Stroke Care Task Force, the HDSP Section is establishing a state stroke registry within the Arkansas Department of Health. By 2011, 15 hospitals are expected to participate in the registry. The stroke registry data aims to promote quality stroke care and improve health outcomes for stroke patients.
• The HDSP Section is one of several partners in the Arkansas Stroke Assistance through the Virtual Emergency Support (SAVES) program. The Section provides support for SAVES’ annual conference and helps facilitate enrollment of SAVES hospitals in the state stroke registry.  The SAVES program, funded through Medicaid, provides telestroke services statewide to 2 “hub” hospitals and 27 “spoke” facilities—usually smaller hospitals that do not have extensive neurology support. The SAVES program continues to advance stroke care in Arkansas by minimizing and potentially reversing the damaging effects of stroke by eliminating the debilitating effects of stroke through the use of tissue plasminogen activator (tPa) and timely care.
•  The HDSP Section provides six hours of cardiovascular updates to approximately 1,800 health care practitioners across the state each year. These updates, delivered through live programming and interactive television, encourage implementation of evidence-based medicine and guidelines. A post-program survey indicated 61% to 73% of respondents would be extremely likely to strongly recommend the CME courses to other health professionals. Topics covered include secondary prevention and treatment guidelines for heart disease and stroke as well as information related to risk factors, such as hypertension, cholesterol, sodium reduction, health literacy, and aspirin therapy.  CME trainings and credits are also provided to hospitals using the American Heart Association’s Get with the Guidelines program and patient management tools for heart failure and stroke.

For more information on heart disease and stroke prevention in the state, visit the Arkansas Department of Public Health Web site.

To view county-level data, visit our interactive map site.