ADVANCES IN CARDIOVASCULAR CARE: 50 YEARS OF PROGRESS Beverly Lowentritt RN,MSN,CS,FNP

ADVANCES IN CARDIOVASCULAR CARE:50 YEARS OF PROGRESS

Beverly Lowentritt RN,MSN,CS,FNP

Joes Story195746 yr old short-haul truck driverFaithful 25 yr employee, husband, father of 4 Smokes 2 packs a day (unfiltered Camels)Ht/Wt: 511/ 230 poundsDiet: bologna and cheese sandwich, Hostess cupcake, whole milkExercise: heavy, physical labor Stress: sole breadwinner, extremes in temp, no air conditioning in truck or companyNo physicianFamily history father died in his 40s

Risk Factors for Acute Coronary Syndrome (ACS)Modifiable:Sedentary lifestyleCigarette smokingObesityHigh-fat dietHypertensionNon-modifiable:Male genderFamily historyDiabetesMenopause

Joes Last Day on the Job

3-day history of weak, dizzy, nausea, indigestion unrelieved by Alka SeltzerTemp outside: 105 in the shadeTells no one!!Noted by another employee to be visibly SOB, sitting down frequentlyFalls out no CPR, dies of heart attack OR

Joes Last Day on the JobSitting down and asks for a doctorAmbulance station wagon and untrained driver transported to a hospital room Physician orders: CBC, oxygen, tepid fluids, no coffee or stimulants, soft bland diet, quiet room, bedrest for 2 weeksDischarged to return home to sedentary lifestyle -NEVER TO WORK AGAIN!!!ROI??? 25 yrs for company, productive life cut short for Joe

Joeys Story200746 yr old short-haul truck driver 12 hr rotating shifts in large, noisy industrial environment6-month employee, husband, father of 4 Smokes 2 packs a day (filtered)Ht/Wt: 511/ 230 poundsDiet: Big Mac, fries, large Coke, apple pieExercise: workStress: divorced, financial overstretchNo physicianFamily history grandfather (Joe) died age 46

Joeys First Day of the Rest of His LifeChronic complainer but today weak, diaphoretic, rubbing chest, SOBFalls out nurse/employees initiate CPR, **AED appliedAmbulance arrives (paramedics) 12-lead EKG transmitted, lab drawn, IV, **ASA, packaged for transport **E.D. - Door to balloon time < 90 minutes**Cath Lab **catheter, balloon, stent**CV surgery - **IABP

Joeys First Day of the Rest of His Life**CCU arterial lines, monitors, 1:1 care, defibrillator and Crash CartStep-down unit after 2 daysCHF STAT Team called tuned up remains on Step Down UnitEarly, aggressive mobilityDischarged < 1 week **Cardiac rehabProgressive recovery at homeRETURN TO WORK in 6-8 weeks!!ROI - $$$thousands at work, immeasurable at home

AMERICAN HEART ASSOCIATION

400,000 to 460,000 die of heart disease each year1261 lives yesterday13% of these deaths are in the workplace

Prevalence of cardiovascular diseases in adults age 20 and older by age and sex (NHANES: 1999-2004). Source: NCHS and NHLBI. These data include coronary heart disease, heart failure, stroke and hypertension.

Chart1

14.89.4

39.139.5

71.375.1

8392

Males

Females

Percent of Population

Sheet1

Prevalence of CVD, U.S. 2003-2004 NHANES

AgeMalesFemales

20-3914.89.4

40-5939.139.5

60-7971.375.1

80+83.092.0

Prevalence of Cardiovascular Diseases in Americans Age 20 and Older by Age and Sex

United States: 1999-2004

Sheet1

Males

Females


Annual rate of first heart attacks by age, sex and race (ARIC: 1987-2000). Source: NHLBIs ARIC surveillance study, 1987-2000.

