A Public Health Action Plan to Prevent Heart Disease and Stroke

Abstract

Scope of the Problem The statistics are disconcerting. Despite intensive efforts, cardiovascular disease (CVD) remains the leading cause of death in this country, claiming more lives each year than do the next 5 leading causes of death combined.1 Every 29 seconds, someone will have a coronary event and nearly 2,600 Americans die of CVD each day.1 Every 45 seconds someone will suffer a new or recurrent stroke; every 3 minutes someone will die from a stroke.1 Women are now more likely than men to die of CVD and African Americans suffer a disproportionate burden of CVD morbidity and mortality.1,2 Fifty percent of Americans have total cholesterol levels over 200 mg/dL; only 12% are taking cholesterol-lowering medications and only 5.4% are treated to goal.3,4 One in 4 Americans has high blood pressure while only 30% are adequately controlled.5 Obesity is pandemic; the majority of Americans (64.5%) are overweight (body mass index [BMI] ≥ 25).1,2 Twenty-seven percent of men and 33% of women are obese (BMI ≥ 30); an estimated 47 million Americans meet the criteria for metabolic syndrome.6 More than 50% of adult Americans are physically inactive.1,7 The average daily caloric consumption is approximately 300 calories higher in the year 2000 than it was in 1985.1,2 The prevalence of diabetes increased 8% from 2000 to 2001.1,2 Only 15% of individuals who suffer a myocardial infarction are referred to cardiac rehabilitation.1,2 The prevalence of overweight and obesity in children and youth tripled between 1980 and 2000; 15% of children 6 to 9 years of age and 10% of children 2 to 5 years of age exceed the 95th age and sex-specific percentile for BMI.8 Minority children fare worse. The prevalence of overweight among non-Hispanic black and Hispanic children has increased 10 percentage points since 1994; minority youth are more likely to have obesity-related comorbidities, including elevated levels of cholesterol, blood pressure, and glucose, than do their white counterparts.1,8 Viewed in context to one another, these statistics are daunting and the prevalence of these largely preventable conditions with unacceptable disparate outcomes for minority groups will continue to increase as our population ages and becomes more diverse, unless bold action is taken. A Vision of Cardiovascular Health for America On April 23, 2004, with a sense of urgency and purpose, the Centers for Disease Control and Prevention (CDC) and the American Heart Association (AHA) convened a broadly based meeting of stakeholders in a unique partnership that bridges basic science, epidemiology, behavioral/social/environmental sciences, community and federal agencies (ie, transportation, agriculture, and education), and private-sector interests including the food and exercise industry. The agenda was to identify strategies to implement the Public Health Action Plan to Prevent Heart Disease and Stroke.2 The action plan offers a “new promise of success” and places equal emphasis on prevention and treatment of CVD and stroke. With the ultimate goals of increasing the quality and years of healthy life and eliminating health disparities, the plan emphasizes the need for environmental policies designed to support healthy lifestyles in our schools, communities, and workplaces (ie, safe affordable places to exercise, affordable healthy food, smoking restrictions). The plan challenges our healthcare system to address the biopsychosocial needs of individuals with evidence-based, high-quality care that is affordable and available to all Americans.8,9Figure 1 delineates the action framework for a comprehensive public health strategy to prevent CVD and stroke.2 The framework chronicles the present reality, where unfavorable social and environmental conditions promote adverse behavioral patterns, which, in turn, contribute to major risk factors and the cycle of illness, disability, and death. It also provides a vision of the future where (1) social and environmental conditions are favorable to health; (2) behavioral patterns promote health; (3) low risk is shared equally across the population; (4) CVD and stroke morbidity and mortality are reduced; (5) return to full functional capacity and low risk of recurrent events are increased; and (6) quality of life until death is optimized.2FIGURE 1: Action framework for a comprehensive public health strategy to prevent heart disease and stroke.2The Role of Nursing This initiative provides an important opportunity for nursing to assume its place at the table. As cardiovascular nurses, we may not view ourselves as “public health” nurses, but are, without a doubt, entrusted with the health of the public. As the largest group of health professionals who provide cardiovascular care, our contributions to health promotion, disease prevention, and disease management are critical to the success of the action plan. This initiative provides an important window of opportunity for nursing to join our colleagues from other disciplines and the community to address adverse environmental and social conditions. Each encounter with a patient is a critical window of opportunity: an opportunity to educate people about risk factors and healthy lifestyles; an opportunity to assure that the individual and his/her family is insured and has access to care; an opportunity to interact in a culturally competent manner; an opportunity to determine if the person smokes and offer help with cessation; an opportunity to assess behavioral and psychosocial risk factors; an opportunity to refer the patient to a risk reduction or chronic disease management program; an opportunity to get the whole family (including children) into preventive care; an opportunity to assure that evidence-based primary and secondary prevention guidelines and disease management protocols guide care; an opportunity to view the patient as a whole being with physical, psychosocial, and environmental needs; and an opportunity to deliver high-quality care for all. Opportunity maximized or opportunity missed? At the point of service, the patient encounter, the choice is ours. We must take action and put present knowledge to work.2 We must assume our role as stewards of the public's health and help make the action plan's vision of the future a reality.