CDC National Heart Disease and Stroke Prevention Program

Montana
Basic Implementation

The Montana Department of Public Health and Human Services (MDPHHS) began receiving funds from CDC in 2000 to support a state heart disease and stroke prevention program. The program received increased funding for basic implementation beginning in 2003.

Burden of Heart Disease and Stroke

Nearly 1 out of 4 deaths in Montana are due to heart disease. (National Vital Statistics Report, 2009.)
1,869 Montanans died from heart disease in 2006 (22.1% of total deaths in Montana). (National Vital Statistics Report, 2009.)
461 Montanans died from stroke in 2006 (5.4% of total deaths in Montana). (National Vital Statistics Report, 2009.)

See the Montana Department of Public Health and Human Services report, The Burden of Heart Disease and Stroke in the Big Sky State—Montana 2007, [PDF–3.5M] and the Northwest Regional Stroke Network report, Burden of Stroke in the Pacific Northwest—August 2008, [PDF–693K] for more burden statistics.

According to 2007 Behavioral Risk Factor Surveillance System (BRFSS) survey results, adults in Montana reported having the following risk factors for heart disease and stroke:
- 25.2% had high blood pressure
- 34.6% of those screened reported having high blood cholesterol
- 6.6% had diabetes
- 19.5% were current smokers
- 61.8% were overweight or obese (Body Mass Index greater than or equal to 25.0)
- 42.0% reported no exercise in the prior 30 days
- 74.7% ate fruit and vegetables less than 5 times a day

Heart disease and stroke risk factors among adults—Montana compared with the United States.

Risk Factor	Montana	Nationwide (States and D.C.)
Eat fruits and vegetables less than 5 times/day	74.7	75.6
Overweight or obese	61.8	62.9
No moderate or vigorous physical activity	42.0	50.5
High total blood cholesterol	34.6	37.6
High blood pressure	25.2	27.8
Cigarette smoking	19.5	19.8
Diabetes	6.6	8.0

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 2007, Montana’s Cardiovascular Health (CVH) program began to focus efforts on disparate socioeconomic populations, by working with nine community health centers and one satellite clinic. The effort focused on establishing patient education and home blood pressure monitoring, reviewing the patient’s blood pressure log, and advancing medical therapy. Results include
- An estimated 1,676 patients were reached—712 patients with diabetes and 964 patients with hypertension and no diabetes.
- A 2010 evaluation showed blood pressure control rates increased from 33% to 42% for patients with diabetes and from 56% to 62% for patients with high blood pressure and no diabetes.
- Of the 607 patients who received a blood pressure kit, 47% achieved control rates. Average blood pressure for those receiving a blood pressure kit decreased in both patients with diabetes (from 142.9/83.5 mmHg to 134.8/78.6 mmHg) and patients with hypertension and no diabetes (from 149.8/91.9 mmHg to 138.3/84.6 mmHg).
In May 2010, the CVH program launched a statewide Hypertension Coalition. Coalition members are helping to develop a hypertension improvement program that targets high blood pressure control in healthcare and work site settings.
In 2010, the CVH program implemented a blood pressure awareness project, which resulted in the Montana City School Board in Clancy, MT, passing an employee wellness policy. This policy supports wellness through employee self-monitoring of blood pressure and healthy food offerings at meetings and events.
The CVH program has provided or partnered with others to provide training for Emergency Medical Services (EMS) staff. Forty-six dispatchers from 14 of 57 Public Safety Answering Points received access to online cardiac and stroke classes. More than 400 EMS staff and 28 dispatchers accessed the American Stroke Association's online pre-hospital education. Four National Stroke Association EMS trainings were held in communities with telestroke systems. Through Montana’s participation in the Northwest Regional Stroke Network, 184 rural EMS staff were offered EMS online training.
Six hospitals—in Lewistown, Havre, Libby, Whitefish, Ronan and Glasgow—are now part of a telestroke system. Neurologists provide telestroke consults to these hospitals, increasing access to high quality stroke care in rural Montana.
The Board of Medical Examiners approved protocols to enhance emergency response for cardiac events.
One hundred and six cardiac rehabilitation programs in 12 states participate in Montana's Outcomes Project. Through this project, these programs tracked outcomes on more than 10,000 patients within a year.
To establish a system of care for acute coronary syndrome patients, the CVH Program and Cardiac Workgroup disseminated examples of standing orders, evidence-based care guidelines, quality score cards and other materials to all 51 Critical Access hospitals. As of September 2010, the program reached 253 health professionals, emphasizing recognition, management, and treatment of cardiac patients in rural settings.
In 2010, the CVH Program completed stroke campaigns in Gallatin County and the Flathead Reservation, heart attack campaigns in Yellowstone County and Rocky Boy’s Reservation, and a high-intensity stroke campaign on the Fort Belknap Reservation. The Yellowstone post-campaign survey showed a statistically significant increase in respondents’ awareness of heart attack signs.