Chart4

1.081.530.250.73

3.454.241.062.15

7.167.782.745.67

11.9713.96.369.3

White Men

Black Men

White Women

Black Women

Ages

Per 1,000 Persons

Sheet1

CVDCVD2001 CVD total mortalityLCD BLACK M/F, 2001LCD AM. INDIAN M/F, 2001AgesMenWomenMenWomenNHES IIINHANES INHANES III

MalesFemales145,908141,80125-442.02.8A2.61.1Non-Hispanic WhitesNon-Hispanic BlacksMexican AmericansWhite Males163163155% of Men using PA to lose weight% of Men meeting PA guidelines% of Women using PA to lose weight% of Women meeting PA guidelinesNumber of TransplantsEST. COST OF CV DISEASES 2004

1979500469MALESFEMALESMALESFEMALES45-546.75.5B4.02.0Black Males171165166Whites66.522.863.520.1196823

80510490Coronary Heart Disease54502,18954CVD+cong.A33.5CVD+cong.A40.1D of H/St.A24.4D of H/St.A25.455-6413.18.4C5.43.5Awareness69.573.957.8White Females170166163Blacks70.122.662.816.9197010Heart Disease238.6

81500484Stroke18163,53818CancerB22.4CancerB20.8CancerB17.1CancerB19.165-7417.711.1D8.46.3Treatment60.163.040.3Black Females172174168Hispanics63.817.152.714.3197522Coronary Heart Disease133.2

82495484Congestive Heart Failure652,8286AccidentsC5.9DiabetesF5.1Acc.C14.0Acc.C8.275+18.616.1E14.819.1Control, Treated55.644.644.0Others68.423.063.520.6198057Stroke53.6

83498494High Blood Pressure546,7655Assault(Homicide)D4.6Nephritis, etc.G2.9C. Liver D.D4.8DiabetesE6.7F22.427.0Control, All Hypertensives33.428.117.7Trends in Mean Total Blood Cholesterol Among Adolescents Ages 12-17 by Sex and Race and Survey1985719Hypertensive Disease55.5

84491493Diseases of the Arteries439,4044HIV(Aids)E3.7AccidentsC2.8DiabetesE4.3C. Lower res.D.F4.1Prevalence of Coronary Heart Disease by Age and SexNHES III, NHANES I, NHANES III: 1966-70, 1971-74 and 1988-94Leisure-time Physical Activity (PA) Patterns Among Overweight Adults by Race/Ethnicity and Sex19902,107Congestive Heart Failure28.8

85491498Rheumatic Fever/Rheumatic Heart Disease0.43,4890.4NHANES III: 1988-94Estimated 10 Year Stroke Risk in 55 Year Old AdultsBRFSS: 199819952,363Total CVD*368.4

86481498Congenital Cardiovascular Defects0.44,1090.4Leading Causes of Death for Black or African American Males and FemalesLeading Causes of Death for American Indian/Alaska Native Males and FemlaesAccording to Levels of Various Risk FactorsExtent of Awareness, Treatment and Control of High Blood Pressure by Race/Ethnicity20002,199

87475499Other13118,78613United States: 2001United States: 2001Framingham Heart StudyNHANES IV: 1999-200020022,154Estimated Direct and Indirect Costs (in Billions of Dollars) of Cardiovascular Diseases and Stroke

88476504100.8931,108100.0United States: 2004

89456486Trend in Heart Transplants

90448478Percentage Breakdown of Deaths From Cardiovascular DiseasesUnitedStates: 1968-2002

91447479United States:2001

92444479

93457500

94452498

95455505

96453506

97450503

98446504

99446513

00439507Non-Hispanic WhitesNon-Hispanic BlacksMexican Americans

01432499YearMalesFemales12% of high school students who participated in vigorous or moderate physical physical activity in past 7 daysMen5.47.68.1

70779597Whites76.644.218.2Women4.79.511.4

Cardiovascular Disease Mortality Trends for Males and FemalesMales71851628Blacks26.724.116.4Non-Hispanic White MalesNon-Hispanic White FemalesNon-Hispanic Black MalesNon-Hispanic Black FemalesHispanic MalesHispanic FemalesMalesFemales

United States: 1979-2001Males72935693ABCDEFCHF PREVALENCEMexican Americans34.317.317.5Vigorous73.759.872.447.868.852.4Non-Hispanic Whites12.45.3Prevalence of Age-Adjusted (2000) Physician-Diagnosed Diabetes in Americans Age 20 and Older by Sex and Race/Ethnicity

73982725Blood Pressure*95-105138-148138-148138-148138-148138-148MalesFemalesModerate29.824.723.716.525.918.5Non-Hispanic Blacks17.514.6NHANES III: 1988-94 NHANES III

741030756DiabetesNoNoYesYesYesYes20-240.10.1Prevalence of Current Smoking for Men Ages 18-24 by Education and Race/EthnicityHispanics21.38.8

751043789Cigarette SmokingNoNoNoYesYesYes25-340.10.1NHANES III: 1988-94Prevalence of Students in Grades 9-12 Who Participated in Sufficient Vigorousu.s. 1979-00

Prevalence of CVD, U.S. 1988-94 NHANES III761087843Prior AFNoNoNoNoYesYes35-440.70.5or Moderate Physical Activity During the Past 7 Days by Race/Ethnicity and SexPercentage of Overweight Among Students in Grades 9-12 by Sex and Race/EthnicityCatheterizationsOpen-HeartBypassPTCAEndarterectomyPacemakers

771111852Prior CVDNoNoNoNoNoYes45-541.81.3United States: 2001United States: 200119792991721145442

AgeMalesFemales78111084455-646.23.4803501971375544

20-245.54.6791014724* - Closest ranges for women are : 95-104 and 115-124.65-746.86.6814162221597326

25-3410.44.280104973775+9.89.7824732401708231

35-4417.413.6811095765MenWomen835122601919525

45-5434.228.982116084120-349.80.0Prevalence of Congestive Heart Failure by Age and Sex8457627820210339

55-6451.048.183122985235-4417.116.0NHANES III: 1988-948569030823010740

65-7465.265.284104484045-5432.330.5867863702848332

75+70.779.085120584655-6444.153.0878794093321568189

86125088965-7459.970.38894445735321170120

Females87126890175+68.884.18999846836824370107

Prevalence of Cardiovascular Diseases in Americans Age 20 and Older by Age and SexFemales8812208309010465013922666897

NHANES III :1988-94MenWomen891174819Prevalence of High Blood Pressure in Americans Age 20 and Over by Age and Sex91105751840730367121

DR FOR WOMEN, CV AND CANCER 2001A55901151795United States: 1999-200092108459046836791113

LCD HISPANIC M/F, 2001B138911146806WhitesBlacksMexican Americans93107860648536989123

White FemalesBlack Females63,31747,082C252092124788612

Estimated direct and indirect costs of major cardiovascular diseases and stroke (United States: 2007).Source: NHLBI.

Chart6

151.6

62.7

66.4

33.2

Billions of Dollars

Sheet1

HF PREVALENCECHD MortalityCVD MortalityTotal Mortality

MenWomenNo MetS or DM2.65.314.4

20-390.30.2MetS w/o DM4.37.817.1

40-592.01.5MetS w/DM4.88.621.1

60-797.25.2DM only6.311.526.1

80+11.612.4Prior CVD10.916.730.0

Prior CVD and DM17.028.144.1

Chart 7A: Prevalence of heart failure by sex and ageChart 10A: Total mortality rates in U.S. adults, ages 3075, with metabolic syndrome (MetS), with and without diabetes mellitus (DM) and pre-existing CVD

NHANES: 199904NHANES II 197680 Follow-Up Study*

Source : NCHS and NHLBI.Source: Malik et al.(10) *Average of 13 years of follow-up.

Chart 7B: Hospital discharges for heart failure by sex

United States: 19702004

Note: Hospital discharges include those inpatients discharged alive, dead or status unknown. Source: NHDS, NCHS and personal communication with NHLBI.

Hospital Discharges for HF

CHF Discharges

-----------In thousands------

MalesFemales

708074

7986

98102

107111

121113

75122131

123143

143152

157173

174203

80176224

182240

195243

208255

228303

85247310

274308

269336

277357

304339

90315386

360405

373449

394481

390484

95378494

377493

431526

438540

430532

00418581

444551

441529

471566

04524575

Chart 7C. Incidence of heart failure* by age and sex

FHS 19802003

* - HF based on physician review of medical records and strict diagnostic criteria.

Source: NHLBI.(10)

7010

7522

8057

85719

902,107

952,363

002,199

052,125

Chart 13A: Trends in heart transplants

UNOS: 19702005

Source: United Network for Organ Sharing (UNOS), scientific registry data.

est. cv oper. & proc

u.s. 1979-03 (000)

CatheterizationsOpen-HeartBypassPTCACarotid EndarterectomyPacemakers

`NH WhitesNH BlacksHispanics792991721145442

Males24.914.024.8803501971375544

Females27.011.919.28569030823010740

9010465013922666897

Chart 9A: Prevalence of high school students in grades 912 reporting current cigarette use951137722573419132136

by sex and race/ethnicity001318686519561124152

YRBS: 2005011314690516571128177

021463709515657134199

04129764642766498170

Chart 13B: Trends in cardiovascular inpatient operations and procedures

United States: 19792004

Source: MMWR.4 NH indicates non-Hispanic.

MenWomen

NH White24.120.4

NH Black23.920.2

Hispanic18.915

Asian17.811.3Source: NHDS. NCHS and NHLBI. Note: In-hospital procedures only.

American Indian or Alaska Native37.333.4

Chart 9B: Prevalence of current smoking for Americans age 18 and older by race/ethnicity and sexEST. COST OF CV DISEASES 2007

NHIS: 2004Coronary Heart Disease142.5

Stroke57.9

Hypertensive Disease63.5

Heart Failure29.6

Chart 14A: Estimated direct and indirect costs (in billions of dollars) of major cardiovascular diseases and stroke

United States: 2007

Source: MMWR.1 NH indicates non-Hispanic.

1988-941999-022003-04

NH White206204202

NH Black204199197

Mexican American205202201Source: NHLBI

Chart 9C: Trends in mean total serum cholesterol among adults by race, sex and survey

NHANES: 198894, 199902 and 200304

Source: NCHS and NHLBI.

Note: Needs split scale.

1976-801988-941999-022003-04

White Males163163155156

Black Males171165166161

White Females170166163164

Black Females172174168161

Chart 9D: Trends in mean total serum cholesterol among adolescents ages 1217 by race, sex and survey

NHANES:1976-80,1988-94, 1999-02 and 2003-04


Note: Needs split scale.

MenWomen

Total Population32.032.0

NH Whites32.034.0

NH Blacks32.030.0

Mexican Americans39.031.0

Chart 9E: Age-adjusted prevalence of Americans age 20 and older with

LDL cholesterol of 130 mg/dL or higher by race/ethnicity and sex

NHANES: 200304


MenWomen

Total259

NH Whites269

NH Blacks167

Mexican Americans2813

Chart 9F: Age-adjusted prevalence of Americans age 20 and older with

HDL cholesterol under 40 mg/dL by race/ethnicity and sex

NHANES: 200304


NH WhiteNH BlackHispanic

Male46.938.239

Female30.221.326.5

Chart 9G: Prevalence of students in grades 912 who met currently recommended

levels of physical activity during the past 7 days by race/ethnicity and sex

YRBS: 2005

Note: Currently recommended levels is defined as activity that increased their heart rate and made them breathe hard some of the time for a total of at least 60 minutes/day on 5 or more of the 7 days preceding the survey. Source: MMWR.1

Source:YRBS (4)

19942004

NH White Male26.418.4

NH Black Male34.227.0

Hispanic Male37.532.5

Asian/Pacific Islander Male25.020.4

Am. Indian/Alaska Native Male34.423.8

NH White Female28.321.6

NH Black Female45.733.9

Hispanic Female44.839.6

Asian/Pacific Islander Female31.524.0

Am. Indian/Alaska Native Female36.331.8

Chart 9H: Prevalence of leisure-time physical inactivity among adults age 18 and older by race/ethnicity and sex

BRFSS: 1994 and 2004

Source: MMWR.(11) NH indicates non-Hispanic.

MalesFemales

NH Whites15.28.2

NH Blacks15.916.1

Hispanics21.312.1

Chart 9i: Prevalence of overweight among students in grades 912 by sex and race/ethnicity

YRBS: 2005

Source: BMI 95th percentile or higher by age and sex of the CDC 2000 growth chart. MMWR.(2) NH indicates non-Hispanic.

MenWomen

65-749.24.7

75-8422.314.8

85-9443.030.7

1960-621971-741976-801988-942001-2004

Men10.712.212.820.630.2

Women15.716.817.126.034.0

Chart 9J: Age-adjusted prevalence of obesity in Americans ages 2074 by sex and survey

NHES 196062; NHANES: 197174, 197680, 198894 and 200104

Note: Obesity is defined as a BMI of 30.0 or higher. Source: Health, United States, 2006; Unpublished data, NCHS.

6-1112-19

1971-744.33.6

1976-806.66.4

1988-9411.611.0

2001-200418.716.3

Chart 9K: Trends in the prevalence of overweight among U.S. children and adolescents by age and survey

NHANES: 197174, 197680; 198894 and 200104

Source: Health, United States, 2006. Unpublished data. NCHS.

NH WhitesNH BlacksMexican Americans

Men69.89.9

Women4.512.211

Chart 9L: Prevalence of physician-diagnosed diabetes in Americans age 20 and older by race/ethnicity and sex

NHANES: 19992004

NCHS and NHLBI


Less than high school7.512.010.1

High school5.69.76.0

More than high school4.29.89.8

Chart 9M. Prevalence of Non-Insulin-Dependent (Type 2) Diabetes in Adults Age 18+

by Race/Ethnicity and Years of Education

NHANES: 1999-2004


Sheet1

10.712.212.820.630.2

15.716.817.12634

1960-62

1971-74

1976-80

1988-94

2001-2004


Sheet2

4.36.611.618.7

3.66.41116.3

1971-74

1976-80

1988-94

2001-2004


Sheet3

185.303214.49

190.125240.37

194.834252.488

207.11257.35

221.391275.644

236.69317.084

258.645326.377

287.202327.978

281.616347.436

288.585374.508

312.253351.142

324.63397.288

369.68417.005

383.856455.757

403.565490.614

395.02491.788

383.917496.515

381.013496.109

436.463530.027

442.23547.189

433.785540.992

421.896585.791

446.166553.626

442.772530.311

495.774597.144

524575

Male

Female

Years

Discharges in Thousands

299172114795442

350197137805544

6903082308510740

10465013922666897

1137722573419132136

1318686519561124152

129764642766498170

Catheterizations

Open-Heart

Bypass

PCI

Carotid Endarterectomy

Pacemakers

Years

Procedures in Thousands

24.927

1411.9

24.819.2

Males

Females


24.123.918.917.837.3

20.420.21511.333.4

NH White

NH Black

Hispanic

Asian

American Indian or Alaska Native


46.938.239

30.221.326.5

NH White

NH Black

Hispanic

Sex and Race/Ethnicity


151.6

62.7

66.4

33.2

Billions of Dollars

0.30.2

21.5

7.25.2

11.612.4

Men

Women


206204202

204199197

205202201

1988-94

1999-02

2003-04

Mean Serum Total Cholesterol

2.64.34.86.310.917

5.37.88.611.516.728.1

14.417.121.126.13044.1

No MetS or DM

MetS w/o DM

MetS w/DM

DM only

Prior CVD

Prior CVD and DM

Deaths/1,000 Person Years

MBD0006B35A.xls

Chart6

3232

3234

3230

3931

Men

Women


OVERWT

1960-621971-741976-801988-942001-2004

Men10.712.212.820.630.2

Women15.716.817.126.034.0

Age-Adjusted Prevalence of Obesity* in Americans Ages 20-74 by Sex and Survey

NHES and NHANES: 1960--62, 1971--74, 1976--80, 1988--94 and 2001-2004

Source:Health US, 2004.

Obesity is defined as BMI of 30 plus.

&A

Page &P

OVERWT

1960-62

1971-74

1976-80

1988-94

2001-2004


cholchild

Estimated Percentage of Children With Serum Cholesterol of 170 mg/dl or More, United States

WhiteBlack

Males 0-9 Years2940

Females 0-9 Years3350

Males 10-19 Years2534


Estimated Percentage of Children With Serum Cholesterol of 170 mg/dL

or More, United States

Trends in Mean Total Blood Cholesterol Among Adolescents Ages 12-17 by Sex and Race and Survey

NHANES:1976-80,1988-94, 1999-02 and 2003-04

1976-801988-941999-022003-04


Black Males171165166161`



`

cholchild

&A

Page &P

White

Black


diabetes

1976-80

1988-94

1999-02

2003-04

Mean Total Blood Cholesterol

Strokerace


Men6.710.711.0

Women5.613.210.9

Age-Adjusted Prevalence of Physician-Diagnosed Diabetes in Americans Age 20 and Older by Sex and Race/Ethnicity

NHANES: 1999-2004

WhitesBlacksMexican Americans

122.95.46.4

Prevalence of Non-Insulin-Dependent (Type 2) Diabetes in Women Ages 25-64

by Education and Race/Ethnicity

NHANES III: 1988-94

OLD

Winkleby et al.





Prevalence of Non-Insulin-Dependent (Type 2) Diabetes in Americans Age 18+

by Education, Race/Ethnicity and Years of Education

NHANES: 1999-2004

`

NCHS and NHLBI.

&A

Page &P

Strokerace

000

000

NH Whites

NH Blacks

Mexican Americans


Hdl&Ldl

000

000

000

000

Whites

Blacks

Mexican Americans

Years of Education


smokhschool

000

000

000

Less than high school

High school

More than high school


Metsyndr.

Relative Risk of Deaths due to StrokeCompared to Non-Hispanic Whites, by Race/Ethnicity and Age Groups, U.S., 1997

Non-Hispanic BlacksAmerican Indians/ Alaska NativesAsian/Pacific IslandersHispanics

35-444.01.91.31.3

45-543.91.31.31.3

55-643.01.51.41.2

65-741.90.91.10.9

75-841.20.81.00.6

85+0.90.40.70.5

Risk for Stroke Mortality Among Racial/Ethnic Groups Compared With Non-Hispanic Whites,

by Age Groups

United States: 1997

Metsyndr.

000000

000000

000000

000000

35-44

45-54

55-64

65-74

75-84

85+

Race/Ethnicity

Relative Risk

PhysicAct.

Estiamted % of Americans Age 20 and Over with High-Risk LDL-Cholesterol of 130 mg/dL or More by Race and Sex

MenWomen


NH Whites32.034.0

NH Blacks32.030.0


Age-Adjusted Prevalence of Americans Age 20 and Older With

LDL-Cholesterol of 130 mg/dL or Higher by Race/Ethnicity and Sex


MenWomen

Total259

NH Whites269

NH Blacks167


Estimated Age-Adjusted (2000) Prevalence of Adults Age 20 and Over With

HDL-Cholesterol Under 40 mg/dL by Race and Sex

United States: NHANES 2003-2004

PhysicAct.

Men

Women


smokmf

Men

Women


NHANESrf

`NH WhitesNH BlacksHispanics

Males24.914.024.8

Females27.011.919.2

Prevalence of High School Students in Grades 9-12 Reporting Current Cigarette Use

Within the last 30 days by Race/Ethnicity and Sex

YRBS: 2005

&A

Page &P

NHANESrf

00

00

00

Males

Females


oweight hs

CHD MortalityCVD MortalityTotal Mortality

No MetS or DM2.65.314.4

MetS w/o DM4.37.817.1

MetS w/DM4.88.621.1

DM only6.311.526.1

Prior CVD10.916.730.0


Total Mortality Rates in US Adults Age 30-75, with Metabolic Syndrome, With and Without Diabetes and Pre-Existing CVD

NHANES1976-80 Follow-Up Study

oweight hs

000000

000000

000000

No MetS or DM

MetS w/o DM

MetS w/DM

DM only

Prior CVD

Prior CVD and DM


RFNHANES

% of high school students who participated in vigorous or moderate physical physical activity in past 7 days

NH WhiteNH BlackHispanicBMI

RISK ASSESSMENT FOR CARDIOVASCULAR DISEASE

EARLY INTERVENTION IS KEY TO SUCCESS

KNOW AND TREAT RISK FACTORS BY AGE 20!!!

RISK FACTORS FOR CV DISEASEMajor That Cannot Be Changed:

Increasing age - >83% who die are 65 or olderGender maleHeredity ITS HARD TO OUTRUN YOUR GENES!!!

RISK FACTORS FOR CV DISEASEMajor That Can Be Modified:

TobaccoElevated cholesterolHigh blood pressurePhysical inactivityObesityDiabetes

Trends in the age-adjusted prevalence of health conditions, U.S. adults ages 20-74 (NHANES: 1971-74 to 1999-2000). Source: Briefel and Johnson. Annu Rev Nutr. 2004;24:401-431. Printed with permission from the Annual Review of Nutrition.

Chart1

484029

474028

562420

652918

Overweight/Obesity

Hypertension

High Blood Cholesterol


OVERWT

1960-621971-741976-801988-941999-2002

Men10.712.212.820.628.1

Women15.716.817.126.034.0





&A

Page &P

OVERWT

1960-62

1971-74

1976-80

1988-94

1999-2002


cholchild


WhiteBlack

Males 0-9 Years2940







NHES:1966-70; NHANES:1971-74 and 1988-94

1966-701971-741988-94





`

cholchild

&A

Page &P

White

Black


diabetes

1966-70

1971-74

1988-94


Strokerace


Men6.210.310.4

Women4.712.611.3


NHANES: 1999-2002


122.95.46.4



NHANES III: 1988-94

&A

Page &P

Strokerace

NH Whites

NH Blacks

Mexican Americans


Hdl&Ldl

Whites

Blacks

Mexican Americans

Years of Education


smokhschool



35-444.01.91.31.3

45-543.91.31.31.3

55-643.01.51.41.2

65-741.90.91.10.9

75-841.20.81.00.6

85+0.90.40.70.5


by Age Groups

United States: 1997

smokhschool

35-44

45-54

55-64

65-74

75-84

85+

Race/Ethnicity

Relative Risk

Metsyndr.


MenWomen


NH Whites43.836.9

NH Blacks36.034.5




United States:1999-2002

MenWomen

Total33.612.6

NH Whites34.512.4

NH Blacks22.711.3





Metsyndr.

Men

Women


PhysicAct.

Men

Women


smokmf


Males23.319.319.1

Females26.610.817.7



YRBS: 2003

&A

Page &P

smokmf

Males

Females


NHANESrf



MetS w/o DM4.37.817.1

MetS w/DM4.88.621.1

DM only6.311.526.1

Prior CVD10.916.730.0




NHANESrf

No MetS or DM

MetS w/o DM

MetS w/DM

DM only

Prior CVD

Prior CVD and DM


oweight hs


NH White MalesNH White FemalesNH Black MalesNH Black FemalesHispanic MalesHispanic FemalesBMI

CONTRIBUTING FACTORS StressAlcohol??????

TOP 10 ADVANCES IN CV CARE IN PAST 50 YEARS1) Cardiac catheterizationAccurate diagnosis of coronary diseaseProduced first clear images of abnormal blood vessels, cardiac chambers, and valvesPaved way for successful cardiac surgery and interventional radiology

TOP 10 ADVANCES IN CV CARE IN PAST 50 YEARS2) CV Interventional Therapy Balloon angioplasty, stent placement (drug-eluting vs. bare metal), ASD repairExcellent results overall!!Risk of M.I., stroke, death

DRUG-ELUTING STENT

TOP 10 ADVANCES IN CV CARE IN PAST 50 YEARS3) Cardiovascular surgeryCardiopulmonary bypass machineCardiac windowRapid, safe interventions commonplace in many hospitals Some are not candidates

TOP 10 ADVANCES IN CV CARE IN PAST 50 YEARSLifesaving techniques AEDs, antiarrhythmic drugs, implantable defibrillators, ablationReduced incidence of sudden cardiac deathDrugs have fatal S.E.s, no evidence of prolonged life

TOP 10 ADVANCES IN CV CARE IN PAST 50 YEARS5) Intensive CareMajor reduction in inpatient mortality through monitoring, central venous and right heart monitoring, drug delivery and highly skilled carePatients still die despite all

RAPID RESPONSE TEAMRRMC MODELSituation Triggers Assessment/Treatment (STAT) TeamCritical Care Charge Nurse (or designee) CoordinatorSupervisorRespiratory TherapistUnit Charge NursePatients Nurse

STAT TEAMCriteria:Acute change in vital signs (defined)Acute decline in O2 saturationAltered mental statusS&S of strokeRepeated seizuresCONCERNED staff

Chart1

0.510.480.360.67

0.20.080.150.23

0110.88

00.720.760.75

1Q06

2Q06

3Q06

4Q06

STAT TEAM IMPACT ON SURVIVAL RATES

Sheet1

Code Survival Past CodeCode Survival to DischargeSTAT Team Survival Past CallSTAT Team Survival to Discharge

1st Qtr 06601800

2nd Qtr 0647810072

1Q062Q063Q064Q06

Survival Past Code51%48%36%67%

Survival to Discharge20%8%15%23%

STAT Team Survival Past Event0%100%100%88%

STAT Team Survival to Discharge0%72%76%75%

Sheet1

1Q06

2Q06

ELEMENT

PERCENTAGE

STAT TEAM IMPACT ON SURVIVAL RATES

Sheet2

Sheet3

TOP 10 ADVANCES IN CV CARE IN PAST 50 YEARS6) Noninvasive CV diagnosisReduces hazard of invasive procedures (Holter monitor, CTA, cardiac MRI, Echo, stress test)Improved accuracy of diagnosisSubjective (false positives and negatives) SHOULD NOT REPLACE GOOD OL H&P and critical thinking

TOP 10 ADVANCES IN CV CARE FOR PAST 50 YEARS7) Molecular review of CV system normal and abnormal evaluation to the molecular level (thrombosis, heart failure, acute coronary syndrome)

Pathogenesis of ACSAtheromaFibrous PlaqueComplicated Lesion/RuptureIntracoronary ThrombusReduced Blood FlowMyocardial IschemiaMyocardial NecrosisAsymptomaticUnstable AnginaMyocardial InfarctionTnI, TnT, CK-MB, Myoglobin

Risk Factors for Acute Coronary Syndrome (ACS)Modifiable:Sedentary lifestyleCigarette smokingObesityHigh-fat dietHypertensionNon-modifiable:Male genderFamily historyDiabetesMenopause

TOP 10 ADVANCES IN CV CARE IN PAST 50 YEARS Management of AMI:

ASA, B-blocker, ACE or ARB if LVSD, time to percutaneous coronary intervention (PCI)

TOP 10 ADVANCES IN CV CARE IN PAST 50 YEARSTreatment of Heart FailureACE, ARBIntraaortic balloon pump (IABP)Heart transplantationFeel betterLittle impact on overall mortality

TOP 10 ADVANCES IN CV CARE IN PAST 50 YEARS10) Cardiovascular preventive medicine

Framingham Heart Study landmark studySteady decline in M.I. and stroke mortality and sudden death, exercise, cardiac rehab and smoking cessation programs More work to do!! < 50% pts with HTN adequately treated and worse for lipid disorders!!!!

1995Obesity Trends* Among U.S. Adults BRFSS, 1990, 1995, 2005(*BMI 30, or about 30 lbs overweight for 54 person)20051990No Data

Extent of awareness, treatment and control of high blood pressure by age (NHANES : 1999-2004.) Source: NCHS and NHLBI.

Chart1

52.374.675.3

35.862.568.4

24.639.834.3

20-39

40-59

60+


OVERWT

1960-621971-741976-801988-942001-2004

Men10.712.212.820.630.2

Women15.716.817.126.034.0





&A

Page &P

OVERWT

1960-62

1971-74

1976-80

1988-94

2001-2004


cholchild


WhiteBlack

Males 0-9 Years2940







NHANES:1976-80,1988-94, 1999-02 and 2003-04

1976-801988-941999-022003-04





`

cholchild

&A

Page &P

White

Black


diabetes

1976-80

1988-94

1999-02

2003-04


Strokerace


Men6.710.711.0

Women5.613.210.9


NHANES: 1999-2004


122.95.46.4



NHANES III: 1988-94

OLD

Winkleby et al.





Prevalence of Non-Insulin-Dependent (Type 2) Diabetes in Americans Age 18+

by Education, Race/Ethnicity and Years of Education

NHANES: 1999-2004

`

NCHS and NHLBI.

&A

Page &P

Strokerace

NH Whites

NH Blacks

Mexican Americans


Hdl&Ldl

Whites

Blacks

Mexican Americans

Years of Education


smokhschool

Less than high school

High school

More than high school


Metsyndr.



35-444.01.91.31.3

45-543.91.31.31.3

55-643.01.51.41.2

65-741.90.91.10.9

75-841.20.81.00.6

85+0.90.40.70.5


by Age Groups

United States: 1997

Metsyndr.

35-44

45-54

55-64

65-74

75-84

85+

Race/Ethnicity

Relative Risk

PhysicAct.


MenWomen


NH Whites32.034.0

NH Blacks32.030.0





MenWomen

Total259

NH Whites269

NH Blacks167





PhysicAct.

Men

Women


smokmf

Men

Women


NHANESrf


Males24.914.024.8

Females27.011.919.2



YRBS: 2005

&A

Page &P

NHANESrf

Males

Females


oweight hs



MetS w/o DM4.37.817.1

MetS w/DM4.88.621.1

DM only6.311.526.1

Prior CVD10.916.730.0




oweight hs

No MetS or DM

MetS w/o DM

MetS w/DM

DM only

Prior CVD

Prior CVD and DM


RFNHANES


NH WhiteNH BlackHispanicBMI

STATINS!!!!

STATINS: FUTURE IMPLICATIONS

STATINS: FUTURE IMPLICATIONSAlzheimersCancer prostate, breast, colorectalMultiple SclerosisInflammatory Rheumatic DiseasesOsteoporosis and Ortho ESRD and Kidney TransplantsDepressionHIV infectionGlaucoma

FUTURE OF CARDIOVASCULAR CAREHuman Genome Project: Genetic screening early and receive individual risk profiles for CVD and lipid disordersNew classes of drugs and cell-targeted therapyBiologic sensing monitorsSwine hearts for transplantation?Laboratory-grown replacement organs Risk, benefit and cost ratios???

EARLY DETECTION AND INTERVENTIONTake the time to advocate for each employees health:

Ask if they know what their risks are for CVDEducate!! Find the hook that gets their personal attentionFollow up is everything!!!

SUNRISE OR SUNSET???

Documents

ADVANCES IN CARDIOVASCULAR CARE: 50 YEARS OF PROGRESS Beverly Lowentritt RN,MSN,CS,FNP